Psychosocial Influences on Medical Help Seeking for Cancer Symptoms and Treatment in Low- and Middle-Income Countries: A Meta-Analysis and Mixed Methods Systematic Review

Abstract

PURPOSE Cancer disproportionately affects people living in low- and middle-income countries (LMICs), partly because of delayed medical help-seeking behavior (HSB). Our mixed-methods systematic review synthesized existing studies in LMICs to understand psychosocial influences on cancer-related medical HSB to inform the development of effective interventions to promote earlier HSB for cancer. METHODS We searched peer-reviewed literature databases for quantitative, qualitative, and mixed-methods studies exploring barriers/facilitators to medical HSB for cancer symptoms in adults living in LMICs. Study exclusion criteria were low methodologic quality, non-English language publication, non–peer-reviewed publication, and studies conducted in high-income countries. Study findings were synthesized using meta-analysis, meta-ethnography, and narrative synthesis methods, according to individual study design. RESULTS Fifty studies were included. Many studies used nonstandardized measures/designs, which increased the difficulty integrating findings. Preliminary findings indicate that the use of traditional healers is a key barrier to prompt medical HSB in LMICs. Use of traditional healers for cancer symptoms/treatment was influenced by causal beliefs about symptoms, familial pressure, ease of access, affordability, and a preference to avoid biomedical treatment, which was perceived as invasive, ineffective, and expensive. Additional psychosocial barriers included shame and stigma associated with cancer, such as fear of marital rejection/divorce; limited knowledge of cancer and associated symptoms; financial and access barriers associated with travel and appointments; and cultural barriers, such as women needing permission from the family network. CONCLUSION Such barriers as low symptom knowledge and negative beliefs about cancer are universal barriers to cancer HSB in high-income countries and LMICs, whereas the use of traditional healers and women needing permission to seek medical help seem to be unique to LMICs. Intervention developers should work with local communities to appropriately tailor cancer awareness interventions in LMICs, taking into account cultural influences on HSB. Future evaluations would benefit from using validated measures and robust study designs.