Measuring factors influencing time to presentation is important in developing and evaluating interventions to promote timely cancer diagnosis, yet there is a lack of validated, culturally relevant measurement tools. To address this we developed the African Women Awareness of CANcer (AWACAN) breast and cervical cancer tool for use in Sub-Saharan Africa.
Tool development steps included: 1) Item generation 2) Item refinement 3) Assessment of test-retest reliability, construct validity and internal reliability 4) Local language translation. Intra-class correlation (ICC) indicated good rest-retest reliability. The tool had good construct validity and high internal reliability.
Women’s (n=1,758) breast and cervical cancer awareness, health-seeking behavior and barriers to care were measured using the AWACAN tools in cross-sectional community-based surveys conducted in SA and Uganda.
In-depth interviews with 26 women from Uganda with symptoms suggestive of breast and cervical cancer indicated that changes were interpreted based on previous life experience; information from healthcare professionals and media and; on views of husbands, trusted relatives and friends. Changes were frequently normalized and few thought their symptoms could be cancer-related.
Interventions in the UK to promote timely presentation with possible cancer symptoms have resulted in increased rates of presentation and cancer diagnosis, although to date less evidence of earlier stage diagnosis. Approaches will be reviewed for potential application in LMIC settings.