Women’s appraisal, interpretation and help-seeking for possible symptoms of breast and cervical cancer in South Africa: a qualitative study

Harries, Jane; Scott, Suzanne E.; Walter, Fiona M; Mwaka, Amos Deogratius; Moodley, Jennifer

doi:10.1186/s12905-020-01120-4

Cited by 18 publications

(22 citation statements)

References 30 publications

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“…( 25) System-level delays are a common occurrence in sub-Saharan Africa which leads to delays in treatment initiation as well as a deterrent for utilizing screening services. (24,25) In comparison to studies in the general population in Africa, we observed high rates of cervical cancer knowledge, which has also been noted in other studies looking at awareness of cervical cancer screening in Botswana. (11,26) Furthermore, women included in our study have undergone treatment for cervical cancer already and likely discussed screening and risk factors in greater detail than women who have not been diagnosed with cancer.…”

Section: Discussionsupporting

confidence: 82%

Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study

Grover

Rendle

Ramogola‐Masire

et al. 2022

Preprint

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Background: Delays in screening and timely diagnosis contribute significantly to global disparities in cervical cancer mortality in Botswana and other low- and middle-income countries, particularly those with high rates of HIV. Little is known about the modifiable factors shaping these delays from the perspectives of women themselves.Methods: From March-May 2019, we conducted a concurrent, mixed methods study of patients receiving cervical cancer care in Botswana. Structured questionnaires captured beliefs and knowledge related to cervical cancer screening and HIV. Clinical data were abstracted from medical records and confirmed by participants. Semi-structured interviews examined patients’ understanding of and experiences with cervical cancer screening. Quantitative data were analyzed using descriptive and bivariate statistics. Qualitative data were analyzed using deductive and inductive content analysis and triangulated with quantitative data to identify areas of convergence and divergence.Results: Forty-two women were interviewed, 64% of whom were living with HIV. Median age was 45 years in women living with HIV (LWH) and 64 years in those without HIV. Overall screening rates prior to symptomatic disease were low (24%). Median time from most proximal screening to diagnosis was 52 median days (IQR: 15-176), with no significant differences by HIV status. General screening knowledge was higher among women living with HIV versus those without (100% vs 73%), but knowledge about specific risk factors including HPV was low in both groups. In interviews, participants expressed limited awareness of needing to be screened prior to symptoms. Additionally, participants reported significant delays in receipt of screening results and in obtaining referrals for follow-up care. However, participants also described myriad sources of social and tangible support that helped them to overcome some of these challenges. Conclusion: Interventions focused on increasing routine screening and supporting timely awareness and access to care are needed to reduce global disparities in cervical cancer.

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Section: Discussionsupporting

confidence: 82%

Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study

Grover

Rendle

Ramogola‐Masire

et al. 2022

Preprint

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“…These women also reported fear or embarrassment of undergoing the screening test itself, and abandonment after a cancer diagnosis. Judgmental attitudes by health care providers have also been reported as a contributing factor to this fear [ 30 ]. System-level delays are a common occurrence in sub-Saharan Africa which leads to delays in treatment initiation and acts as a deterrent for utilizing screening services [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study

