La teoría fundamentada en la investigación social: experiencia en un estudio sociocultural en salud

Objective. Conduct a comprehensive assessment of the indicators of screening programs for early detection of breast and cervical cancer in the Gomel region.Materials and methods. A total of 7,611 first-time detected cases of breast cancer and 1,370 cases of cervical cancer in the Gomel region were analyzed for the period 2012-2022 (according to Belarusian Cancer Registry). The results of examination of 105130 participants of the screening program for early detection of breast cancer and 70258 participants of the screening program for early detection of cervical cancer were analyzed.Results. During the period 2017-2022, due to screening, 12% of cases of breast cancer were detected from the total number of newly diagnosed malignant breast pathologies. From 2018 to 2022, the proportion of newly detected cases of cervical cancer within the screening program increased from 0.83% to 2.61%, which indicates that the introduction of the screening program contributes to an increase in the detection of precancerous conditions of the cervix.Conclusions. The screening program for breast cancer and cervical cancer has shown its effectiveness in detecting new cases of malignant neoplasms of these localizations. An important result of the screening conducted in the Gomel region is the fact that the observed trend towards a decrease in the detection of breast cancer and cervical cancer in the early stages does not give any cause for optimism, as this is evidence of a deterioration in the structure of the detected pathology.

The purpose of this article is to explore and describe the perceptions of traditional healers of cervical cancer care. The incidence of cervical cancer, especially among black South African females, is among the highest in the world. Women report at clinics and hospitals on a daily basis with advanced stages (stages III and IV) of cervical cancer. Black women consult traditional healers first, before they consult health-care professionals. Although cervical cancer survival rates are said to be improving across South Africa, not all women benefit from the screening programme for early detection of cervical cancer. Traditional healers perform an indispensable role in the delivery of health care, especially in rural areas where access to biomedical care is limited. The article is based on a qualitative, descriptive, and exploratory study. The study population included traditional healers who were chosen through snowball sampling. Data was collected by means of in-depth interviews. Data was analysed using Tesch's method. The findings of this study demonstrated that the traditional health practitioners have good knowledge about cervical cancer care. This was shown by the knowledge they had of naming the disease, predisposing factors and causes, of cancer care, symptoms of diseases, diagnostic measures and methods of treatment. The findings of this study provided valuable information on the perceptions of traditional healers of cervical cancer care. In view of the knowledge that the traditional healers possess, this study recommended that there be sharing of knowledge and collaboration between modern health-care practitioners and traditional healers. Collaboration may assist in early detection and treatment of cervical cancer, thereby improving the mortality rate Keywords : Traditional healers, traditional medicine, western medicine, cervical cancer, perceptions. Indilinga Vol. 7 (1) 2008: pp. 103-116

A vision for improved cancer screening in Nigeria.

In this chapter, the importance and link between social research and theory are discussed. Social research is taken as the sociological understanding of connections—connections between action, experience, and change—and it is the major vehicle for realizing these connections. The debate on using theory in any scope of social research is being deliberated by various scholars with many emphasizing the merits of using theory in social research. They argue that an appropriate theory clarifies the findings a researcher has uncovered in the study. Without a theory, the researcher could face difficulties in streamlining the study or the researcher may overlook particular phenomena or events from within the study. Thus, the researcher would be unable to relate the variables in the study. A theorist always tries to view things from his/her perspective. Upon reflection, the theorist may develop a refined framework which then becomes the intensive framework, hereby, called a theory. This phenomenon may not necessarily be agreed upon by every social scientist as can be illustrated by cases where, after using a theory, researchers have modified such a theory to suit their outcomes. The theory used in social research supports and facilitates the researcher to raise fundamental questions and facts which could serve as the common core or body of knowledge. From the basis of given facts and explanations, it can be claimed that the theory used in social research has a pivotal role to align the study. In social research, a researcher should make the matter of selecting a theory seriously as a good theory produces a better piece of research work. This chapter elaborates on the various aspects of using theory in social research. Several diagrams are used to make explanations clear.KeywordsSocial researchTheorySocial processFrameworkSocial sciencesStructure

