Sociocultural barriers to breast and cervical cancer screening among women in Kaduna, northern Nigeria

 

Breast and cervical cancer account for the highest cancer-related morbidity and mortality

among Nigerian women. Late stage diagnoses are common due to lack of National

screening programme, although opportunistic screening occurs in some States. Research

in Northern Nigeria has predominantly investigated demographic factors influencing

breast and cervical cancer screening behaviours, however few studies have assessed the

effects of social and cultural factors. This thesis aimed to examine and gain understanding

of Kaduna women’s and healthcare professionals’ perceptions, knowledge, attitude, and

practice towards breast and cervical cancer, and screening behaviours. It also aimed to

assess sociodemographic and sociocultural factors that may influence screening and

develop strategies towards improving services and uptake. A sequential explanatory

Mixed Method Methodology was applied, following a critical review of health

behaviours, screening uptake, and intervention approaches. First, quantitative surveys

investigated cancer related knowledge, attitude, perception, and factors influencing

screening behaviours among 250 adult women. Next, qualitative interviews with 12

women, and 6 healthcare professionals further assessed the phenomena. The moderate

sample size (250) used due to security unrest in Kaduna during the study, limited

generalisability of the findings. Quantitative results revealed gap in cancer knowledge,

and low screening uptake. Having professional jobs, tertiary education, and being married

were associated with better awareness, positive attitude and perception of cancer and

screening. Healthcare professionals stated that low-risk perception, lack of services and

trained providers hindered screening uptake. Women expressed that sociocultural norms

and beliefs including fatalism, need for support from husbands, and gender of health

providers influenced their screening behaviours. A model to guide development and

implementation of screening intervention strategies was produced from the findings. This

emphasised the need for multi-organisation collaborations, and development of culturally

and socially sensitive programmes. Accessible, affordable, and equipped facilities with

trained health workers could improve uptake, and subsequently reduce cancer related

morbidity and mortality.