Skip to main content
Top
Published in: BMC Primary Care 1/2013

Open Access 01-12-2013 | Research article

Mind the gaps: a qualitative study of perceptions of healthcare professionals on challenges and proposed remedies for cervical cancer help-seeking in post conflict northern Uganda

Authors: Amos D Mwaka, Henry R Wabinga, Harriet Mayanja-Kizza

Published in: BMC Primary Care | Issue 1/2013

Login to get access

Abstract

Background

There are limited data on perceptions of health professionals on challenges faced by cervical cancer patients seeking healthcare in the developing countries. We explored the views of operational level health professionals on perceived barriers to cervical screening and early help–seeking for symptomatic cervical cancer and the proposed remedies to the challenges.

Methods

Fifteen key informant interviews were held with health professionals including medical directors, gynecologists, medical officers, nurses and midwives in the gynecology and obstetrics departments of two hospitals in northern Uganda during August 2012 to April 2013. We used content analysis techniques to analyze the data.

Results

Health professionals’ perceived barriers to cervical cancer care included: (i) patients and community related barriers e.g. lack of awareness on cervical cancer and available services, discomfort with exposure of women’s genitals and perceived pain during pelvic examinations, and men’s lack of emotional support to women (ii) individual healthcare professional’s challenges e.g. inadequate knowledge and skills about cervical cancer management; (iii) health facility related barriers e.g. long distances and lack of transport to cervical cancer screening and care centers, few gynecologists and lack of pathologists, delayed histology results, lack of established palliative care services and inadequate pain control; and (iv) health policy challenges e.g. lack of specialized cancer treatment services, and lack of vaccination for human papilloma virus. Other challenges included increased number of cervical cancer patients and late stage of cervical cancer at presentations.

