Strategies to enhance the approach to prostate cancer screening of African men in the Free State

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Benedict, Matthew Olukayode Abiodun
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University of the Free State
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Prostate cancer is a significant public health concern in South Africa, with rising incidence and mortality rates, particularly among African men. Prostate-specific antigen (PSA) screening is a practical method for early detection and improved outcomes. However, it carries the risks of overdiagnosis and overtreatment. Recent studies have shown a more significant net benefit of PSA screening for Black men than the general population. However, there are knowledge, attitude and practice gaps among primary healthcare providers and users, especially Black men, regarding prostate cancer screening. Practical strategies to address these gaps are lacking. This study focuses on vulnerable African men in the Free State Province, South Africa. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: This thesis presents the results of five complementary studies aiming to identify gaps in prostate cancer screening and determine strategies to enhance prostate cancer screening among African men in the Free State Province from the perspectives of primary healthcare providers and users. The first study employed a cross-sectional descriptive design, using case record information and self-administered questionnaires to profile Black South African men with prostate cancer attending a tertiary hospital’s oncology and urology clinics in the Free State Province. The second study used a cross-sectional analytical survey design, administering self-administered questionnaires to assess the knowledge, attitude and practice of primary healthcare providers in the study setting. The third study also employed a cross-sectional analytical survey design, utilising self-administered questionnaires to investigate African men’s knowledge, cultural beliefs and screening intentions regarding prostate cancer screening. Factors associated with their intention to screen for prostate cancer were examined. Quantitative data were analysed using descriptive statistics, and associations were tested using chi-squared or Fisher’s exact tests. The fourth and fifth studies comprised a scoping review and a modified Delphi survey to identify and propose strategies to enhance prostate cancer screening among African men in the study setting, addressing the identified gaps. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: The findings revealed that aggressive prostate cancer is prevalent among African men in the study setting. Poor knowledge and awareness of the disease and low screening uptake were observed. Factors such as dietary habits, lifestyle and presentation time were associated with aggressive disease at diagnosis. Cultural beliefs influenced screening uptake among men. Factors associated with a higher intention to screen included reduced fear, perceived benefits, situational barriers, and perceived risk of developing prostate cancer. Regarding primary healthcare providers, the majority demonstrated poor knowledge (64.8%), neutral attitudes (58.6%) and poor practice (40.0%) related to prostate cancer screening. Female providers, lower cadre nurses and community health workers had lower knowledge scores. Lack of prostate cancer-related continuing education was significantly associated with poor knowledge, negative attitudes and poor practice among healthcare providers. The study proposed strategies to address the identified gaps among African men and primary healthcare providers. Community-oriented approaches involving the active participation of both providers and community members were emphasised. These strategies focused on relevant prostate cancer health education topics in public spaces, employing diverse, comprehensive, user-friendly and culturally sensitive methods. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: This thesis highlights the gaps in prostate cancer screening among African men and primary healthcare providers in the Free State Province, South Africa. Targeted strategies are needed to enhance prostate cancer screening uptake and improve outcomes in this vulnerable population. Implementing the proposed strategies can improve awareness and knowledge of the disease and ultimately enhance screening practices among African men in the study setting.
Thesis (Ph.D. (Family Medicine))--University of the Free State, 2023
Prostate cancer screening, awareness, disease stage and grade, social determinants, Black men, African men, healthcare providers, knowledge, attitude and practice, KAP, screening intentions