et al. 2022

View full text Add to dashboard Cite

Background Delays in screening and timely diagnosis contribute significantly to global disparities in cervical cancer mortality in Botswana and other low- and middle-income countries, particularly those with high rates of HIV. Little is known about the modifiable factors shaping these delays from the perspectives of women themselves and how these perspectives may differ between those living with and without HIV. Methods From March–May 2019, we conducted a concurrent, mixed methods study of women receiving treatment for cervical cancer at a multidisciplinary oncology clinic in Botswana. Enrolled participants completed a one-time, concurrent semi-structured interview and structured questionnaire assessing patient characteristics, screening and HIV-related beliefs and knowledge, and barriers and facilitators to screening and follow-up care. Qualitative data were analyzed using directed content analysis guided by the Model of Pathways to Treatment and triangulated with quantitative questionnaire data to identify areas of convergence and divergence. Fisher’s exact tests were used to explore associations between questionnaire data (e.g., screening knowledge) and HIV status. Results Forty-two women enrolled in the study, 64% of whom were living with HIV and 26% were diagnosed with stage III cervical cancer. Median age was 45 years (IQR 54–67) in those living with HIV and 64 years (IQR 42–53) in those living without. Overall screening rates before symptomatic disease were low (24%). Median time from most proximal screen to diagnosis was 52 median days (IQR 15–176), with no significant differences by HIV status. General screening knowledge was higher among those living with HIV versus those without (100% vs 73%; p < 0.05), but knowledge about HPV and other risk factors was low in both groups. Similar to questionnaire results, qualitative results indicate limited awareness of the need to be screened prior to symptoms as a central barrier to timely screening. Some participants also noted that delays in the receipt of screening results and fear also contributed to treatment delays. However, many participants also described myriad sources of social and tangible support that helped them to overcome some of these challenges. Conclusion Interventions focused on increasing routine screening and supporting timely awareness and access to care are needed to reduce global disparities in cervical cancer.

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“…Our vignettes were developed to capture aspects of provider symptom interpretation; reasoning, judgements and actions related to investigations and management; referral and feedback processes and consideration of infective or alternative diagnoses. The content of the vignettes was informed by findings from the preceding community-based cross-sectional survey, qualitative IDIs with symptomatic women and from drawing on the literature [ 18 , 20 ]. Briefly, the vignettes described a 50-year-old woman with diabetes mellitus and a breast lump ( scenario 1 ); a 50-year-old woman with diabetes mellitus and breast skin changes ( scenario 2 ); a 35-year-old woman with human immunodeficiency virus (HIV), a vaginal discharge and post coital bleeding ( scenario 3 ) and a 60-year-old woman with post-menopausal vaginal bleeding ( scenario 4 ) ( Appendix A ).…”

Section: Methodsmentioning

confidence: 99%

“…This qualitative sub-study formed part of a larger study aimed at better understanding pathways to care for women with possible breast and cervical cancer symptoms. We used both quantitative and qualitative methods to meet the overall study aim [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Exploring primary care level provider interpretation and management of potential breast and cervical cancer signs and symptoms in South Africa

Moodley¹,

Harries²,

Scott³

et al. 2021

ecancer

Self Cite

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Objectives: Women with potential breast and cervical cancer symptoms in South Africa (SA) usually self-present to primary health care (PHC) clinics. The aim of this study was to explore PHC provider interpretation and management of potential breast and cervical cancer signs and symptoms. Methods:In-depth interviews with PHC providers incorporating vignettes were conducted between April and May 2019 in two sites in SA. Four vignettes (two breast and two cervical) were developed by the research team to capture aspects of provider symptom interpretation, reasoning, actions and challenges. The content of the vignettes was informed by a preceding community-based survey and qualitative interviews with symptomatic women. Interviews were audio recorded, transcribed verbatim and analysed using a thematic analysis approach.Results: Twenty-four PHC providers were interviewed (12 urban, 12 rural; median age: 43 years). Four main themes relating to clinical assessment and reasoning; referral and feedback challenges; awareness of breast and cervical cancer policy guidelines and training and education needs emerged. Vignette-prompted questions relating to presenting symptoms, and possible accompanying symptoms and signs, demonstrated comprehensive proposed history taking and clinical assessment by PHC providers. Cancer was considered as a potential diagnosis by the majority of PHC providers. PHC providers also considered the possibility of infectious causes for both breast and cervical vignettes indicating they would ask questions around human immunodeficiency virus status, use of anti-retroviral therapy, and, for those with cervical symptoms, would need to rule out a sexually transmitted infection. Sexual assault was considered in assessing the cervical Research

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Women’s appraisal, interpretation and help-seeking for possible symptoms of breast and cervical cancer in South Africa: a qualitative study

Cited by 18 publications

References 30 publications

Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study

Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study

Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study

Exploring primary care level provider interpretation and management of potential breast and cervical cancer signs and symptoms in South Africa

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