Conclusions

Operational level healthcare professionals in northern Uganda reported several practical challenges facing cervical cancer care that influence their decisions, management goals and practices. The challenges and proposed remedies can inform targeted interventions for early detection, management, and control of cervical cancer in Uganda.
Literature
1.
go back to reference Ngugi CW, Boga H, Muigai AW, Wanzala P, Mbithi JN: Factors affecting uptake of cervical cancer early detection measures among women in Thika, Kenya. Health Care Women Int. 2012, 33 (7): 595-613. 10.1080/07399332.2011.646367.CrossRefPubMed Ngugi CW, Boga H, Muigai AW, Wanzala P, Mbithi JN: Factors affecting uptake of cervical cancer early detection measures among women in Thika, Kenya. Health Care Women Int. 2012, 33 (7): 595-613. 10.1080/07399332.2011.646367.CrossRefPubMed
2.
go back to reference Fort VK, Makin MS, Siegler AJ, Ault K, Rochat R: Barriers to cervical cancer screening in Mulanje, Malawi: a qualitative study. Patient preference and adherence. 2011, 5: 125-131.CrossRefPubMedPubMedCentral Fort VK, Makin MS, Siegler AJ, Ault K, Rochat R: Barriers to cervical cancer screening in Mulanje, Malawi: a qualitative study. Patient preference and adherence. 2011, 5: 125-131.CrossRefPubMedPubMedCentral
3.
go back to reference Chirenje ZM, Rusakaniko S, Kirumbi L, Ngwalle EW, Makuta-Tlebere P, Kaggwa S, Mpanju-Shumbusho W, Makoae L: Situation analysis for cervical cancer diagnosis and treatment in east, central and southern African countries. Bull World Health Organ. 2001, 79 (2): 127-132.PubMedPubMedCentral Chirenje ZM, Rusakaniko S, Kirumbi L, Ngwalle EW, Makuta-Tlebere P, Kaggwa S, Mpanju-Shumbusho W, Makoae L: Situation analysis for cervical cancer diagnosis and treatment in east, central and southern African countries. Bull World Health Organ. 2001, 79 (2): 127-132.PubMedPubMedCentral
4.
go back to reference Bingham A, Bishop A, Coffey P, Winkler J, Bradley J, Dzuba I, Agurto I: Factors affecting utilization of cervical cancer prevention services in low-resource settings. Salud publica de Mexico. 2003, 45 (Suppl 3): S408-S416.CrossRefPubMed Bingham A, Bishop A, Coffey P, Winkler J, Bradley J, Dzuba I, Agurto I: Factors affecting utilization of cervical cancer prevention services in low-resource settings. Salud publica de Mexico. 2003, 45 (Suppl 3): S408-S416.CrossRefPubMed
5.
go back to reference Mutyaba T, Faxelid E, Mirembe F, Weiderpass E: Influences on uptake of reproductive health services in Nsangi community of Uganda and their implications for cervical cancer screening. Reprod Health. 2007, 4: 4-10.1186/1742-4755-4-4.CrossRefPubMedPubMedCentral Mutyaba T, Faxelid E, Mirembe F, Weiderpass E: Influences on uptake of reproductive health services in Nsangi community of Uganda and their implications for cervical cancer screening. Reprod Health. 2007, 4: 4-10.1186/1742-4755-4-4.CrossRefPubMedPubMedCentral
6.
go back to reference Kawonga M, Fonn S: Achieving effective cervical screening coverage in South Africa through human resources and health systems development. Reprod Health Matters. 2008, 16 (32): 32-40. 10.1016/S0968-8080(08)32403-3.CrossRefPubMed Kawonga M, Fonn S: Achieving effective cervical screening coverage in South Africa through human resources and health systems development. Reprod Health Matters. 2008, 16 (32): 32-40. 10.1016/S0968-8080(08)32403-3.CrossRefPubMed
7.
go back to reference Delvaux N, Razavi D, Farvacques C: Cancer care--a stress for health professionals. Soc Sci Med. 1988, 27 (2): 159-166. 10.1016/0277-9536(88)90324-3.CrossRefPubMed Delvaux N, Razavi D, Farvacques C: Cancer care--a stress for health professionals. Soc Sci Med. 1988, 27 (2): 159-166. 10.1016/0277-9536(88)90324-3.CrossRefPubMed
8.
go back to reference Spencer K, Carr A, Doherty M: Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis. 2012, 71 (9): 1490-1495. 10.1136/annrheumdis-2011-200801.CrossRefPubMed Spencer K, Carr A, Doherty M: Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis. 2012, 71 (9): 1490-1495. 10.1136/annrheumdis-2011-200801.CrossRefPubMed
