Skip to main content

Table 2 Overview of studies that focused on help-seeking for cancer

From: Factors related to help-seeking for cancer medical care among people living in rural areas: a scoping review

Ref. No.

Author(s), year of publication

Country, region

Cancer type

Purpose

Study design

Targets; No. of samples

Excerpts of descriptions relating to help-seeking

[23]

Moodley et al., 2021

Uganda, South Africa

(Africa)

Breast cancer, uterine cancer

To identify the factors that impede timely help-seeking behaviors when symptoms appear.

Quantitative

South Africa: 428 people in rural areas; 445 in cities

Uganda: 427 people in rural areas; 458 in cities

In South Africa, those living in rural areas felt strongly that, compared with urban residents, they lacked the money to travel to and pay for medical institutions, and that their dialect and culture would not be understood by medical professionals. In Uganda, compared with urban residents, those living in rural areas were likely to have other role obligations and have husbands and/or partners who did not approve of help-seeking. Rural residents in both countries self-medicated when they became aware of cancer symptoms.

[24]

Goodwin et al., 2021

Australia

Various cancers

To identify awareness of delays when seeking help and factors related to the intention to seek help.

Quantitative

648 people residing in regional and rural areas who had been diagnosed with cancer

Being dismissive of problems, religion, the need for self-management, and having fatalistic views and attitudes were not associated with undergoing health screening examinations or delayed help-seeking.

[25]

Adsul et al., 2020

India (South Asia)

Uterine cancer

To identify the sociocultural factors that affect help-seeking for uterine cancer screening.

Qualitative

14 women residing in rural areas

Help-seeking was affected by shame and hesitation in discussing the uterus, a sex organ, as well as the belief that screening would not save them if it was their fate to develop cancer. Women had roles to play within the family and could not seek help without their husband’s permission. For some women who already had been diagnosed with cancer, their husbands and mothers-in-law remained unsupportive, and there was a stigma against cancer in the community. In addition to the financial burden of paying for the screenings themselves, women had to take time off work to undergo screenings.

[26]

Bergin et al., 2020

Australia

Colon cancer,

Breast cancer

To compare the experience of patients living in rural and urban areas starting from receiving a diagnosis to undergoing treatment.

Qualitative

46 cancer patients residing in rural and urban areas

Characteristics of rural residents: In rural areas, it takes time to access the tests required to receive a diagnosis. In particular, there were no specialized hospitals in the area that could provide treatment, there were long waiting times to be attended to by specialists, and rural residents had other priorities, such as family and work.

Factors in common with those living in urban areas: Help-seeking was delayed for the following reasons: did not think the symptoms were those of cancer; experienced similar symptoms in the past that were not due to cancer; felt that symptoms were natural and not problematic; in good health; the symptoms worsened gradually, so they were not linked to cancer; tried to manage cancer on their own; and felt that having cancer was shameful. Triggers that promoted help-seeking were as follows: development of abnormal symptoms and social recognition (e.g., being told by friends or other people around them that their symptoms might be cancer).

[27]

Goodwin et al., 2019

Australia

Colon cancer

To investigate the characteristics of patient attitudes and awareness related to help-seeking for colon cancer screening.

Quantitative

371 adults in the general population residing in rural, regional, and metropolitan areas

Compared with those living in regional and metropolitan areas, people in rural areas were significantly more dismissive of problems. This dismissiveness was associated with lower compliance with screenings and delayed help-seeking.

[28]

Steiness et al., 2018

Bangladesh (South Asia)

Breast cancer

To identify the factors that contribute to delayed help-seeking.

Qualitative

43 women residing in rural areas with breast cancer symptoms and 20 of their husbands

Participants identified having insufficient knowledge of breast cancer; inability to pay the costs of diagnosis and treatment; distant location of medical institutions; lack of doctors, laboratories, and pharmacies; lack of doctors whom they could trust; and having had an unpleasant past experience with a doctor. The following were also identified as barriers: fear of treatment and fatalism, views and attitudes toward disease (e.g., stigma), villagers’ cultural norms (e.g., not wanting to let women leave the village), and negligence or disinterest from family members (e.g., husbands and their family members did not allow their wives to receive the treatment). Religion was not associated with help-seeking.

