The perspectives of healthcare providers, traditional healers, and other key informants on the late diagnosis of breast cancer in northern Tanzania : a qualitative study

Abstract

Background

Breast cancer (BC) is the most common cancer among women in Tanzania and has one of the highest mortality rates worldwide due to late-stage diagnosis and suboptimal treatment. The role of traditional healers in late-stage diagnosis has not been widely studied. We aimed to identify the barriers to early BC diagnosis in Tanzania and possible solutions by interviewing healthcare providers (HCPs), traditional healers (THs), and other key informants (KIs). Methods

We used phenomenological qualitative study design. We administered six open-ended qualitative questions to 20 HCPs (including 10 doctors and 10 nurses), 10 THs, and 9 KIs in rural and urban community settings in the Kilimanjaro region. A focus group discussion with 8 THs was also conducted. The questions explored perceived reasons for late diagnosis of BC, the initial reaction of patients who presented with a noticeable breast changes and reasons for visiting a health facility after the disease had advanced. Participants were recruited after their working hours. Data were analyzed using thematic approach and NVIvo 12 software. Results

The findings were synthesized into five themes to explain late diagnosis: (1) HCPs and THs have limited knowledge and misconceptions about the causes, signs, and symptoms of breast cancer; (2) patients experience stigma (3) treatment is expensive and difficult to access; (4) patients perceive barriers based on myths, misperceptions and spiritual beliefs; and (5) HCPs and THs often blame each other for ineffective treatment and delays in effective treatment. The participants also provided suggestions to reduce delays in diagnosis and treatment, including enhancing knowledge and awareness among THs and HCPs to help them recognize the signs and symptoms of BC through education campaigns, addressing the cost of access to care and treatment, addressing stigma associated with BC, and developing collaborative efforts between HCPs and THs. Conclusion

In this study, limited knowledge, misconceptions, stigma, access and cost was observed as barriers across all groups.Raising community awareness and improving understanding of BC is crucial in reducing misconceptions and stigma. Future collaboration between healthcare providers and traditional healers could be beneficial in the development of strategies to recognize the early signs and symptoms of BC and promote pathway referral to care.