Abstract
Background: Globally, female breast cancer is the second most frequently diagnosed cancer, and the leading cause of cancer death in women. Although incidence rates of breast cancer are higher in high income countries (HICs) compared to low and medium income (LMICs), there is increasing incidence in the latter due to demographic and epidemiological changes in these settings. Despite the higher incidences in HICs, there is disproportionately higher mortality and poorer survival rates in LMICs. Although many reasons may explain this health outcome disparity, the stage of breast cancer at diagnosis is generally accepted as the main predictor of breast cancer outcome. Majority of women in LMICs present with advanced stage breast cancer. In Kenya, over 80% of women diagnosed with breast cancer present at advanced stage.Aims: The overall aim of this study was to explore the determinants of patient interval within a rural setting in Kenya. The study was guided by the need to explore influences of the time women take to seek help upon self-discovery of breast cancer symptoms.
To be able to meet the study’s aim, two broad research questions were posed:
a. What are the women-related determinants of patient interval in a rural setting in Kenya, with particular reference to individual attributes, social relationships and cultural factors?
b. What are the women’s perspectives of the healthcare system-related determinants of patient interval, with particular focus on women-health care professional relationships, and healthcare infrastructure?
Methods: This thesis is a critical ethnography using in-depth interviews and focus groups. In-depth interviews were first conducted with 12 women who had been diagnosed with breast cancer. Additionally, three focus groups were conducted with women’s nominees comprising of people who had played a significant role during the women’s patient interval. The textual data was analysed inductively through thematic analysis.
Findings: Data analysis resulted in seven core themes: local cancer knowledge, embodied experience, women’s responses, social networks, cultural cancer schemas, gendered social structures, and healthcare system experiences. An additional theme, women’s empowerment strategies, comprised of participants’ suggestions about strategies that may promote symptomatic women’s help-seeking behaviour.
Conclusions: Multi-structural constraints and enablers influence symptomatic women’s length of time to presentation. Most determinants of the length of patient interval influence symptoms appraisal phase rather than help-seeking phase. Public education and campaigns is required to promote breast cancer awareness, counter breast cancer myths, as well as to empower women. Policies also need to be enacted to create an enabling environment for intervention implementation. Further research to explore determinants of diagnostic and treatment intervals of women’s pathways to treatment is warranted. Moreover, future interventions research should aim to develop a multi-structural early diagnosis intervention to shorten symptomatic women’s time to presentation
| Date of Award | 2020 |
|---|---|
| Original language | English |
| Supervisor | Mary Renfrew (Supervisor), Elaine Lee (Supervisor) & Cara Taylor (Supervisor) |