Enhancing Breast Cancer Early Detection in Malawi: A Mixed Methods Study to Understand Knowledge and Preferences Public Deposited

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  • March 19, 2019
  • Kohler, Racquel
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • Breast cancer is the most common cancer in sub-Saharan Africa, and the number of new cases is increasing. Although early diagnosis is a vital factor for treatment outcomes, it is rare in resource-limited settings like Malawi. Currently there is insufficient evidence on how breast cancer knowledge among Malawians influences early detection. The purpose of this dissertation was to better understand knowledge, beliefs, and preferences related to breast cancer in Malawi. The first analysis entailed eliciting beliefs and perceptions related to breast cancer and cancer care to explore various factors influencing diagnosis and treatment initiation. Results from interviews with breast cancer patients indicated that individual, interpersonal, provider, and health system factors influenced access to care and led to long delays from when a woman noticed symptoms to when she inferred illness, decided to seek help, reached the health facility, and received care. The second analysis involved interviews with community women and health workers to identify factors influencing early detection behaviors and preferences. Based on the responses, we developed a discrete choice experiment (DCE) to elicit women's preferences about early detection. Cognitive testing demonstrated the feasibility of administering a DCE in a low-literacy population where DCEs and early detection are uncommon. Finally, we conducted a survey among community women to assess knowledge, beliefs, and preferences related to breast cancer and early detection. Our results showed that less than half of the sample was aware of breast cancer. Misconceptions about causes were more commonly reported than established risk factors. The results from the DCE suggest future interventions should provide clinical breast exams and education in convenient settings. This dissertation provides a framework for understanding breast cancer delay in sub-Saharan Africa, identifies what women know about breast cancer, and indicates what women value about early detection interventions. Taken together, the findings can be used to tailor future cancer services and educational programs to meet local needs. Policy, practice, and future research should focus on training providers and educating the public about breast cancer signs and symptoms and also expanding access to clinical breast exams for symptomatic women to improve early detection and treatment outcomes.
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Rights statement
  • In Copyright
  • Weiner, Bryan
  • Wheeler, Stephanie
  • Lee, Clara
  • Gopal, Satish
  • Reeve, Bryce
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2015
Place of publication
  • Chapel Hill, NC
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