Qualitative findings from providers and patients for planning implementation of screening clinical breast examination in Soweto, South Africa.

Abstract

1539 Background: Over 50% of South African women with breast cancer (BC) are diagnosed at stages III & IV. To inform an Implementation Mapping process to design strategies for implementing screening clinical breast exam (CBE) in primary care facilities in Soweto, South Africa, we gathered qualitative data from local primary care providers and patients on barriers to CBE and possible implementation approaches. Methods: We conducted semi-structured interviews with administrators, nurses, doctors, and community health workers (CHWs) and focus groups with women potentially eligible for screening CBE at four Soweto primary care facilities that do not offer BC screening. Our discussion guide explored BC screening perceptions among both groups. We also asked providers for recommendations about how to best implement a future CBE screening program, and we asked patients about factors that would motivate them to participate in such a program. We analyzed transcripts deductively in parallel with data collection. We organized themes using the Consolidated Framework for Implementation Research (CFIR). To support Implementation Mapping’s emphasis on addressing the needs of individual stakeholders, our analysis focused on the CFIR Individuals domain and Characteristics subdomain taken from the COM-B system. Results: We analyzed 27 interviews with 8 administrators, 1 medical officer, 14 nurses, 3 CHWs, and 1 clerk, and 4 focus groups with 23 total women. Providers ( i.e., deliverers) and patients ( i.e., recipients) alike expressed enthusiasm for CBE’s potential to decrease BC mortality and morbidity. Both groups also cited CBE’s potential to overcome and counteract patients’ limited knowledge of breast health and BC symptoms. The primary barrier to CBE, according to both groups, is the high patient volume at public facilities. Providers described staff shortages limiting opportunity to perform CBE and patients cited long wait times as a barrier to pursuing “extra” services. Providers often recommended hiring new personnel designated for CBE screening. Patients suggested various approaches to expanding access, such as screening in both the clinic and community, opportunistic screening while patients wait for other clinic services, and walk-in access for “screening only” visits. Patients also emphasized the need to improve trust in the clinics and their staff. Regarding educational outreach, providers focused on expert-delivered teaching in both the clinic and community. Patients valued experts but also recommended engaging BC survivors and other community members to promote screening through word-of-mouth. Conclusions: Soweto’s primary-care clinicians and patients expressed enthusiasm for the health benefits of BC screening, but successful implementation must address barriers faced by both groups, including long clinic wait times and personnel shortages.