Sirili Nathanael, Msami Khadija, Ruwaichi Thadeus, Nyamle Notikela
Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Ocean Road Cancer Institute, Directorate of Cancer Preventive Services, Dar es Salaam, Tanzania.
PLOS Glob Public Health. 2024 Nov 4;4(11):e0003390. doi: 10.1371/journal.pgph.0003390. eCollection 2024.
Worldwide, there has been an increase in the breast cancer mortality rate, with disproportionately high rates in low and middle-income countries. Addressing breast cancer starts with early detection through screening services. In Tanzania, despite being among countries with high rates of breast cancer, screening services uptake has remained low. This study aimed to explore the drivers for breast cancer screening among women accessing health care services at a specialized cancer treatment hospital in Dar es Salaam, Tanzania. We adopted an exploratory case study employing qualitative techniques to analyze the drivers for breast cancer screening among women in Dar es Salaam. We interviewed four groups of respondents: women with breast cancer attending cancer treatment clinics, young women and old women without breast cancer attending cancer screening units, and older women who do not show up for breast cancer screening. From analysis of the in-depth interviews and focus group discussions we found that the drivers for breast cancer screening operate at different levels; individual as a centre of making the decision to be screened, family as an attribute to decide uptake of screening, the society drivers, the healthcare providers related drivers and health facility related drivers. These attributes were found to influence women's decisions to screen, and the possibility of uptake of breast cancer screening was dependent on family and social motivation. In most instances, women were driven to utilize breast cancer screening when the services were readily available at their neighbouring health facilities. The findings from this study have enlightened that people's decision about utilizing breast cancer screening services is based not only on perceptions of their risk but also on fellow community members who have survived the disease, the experiences of breast cancer screening services from their networks and the performance of healthcare institutions in delivery of such services. The use of breast cancer survivors' support groups to promote breast cancer screening services is advocated from the findings of our study.
在全球范围内，乳腺癌死亡率呈上升趋势，低收入和中等收入国家的死亡率尤其高。应对乳腺癌要从通过筛查服务进行早期检测开始。在坦桑尼亚，尽管该国是乳腺癌发病率较高的国家之一，但筛查服务的利用率仍然很低。本研究旨在探讨在坦桑尼亚达累斯萨拉姆一家专门的癌症治疗医院接受医疗服务的女性中，乳腺癌筛查的驱动因素。我们采用探索性案例研究，运用定性技术分析达累斯萨拉姆女性乳腺癌筛查的驱动因素。我们采访了四组受访者：在癌症治疗诊所就诊的乳腺癌女性患者、在癌症筛查单位就诊的无乳腺癌的年轻女性和老年女性，以及未参加乳腺癌筛查的老年女性。通过对深入访谈和焦点小组讨论的分析，我们发现乳腺癌筛查的驱动因素在不同层面发挥作用；个人是决定接受筛查的核心，家庭是决定是否接受筛查的一个因素，社会驱动因素、医疗服务提供者相关驱动因素和医疗机构相关驱动因素。这些因素被发现会影响女性的筛查决定，接受乳腺癌筛查的可能性取决于家庭和社会动机。在大多数情况下，当附近的医疗机构能够随时提供乳腺癌筛查服务时，女性才会被促使去利用这些服务。本研究的结果表明，人们关于利用乳腺癌筛查服务的决定不仅基于对自身风险的认知，还基于社区中战胜该病的其他成员、她们社交网络中乳腺癌筛查服务的体验以及医疗机构提供此类服务的表现。根据我们的研究结果，提倡利用乳腺癌幸存者支持小组来推广乳腺癌筛查服务。
