Seeking a woman in Brest county

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Seeking a woman in Brest county

BoxEldoret, Kenya. BoxNairobi, Kenya. We have presented all our main data in the form of themes and tables. The datasets supporting the conclusions of this article are included within the article and its Additional files. The study sought to evaluate the knowledge, attitude and health seeking behavior towards breast cancer and its screening in a quest to explain why women present for prognosis and treatment when symptomatic pointers are in advanced stages, impeding primary prevention strategies. Eight focus groups 6—10 members per group and four key informant interviews were conducted among adult participants from rural and urban settings.

Sessions were audio-recorded and transcribed. A thematic analysis of the data was based on the concepts of the health belief model. Most women perceived breast cancer as a fatal disease and conveyed fear of having early screening. Rural women preferred self-prescribed Seeking a woman in Brest county and the use of alternative medicine for long periods before presenting for professional care on suspicion that the lump is cancerous. Accessibility to equipped health facilities, lack of information to establish effective follow-up treatment and low-income status were underscored as their major health seeking behavior barriers whereas, urban women identified marital status as their main barrier.

Key informant interviews revealed that health communication programs emphasized more on communicable diseases. This could in part explain why there is a high rate of misconception and suspicion about breast cancer among rural and urban women in the study setting. Creating breast cancer awareness alongside clear guidelines on accessing screening and treatment infrastructure is critical.

It was evident, a diagnosis of breast cancer or lump brings unexpected confrontation with mortality; fear, pain, cultural barriers, emotional and financial distress. Without clear referral channels to enable those with suspicious lumps or early stage disease to get prompt diagnosis and treatment, then well-meaning awareness will not necessarily contribute to reducing morbidity and mortality. The online version of this article Cancer is the third highest cause of mortality in Kenya after infectious and cardiovascular diseases.

Leading cancers are breast and cervical for women [ 12 ]. Like many other Non-Communicable Diseases NCDs breast cancer progresses slowly, degenerates to devastating disabilities and the management costs are high if not timely diagnosed and treated. There is better prognosis, greater chances of successful treatment and high survival rates when detected at early stages. Methods such as clinical breast exams CBEmammograms and breast self-examinations BSE have been used as main approaches [ 34 ]. Health care access is considered a multidimensional concept encompassing both financial and non-financial dimensions [ 56 ].

The five core components of access that have been outlined are: acceptability, affordability, accessibility, accommodation, and availability [ 5 — 9 ].

Seeking a woman in Brest county

In Kenya, tremendous gains have been made in the recent past on affordability, accommodation, and availability of cancer screening and treatment services whereas much more effort still needs to be put on accessibility and acceptability [ 89 ]. Compelling findings on breast cancer in Kenya still show that most women are not aware of s and symptoms of breast cancer due to cultural diversity views and limited education and awareness programs with a lag on clear referral channels information empowerment [ 810 — 14 ].

This considers the fact that, there are varied underlying information and awareness factors Seeking a woman in Brest county Kenyan women on early cancer screening and on why and under what conditions they would take action towards medical attention for prevention or early screening and treatment [ 41516 ]. As studies shed more understandings on the the risks and benefits of early breast cancer screening, indepth understanding of women perceived risk and barriers have become integral [ 131718 ]. The insights can help influence women choice of approaching early screening and treatment options or risk-reduction strategies and effective follow-up treatment [ 17 — 19 ] in a targeted approach that resonate with their gendered socio-cultural role; their perceived susceptibility, severity, benefits and perceived health needs [ 620 ].

The study thus generates and enhances the pool of evidence that would aid inform the development of local cancer information, education and communications IEC tailored for communities in Kenya incorporating approaches that fully engage the target populations [ 21 ].

As a result, potentially promote optimization of the existing and upcoming national health systems for cancer management under the vision and beyond as envisaged under Seeking a woman in Brest county cancer awareness, community engagement plan [ 61421 — 23 ]. The qualitative research was conducted between November and March A qualitative de using focus group discussion FGD and key informant interview KII methods was applied as an ideal approach to explore perceived motivators and barriers to healthy behaviours [ 24 ]. Interview guide for the focus group discussions and in-depth interviews key informants are as provided see Additional file 1.

