Racquel E Kohler1, Satish Gopal2, Anna R Miller3, Clara N Lee4, Bryce B Reeve5, Bryan J Weiner5, Stephanie B Wheeler5. 1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA; UNC Project-Malawi, Lilongwe, Malawi. Electronic address: rkohler@email.unc.edu. 2. UNC Project-Malawi, Lilongwe, Malawi; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA. 3. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA. 4. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA. 5. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Abstract
OBJECTIVE: Many women in Africa are diagnosed with advanced breast cancer. We explored Malawian breast cancer patients' perspectives about their diagnosis and ability to access care to identify help-seeking behaviors and to describe factors influencing delay. METHODS: We purposively sampled 20 Malawian breast cancer patients to conduct in-depth interviews. Transcripts were double coded to identify major themes of breast cancer help-seeking behaviors and what delayed or facilitated access to care. RESULTS: We outlined a breast cancer help-seeking pathway describing decisions, behaviors, and interactions from symptom presentation to receipt of cancer care. Patients were largely unaware of breast cancer and did not immediately notice or interpret symptoms. As symptoms progressed, women inferred illness and sought help from social networks, traditional remedies, and medical care. Economic hardship, distance to the facility, provider knowledge, health system factors, and social norms often delayed reaching the facility, referrals, diagnosis, and receipt of care. CONCLUSIONS: Social-contextual factors at the individual, interpersonal, health system, and societal levels delay decisions, behaviors, and access to breast cancer detection and appropriate care. PRACTICE IMPLICATIONS: A comprehensive approach to improving breast cancer early detection must address public awareness and misconceptions, provider knowledge and communication, and cancer care delivery.
OBJECTIVE: Many women in Africa are diagnosed with advanced breast cancer. We explored Malawian breast cancerpatients' perspectives about their diagnosis and ability to access care to identify help-seeking behaviors and to describe factors influencing delay. METHODS: We purposively sampled 20 Malawian breast cancerpatients to conduct in-depth interviews. Transcripts were double coded to identify major themes of breast cancer help-seeking behaviors and what delayed or facilitated access to care. RESULTS: We outlined a breast cancer help-seeking pathway describing decisions, behaviors, and interactions from symptom presentation to receipt of cancer care. Patients were largely unaware of breast cancer and did not immediately notice or interpret symptoms. As symptoms progressed, women inferred illness and sought help from social networks, traditional remedies, and medical care. Economic hardship, distance to the facility, provider knowledge, health system factors, and social norms often delayed reaching the facility, referrals, diagnosis, and receipt of care. CONCLUSIONS: Social-contextual factors at the individual, interpersonal, health system, and societal levels delay decisions, behaviors, and access to breast cancer detection and appropriate care. PRACTICE IMPLICATIONS: A comprehensive approach to improving breast cancer early detection must address public awareness and misconceptions, provider knowledge and communication, and cancer care delivery.
Authors: Victoria M Youngblood; Ruth Nyirenda; Richard Nyasosela; Takondwa Zuze; Yi Yang; Evaristar Kudowa; Agnes Moses; Jennifer Kincaid; Chifundo Kajombo; Coxcilly Kampani; Fred Chimzimu; Maurice Mulenga; Chrissie Chilima; Grace K Ellis; Ryan Seguin; Maganizo Chagomerana; Rebecca Maine; Sheryl Jordan; Anthony Charles; Clara Lee; Satish Gopal; Tamiwe Tomoka Journal: Cancer Causes Control Date: 2020-03-02 Impact factor: 2.506
Authors: Leonie Ströbele; Eva Johanna Kantelhardt; Timongo Francoise Danielle Traoré Millogo; Maurice Sarigda; Jürgen Wacker; Kirstin Grosse Frie Journal: BMC Public Health Date: 2018-04-04 Impact factor: 3.295