College of Nursing, University of Rhode Island, Providence, RI.
Monitoring, Evaluation and Research, Jhpiego India Country Office, New Delhi, India.
JCO Glob Oncol. 2024 Oct;10:e2400001. doi: 10.1200/GO.24.00001. Epub 2024 Oct 10.
To understand key barriers to diagnostic follow-up for women with an abnormal clinical breast examination (CBE) at the primary care level in the Uttar Pradesh state in India. We also explored acceptability of mobile phones to address barriers to CBE follow-up for women.
We conducted 28 semistructured in-depth interviews with 12 women with an abnormal CBE at the primary health facility who did not have diagnostic follow-up, four community health workers, nine health care providers from health facilities in rural and urban settings, and three state-level decision makers. Interviews were audiorecorded, transcribed verbatim, and translated from Hindi to English. Thematic analysis was conducted using Dedoose qualitative software. Themes were organized by multilevel barriers to follow-up.
Key barriers to CBE follow-up included knowledge, fear, and stigma about breast cancer; women's health not being prioritized in the family; discomfort seeing male providers; and difficulty navigating the diagnostic facility. Despite community education and outreach efforts by community health workers (known as Accredited Social Health Activists), lack of awareness of breast cancer and the importance of follow-up for abnormal CBE remains a barrier to early detection. Despite widespread access to mobile phones, perceived acceptability varied among stakeholders regarding mobile phone use for breast health education and communication with clients.
Knowledge, cultural, and health system barriers challenge women's ability to follow recommendations for diagnostic follow-up of an abnormal CBE. Multilevel and gender-responsive strategies are needed to address these barriers. Our results suggest that mobile phones could be used to further improve breast health awareness, patient navigation, and tracking, and further research is needed.
了解印度北方邦初级保健水平异常临床乳房检查（CBE）女性进行诊断随访的主要障碍。我们还探讨了手机在解决 CBE 随访障碍方面对女性的可接受性。
我们对 12 名在初级卫生机构接受异常 CBE 检查但未进行诊断随访的女性、4 名社区卫生工作者、9 名来自农村和城市卫生设施的卫生保健提供者以及 3 名州级决策者进行了 28 次半结构式深入访谈。访谈进行了录音，并逐字转录为英文。采用 Dedoose 定性软件进行主题分析。主题按照随访的多层次障碍进行组织。
CBE 随访的主要障碍包括对乳腺癌的知识、恐惧和耻辱感；妇女的健康在家庭中未被优先考虑；看男医生的不适；以及难以在诊断机构中找到路。尽管社区卫生工作者（称为认证社会卫生活动家）进行了社区教育和外展工作，但对乳腺癌的认识不足以及对异常 CBE 随访的重要性仍然是早期发现的障碍。尽管普遍可以使用手机，但利益相关者对手机在乳腺癌健康教育和与客户沟通方面的使用的可接受性存在差异。
知识、文化和卫生系统障碍挑战了女性遵循异常 CBE 诊断随访建议的能力。需要采取多层次和对性别敏感的策略来解决这些障碍。我们的结果表明，手机可以用于进一步提高乳腺癌意识、患者导航和跟踪，需要进一步研究。
