Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer

Moodley, Jennifer; Scott, Suzanne E.; Mwaka, Amos Deogratius; Constant, Deborah; Githaiga, Jennifer Nyawira; Stewart, Tessa; Payne, Annette; Cairncross, Lydia; Somdyala, Nontuthuzelo; Walter, Fiona M

doi:10.1371/journal.pone.0220545

Cited by 23 publications

(27 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data were collected by trained interviewers using a hand-held electronic tablet customised with the AWACAN breast and cervical cancer tool. Details of the content, development and validation of the tool, are described elsewhere [ 15 ]. Women were interviewed face-to-face in a private space in their homes, either in their local language (isiXhosa or Acholi) or in English depending on their preference.…”

Section: Methodsmentioning

confidence: 99%

“…Fewer studies report awareness at a community level among undiagnosed women where levels of cancer symptom and risk factor awareness and beliefs may differ. Furthermore, most studies in SSA, whether hospital or community-based have not used locally validated measures [ 15 ]. The aim of this study was to measure breast and cervical cancer symptom and risk factor awareness and lay beliefs in urban and rural settings in Uganda and SA using a culturally relevant, locally validated measurement tool.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Breast and cervical cancer are leading causes of cancer burden in Sub-Saharan Africa (SSA). We measured breast and cervical cancer symptom and risk factor awareness and lay beliefs in Uganda and South Africa (SA). Methods Between August and December 2018 we conducted a cross-sectional survey of women ≥18 years in one urban and one rural site per country. Households were selected using systematic random sampling, then one woman per household randomly selected to participate. Data were collected by interviewers using electronic tablets customised with the locally validated African Women Awareness of Cancer (AWACAN) tool. This has unprompted questions (testing recall) followed by prompted questions (testing recognition) on risk factor, symptom awareness and lay beliefs for breast and cervical cancer. Mann Whitney and Kruskal Wallis tests were used to compare the association between socio-demographic variables and outcomes. Poisson regression with robust variance was conducted to identify independent socio-demographic predictors. Results Of the 1758 women interviewed, 90.8% had heard of breast and 89.4% of cervical cancer. 8.7% recalled at least one breast risk factor and 38.1% recalled at least one cervical cancer risk factor. 78.0% and 57.7% recalled at least one breast/cervical cancer symptom respectively. Recognition of risk factors and symptoms was higher than recall. Many women were unaware that HPV, HIV, and not being screened were cervical cancer risk factors (23.7%, 46.8%, 26.5% respectively). In SA, urban compared to rural women had significantly higher symptom and risk factor awareness for both cancers. In Uganda married women/living with a partner had higher awareness of breast cancer risk factors and cervical cancer symptoms compared to women not living with a partner. Women mentioned several lay beliefs (e.g. putting money in their bra as a breast cancer risk factor). Conclusion We identified gaps in breast and cervical cancer symptom and risk factor awareness. Our results provide direction for locally targeted cancer awareness intervention programs and serve as a baseline measure against which to evaluate interventions in SSA.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Data collection A standardised pretested questionnaire adapted from the African Women Awareness of CANcer (AWACAN) tool (www.awacan.online) was used to collect data [32]. Data from the pretest was used to refine the questionnaire to make it relevant and suitable to the circumstance of this study setting.…”

Section: Study Settingmentioning

confidence: 99%

Knowledge of cervical cancer risk factors and symptoms among women in a refugee settlement: a cross-sectional study in northern Uganda

