Implementing Patient-Directed Cancer Education Materials Across Nigeria

PURPOSE As access to cancer care expands in low-income countries, developing tools to educate patients is paramount. We took a picture booklet, which was initially developed by the nonprofit Global Oncology for Malawi and Rwanda, and adapted it for use in Nigeria. The primary goal was to assess acceptability and provide education. The secondary goals were (1) to describe the collaboration, (2) to assess knowledge gained from the intervention, (3) to assess patient understanding of their therapy intent, and (4) to explore patient's experiences via qualitative analysis. METHODS We piloted the original English booklet at a single site and requested feedback from patients and providers. The booklet was updated; translated into Hausa, Yoruba, Igbo, and Pidgin English; and used at three additional sites. For the three-site cohort, we collected basic demographics, pretest and post-test assessing content in the booklet, and performed a qualitative analysis. RESULTS The original booklet was widely acceptable and recommended by patients at site one (n = 31) and by providers (N = 26) representing all four sites. In the three-site cohort (n = 103), 94% of patients recommended the booklet. An immediate post-test focusing on when patients should present to care showed a statistically significant improvement in one of the seven questions. Fifty-one percent of the patients (n = 103) knew their treatment intent (curative v palliative). Qualitative analysis highlighted that the patient's thoughts on cancer are dominated by negative associations, although curability and modern therapy are also frequently cited. CONCLUSION We adapted an educational booklet to a novel context and had it delivered by local partners. The booklet was widely recommended to future patients. The booklet had an impact on patient's knowledge of cancer treatment, potentially allowing for decreased abandonment.

Working With the Commercial Motorists to Promote Cancer Awareness

Background and context: Motorcycle transport system also known as “BodaBoda”' is one of Uganda's commonest means of transport with over 10,000 motorists ridding on the streets of Kampala on daily basis according to the statistics from Kampala City Authority. HealthAid Uganda (HAU) strategically engaged the above group in to promotion of cancer awareness, screening and blood donation for cancer patients following the lack of blood at the cancer institute for cancer patients. The process was strengthened by working in partnership with the Uganda Bodaboda Association 2010, an umbrella association that brings all the motorists together. It also included the Uganda Police Services, Ministry of Health and the private sector. Aim: To use motorists to deliver cancer education, awareness and facilitate blood donation for cancer patients in Uganda. Strategy/Tactics: The event was branded with the theme “Know your health, donate blood, save life”. It involved mobilization of the motorcycle riders through the BodaBoda 2010 association, a cancer awareness motorcycle ride across Kampala City, led by the head of traffic Uganda police as the chief rider. This was conducted along Kampala road and finally convened on the Uganda railway grounds, where the event was crowned with cancer education, screening and blood donation for the cancer patients. Program/Policy process: Community involvement and advocacy. Outcomes: There were large number of motorcycle riders 1000 who passionately turned up for the community event, high expectations to know about cancer and being able to go with cancer education materials for their families and communities. Blood bank collection team declared collecting 400 units of blood. The head, Department of Non Communicable Diseases at the Ministry of Health appreciated the efforts of HAU and pledged that the MOH will strongly work and support HAU on the initiative. The event attracted over 1500 individuals both the motorcycle riders and the community. What was learned: Using popular service groups has a high success rate in delivering cancer awareness and screening services to the least households in the community. HAU's success in this strategy was accelerated by the principle in which it focuses on working with organized groups so as to reach the households with cancer information and empower them to be able to make best choices. HAU looks further to extending the same activities to other communities of similar nature.

Working With Organized Groups to Change Cultural Beliefs and Norms Toward Cancer in Uganda

Background and context: Cultural norms, beliefs and practices are great hindrance to efforts toward early detection and treatment of cancer in Uganda as most of the individuals believe its witchcraft, curse or bad luck. Working with organized groups such as churches, cultural associations, women associations, is key in changing such beliefs. HealthAid Uganda (HAU) for the last 3 years has worked in partnership with Watoto Church among other groups to deliver cancer awareness, screening and screening for other health problems in the districts of Mukono, Kampala and Wakiso. Aim: To mobilize organized groups within the community to raise awareness about cancer to correct prevailing myths, misconceptions and negative cultural beliefs, norms and practices. Strategy/Tactics: HAU built a strong partnership with its target groups one of which being Watoto church with whom joint planning activities were carried out. It involved the review of HAU's previous community health outreaches as a source of experience. The review also gave insight into the development of the activity plan; including the services to be rendered, the community leaders to be involved and the day in which the events would be conducted. The event included health talks on HPV, cervical and breast cancer, testimonies by the survivors, practical demonstration for self-breast examination, cervical cancer screening and distribution of cancer education materials. Program/Policy process: Involvement of community groups and champions in changing beliefs toward cancer epidemic is key. Outcomes: There was increased spirit of partnership which attracted various civil society organizations with Watoto church being the key partner. The government health center administration recognized efforts and pledged to offer further support in mobilizing the community. The awareness walk attracted public participation and need for the services. It demonstrated need to further work with organized groups within the community to form cancer task force groups to bring cancer information to every household. The events were covered by media, leading to increased demand for the services provided, with estimated 1500 individuals who received with both awareness, screening and consultative services. What was learned: HAU-Watoto partnership involvement showed that working with organized groups produces better results in cancer control and treatment in Uganda. Indeed changing cultural beliefs, norms and practices toward cancer prevention and control can be a success story if working with organized local groups is taken into consideration as a tool to reaching out to individuals and the approach during this year showed much more results than 2016.