9.
go back to reference Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, Guthrie B, Lester H, Wilson P, Kinmonth AL: Designing and evaluating complex interventions to improve health care. BMJ. 2007, 334 (7591): 455-459. 10.1136/bmj.39108.379965.BE.CrossRefPubMedPubMedCentral Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, Guthrie B, Lester H, Wilson P, Kinmonth AL: Designing and evaluating complex interventions to improve health care. BMJ. 2007, 334 (7591): 455-459. 10.1136/bmj.39108.379965.BE.CrossRefPubMedPubMedCentral
12.
go back to reference Pope C, Mays N: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995, 311 (6996): 42-45. 10.1136/bmj.311.6996.42.CrossRefPubMedPubMedCentral Pope C, Mays N: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995, 311 (6996): 42-45. 10.1136/bmj.311.6996.42.CrossRefPubMedPubMedCentral
13.
go back to reference Curry LA, Nembhard IM, Bradley EH: Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009, 119 (10): 1442-1452. 10.1161/CIRCULATIONAHA.107.742775.CrossRefPubMed Curry LA, Nembhard IM, Bradley EH: Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009, 119 (10): 1442-1452. 10.1161/CIRCULATIONAHA.107.742775.CrossRefPubMed
14.
go back to reference Silverman D: Interpreting Qualiataive data. A guide to the Principles of Qualitative Research, 4th edition. 2011, Los Angeles, London, New Delhi, Singapore, Washington DC: Sage Publications Ltd Silverman D: Interpreting Qualiataive data. A guide to the Principles of Qualitative Research, 4th edition. 2011, Los Angeles, London, New Delhi, Singapore, Washington DC: Sage Publications Ltd
15.
go back to reference Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, Grimshaw JM: What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010, 25 (10): 1229-1245. 10.1080/08870440903194015.CrossRefPubMed Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, Grimshaw JM: What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010, 25 (10): 1229-1245. 10.1080/08870440903194015.CrossRefPubMed
16.
go back to reference Guest G, Bunce A, Johnson L: How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field Methods. 2006, 18 (1): 59-82. 10.1177/1525822X05279903.CrossRef Guest G, Bunce A, Johnson L: How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field Methods. 2006, 18 (1): 59-82. 10.1177/1525822X05279903.CrossRef
18.
go back to reference Markovic M, Kesic V, Topic L, Matejic B: Barriers to cervical cancer screening: a qualitative study with women in Serbia. Soc Sci Med. 2005, 61 (12): 2528-2535. 10.1016/j.socscimed.2005.05.001.CrossRefPubMed Markovic M, Kesic V, Topic L, Matejic B: Barriers to cervical cancer screening: a qualitative study with women in Serbia. Soc Sci Med. 2005, 61 (12): 2528-2535. 10.1016/j.socscimed.2005.05.001.CrossRefPubMed
19.
go back to reference McFarland DM: Cervical cancer and Pap smear screening in Botswana: knowledge and perceptions. Int Nurs Rev. 2003, 50 (3): 167-175. 10.1046/j.1466-7657.2003.00195.x.CrossRefPubMed McFarland DM: Cervical cancer and Pap smear screening in Botswana: knowledge and perceptions. Int Nurs Rev. 2003, 50 (3): 167-175. 10.1046/j.1466-7657.2003.00195.x.CrossRefPubMed
20.
go back to reference Busingye P, Nakimuli A, Nabunya E, Mutyaba T: Acceptability of cervical cancer screening via visual inspection with acetic acid or Lugol’s iodine at Mulago Hospital, Uganda. Int J Gynaecol Obstet. 2012, 119 (3): 262-265. 10.1016/j.ijgo.2012.06.015.CrossRefPubMed Busingye P, Nakimuli A, Nabunya E, Mutyaba T: Acceptability of cervical cancer screening via visual inspection with acetic acid or Lugol’s iodine at Mulago Hospital, Uganda. Int J Gynaecol Obstet. 2012, 119 (3): 262-265. 10.1016/j.ijgo.2012.06.015.CrossRefPubMed
21.
go back to reference Lovell S, Kearns RA, Friesen W: Sociocultural barriers to cervical screening in South Auckland, New Zealand. Soc Sci Med. 2007, 65 (1): 138-150. 10.1016/j.socscimed.2007.02.042.CrossRefPubMed Lovell S, Kearns RA, Friesen W: Sociocultural barriers to cervical screening in South Auckland, New Zealand. Soc Sci Med. 2007, 65 (1): 138-150. 10.1016/j.socscimed.2007.02.042.CrossRefPubMed