et al. 2020

View full text Add to dashboard Cite

Background There are limited data on awareness of cervical cancer risk factors and symptoms among refugee populations living in Uganda. In this study, we sought to determine the awareness and knowledge of cervical cancer risk factors and symptoms among women in Palabek refugee settlement, northern Uganda. Methods We conducted a cross-sectional study. 815 women (aged 18–60 years) were randomly selected using multistage sampling in Palabek refugee settlement. Data were collected using pre-tested, structured questionnaires. Logistic regression models were used to determine magnitudes of association between socio-demographic and health system factors, and knowledge on cervical cancer risk factors and symptoms. Results The majority of participants (53%, n = 433) were young (18–29 years), married (68%, n = 553), and did not have formal employment (93%, n = 759). Less than half (40%, n = 325) had heard of cervical cancer. Of those who had heard, most recognized multiple male sexual partners, early onset of sexual intercourse and HPV infections as risk factors for cervical cancer (93%, n = 295; 89%, n = 283; and 86%, n = 271 respectively). Median knowledge score for risk factor recognition = 7 (IQR: 3–9). Median knowledge score for symptoms recognition = 7 (IQR: 1–10). Half of women (50%, n = 409) correctly recognized 7 to 11 symptoms of cervical cancer, with vaginal bleeding between menstrual periods, pelvic pain, and vaginal bleeding during/after sexual intercourse recognized by 58, 52 and 54% respectively. Single women (OR = 0.59 (95%CI: 0.38–0.94), and women that lived farther than 1 kilo meter from nearest health facility in South Sudan (OR = 0.36–0.49 (95%CI: 0.26–0.84) were less likely to be knowledgeable of symptoms of cervical cancer. Conclusion A significant proportion of women in Palabek refugee settlement had not heard about cervical cancer. Refugee health services providers could increase awareness of cervical cancer risk factors and symptoms through health education in order to promote risk reduction behaviours and guide women during symptoms appraisal. Single women and those who lived more than one kilo metre from nearest health facility in home country could be a priority group for awareness intervention in the settlement.

show abstract

“…This qualitative study formed part of a larger study involving a community-based cross-sectional survey to assess women's breast and cervical cancer symptom and risk factor awareness, lay beliefs and helpseeking behaviors [21]. The study was conducted between September and November 2018 in one urban site in the Western Cape Province and one rural site in the Eastern Cape Province, SA.…”

Section: Study Population and Settingmentioning

confidence: 99%

Women's appraisal, interpretation and help-seeking for possible symptoms of breast and cervical cancer in South Africa: a qualitative study

Harries

Scott

Walter

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: In South Africa, breast cancer is the most commonly diagnosed cancer and cervical cancer the leading cause of cancer mortality. Most cancers are diagnosed at a late-stage and following symptomatic presentation. This qualitative study set out to explore appraisal, attribution and management of potential breast and cervical cancer symptoms at a community level among undiagnosed women. Methods: In-depth interviews were conducted with women with potential breast or cervical cancer symptoms from urban and rural South Africa. Participants were recruited from a community-based cross-sectional study on breast and cervical cancer awareness. Data were analysed using a thematic analysis approach. Results: Eighteen women were interviewed (10 urban, 8 rural): the median age was 34.5 years (range 22–58). Most were unemployed, and five were HIV positive. Themes included impact and attribution of bodily changes; influence of social networks and health messaging in help-seeking; management of symptoms and help-seeking barriers. Breast changes were often attributed to manual activities or possible cancer. Women were often unsure how to interpret vaginal symptoms, attributing them to HIV, hormonal contraceptives, or partner infidelity. Concerns about cancer were based on health information from the radio, social networks, or from primary care providers. Prompt care seeking was triggered by impact of symptoms on personal lives. Rural women, especially with possible symptoms of cervical cancer, experienced challenges during help-seeking including judgmental attitudes of clinic staff. Most participants were skeptical of traditional medicine. Conclusions: This is the first study exploring interpretation of possible breast and cervical cancer symptoms at a community level in South Africa. The process of interpreting bodily changes, symptom attribution and help-seeking is complex and influenced by women’s everyday life experiences. Timely diagnosis interventions should not only include cancer symptom awareness but also address individual, structural and health systems related barriers to care.

show abstract

Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer

Cited by 23 publications

References 43 publications

Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa

Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa

Knowledge of cervical cancer risk factors and symptoms among women in a refugee settlement: a cross-sectional study in northern Uganda

Women's appraisal, interpretation and help-seeking for possible symptoms of breast and cervical cancer in South Africa: a qualitative study

Contact Info

Product

Resources

About