Identifying Barriers and Facilitators to Breast Cancer Early Detection and Subsequent Treatment Engagement in Kenya: A Qualitative Approach

Abstract

Background. Early detection and prompt access to quality treatment and palliative care are critical for good breast cancer outcomes. Interventions require understanding of identified barriers and facilitators to care. A hermeneutic phenomenological approach, whose purpose is to describe feelings and lived experiences of participants, can expand the existing scope of understanding of barriers and facilitators in accessing breast cancer care in Kenya. Methods. This is qualitative research applying focus groups and a hermeneutic phenomenological approach to identify barriers and facilitators to breast cancer care from the knowledge, perceptions, and lived experiences of women with and without a diagnosis of breast cancer in Kenya. We conducted four focus group discussions with 6-11 women aged 30-60 years in each. Groups were classified according to breast cancer diagnosis and socioeconomic status. The transcribed discussions were coded independently by two investigators. Together they reviewed the codes and identified themes.Results. The key barriers were costs, inadequate knowledge, distance to health facilities, communication with health providers, medicines stockouts, long waiting periods, limited or no counseling at diagnosis, patient vulnerability, and limited access to rehabilitation items. Facilitators were dependable social support, periodical access to subsidized awareness, and early detection services and friendly caregivers. We found no marked differences in perceptions between groups by socioeconomic status. Conclusion. There is need for targeted awareness and education for health providers and the public, early detection services with onsite counseling and cost mitigation. Support from the society and religious organizations and persons may be leveraged as adjuncts to conventional management. Further interpretations are encouraged. The Oncologist 2019;24:1549-1556 Implications for Practice: Continuing cancer education for health providers in technical skills for early detection, treatment, and survivorship care, as well as nontechnical skills like communication, and an understanding of their patients' preferences and socioeconomic status may guide individualized management plans and positively affect patient experiences. Patients and the general public also need education on cancer to avoid misconceptions and inaccuracies that perpetuate fear, confusion, delayed presentation for treatment, and stigma. Critical analysis of the cancer care value chain and processes, development, and implementation of interventions to reduce costs while streamlining processes may improve client experiences. and treatment services [2]. Although several studies in sub-Saharan Africa (SSA), including Kenya, have identified barriers and facilitators to early detection, diagnosis, and treatment, it is not clear if the list is exhaustive. Barriers identified include Correspondence: Robai Gakunga, B.V.M., M.B.A.,

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“…Various hospital departments turned women away because the computer was broken or the X-ray machine was not working [28,30,32]. Study results also identi ed drug shortages as an important factor in treatment delay [32,44,46].…”

“…Some studies reported that poor attitudes and corruption among health workers were factors that accounted for delays in the start of de nitive treatment. Patients also said some health workers disrespect them, refused to answer their questions or did not treat them well, which forced them to delay the start of treatment [28], while others had good communication with health care providers, which made it easier for them to manage their breast cancer [46].…”

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