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Symptom appraisal, help-seeking and perceived barriers to healthcare seeking in Uganda: an exploratory study among women with potential symptoms of breast and cervical cancer

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Mwaka, Walter, Suzanne Scott, Harries, Wabinga, Moodley

Original languageEnglish
Article number041365
JournalBMJ Open
Issue number2
Published5 Feb 2021

Bibliographical note

Funding Information: Contributors Study concept and design—JM, FMW and ADM. Acquisition of data—ADM and HW. Analysis of data—ADM, JH and SS. Interpretation of data—all authors. Drafting of the manuscript— ADM. Critical revision of the manuscript for important intellectual content—all authors. Study supervision—JM, FMW, ADM and HW. Final approval of the submitted version of the manuscript and where to submit—all authors. Funding Research reported in this article was jointly supported by the Cancer Association of South Africa (CANSA), the University of Cape Town and the South African Medical Research Council with funds received from the South African National Department of Health, GlaxoSmithKline (GSK) Africa Non-Communicable Disease Open Lab (via a supporting grant project number: 023), the UK Medical Research Council, MRC (via the Newton Fund). GSK provided in-kind scientific and statistical support as part of capacity strengthening. Award/Grant number is not applicable. FMW is Director and SS is Co-Investigator of the multi-institutional CanTest Collaborative, which is funded by Cancer Research UK (C8640/A23385). Publisher Copyright: © Copyright: Copyright 2021 Elsevier B.V., All rights reserved.


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Objective We assessed the process of recognising abnormal bodily changes, interpretations and attributions, and help-seeking behaviour among community-based Ugandan women with possible symptoms of breast and cervical cancer, in order to inform health interventions aiming to promote timely detection and diagnosis of cancer. Design Qualitative in-depth interviews. Setting Rural and urban communities in Uganda. Participants Women who participated in the African Women Awareness of CANcer cross-sectional survey who disclosed potential breast and cervical cancer symptoms were eligible; recruitment was purposive. Interviews were conducted in women's homes, lasted between 40 and 90 min, were audio-recorded, transcribed verbatim and translated to English. Thematic analysis was used to identify themes and subthemes, underpinned by the conceptual framework of the Model of Pathways to Treatment. Results 23 women were interviewed: 10 had potential symptoms of breast cancer and 13 of cervical cancer. Themes regarding symptom appraisal and help-seeking included the: (1) detection and interpretation of abnormal bodily sensations; (2) lay consultations regarding bodily changes; (3) iterative process of inferring and attributing illnesses to the bodily changes; (4) restricted disclosure of symptoms to lay people due to concerns about privacy and fear of stigmatisation; (5) help-seeking from multiple sources including both traditional and biomedical health practitioners, and (6) multiple perceived barriers to help-seeking including long waiting times, lack of medicines, absenteeism of healthcare professionals, and lack of money for transport and medical bills. Conclusion Women with potential symptoms of breast and cervical cancer undergo complex processes of symptom interpretation, attributing symptoms or inferring illness, and lay consultations before undertaking help-seeking and management. Increasing community understanding of breast and cervical cancer symptoms, and tackling perceived barriers to health-seeking, could lead to prompt and appropriate symptom appraisal and help-seeking, and contribute to improving cancer outcomes.

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