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.


No Thumbnail Available
Type
Article
Change log
Authors
Mwaka, Amos Deogratius 
Scott, Suzanne 
Harries, Jane 
Wabinga, Henry 
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.

Description
Keywords
breast tumours, gynaecological oncology, primary care, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Health Services Accessibility, Humans, Patient Acceptance of Health Care, Qualitative Research, Uganda, Uterine Cervical Neoplasms
Journal Title
BMJ Open
Conference Name
Journal ISSN
2044-6055
2044-6055
Volume Title
11
Publisher
BMJ
Rights
All rights reserved
Sponsorship
MRC (via University of Cape Town) (MRC-RFA-SHIP 01-2015)