[29]

Funnell et al., 2017

Australia

Skin cancer

To identify the factors that impede specialist help-seeking among patients receiving a skin cancer diagnosis.

Quantitative

201 adults in the general population residing in rural areas

Participants aged over 63 years and those who had lower education levels were more likely to solve problems on their own, be dismissive of problems, control their emotions so as not to let others see them, and distrust caregivers.

[30]

Mandengenda et al., 2014

Zimbabwe (Africa)

Various cancers

To identify the perceptions on cancer and the barriers to help-seeking as perceived by residents.

Quantitative

384 adults in the general population residing in rural areas

Lack of knowledge on cancer was cited as a barrier to help-seeking and was also associated with a low level of education.

[31]

Emery et al., 2013

Australia

Various cancers

To identify the factors associated with help-seeking during the interval between the presentation of symptoms and help-seeking.

Mixed-methods

66 adult cancer patients residing in rural areas

Factors associated with the delayed interval between becoming aware of cancer symptoms and seeking help were as follows: development of serious symptoms such as pain or dyspnea, geographic distance to medical institutions, optimism, stoicism, machismo, fear of undergoing medical tests, shame, and other role obligations.

[32]

Fort et al., 2011

Republic of Malawi (Africa)

Uterine cancer

To enhance the understanding of the barriers to help-seeking for uterine cancer screening.

Qualitative

20 women residing in rural areas

Participants’ knowledge on cancer screenings and symptoms was poor. Stigma against illness also influenced help-seeking. Additional barriers included a fatalistic view of cancer, securing time to undergo screenings and seek help, long waiting times at the hospital, and fear of whether they could afford the cost of screening. Facilitators of help-seeking included the appearance of symptoms, such as pain, and being able to receive support from neighbors, family members, and healthcare professionals.

[33]

Grunfeld et al., 2010

India (South Asia)

Breast cancer

To examine the beliefs about and help-seeking for breast cancer among urban- and rural-based Indian women.

Quantitative

Women in the general population (318 rural and 367 urban residents)

People residing in rural areas had poor knowledge of the symptoms of breast cancer and believed that cancer was a disease that always had a poor prognosis. They also tended to delay help-seeking even when they had become aware of the symptoms.

[34]

Schoenberg et al., 2010

USA

Uterine cancer

To identify the factors and circumstances surrounding a woman’s decision to seek follow-up treatment after receiving abnormal Papanicolaou test results.

Qualitative

27 women residing in Appalachia who had received abnormal Pap test results

Barriers to follow-up treatment including age < 18 or > 50 years; work, family, and other role obligations; the view that they could solve the problem on their own, lack of confidentiality owing to strong community ties, distrust of medical experts, not being accustomed to visiting the hospital because the family had never done so previously, fear, inability to pay treatment costs, lack of specialists, lack of community care, the time required to seek help or receive test results, dealing with different doctors during every visit, and insufficient means of transportation to reach the hospital with long waiting times.

[35]

Griffith et al., 2007

USA

Prostate cancer

To identify how the rural environment affects decision-making on treatment and screening

Qualitative

66 African-American men residing in rural areas

The participants cited the lack of medical services available to provide cancer treatment and the difficulty in obtaining information on treatment and screenings as barriers to help-seeking. Masculinity notions (e.g., a man would never seek treatment unless he felt pain and men should not seek medical help frequently) also influenced help-seeking. Participants also talked about feeling shame about having the disease (a disease of the male sex organ). They also discussed experiences, such as finding out that they had cancer after seeking help accompanied by another family member or having a family member who developed cancer and could not be saved, although they sought help at a hospital. These experiences suggest that social and family networks influenced help-seeking. Participants also did not see any benefits to undergoing cancer screening and receiving a diagnosis and said that being black and having a poor socioeconomic status affected help-seeking behavior.