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A qualitative study to explore healthcare providers' perspectives on barriers and enablers to early detection of breast and cervical cancers among women attending primary healthcare clinics in Johannesburg, South Africa.

作者信息

Tshabalala Gugulethu, Blanchard Charmaine, Mmoledi Keletso, Malope Desiree, O'Neil Daniel S, Norris Shane A, Joffe Maureen, Dietrich Janan Janine

机构信息

Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

PLOS Glob Public Health. 2023 May 9;3(5):e0001826. doi: 10.1371/journal.pgph.0001826. eCollection 2023.


DOI:10.1371/journal.pgph.0001826
PMID:37159437
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10168575/
Abstract

Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/98b4/10168575/ac5b52c789c0/pgph.0001826.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/98b4/10168575/cdd427ecb427/pgph.0001826.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/98b4/10168575/ac5b52c789c0/pgph.0001826.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/98b4/10168575/cdd427ecb427/pgph.0001826.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/98b4/10168575/ac5b52c789c0/pgph.0001826.g002.jpg

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引用本文的文献

[1]
Assessment of barriers to cervical cancer screening at primary health care centers in Makurdi, North-Central Nigeria: a mixed-methods study.

BMC Cancer. 2025-7-1

[2]
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Cochrane Database Syst Rev. 2025-3-20

[3]
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BMC Womens Health. 2024-11-6

[4]
Mental health and quality of life following breast cancer diagnosis in patients seen at a tertiary care hospital in Nairobi, Kenya: A qualitative study.

Glob Ment Health (Camb). 2024-10-24

[5]
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[6]
Cost-effectiveness of single-visit cervical cancer screening in KwaZulu-Natal, South Africa: a model-based analysis accounting for the HIV epidemic.

Front Oncol. 2024-4-24

本文引用的文献

[1]
Cancer in sub-Saharan Africa: a Lancet Oncology Commission.

Lancet Oncol. 2022-6

[2]
Breast cancer screening in sub-Saharan Africa: a systematic review and ethical appraisal.

BMC Cancer. 2022-2-23

[3]
Barriers and Facilitators to Integrating Clinical Breast Examinations With Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya.

JCO Glob Oncol. 2021-12

[4]
Assessing national cervical cancer screening guidelines: Results from an HIV testing clinic also screening for cervical cancer and HPV in Soweto, South Africa.

PLoS One. 2021

[5]
Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis.

Public Health. 2021-6

[6]
Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

CA Cancer J Clin. 2021-5

[7]
Healthcare worker compliance with cervical cancer screening guidelines. An audit at district and regional level of care in the Pietermaritzburg Metropolitan area of KwaZulu-Natal.

South Afr J HIV Med. 2020-9-2

[8]
A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings.

Gynecol Oncol Rep. 2020-6-22

[9]
Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa.

BMC Public Health. 2020-3-4

[10]
Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: a cross sectional study.

BMC Womens Health. 2019-10-22

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