School of Nursing, University of Embu, Embu, Kenya.
Mother and Infant Research Unit, School Health Sciences, University of Dundee, Dundee, UK.
J Adv Nurs. 2023 May;79(5):1882-1897. doi: 10.1111/jan.15645. Epub 2023 Mar 22.
The aim of the study was to explore the determinants of time to presentation of women with breast cancer symptoms within a rural setting in Kenya.
A critical ethnographic study.
Data were collected between July 2019 and April 2020 using semi-structured interviews and focus groups with 12 women and 23 disclosure recipients, respectively. Interviews and focus group discussions were audio recorded, transcribed verbatim, translated into English and thematically analysed. Further analysis using an intersectional lens added new insights into the data. Ethics approval was obtained in both Kenya and United Kingdom.
Participants narrated their experiences from the time they self-discovered breast cancer symptoms to the time they first came into contact with a healthcare professional. The core themes identified included local cancer knowledge, embodied experience, women's responses, social networks, cultural cancer schemas, gendered social structures and healthcare system experiences.
The findings revealed that symptomatic women predominantly faced multiple intersecting barriers to timely presentation. The key drivers of timeliness to presentation of women with breast cancer symptoms were identified. Several proximal and distal determinants, including economic, social, psychological and cultural determinants intersected to shape women's timeliness to symptomatic presentation.
This study identified intersectional structural determinants to timely symptomatic presentation of women with breast cancer symptoms. The findings have global health implications for social inequalities in female breast cancer and may inform the development of intersectional interventions to promote timely symptomatic presentation. Furthermore, this study identified an additional interval, precursory interval and revision of the Model of pathway to treatment may be needed should this interval be validated by future studies.
To ensure the interview guides were culturally sensitive, they were co-designed with a female breast cancer survivor, nurses providing reproductive health care to women and a bilingual expert. Both women and disclosure recipients participated in scheduling for the interviews, including the mutually agreeable days and time. Participants were frequently contacted during data analysis and report writing to clarify meaning of certain words or pieces of data.
本研究旨在探讨肯尼亚农村地区女性出现乳腺癌症状后至就诊的时间决定因素。
关键人种学研究。
2019 年 7 月至 2020 年 4 月，通过半结构式访谈和焦点小组分别对 12 名女性和 23 名告知对象进行了数据收集。访谈和焦点小组讨论均进行了录音，逐字转录，翻译成英文，并进行了主题分析。使用交叉视角的进一步分析为数据提供了新的见解。在肯尼亚和英国均获得了伦理批准。
参与者叙述了从自我发现乳腺癌症状到首次接触医疗保健专业人员的时间内的经历。确定的核心主题包括当地的癌症知识、身体体验、女性的反应、社交网络、文化癌症模式、性别社会结构和医疗保健系统体验。
研究结果表明，出现症状的女性主要面临着多种交织的及时就诊障碍。确定了影响女性乳腺癌症状及时就诊的主要驱动因素。包括经济、社会、心理和文化等多个近端和远端决定因素相互交织，影响了女性出现症状后及时就诊的情况。
本研究确定了女性乳腺癌症状及时就诊的交叉结构决定因素。研究结果对女性乳腺癌的全球健康不平等具有影响，可能为促进女性及时出现症状而就诊的交叉干预措施的制定提供信息。此外，如果未来的研究验证了这一间隔，可能需要对治疗途径模型进行交叉间隔、前驱间隔和修订。
为确保访谈指南具有文化敏感性，与一名女性乳腺癌幸存者、为女性提供生殖健康护理的护士和一名双语专家共同设计了访谈指南。女性和告知对象均参与了访谈安排，包括双方都同意的日期和时间。在数据分析和报告撰写过程中，经常与参与者联系，以澄清某些单词或数据片段的含义。
