Factors Associated with The Uptake of Screening Services for Early Detection of Cancer Among Clients Visiting Masinga Level Four Hospital Outpatient Department, Masinga Sub County, Machakos County, Kenya

Abstract

Cancer screening is known to reduce cancer morbidity and mortality, but this disease still remains to be one of the leading causes of cancer deaths in Kenya because of low screening uptake. This study, therefore, aimed at examining psychological, social and behavioral factors associated with the uptake of cancer screening services in Masinga sub-county, Machakos county, Kenya. Mixed method research design was used: case-control with systematic sampling method for quantitative data; and phenomenological approach with purposive sampling method for qualitative data. Quantitative data was collected using an interviewer-administered questionnaire and analyzed using SPSS version 26.0. Chi square/Fishers exact, Odds Ratios, T test and Mann-Whitney U tests were used to determine significance of the association between outcome and independent variables. Focus group discussions (FGDs) were used to collect qualitative data which was analyzed thematically. The data was presented using frequency polygons, tables and narratives. Confidence level was 95%. Data was gathered from a sample of 42 cases (screened [male- prostate, esophageal and colorectal; female- breast, cervical and esophageal]) and 116 controls (never been screened). Health belief model constructs, cognitive well-being, stress, autonomy and general self-efficacy were used as psychological variables. Social variables assessed were social network and social exclusion. Behavioral factors assessed encompassed knowledge on cancer screening (cues to action) and the effect they had on uptake of cancer screening, determinants of health seeking behaviors with regard to screening uptake, facilitators and barriers to screening and knowledge on preventive behaviors to cancer development. Qualitative data from nine FGDs were collected to enrich the quantitative data. Mantel-Haenszel test revealed that uptake of cancer screening is associated with cognitive well-being [OR .440 at 95% C.I .338- .572, p <0.001], autonomy [awareness of self (OR .172 at 95% C.I .049- .602, p .006 ), perceived choice (OR .119 at 95% C.I .048- .300, p <0.001)], general self-efficacy [OR .727 at 95% C.I .638- .828, p <0.001], increased perceived stress [OR .768 at 95% C.I .620- .951, p .016], perceived susceptibility (OR 2.758 at 95% C.I 1.155-6.585, p .022), perceived severity (OR 5.720 at 95% C.I 1.835-17.832, p .003), perceived benefits (OR 2.217 at 95% C.I 1.087-4.520, p .029). Also, for social factors, screening uptake was associated with decreased social exclusion [OR 1.785 at 95% C.I 1.390-2.291, p<0.001] and better social network [(Emotional loneliness OR 5.791 at 95% C.I 1.384-24.225, p .016) (Social loneliness OR .200 at 95% C.I .114- .351, p <0.001)]. This study established strong association between psychosocial factors and cancer screening uptake. Generally, there was poor knowledge on behaviors that contribute to cancer among the controls compared to cases. Based on the findings, special emphasis should be directed at increasing awareness, perception and dispelling the myths surrounding cancer and cancer screening at all community primary care points through well-designed health education programs.