The concepts included; percieved severity of breast cancer, perception of susceptibility to breast cancer, perceived benefits of breast cancer early detection measures, perceived barriers to breast cancer early detection measures, self-efficacy and cues to action. The conceptual framework for the qualitative interview was adapted as earlier reported [ 3031 ] and is shown in Fig. This approach was selected because FGDs and KIIs can be undertaken in naturalistic settings which may stimulate more openness and candor [ 3233 ]. Also the group interaction has the capability to elicit information and insights that are less accessible during individual interviews [ 34 ].

Probing by the moderator allowed in depth exploration of unanticipated issues as well as an opportunity to clarify and enhance understanding of responses [ 33 ]. Conceptual framework for the qualitative interview. Adapted from [ 3031 ]. The county has a population of about 1. According to the census, Of the approximately 1. The researcher divided the 12 constituencies into two groups; urban and rural using Kakamega First County Development Plan, Map of the study areas, Kakamega couty constituencies and study locations see Additional file 2.

Two constitntuencies for rural settings Ikolomani and Likuyani and urban settings Mumias West and Lurambi respectively were randomly selected. Eligible participants were selected using a purposive sampling method. Thus, for the FGDs, homogenity on particular characteristics was considered; in this case it was for gender, age and rural or urban and recruited from the communities of the randomly selected constituencies. Convenience sampling of locations and sub locations per consitutency for more objective representation was utilized for selection of the FGDs members by the researchers with the help of local leaders chiefs and sub-chiefs through their documented community governance records.

Thus, the FGDs were conducted in two groups: young women of age group 18—35 and older women of age group 36—60 emanating from either urban or rural concsitituency. Hence, 72 participants all above 18 years were interviewed, and comprised of four key informants and 68 members of 8 FGDs with between 6 and 10 participants per FGD.

Two 2 focus groups were drawn from each constituency. For each set of 2 groups, 1 FGD constituted women of age 18—35, and another of women of age 36— One 1 key informant was drawn from each constituency. The DPHN were considered because, they interact with a ificant proportion of women in these communities and therefore considered to be more knowledgeable of what the women face in obtaining early breast cancer screening. Consented participants were allocated to a focus group session or Key informant interviews KII based on the respective eligibility cirteria.

The items in the focus group discussion interviews and key informant interviews were developed based on the concepts of the health belief model as above-mentioned and detailed. The concepts were pretested with small groups outside the target study area and revisions made where necessary. Thus, gaining further understanding on the validity of DPHN perspective in resonance to the population they attend to and considering they often provide inputs in appraising government health sector operational guidelines and policies which have a direct bearing on the populations they serve.

Focus groups lasted between 43 to 65 min. Rural focus groups were conducted in Swahili while discussions with urban women took place in Swahili and English. The items in FGD interviews were initially formulated in English then translated into Swahili for the use in the different study locations. Data collected in Swahili versions were translated back to English to ensure consistitency with the data collected in English versions.

The five-phase cycle of compiling, disassembling, re-assembling and arrayinginterpreting and concluding were used to process the data as earlier described [ 36 ]. Coding was done as earlier described [ 36 ] with level 1 to level 3 coding with the following major emerging from the level three coding: health seeking behavior of breast cancer and its screening, knowledge of breast cancer and its screening, attitude towards breast cancer and its screening and breast health promotional strategies.

Comparisons between the four groups; urban rural, 18—35 year old women and those aged 36—60 years were made as emerged. Findings from the focus group discussions and key informant interviews are presented per the main from level 3 coding that emerged. Sixty-eight women aged 18—60 years age: 18— 36 and 36— 32 from the selected rural and urban constituencies of Kakamega county Kenya participated in eight focus groups average 8. Of these 63 Participants were predominantly married The educational level of the respondents varied considerably; There were 32 women from the rural setting and 36 urban.

The average Seeking a woman in Brest county size was 6 persons, with an average of 4 children per woman. All working women had government medical cover, the National Health Insurance Fund NHIF through their jobs, granting coverage for health service use at governmental facilities for themselves and their dependents. Despite having NHIF cover, the women expressed a generalized preference for private health care providers. They however explained that, their choice to use public rather than private services was often mediated by a series of social, economic, and geographical considerations.

