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Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe

BACKGROUND: Cervical cancer treatment and care services have remained largely centralized in Zimbabwe thereby entrenching inequities to access amongst patients. The objective of this study was to investigate the determinants of access to treatment and care among women with cervical cancer in Harare,...

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Autores principales: Tapera, O., Dreyer, G., Kadzatsa, W., Nyakabau, A. M., Stray-Pedersen, B., Hendricks, S. J. H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664562/
https://www.ncbi.nlm.nih.gov/pubmed/31357977
http://dx.doi.org/10.1186/s12889-019-7355-3
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author Tapera, O.
Dreyer, G.
Kadzatsa, W.
Nyakabau, A. M.
Stray-Pedersen, B.
Hendricks, S. J. H.
author_facet Tapera, O.
Dreyer, G.
Kadzatsa, W.
Nyakabau, A. M.
Stray-Pedersen, B.
Hendricks, S. J. H.
author_sort Tapera, O.
collection PubMed
description BACKGROUND: Cervical cancer treatment and care services have remained largely centralized in Zimbabwe thereby entrenching inequities to access amongst patients. The objective of this study was to investigate the determinants of access to treatment and care among women with cervical cancer in Harare, Zimbabwe. METHODS: A sequential explanatory mixed methods design was used. In phase 1, three surveys (namely community, patient and health worker) were conducted with sample sizes of 143, 134 and 78 participants respectively. Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data collection during the surveys. Univariate, bivariate and multivariate logistic regression analyzes were conducted using STATA® version 14 to generate descriptive statistics and identify determinants of access to cervical cancer treatment and care. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain quantitative data. Participants were purposively selected and saturation principle was used to guide sample sizes. Manually generated thematic codes were processed in Dedoose software to produce final outputs for qualitative study. RESULTS: Knowledge of causes (p = 0.046), perceptions of adequacy of specialists (p < 0.001), locus of control (p = 0.009), service satisfaction (p = 0.022) and walking as a means of reaching nearest health facilities (p < 0.001) were associated with treatment or perceptions of access by healthy women. Perceptions of access to treatment amongst health workers were associated with their basic training institution (p = 0.046), health service quality perceptions (p = 0.035) and electricity supply status in their respective health facilities (p = 0.036).Qualitative findings revealed health system, societal and individual factors as barriers to accessing treatment and palliative care. CONCLUSIONS: There are numerous prevailing multi-dimensional barriers to accessing cervical cancer treatment and palliative care in a low –income setting. The findings of this study revealed that heath system and societal factors were more important than individual level factors. Multi-sectoral approaches are recommended to address all the multifaceted barriers in order to improve cervical cancer treatment and palliative care access for better outcomes in resource-limited contexts.
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spelling pubmed-66645622019-08-05 Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe Tapera, O. Dreyer, G. Kadzatsa, W. Nyakabau, A. M. Stray-Pedersen, B. Hendricks, S. J. H. BMC Public Health Research Article BACKGROUND: Cervical cancer treatment and care services have remained largely centralized in Zimbabwe thereby entrenching inequities to access amongst patients. The objective of this study was to investigate the determinants of access to treatment and care among women with cervical cancer in Harare, Zimbabwe. METHODS: A sequential explanatory mixed methods design was used. In phase 1, three surveys (namely community, patient and health worker) were conducted with sample sizes of 143, 134 and 78 participants respectively. Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data collection during the surveys. Univariate, bivariate and multivariate logistic regression analyzes were conducted using STATA® version 14 to generate descriptive statistics and identify determinants of access to cervical cancer treatment and care. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain quantitative data. Participants were purposively selected and saturation principle was used to guide sample sizes. Manually generated thematic codes were processed in Dedoose software to produce final outputs for qualitative study. RESULTS: Knowledge of causes (p = 0.046), perceptions of adequacy of specialists (p < 0.001), locus of control (p = 0.009), service satisfaction (p = 0.022) and walking as a means of reaching nearest health facilities (p < 0.001) were associated with treatment or perceptions of access by healthy women. Perceptions of access to treatment amongst health workers were associated with their basic training institution (p = 0.046), health service quality perceptions (p = 0.035) and electricity supply status in their respective health facilities (p = 0.036).Qualitative findings revealed health system, societal and individual factors as barriers to accessing treatment and palliative care. CONCLUSIONS: There are numerous prevailing multi-dimensional barriers to accessing cervical cancer treatment and palliative care in a low –income setting. The findings of this study revealed that heath system and societal factors were more important than individual level factors. Multi-sectoral approaches are recommended to address all the multifaceted barriers in order to improve cervical cancer treatment and palliative care access for better outcomes in resource-limited contexts. BioMed Central 2019-07-29 /pmc/articles/PMC6664562/ /pubmed/31357977 http://dx.doi.org/10.1186/s12889-019-7355-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Tapera, O.
Dreyer, G.
Kadzatsa, W.
Nyakabau, A. M.
Stray-Pedersen, B.
Hendricks, S. J. H.
Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe
title Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe
title_full Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe
title_fullStr Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe
title_full_unstemmed Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe
title_short Determinants of access and utilization of cervical cancer treatment and palliative care services in Harare, Zimbabwe
title_sort determinants of access and utilization of cervical cancer treatment and palliative care services in harare, zimbabwe
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664562/
https://www.ncbi.nlm.nih.gov/pubmed/31357977
http://dx.doi.org/10.1186/s12889-019-7355-3
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