Examining how to strengthen the primary health care capacity for early breast cancer detection in Uganda: a socioecological approach

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Ikhile, D.E. ORCID: 0000-0002-4343-1674, 2021. Examining how to strengthen the primary health care capacity for early breast cancer detection in Uganda: a socioecological approach. PhD, Nottingham Trent University.

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Abstract

Breast cancer in Uganda is usually detected late as a result of complex and interacting factors. Although primary health care (PHC) is an integral platform for facilitating early detection of breast cancer in low-income countries (LICs), this has not been fully explored in Uganda. Thus, this study critically examined how the PHC capacity can be strengthened to deliver early breast cancer detection services for women in Kajjansi town council, a semi-rural community in Uganda.

This study was conducted through a sequential explanatory mixed methodology design using quantitative and qualitative approaches. The quantitative phase evaluated the existing PHC capacity to deliver early breast cancer detection services through Health Centres Assessment of the only existing government health centres (n=3), and an assessment of all community health workers (CHWs) within the project area (n=292). This data was then analysed and followed by a qualitative phase which examined how the PHC capacity can be strengthened for early breast cancer detection. The qualitative data was collected through semi-structured interviews among CHWs (n=14) and key informants (n=11).

The findings from the quantitative phase established that early detection services for breast cancer were limited at the PHC level. The situation analysis established that the PHC system in Kajjansi town council was not oriented towards providing organised breast cancer detection services. The key findings from the qualitative component revealed 1) the need to deliver breast cancer detection services at a community level by leveraging on the existing PHC system and carrying out community outreach 2) engagement with multi-sectoral stakeholders, including the PHC workers, community health workers, community leaders, institutional leaders, government, non-governmental organisations, community members (both men and women).

The quantitative and qualitative findings were then synthesised to inform the development of 'A breast cancer detection' (ABCD) framework. Guided by a socioecological model, the ABCD framework proposes multi-level interventions which can be implemented either individually or holistically towards strengthening the PHC capacity for early breast cancer detection. These interventions include community wide breast cancer education (individual level); capacity building of CHWs (community level); community outreach (structural level); integrated PHC delivery, establishing breast cancer clinics and capacity building of PHC workers (organisational level); development and implementation of a national cancer control plan and breast cancer guidelines (policy level).

This thesis adds to existing knowledge through the development of a multi-level framework for promoting early breast cancer detection in LICs.

Item Type:	Thesis
Creators:	Ikhile, D.E.
Date:	May 2021
Rights:	The copyright in this work is held by the author. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed to the author.
Divisions:	Schools > School of Social Sciences
Record created by:	Linda Sullivan
Date Added:	10 May 2021 11:22
Last Modified:	31 May 2021 15:03
URI:	https://irep.ntu.ac.uk/id/eprint/42840