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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

Mwaka, A.D.
Walter, F.M.
Scott, S.
Harries, J.
Wabinga, H.
Moodley, J.
Abstract
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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Date
2021-02-05
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Publisher
BMJ
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Keywords
Breast tumours , Gynaecological oncology , Primary care , Cervical cancer , Women , Uganda , SDG-03 Good health and well-being
Citation
Mwaka AD, Walter FM, Scott S, Harries J, Wabinga H, Moodley J. 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. BMJ Open. 2021 Feb 5;11(2):e041365. doi: 10.1136/bmjopen-2020-041365.
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