Mixed-Methods Evaluation of Multiple Perspectives on Breast Cancer Control to Guide Stakeholder Selection of Implementation Strategies: The Time to A.C.T. Study in Mwanza, Tanzania

PURPOSE Tanzania recently developed national guidelines for early diagnosis of breast cancer to combat increasing incidence and mortality. The aim of this multiphase, adaptive implementation science study was therefore to assess the local context, couple implementation strategies with identified barriers, and test these strategies to improve breast cancer control, creating an adaptive A.C.T. framework with broad applicability to other low- and middle-income country settings. METHODS The assessment phase was made up of a broad medical chart review of women seeking care for breast concerns (n = 664); a knowledge, attitudes, and practices survey of community women (n = 1,129); and a knowledge, attitudes, and practices survey of health care providers (n = 114), followed by in-depth interviews (n = 15). RESULTS Women presented to the Zonal Hospital with swelling (45%) or a palpable lump (31%), with an average symptom duration of 6 months. Most diagnoses were based on clinical exam only (54%) and included 16% breast cancer. Of these, 43% had no treatment recorded, 50% had surgery at a median of 2.5 months, and 7% had chemotherapy only. Knowledge surveys indicated that 59% of women had heard of breast cancer, but only 14% felt they knew any signs or symptoms. Encouragingly, 56% were fairly to very confident that they would notice breast changes, and 74% said they would be somewhat to very likely to seek care, with 96% noting the severity of symptoms as a motivator. Providers indicated that barriers to care included low community knowledge and repeated misdiagnosis at the primary level. The majority of providers (95%) believe clinical breast examination is feasible to implement for symptomatic patients, yet only 65% feel they have sufficient training. CONCLUSION In all, 8 larger barriers were synthesized and linked to evidence-based interventions as potential solutions. All barriers and solutions were ranked by key stakeholders on the basis of feasibility, importance, and sustainability. These were incorporated into a 3-component intervention to improve breast cancer care at the Zonal Hospital and rollout is underway.

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Knowledge Summaries for Comprehensive Breast Cancer Control: Feedback From Target Audiences in Kenya

Journal of Global Oncology ◽

10.1200/jgo.18.00119 ◽

2019 ◽

pp. 1-6

Author(s):

Mishka Kohli Cira ◽

Jo Anne Zujewski ◽

Allison Dvaladze ◽

Nathan R. Brand ◽

Amanda L. Vogel

Keyword(s):

Breast Cancer ◽

Cancer Prevention ◽

Prevention And Control ◽

Cancer Control ◽

Breast Cancer Prevention ◽

Care Providers ◽

Cancer Prevention And Control ◽

Control Feedback ◽

And Control ◽

Breast Cancer Control

PURPOSE Comprehensive breast cancer control programs are needed to decrease breast cancer mortality, but few tools exist to assist stakeholders in limited-resource settings. The Knowledge Summaries for Comprehensive Breast Cancer Control (KSBCs) are a series of evidence-based publications intended to support cancer control planning at various resource levels. The goals of this evaluation research study were to learn about the extent to which the KSBCs could be useful to policymakers, health care providers, and breast cancer advocates in Kenya, and whether introducing the KSBCs led to their uptake, and if so, how they were used. METHODS This study used one-on-one interviews, focus groups, and self-administered online surveys. Policymakers were recruited from the Ministry of Health. Providers were recruited from four hospitals in two cities, Nairobi and Eldoret, and one rural municipality, Kijabe. Advocates were recruited from cancer advocacy organizations. RESULTS Twenty individuals participated in the research. They found the KSBCs to be educational reference tools that create a shared planning-related knowledge base among diverse stakeholders. The KSBCs were seen to be applicable to a variety of contexts and stakeholders. CONCLUSION This study found that the KSBCs can be useful as both an educational tool and a convening tool for multistakeholder engagement in breast cancer prevention and control in a variety of settings. Additional engagement with users of the KSBCs can provide more knowledge about how the KSBCs are used and how they contribute to building collaborations across stakeholder groups to strengthen breast cancer prevention and control in low-resource settings.

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Childhood Obesity: Knowledge, Attitudes, and Practices of European Pediatric Care Providers

PEDIATRICS ◽

10.1542/peds.2012-3239d ◽

2013 ◽

Vol 132 (1) ◽

pp. X28-X28

Keyword(s):

Childhood Obesity ◽

Pediatric Care ◽

Care Providers ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

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Exploiting for Breast Cancer Control a Proposed Unified Mechanism for Reduction of Human Breast Cancer Risk by the Hormones of Pregnancy

10.21236/ada473791 ◽

2007 ◽

Author(s):

Herbert Jacobson ◽

Thomas T. Andersen ◽

James A. Bennett

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Human Breast Cancer ◽

Cancer Control ◽

Human Breast ◽

Breast Cancer Control

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Relation between parity and pregnancy-related hormones and breast cancer control

Breast Cancer Management ◽

10.2217/bmt.14.52 ◽

2015 ◽

Vol 4 (2) ◽

pp. 111-118

Author(s):

Takashi Yuri ◽

Airo Tsubura

Keyword(s):

Breast Cancer ◽

Cancer Control ◽

Breast Cancer Control

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Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A Knowledge, Attitudes and Practices Survey

10.21203/rs.2.12353/v3 ◽

2020 ◽

Author(s):

Andrit Lourens ◽

Peter Hodkinson ◽

Romy Parker

Keyword(s):

South Africa ◽

Emergency Care ◽

Pain Assessment ◽

Prehospital Setting ◽

Western Cape ◽

Care Providers ◽

Attitudes And Practices ◽

The Mean ◽

Pain Care ◽

Knowledge Attitudes And Practices

Abstract Background: Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between health care providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care. Methods: A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results: Responses of 100 participants was included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD8.13) years and the mean years’ experience 10.02 (SD6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last two years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%. Conclusion: Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Further, gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.

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