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 |
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[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 |
[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. |