22.
go back to reference Bener A, Denic S, Alwash R: Screening for cervical cancer among Arab women. Int J Gynaecol Obstet. 2001, 74 (3): 305-307. 10.1016/S0020-7292(01)00397-6.CrossRefPubMed Bener A, Denic S, Alwash R: Screening for cervical cancer among Arab women. Int J Gynaecol Obstet. 2001, 74 (3): 305-307. 10.1016/S0020-7292(01)00397-6.CrossRefPubMed
23.
go back to reference Kivuti-Bitok LW, Pokhariyal GP, Abdul R, McDonnell G: An exploration of opportunities and challenges facing cervical cancer managers in Kenya. BMC Res Notes. 2013, 6: 136-10.1186/1756-0500-6-136.CrossRefPubMedPubMedCentral Kivuti-Bitok LW, Pokhariyal GP, Abdul R, McDonnell G: An exploration of opportunities and challenges facing cervical cancer managers in Kenya. BMC Res Notes. 2013, 6: 136-10.1186/1756-0500-6-136.CrossRefPubMedPubMedCentral
24.
go back to reference Agurto I, Arrossi S, White S, Coffey P, Dzuba I, Bingham A, Bradley J, Lewis R: Involving the community in cervical cancer prevention programs. Int J Gynaecol Obstet. 2005, 89 (Suppl 2): S38-S45.CrossRefPubMed Agurto I, Arrossi S, White S, Coffey P, Dzuba I, Bingham A, Bradley J, Lewis R: Involving the community in cervical cancer prevention programs. Int J Gynaecol Obstet. 2005, 89 (Suppl 2): S38-S45.CrossRefPubMed
25.
go back to reference van Schalkwyk SL, Maree JE, Wright SC: Cervical cancer: the route from signs and symptoms to treatment in South Africa. Reprod Health Matters. 2008, 16 (32): 9-17. 10.1016/S0968-8080(08)32399-4.CrossRefPubMed van Schalkwyk SL, Maree JE, Wright SC: Cervical cancer: the route from signs and symptoms to treatment in South Africa. Reprod Health Matters. 2008, 16 (32): 9-17. 10.1016/S0968-8080(08)32399-4.CrossRefPubMed
27.
go back to reference Agurto I, Bishop A, Sanchez G, Betancourt Z, Robles S: Perceived barriers and benefits to cervical cancer screening in Latin America. Preventive medicine. 2004, 39 (1): 91-98. 10.1016/j.ypmed.2004.03.040.CrossRefPubMed Agurto I, Bishop A, Sanchez G, Betancourt Z, Robles S: Perceived barriers and benefits to cervical cancer screening in Latin America. Preventive medicine. 2004, 39 (1): 91-98. 10.1016/j.ypmed.2004.03.040.CrossRefPubMed
28.
go back to reference Hongoro C, McPake B: How to bridge the gap in human resources for health. Lancet. 2004, 364 (9443): 1451-1456. 10.1016/S0140-6736(04)17229-2.CrossRefPubMed Hongoro C, McPake B: How to bridge the gap in human resources for health. Lancet. 2004, 364 (9443): 1451-1456. 10.1016/S0140-6736(04)17229-2.CrossRefPubMed
29.
go back to reference Benediktsson H, Whitelaw J, Roy I: Pathology services in developing countries: a challenge. Arch Pathol Lab Med. 2007, 131 (11): 1636-1639.PubMed Benediktsson H, Whitelaw J, Roy I: Pathology services in developing countries: a challenge. Arch Pathol Lab Med. 2007, 131 (11): 1636-1639.PubMed
30.
go back to reference Lingwood RJ, Boyle P, Milburn A, Ngoma T, Arbuthnott J, McCaffrey R, Kerr SH, Kerr DJ: The challenge of cancer control in Africa. Nat Rev. 2008, 8 (5): 398-403. 10.1038/nrc2372.CrossRef Lingwood RJ, Boyle P, Milburn A, Ngoma T, Arbuthnott J, McCaffrey R, Kerr SH, Kerr DJ: The challenge of cancer control in Africa. Nat Rev. 2008, 8 (5): 398-403. 10.1038/nrc2372.CrossRef
31.
go back to reference Rujumba J, Kwiringira J: Interface of culture, insecurity and HIV and AIDS: Lessons from displaced communities in Pader District. Northern Uganda. Conflict and health. 2010, 4: 18-10.1186/1752-1505-4-18.CrossRefPubMedPubMedCentral Rujumba J, Kwiringira J: Interface of culture, insecurity and HIV and AIDS: Lessons from displaced communities in Pader District. Northern Uganda. Conflict and health. 2010, 4: 18-10.1186/1752-1505-4-18.CrossRefPubMedPubMedCentral
32.