None of the women had private health insurance cover instead self-help savings and credit groups, commonly known as chamas were common source of building financial capacity and borrowing among the women. The vast majority of women rated their health status as good. There were disparities between the urban and rural when it came to health seeking behavior barriers see Additional file 3.

Most urban women from all the 4 urban FGDs identified marital status as their major barrier to early breast cancer screening. Specifically, young-urban women explained that married women have to consult and at times get not only advice but also permission from their husbands before seeking any medical help or undertaking social commitments that has an impact on their health. An urban woman from group 7 to symbolically contextualize the challenge depth narrated:. An older woman from rural group 4 said:. An interview with Key informant revealed that the health centres and hospitals do not have enough nurses to perform regular breast cancer screening.

She narrated:. Sometimes you will find there is only one nurse who has to do everything in a hospital. When a woman comes in for a BCS, the nurse is most likely to attend to the patients whose lives are at risk first. There should be devolution. The of staff should be increased. Through indepth discussions it was evident cultural religion orientation was a contributing barrier among rural women compared to their urban counterparts. A rural participant from rural group 3 said. Such women do not go for breast cancer screening. The study further revealed that most women are skeptical of having early breast cancer screening as attributed to fear of getting a positive breast cancer diagnosis; stigmatization associated with it and breast cancer related cultural beliefs alongside misconceptions as well as the, what next?

The action taken when a woman realized she had a breast lump was influenced by the community perception of the origin of the disease for the older urban participants, conventional practices and beliefs for most rural participants and level of knowledge by younger-rural women. An older woman from the urban group 8 narrated:. Rural women on the other hand preferred using herbal remedies, self-medicating with painkillers or going to traditional medicine men for complementary and alternative remedy when they suspected they had a cancerous lump in their breast.

A woman from rural group 3 said:. We also established that younger-rural participants and older participants were not aware or clear of simple methods such as breast self-examination or where they could get early breast-screening services.

Several older participants asked to be taught how to detect a lump in their breast while younger women explained that they were not confident on performing breast self-examination on themselves. A young participant explained in frustration how nurses instructed them to palpate their breast but she did not understand how palpation was done or what the nurses meant by palpate.

When asked how to check for lumps in their breast, a participant from urban group 8 said:. You should teach us on how one knows that they have breast cancer. Seeking a woman in Brest county key informant from a rural group explained that most facilities in the county conduct breast screening at facility level once a month. However, she also added that it was likely that women did not know that they could access such services for free due to lack of information.

A participant from rural group 1 defined breast cancer as:. Specifically, young urban participants seemed more knowledgeable about lifestyle issues that predispose individuals to breast cancer. They mentioned smoking, too much sugar and salt in food, use of bleaching pills and self-medicated pills.

A woman in urban group 7 said:. Most women were concerned of breast cancer and were overwhelmingly convinced that it is a serious terminal disease with no cure. A participant in rural group 2 said:. It is an incurable disease. Several participants also described the perceived seriousness of the disease as extremely dangerous and incurable.

A young woman in urban group 5 stated:. One woman that I know went for breast cancer screening and was told that she had it and that her breast had to be removed Some urban participants seemed well aware of the benefits of early breast cancer screening.

Seeking a woman in Brest county

They noted that knowing their breast cancer status early would result to the early treatment of the disease and this would increase the chances of survival. They also explained how early screening uptake reduces the high cost of treatment of the disease if it is detected early. A woman from urban group 6 said:.

Seeking a woman in Brest county

It will be cheaper for me. Despite this knowledge among some of the participants, they were still sceptical of having early breast cancer screening as it would lead to psychological stress, depression and even early death unlike when they were not aware. Most of the participants had very limited knowledge of breast health awareness programs.

Participants could only mention programs aimed at communicable diseases Malaria and HIV awareness creation. Participants from rural group 2 said:. The participants pointed out the reason why they do not have much information on breast cancer was because it was not being given as much prominence as other diseases like malaria per their views on assessment of public health information availed to them most of the times.

An interview with a key informant from urban setting revealed that if participants were given information on breast cancer and its screening; there would be rapid uptake of early breast cancer screening among women. She said:.

Seeking a woman in Brest county

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