Cultural beliefs influencing cervical cancer screening among women in a community healthcare centre

Abstract

Cultural beliefs influencing the uptake of cervical cancer screening among women in a community healthcare centre. 1.1 INTRODUCTION AND BACKGROUND Globally cervical cancer was found to be the fourth most common cancer among women in 2012. There were an estimated 528,000 new cases and approximately 266,000 female deaths of cervical cancer in 2012 worldwide. The Human Papilloma Virus (HPV) was being associated with about 70 percent of all cervical cancers (World Health Organization [WHO] 2015:43). In South Africa, cervical cancer is still the most common cancer diagnosed in women. Despite this fact, the uptake of cervical cancer screening in a designated community centre in the Tshwane district in the Gauteng Province of South Africa (SA) is low. 1.2 PURPOSE OF THE STUDY The purpose of the study was to explore and describe cultural beliefs influencing the uptake of cervical cancer screening among women in a designated community healthcare centre. 1.3 METHOD A qualitative descriptive design was used, as the researcher was interested in exploring and describing whether cultural health beliefs influence the uptake of cervical cancer screening. The study was conducted at a designated community healthcare centre, which is situated in a Pretoria West suburb in the Tshwane Metropolitan Municipality of the Gauteng Province in South Africa. The population were women who were 35 years and older who have not made use of cervical cancer screening services before, and who attend the selected departments for other reasons than for screening for cervical cancer. Purposive sampling was used to select participants as they visited the community health centre’s chronic as well as maternal child and women’s health services (MCHW) at mother and child healthcare departments. The researcher handed out fliers to all women patients of the departments. The fliers contained information about the study and the inclusion criteria for the sample. The researcher’s contact number was also included on the flier in order for interested women to make contact with her once they have decided to participate, or to get more information about the study. Focus group interviews were conducted at the designated community healthcare centre. Consent was obtained for participation as well as for the use of audio recording beforehand. The interviews were conducted in the English and Sesotho language. The same group of participants were interviewed until data saturation was reached, meaning that no new information was to be obtained. The researcher and co-coder (who both understood Sesotho and English) organised data and translated it. The researcher then interpreted and discussed the findings in a ‘dialogue’ between it and the existing knowledge base related to the studied phenomenon. 1.4 FINDINGS The following four categories emerged from this study; Fear of cervical cancer results, cervical cancer is perceived to be caused by sacred or indecent behaviour, spousal approval needed for cervical cancer screening and women should address gynaecological health issues with women. Furthermore nine sub-categories emerged from the categories. The study found that cultural beliefs played an important role in influencing the uptake of cervical cancer screening in the designated community healthcare centre. Most families in this study were led by males, and participants reported that these males lack knowledge of cervical cancer-related issues. Women were expected to be submissive to their husbands and were not allowed to proceed with health-related procedures without the consent of their husbands. Participants verbalised that they lacked spousal support when it came to cervical cancer screening. Husbands could not approve of their wives having cervical cancer screening performed on them, as the disease was stigmatised. Participants in this study did not consider it necessary to seek cervical cancer screening, as they did not present any symptoms. Participants were most fearful of being diagnosed with the disease and feared losing their husbands due to the treatment procedure that entailed the removal of the uterus, and therefore preferred to remain in denial. Fear of contracting other diseases such as Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome while performing cervical cancer screening was also reported. The community believed that women with cervical cancer were promiscuous or had abortions and hence women in this study refrained from screening for the disease for fear of being judged. It was also believed that the disease affected widows who failed to adhere to cultural rituals performed to the following the death of their husbands. The study found that cultural restrictions did not allow women’s bodies to be viewed by men other than their husbands. The disease was regarded as a taboo, and it was never communicated within families and the community. In the families, women were not expected to talk about women health issues to their husbands as it was regarded as disrespectfulness. They were expected to discuss such issues with elderly female structures within the families. This also created a barrier as most participants reported that they did not get along with these elderly female structures. 1.5 CONCLUSION It was evident that cultural beliefs played an important role in cervical cancer screening. The community, including men, need to be educated about cervical cancer-related issues while remaining culturally sensitive. Women had to be given a choice of gender preference at the designated healthcare centre when seeking cervical cancer screening. Keywords: cervical, cancer, screening, uptake, culture, beliefs, Pap smear, Human Papillomavirus, barriers and symptoms.