SOCIOCULTURAL BARRIERS TO BREAST AND CERVICAL CANCER SCREENING AMONG WOMEN IN KADUNA, NORTHERN NIGERIA
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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.
PhD Thesis - School of Sport and Health Sciences
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