BackgroundBreast and cervical cancers are among the most commonly diagnosed cancers in Ghana and impose substantial financial burden on households. Although diagnosis and treatment for these cancers are included in the National Health Insurance Scheme (NHIS) benefits package, stakeholders report limitations in the scope and implementation of coverage, leading to out-of-pocket payments and potential delays in care.ObjectivesTo characterise NHIS coverage for breast and cervical cancer care and to explore challenges affecting implementation from the perspectives of key stakeholders.DesignQualitative exploratory study using semi-structured key informant interviews and a focused desk review of national guidelines and NHIS policy documents.Participants12 key informants were purposively sampled based on roles in cancer policy, financing or service delivery.ResultsAlthough the NHIS officially lists coverage for consultation, diagnosis, radiotherapy and selected chemotherapy medications, participants reported that these benefits are not fully realised in practice. Respondents described persistent out-of-pocket payments for breast and cervical cancer services due to incomplete or delayed reimbursement of screening and diagnostic costs, limited inclusion of costly imaging procedures and the exclusion of some essential and innovative therapies, including immunotherapy. Delayed NHIS reimbursement was cited as a recurrent problem that constrains facility cash flow and contributes to co-payments at the point of care. Stakeholders also highlighted misalignment between NHIS reimbursement tariffs and actual service costs, which discourages some facilities from providing certain listed services and thereby limits patient access.ConclusionNHIS coverage for breast and cervical cancer care still contains significant gaps, particularly in preventive services and access to advanced therapies. Policy actions should focus on strengthening preventive coverage (including screening and human papillomavirus vaccination), aligning tariffs with service costs, ensuring timely reimbursements and updating the medicines list through transparent, evidence-informed review processes.

Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.

Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world’s highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.

Background: Transgender and Allogender Individuals Assigned Female At Birth (transgender and allogender individuals AFAB) face obstacles and inequalities in healthcare access compared to cisgender individuals. These challenges derive from social stigma, knowledge gaps, and scarcity of professionals trained to address the specific needs of these populations. Since transgender and allogender individuals AFAB may retain breast tissue and a cervix, they require integral sexual health care, including early detection of cervical and breast cancer. However, specific barriers and guidelines for early detection in these populations remain undefined. Aim: To review literature on early cervical and breast cancer screening in transgender and allogender individuals AFAB and identify research gaps. Methods: This scoping review followed the Joanna Briggs Institute methodology, and the report adhered to the PRISMA-ScR checklist. Searches were conducted across seven databases, including peer-reviewed and grey literature. Study selection was conducted independently by two reviewers using RAYYAN software. Data from selected studies were analyzed qualitatively by thematic analysis. Results: Out of 709 identified studies, 61 articles and 5 grey literature documents were included in the review dataset. The majority of these were published in 2020 (24.2%), originating from the USA (72.7%), and employing a cross-sectional design (39.4%). From the thematic analysis, six main themes were identified for cervical cancer and five for breast cancer. Among these, five themes were common to both types of cancer: screening rates, barriers, strategies, guidelines, and the role of healthcare professionals. The theme of knowledge, beliefs, and attitudes was found solely in the context of cervical cancer. Conclusions: The evidence indicates that healthcare attention for cervical and breast cancer remains predominantly linked to sex assigned at birth, neglecting gender implications for transgender and allogender AFAB populations. The existing disparities in detection rates and access present a significant challenge in gynecological care for these groups.

Breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC) are among the most common malignant neoplasms (MN), accounting for a significant proportion of deaths due to MN in the Russian Federation. The current program of medical checkup of the adult population in the Russian Federation includes several tests aimed at early detection of these MNs. Objective. To evaluate the socio-economic efficiency of the implementation of measures aimed at early detection of cervical, breast, and colorectal cancer as part of the medical check-up program. Material and methods. The survival rate and costs of medical check-ups, as well as the subsequent life-long costs due to MN were modelled for the cohort with BC, CC and CRC identified during the medical check-ups in 2019. The same set of variables was forecasted for the situation in the absence of the medical check-up program The values of the parameters for modeling were obtained from the statistical observation data in 2019 and other published data; the costs were estimated as of 2022. Results. Additional costs associated with cancer screening during the medical check-ups amounted to 1.711.94 million rubles for breast cancer (3.336 life years gained), 902.74 million rubles for cervical cancer (1.734 life years gained), and 2.527.67 million rubles for the CRC (4.354 life years gained). The cost per 1 life year gained ranged from 513.2 to 1.070.6 thousand rubles, depending on the inclusion of costs due to premature death and disability. These results are below the possible limit values for this indicator (the threshold of willingness to pay) in the Russian Federation. Conclusion. The results confirm the socio-economic efficiency and rationality of measures aimed at early detection of breast, cervical, and colorectal cancer included into the medical check-up program.

Graphic projective techniques are commonly used in research associated with social representation theories. These techniques allow the identification of personality attributes that are revealed through the subject's responses to relatively unstructured, ambiguous, or vague stimuli. Objective: to check the applicability of projective techniques in social representation research. Method: Systematic review of literature. A search for nursing and psychology publications (Qualis/CAPES) was carried out. The keywords social representations, projective techniques and graphic projective techniques were used. Main results: ten articles were selected. The graphic projective technique most used was the thematic drawing story. Usually, the projective techniques are associated with other data collection techniques, as is advised by experts in social representation theories. Conclusion: The publications demonstrated the applicability, relevance and contribution of graphic projective techniques in social representation research. However, the validity of this method is still questioned considerably.

