Effectiveness of Community Based Health Education Intervention on Prostate Cancer Knowledge, Self-Vulnerability, Fatalism and Screening in Kiambu County, Kenya

Abstract

Globally, prostate cancer is the second most frequently diagnosed cancer and fifth leading cause of death among men. Disparities exist regarding the mortality rates of prostate cancer with majority occurring among African men and the highest mortality rates occuring in Asia and African continents, which is attributed to high case fatality rates. The main aim of the study was to assess the effectiveness of Community Based Health Education on prostate cancer knowledge and awareness, self-vulnerability, fatalism and screening among men aged 40-69 years in Kiambu County. This quasi-experimental study adopted an explanatory sequential mixed-method approach. The intervention site was Gatundu North sub-county while the control was the Kiambu sub-county. Participants in the intervention arm received health education delivered by a Community Health Volunteer in their households. Baseline and post-intervention (after six months) assessments were carried out among 288 men aged 40-69 years in each arm. Stratified random sampling was applied. Quantitative data were collected using an interviewer-administered structured questionnaire. Qualitative data was collected using Focus Group Discussion and Key Informant Interview guides. Quantitative data were analyzed using SPSS version 22. Chi-square, Fisher’s exact, and multivariate logistics regression were used to assess for the association between variables. Inductive content analysis was applied for the qualitative data. The proportion of respondents screened for prostate cancer increased significantly from 4.5% to 20.4% (Χ2=32.809, df=1 P=<0.05) in the intervention arm while in the control arm there was no significant change (Χ2=0.133, df=1 P=0.716). Socio-demographic factors (age, marital status and religion) were not significantly associated with screening (P>0.05). Socio-economic factors (land acreage) were associated with screening. Participants owning 1-3 acres of land were 16 times more likely to take up screening (OR=15.672 CI (1.256- 195.478) P= 0.033). The facilitators to screening included the experience of symptoms, the proximity of cancer, accessibility of services and advocacy. Barriers to screening included lack of knowledge, fatalistic beliefs, low perception of self-vulnerability, stigma and male dominance. Awareness of prostate cancer significantly increased from 83.3% to 99.3% (X2=36.607, df=1 P<0.001) in the intervention arm while in the control arm where there was no significant change. Knowledge significantly increased in the intervention arm post-intervention while there was no significant difference in the control arm. Perception of self-vulnerability significantly increased in the intervention arm while in the control arm there was no significant change. Fatalism significantly decreased in the intervention arm while there was no decrease in the control arm. In conclusion, Community Based Health Education was effective in increasing knowledge and awareness, perception of self-vulnerability and screening and decreasing fatalism. Community Based Health Education is an effective strategy for the enhancement of uptake of prostate cancer screening. There is a need to consider the utilization of Community Based Health Education delivered by Community Health Volunteers to enhance uptake of prostate cancer screening.