Barriers and Facilitators to Uptake of Prostate Cancer Screening in a Kenyan Rural Community

Ruth Gathoni Mbugua1, Simon Karanja2, Sherry Oluchina3

1. Mount Kenya University, College of Health Sciences, Community Health Department                                               

2. Jomo Kenyatta University of Agriculture & Technology, School of Public Health

3. Jomo Kenyatta University of Agriculture & Technology, College of Health sciences, Department of Nursing Education Leadership Management & Research.                       

Correspondence to: Dr. Ruth Gathoni Mbugua, Mount Kenya University, rmbugua15@gmail.com

Received: 14 October 2020; Revised: 21 February 2021; Accepted: 08 March 2021; Available online: 18 April 2021

Abstract

Background: Prostate cancer (PC) is curable with early detection, yet it remains a major public health problem globally and a leading cause of mortality among men. The objective of the study was to explore the barriers and facilitators to the uptake of prostate cancer screening among men aged 40–69 years in a rural community in Kenya. Methods: We utilized an explorative qualitative design and purposive sampling to select participants. Six focus group discussions (FGDs) and seven in-depth interviews were conducted among 59 men aged 40–69 years and key informants in Kiambu County, Kenya. Data was collected using a semi-structured guide and content analysis was done. Results: The facilitators of screening included experience of symptoms, proximity and prominence of cancer, accessibility, and advocacy. The barriers to screening included lack of knowledge, fatalistic beliefs, low risk perception, stigma, and male dominance factors. Conclusion: This study provides vital information for the development of interventions to enhance shared decision-making in regard to PC screening. Capacity building of clinicians, task shifting and provision of well-coordinated affordable culturally sensitive screening services should be explored. The concerted effort among policy makers and all health care workers to overcome the stated barriers to screening is highly recommended.

Keywords: Barriers, facilitators, prostate cancer, screening, Kenyan men, Kenya


Ann Afr Surg. 2021 ; 18(3): 130-136 
DOI : http://dx.doi.org/10.4314/aas.v18i3.2
Conflicts of Interest: None
Funding: None
© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License 

Introduction

Prostate cancer (PC) is curable with screening and early detection, yet it remains a major public health problem globally as it is among the leading causes of cancer-related mortality among men worldwide. African men suffer disproportionately from PC with higher mortality reported among men in Sub-Saharan Africa (1, 2). In Kenya, PC is ranked as the most prevalent cancer in males with 2864 new cases (14.9%) in 2018 (3). Generally, low rates of PC screening have been reported among Black men (4, 5).
Globally, prostate specific antigen (PSA) screening remains a much debated issue with varying recommendations across countries. Nevertheless, there is a general agreement on utilization of shared decision-making in-line with the US Preventive Services Task Force recommendations (6). The screening guidelines in Kenya recommend individualized risk-based screening through shared decision-making between the client and clinician among men aged 40–69 years (3). The screening rates, however, remain abysmally low despite high intention to screen (7–10). Unfortunately, the number of men diagnosed with advanced aggressive PC is on the rise with an alarming increase in mortality attributed to low uptake of screening (3, 11). Despite equivocal evidence given on the effects of PC screening on mortality, risk-based screening aimed at early treatment initiation is vital (7).
The low uptake of PC screening among Kenyan men despite a considerably high level of awareness remains a great puzzle in public health that requires further investigation. There is a paucity of studies on barriers to PC screening in developing countries. The few studies carried out in Kenya are quantitative, hence they lack a deeper exploration of the factors influencing screening. The success of PC prevention and control programs requires an in-depth understanding of contextual factors influencing uptake of screening. The study therefore applied a qualitative approach to explore context-specific barriers and facilitators to PC screening among Kenyan men in a rural community.

                                                       

Methods

Design
We used a descriptive exploratory qualitative study design.
Study site
The study was conducted in Gatundu-North and Kiambu Sub-counties in Kiambu County, which are located in the central region of Kenya. The sub-counties were selected as they have linked health facilities which offer PC screening services. The population in the study area is demarcated into Community Units (CUs) for the purpose of implementation of community health strategy. All the 17 CUs were included in the study.

Study population
The study participants included 59 men aged 40–69 years, the eligible age for screening in Kenya (3). The key informants (KIs) included members of the County and Sub-county Health Management Committee including public health nurses and officers and community health strategy coordinators.

Sampling technique
The focus group discussion (FGD) participants were purposively selected which aimed at ensuring heterogeneity and representation of various socio-economic and demographics characteristics. The selection of the KIs was facility-based and included the key people involved in the implementation of the Community Health Strategy in the sub-counties.

Data collection tools
A semi-structured guide based on the key themes of the study was used to conduct the interviews in the months of March–April 2019. The key themes of the study which included the barriers and facilitators of the uptake of screening were included in the guide.

Internal validity and reliability
Lincoln and Guba criteria were used for enhancing trustworthiness. Several debriefing sessions were held by the research team members, who used multiple coders ensuring consensus from the team members before the generation of themes. Referential adequacy was ensured by a review of the original data and findings by two members of the research team who had vast experience in qualitative data analysis and multiple reviews of the data by other research team members before generation of codes to ensure the credibility of the data. Operationalization was also done through member checking at the end of interviews and keeping an audit trail of all the steps undertaken during analysis to ensure rigor. Researcher and methodological triangulation was also done (12).

 

Data collection procedure
We conducted six FGDs which consisted of 59 community members and seven individual in-depth interviews with KIs and achieved saturation with a total of 66 participants. Each FGD was made up of the principal investigator and two research assistants. The FGD was conducted in a private set-up within the linked health f