Social representations research is often undertaken by scholars who seek to ‘give voice’ to knowledge(s) that are held by socially disenfranchised individuals and groups. However, this endeavour poses a number of problems in practice, not least because it assumes that the ‘voices’ voiced by individuals and/or groups in social research will be unambiguous and uniform, and unchanged by the research encounter. Despite the growth of attention to the critical potential of social representations theory, there remains a lack of scholarship on the relationship between the theory's emphasis on the relational, or dialogical, nature of social life (the Ego‐Alter‐Object relation) and the implications of this for critical research. In this article, I argue that the dialogical epistemology from which social representations research must depart incites reflection upon (i) the design of empirical studies, which must equally attend to both ‘Ego’ and ‘Alter’, and (ii) the researcher‐researched relationship, which may itself be best viewed as an Ego‐Alter interaction. I make the case for adopting dialogical epistemology in critical social psychology, and argue that this is essential to undertaking ethical social research. I conclude by suggesting that claims to ‘giving voice’ have little place in critical social psychology in general, and social representations scholarship in particular.

PURPOSEBreast and cervical cancer are the most common cancers among women in East and Southern Africa, where mortality remains high because of late diagnosis and limited access to treatment. We explored local approaches to breast and cervical cancer advocacy to identify the most pressing issues and opportunities for increasing the impact of civil society activities in the region.METHODSFocus group discussions were conducted with participants of the 2016 Women’s Empowerment Cancer Advocacy Network (WE CAN) Summit in Nairobi, Kenya. Discussions were audio-recorded, transcribed, coded, and analyzed for emergent themes. Results were presented to participants of 2019 WE CAN summit for cross-validation.RESULTSFour focus group discussions were conducted with 50 participants. Thirty-six (70%) identified as advocates, 30 (59%) as cancer survivors, 14 (27%) as nongovernmental organization representatives, 13 (25%) as researchers, 4 (8%) as clinicians, and 6 (8%) as policymakers. Although most participants focused on cancer awareness and screening/early detection, some noted that treatment was often unavailable and advocated for a broader strategy to improving access to care. Challenges to designing and implementing such a strategy included knowledge gaps in addressing late diagnosis and access to care, difficulty collaborating with like-minded organizations, approaching policymakers, and addressing treatment financing. Cancer coalitions, although rare, were crucial to building collaborations with ministries of health, policymakers, and international organizations that advanced breast and cervical cancer care.CONCLUSIONParticipants indicated that they would benefit from additional training about resource-appropriate best practices for improving breast and cervical cancer care and outcomes. Coalition-building and collaborations, including with oncologists and other medical professionals involved in cancer care, were crucial to leveraging limited resources, sharing lessons learned, and developing local solutions to common challenges.

Objetivo. Analizar la percepción de mujeres y proveedores de salud sobre cuándo y cómo realizar acciones para la detección temprana del cáncer de mama y cervicouterino en localidades de Morelos con presencia de población indígena. Material y métodos. Se entrevistó a 10 proveedores de salud y 58 usuarias en unidades médicas del primer nivel de atención de cinco localidades; luego se analizó la información con base en el paradigma de la teoría fundamentada. Resultados. El personal de salud está deficientemente familiarizado con los lineamientos oficiales para la detección de cáncer cervicouterino y de mama. Pocos practican sus labores bajo una perspectiva de sensibilización intercultural. Las usuarias tienen nociones imprecisas o equivocadas de las acciones de detección. Conclusiones. La necesidad de capacitación con apego a las normas es evidente. Urge asumir un abordaje con pertinencia cultural que permita la comunicación eficiente y alfabetización en salud para la detección oportuna de estos dos cánceres.

I. Essay: Managed Care: Promise and Concerns

Cervical cancer is the fourth most common cancer worldwide. The fact that cervical cancer takes many years to develop indicates that mortality rates can be significantly decreased with early detection. This is why screening tests for early cervical cancer detection are so important, especially in developing countries where screening programs are not available to the same extent as in developed countries. About 84% of all cervical cancer cases in 2012 occurred in less developed countries mainly due to the lack of effective screening programs. Even if the necessary infrastructure in one country exists, the cost of screening test is usually too high. Finally, the accuracy of screening test needs to be satisfying in order to detect all the abnormal cases and treat them effectively. Papanicolaou test is still the most effective screening test for cervical cancer detection so far. However, the accuracy of Papanicolaou test is closely related to the expertise of the cytopathologist and therefore the accuracy varies producing relatively low sensitivity of Papanicolaou test (50–85%). HPV DNA test is approved as primary screening test, but so far it gives better results when it is used in conjunction with cytology. We present a method and device for detection of cervical cancer based on optomagnetic imaging spectroscopy (OMIS) and compare the results for cancer detection using stained and fresh unstained cervical cell samples. Compared to stained samples, unstained fresh sample classification by OMIS into healthy/cancerous group with Naive Bayes classifier gave higher accuracy (96% compared to 85,18%).