Self reported symptoms and their influence on help seeking for cancer care in Kenya: a mixed methods study
Sharon Mokua (KEMRI); Mercy Njeru (KEMRI); Charlotte Cross (Open University); Lilian N Nyandieka (KEMRI); Richard Mutisya (KEMRI); Vera Manduku (KEMRI); Maureen Mackintosh (Open University)
Presentation given at the Kenya Medical Research Institute (KEMRI) Annual Scientific and Research (KASH) Conference, 8th - 10th June 2021.
Background: Cancer is more curable when detected early. Although some cancers develop completely without symptoms, the disease can be particularly devastating if one ignores symptoms when they occur especially if they do not think that these symptoms might represent cancer. Knowledge about symptoms and whether or not they trigger alarm, influences patient behavior because understanding these potential cancer symptoms then choosing to seek medical care promptly can help to detect cancer before it has spread.Therefore this paper aims to document the self reported symptoms, proportions and patients' help seeking behavior.
Methodology: A convergent parallel mixed methods design was used in the collection, analysis and interpretation of quantitative and qualitative data. A sample of 405 patients took part in a facility survey in Meru, Nairobi and Mombasa counties in Kenya.Four focus group discussions with cancer survivors and 22 in depth interviews with health workers, caregivers and policy makers were also carried out in the selected study sites.
Results: About 68% women and 32% men gave a self report of the first symptoms experienced. Around 109 different symptoms covering a significant area of alarm symptoms were reported. The most common symptoms being breast lump, vaginal bleeding, general pain and abdominal discomfort at 17.2%,7.9%, 6.9% and 6.6% for the different cancer types. About 122 participants reported having experienced more than one symptom at this event.These symptoms prompted various actions by patients where a majority went to a health facility (62.2%),14.7% of the participants did nothing and 8.5% stayed at home. Some patients self medicated or sought alternative-care among others.For those who presented to a health facility, the median time to diagnosis was shorter compared to those who did not go to a health facility for the major cancer types.The qualitative findings provided further insights into the reasons for help seeking including perception of health screening, cultural influences on disclosing symptoms and recognition of symptom severity.
Conclusion: The study findings provide an understanding of how people respond to potential cancer symptoms, and some reasons as to what guides the help seeking behavior considering that symptoms are what pushed a majority of patients to seek healthcare. The health system needs to work very hard to increase awareness among the population to enhance screening and prompt presentation to primary health care with possible cancer symptoms.An increased understanding of the health seeking and help seeking decision making process by patients especially in the Sub-saharan African context is much needed.It will contribute to the development of interventions targeting individuals' swift seeking of medical care in symptomatic cases as we push the health system towards developing and investing in rigorous wellness checks, screening and early detection efforts for better cancer outcomes.