Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

Abstract

IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.MethodsMixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.ResultsOf 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.ConclusionDue to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

Primary healthcare professionals’ perspectives on patient help-seeking for lung cancer warning signs and symptoms: a qualitative study

“…Our previous research with high-risk individuals in Ireland found that stories of misdiagnosis caused mistrust in the healthcare system among some participants, which led them to delay help-seeking for symptoms of LC [ 13 ]. Additionally, a recent systematic review of 64 studies on psychosocial factors influencing cancer help-seeking found that mistrust in medicine deterred patients from seeking medical help for cancer, particularly in low-income and lower middle-income countries [ 27 ].…”

Barriers to help-seeking for Malaysian women with symptoms of breast cancer: a mixed-methods, two-step cluster analysis

“…For example, we observed that women with no delay and great delay similarly reported the use of alternative treatment prior to seeking medical attention. The preference for alternative treatment is commonly reported in this region (14,20,22) as well as other LMICs (8), and has been previously shown to deter help-seeking behaviour (23). Here, we suggest that use of alternative treatment may not always lead to delays in help-seeking.…”

“…This finding is comparable to past studies of Asian women, where poor social support and negative social influences are often reported as primary barriers to seeking help for breast cancer symptoms (15,20,21), and may be a more significant barrier than lack of knowledge in this region (22). In Asian communities, family members appear to have both direct and indirect roles in a women’s decision to seek help (14,23,24). A supportive family can be an enabler of early help-seeking behavior and adherence to treatment (14), whereas lack of support or unstable family dynamics often lead to confusion, uncertainty, and ultimately, delay in seeking medical treatment (23).…”

“…In Asian communities, family members appear to have both direct and indirect roles in a women’s decision to seek help (14,23,24). A supportive family can be an enabler of early help-seeking behavior and adherence to treatment (14), whereas lack of support or unstable family dynamics often lead to confusion, uncertainty, and ultimately, delay in seeking medical treatment (23). Therefore, interventions to improve screening and early detection that consider family dynamics and socio-cultural factors may prove to be more effective than a one-size-fits-all campaign (25).…”

A Socio-Ecological Framework for Cancer Prevention in Low and Middle-Income Countries

“…McCutchan et al conducted a systematic review of psychosocial influences on help-seeking behavior in LMICs (96). They found that the use of traditional, complementary and alternative medicine was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms, and a preference to avoid biomedical treatment.…”