go back to reference Dimitrova B, Balabanova D, Atun R, Drobniewski F, Levicheva V, Coker R: Health service providers’ perceptions of barriers to tuberculosis care in Russia. Health Policy Plan. 2006, 21 (4): 265-274. 10.1093/heapol/czl014.CrossRefPubMed Dimitrova B, Balabanova D, Atun R, Drobniewski F, Levicheva V, Coker R: Health service providers’ perceptions of barriers to tuberculosis care in Russia. Health Policy Plan. 2006, 21 (4): 265-274. 10.1093/heapol/czl014.CrossRefPubMed
33.
go back to reference Kasuya G, Ogawa K, Iraha S, Nagai Y, Hirakawa M, Toita T, Kakinohana Y, Kudaka W, Inamine M, Ariga T, et al: Postoperative radiotherapy for uterine cervical cancer: impact of lymph node and histological type on survival. Anticancer Res. 2013, 33 (5): 2199-2204.PubMed Kasuya G, Ogawa K, Iraha S, Nagai Y, Hirakawa M, Toita T, Kakinohana Y, Kudaka W, Inamine M, Ariga T, et al: Postoperative radiotherapy for uterine cervical cancer: impact of lymph node and histological type on survival. Anticancer Res. 2013, 33 (5): 2199-2204.PubMed
34.
go back to reference Lee TS, Kang SB, Kim YT, Park BJ, Kim YM, Lee JM, Kim SM, Kim JH, Kim KT: Chemoradiation with paclitaxel and carboplatin in high-risk cervical cancer patients after radical hysterectomy: a Korean Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys. 2013, 86 (2): 304-310. 10.1016/j.ijrobp.2013.01.035.CrossRefPubMed Lee TS, Kang SB, Kim YT, Park BJ, Kim YM, Lee JM, Kim SM, Kim JH, Kim KT: Chemoradiation with paclitaxel and carboplatin in high-risk cervical cancer patients after radical hysterectomy: a Korean Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys. 2013, 86 (2): 304-310. 10.1016/j.ijrobp.2013.01.035.CrossRefPubMed
35.
go back to reference Wong LC, Ngan HY, Cheung AN, Cheng DK, Ng TY, Choy DT: Chemoradiation and adjuvant chemotherapy in cervical cancer. J Clin Oncol. 1999, 17 (7): 2055-2060.PubMed Wong LC, Ngan HY, Cheung AN, Cheng DK, Ng TY, Choy DT: Chemoradiation and adjuvant chemotherapy in cervical cancer. J Clin Oncol. 1999, 17 (7): 2055-2060.PubMed
36.
go back to reference Levin CV, El Gueddari B, Meghzifene A: Radiation therapy in Africa: distribution and equipment. Radiother Oncol. 1999, 52 (1): 79-84. 10.1016/S0167-8140(99)00069-9.CrossRefPubMed Levin CV, El Gueddari B, Meghzifene A: Radiation therapy in Africa: distribution and equipment. Radiother Oncol. 1999, 52 (1): 79-84. 10.1016/S0167-8140(99)00069-9.CrossRefPubMed
37.
go back to reference Abdel-Wahab M, Bourque JM, Pynda Y, Izewska J, Van der Merwe D, Zubizarreta E, Rosenblatt E: Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. Lancet Oncol. 2013, 14 (4): e168-e175. 10.1016/S1470-2045(12)70532-6.CrossRefPubMed Abdel-Wahab M, Bourque JM, Pynda Y, Izewska J, Van der Merwe D, Zubizarreta E, Rosenblatt E: Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. Lancet Oncol. 2013, 14 (4): e168-e175. 10.1016/S1470-2045(12)70532-6.CrossRefPubMed
38.
go back to reference Banura C, Mirembe FM, Katahoire AR, Namujju PB, Mbidde EK: Universal routine HPV vaccination for young girls in Uganda: a review of opportunities and potential obstacles. Infect Agents Cancer. 2012, 7 (1): 24-10.1186/1750-9378-7-24.CrossRefPubMedPubMedCentral Banura C, Mirembe FM, Katahoire AR, Namujju PB, Mbidde EK: Universal routine HPV vaccination for young girls in Uganda: a review of opportunities and potential obstacles. Infect Agents Cancer. 2012, 7 (1): 24-10.1186/1750-9378-7-24.CrossRefPubMedPubMedCentral
39.
go back to reference Editorial: Financing HPV vaccination in developing countries. Lancet. 2011, 377 (9777): 1544- Editorial: Financing HPV vaccination in developing countries. Lancet. 2011, 377 (9777): 1544-
Metadata
Title
Mind the gaps: a qualitative study of perceptions of healthcare professionals on challenges and proposed remedies for cervical cancer help-seeking in post conflict northern Uganda
Authors
Amos D Mwaka
Henry R Wabinga
Harriet Mayanja-Kizza
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2013
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-14-193

Other articles of this Issue 1/2013

BMC Primary Care 1/2013 Go to the issue