Perceptions of cervical cancer care among Ethiopian women and their providers: a qualitative study

Abstract

Background Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country’s first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical. Methods This qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women’s and providers’ perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data. Results Providers lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking. Conclusions In-service provider training should be intensified and should include discussions of cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities are also a priority. Expanded cervical cancer health education should focus on stigma reduction and emphasize a broad, wide-spread risk of cervical cancer.

Exploring perception of rural women's towards cervical cancer and its screening in Sadi Chanka district, West Ethiopia: A qualitative study.

“…More of women perceived that cervical cancer is not curable disease and its not be prevented by treatment and screening. This nding was similar to the other study conducted at Wolaita Zone and East Gojjam Zone (12,20). This implies lack of knowledge about the method of prevention and outcome of the treatments of cervical cancer.…”

Cancer signs and risk factors awareness in Addis Ababa, Ethiopia: a population-based survey

“…In Ethiopia, little attention has been paid to examining the impact of culture, socioeconomic status, and religious beliefs on public awareness of cancer [28]. So far, few studies have been undertaken to examine public awareness of specific cancer types, such as cervical [29][30][31], breast [32][33][34], and colorectal cancers [35]. Moreover, more than 80% of cancer cases in Ethiopia are identified at an advanced stage, which is suggested to be due to a lack of public awareness of cancer signs and symptoms [28].…”

Patient delay and related influencing factors in Chinese women under 35 years diagnosed with cervical cancer: A cross-sectional study

“…This finding was unexpected, given that marital and educational status is often shown to be an influential predictor of health-seeking behavior among women. 42 , 43 Considering the small sample size of this study, future studies should focus on young women with cervical cancer as a unique group for the investigation of patient delay and influencing factors.…”