University of Pretoria, School of Health Systems and Public Health, Pretoria, South Africa.
Department of Obstetrics and Gynaecology, Gynaecologic Oncology, University of Pretoria, Pretoria, South Africa.
BMC Public Health. 2019 Jul 29;19(1):1018. doi: 10.1186/s12889-019-7355-3.
Cervical cancer treatment and care services have remained largely centralized in Zimbabwe thereby entrenching inequities to access amongst patients. The objective of this study was to investigate the determinants of access to treatment and care among women with cervical cancer in Harare, Zimbabwe.
A sequential explanatory mixed methods design was used. In phase 1, three surveys (namely community, patient and health worker) were conducted with sample sizes of 143, 134 and 78 participants respectively. Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data collection during the surveys. Univariate, bivariate and multivariate logistic regression analyzes were conducted using STATA® version 14 to generate descriptive statistics and identify determinants of access to cervical cancer treatment and care. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain quantitative data. Participants were purposively selected and saturation principle was used to guide sample sizes. Manually generated thematic codes were processed in Dedoose software to produce final outputs for qualitative study.
Knowledge of causes (p = 0.046), perceptions of adequacy of specialists (p < 0.001), locus of control (p = 0.009), service satisfaction (p = 0.022) and walking as a means of reaching nearest health facilities (p < 0.001) were associated with treatment or perceptions of access by healthy women. Perceptions of access to treatment amongst health workers were associated with their basic training institution (p = 0.046), health service quality perceptions (p = 0.035) and electricity supply status in their respective health facilities (p = 0.036).Qualitative findings revealed health system, societal and individual factors as barriers to accessing treatment and palliative care.
There are numerous prevailing multi-dimensional barriers to accessing cervical cancer treatment and palliative care in a low -income setting. The findings of this study revealed that heath system and societal factors were more important than individual level factors. Multi-sectoral approaches are recommended to address all the multifaceted barriers in order to improve cervical cancer treatment and palliative care access for better outcomes in resource-limited contexts.
津巴布韦的宫颈癌治疗和护理服务主要集中在中央，这使得患者在获得服务方面存在严重的不平等。本研究的目的是探讨哈拉雷宫颈癌患者获得治疗和护理的决定因素。
采用序贯解释性混合方法设计。在第 1 阶段，进行了 3 项调查（即社区、患者和卫生工作者调查），样本量分别为 143、134 和 78 名参与者。在调查过程中，使用了在 Android 平板电脑上编程的验证过的结构化问卷和 SurveytoGo 软件进行数据收集。使用 STATA® 版本 14 进行单变量、双变量和多变量逻辑回归分析，以生成描述性统计数据并确定获得宫颈癌治疗和护理的决定因素。在第 2 阶段，进行了 16 次深入访谈、20 次关键知情人访谈和 6 次焦点小组讨论，以解释定量数据。参与者是根据目的选择的，使用饱和原则来指导样本量。手动生成的主题代码在 Dedoose 软件中进行处理，以生成定性研究的最终输出。
对病因的认识（p=0.046）、对专家是否足够的看法（p<0.001）、控制源（p=0.009）、服务满意度（p=0.022）和步行作为到达最近卫生机构的手段（p<0.001）与健康女性的治疗或对治疗的看法有关。卫生工作者对治疗的看法与他们的基本培训机构（p=0.046）、对卫生服务质量的看法（p=0.035）和各自卫生机构的电力供应状况（p=0.036）有关。定性研究结果表明，卫生系统、社会和个人因素是获得治疗和姑息治疗的障碍。
在低收入环境中，获得宫颈癌治疗和姑息治疗存在许多普遍的多维度障碍。本研究结果表明，卫生系统和社会因素比个人因素更为重要。建议采取多部门办法，解决所有多方面的障碍，以便在资源有限的情况下改善宫颈癌的治疗和姑息治疗的获得，取得更好的结果。
