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11/10/16 - "Assessing the Needs of a Breast Cancer Screening Program in Lagos, Nigeria" by Bilikisu Elewonibi

Assessing the Needs of a Breast Cancer Screening Program in Lagos, Nigeria

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Bilikisu Elewonibi is a graduate student in the Health Policy and Administration and Demography Program.  She received an ARC research grant in Fall 2014 for her project entitled "Evaluation of a Breast Cancer Screening Program in Nigeria".

Late stage diagnosis has been cited as the biggest cause of breast cancer mortality in Nigeria. Low levels of breast cancer awareness among Nigerian women decrease the likelihood they undergo screening; therefore, cancer is often diagnosed at late stages. No established national screening program currently exists for breast cancer in Nigeria. The Optimal Cancer Care Foundation (OCCF) was founded to address the issue of low breast cancer screening and awareness in Lagos, Nigeria.  OCCF provides subsidized screening without long waiting periods or crowds associated with public hospitals. OCCF also conducts weekly seminars on risk factors, signs and symptoms associated with breast cancer. Ongoing assessment of program implementation and effectiveness is necessary for OCCF to provide the maximum benefit.

Bilikisu Reni Elewonibi, a PhD Candidate in Health Policy and Administration and Demography at Penn State University, conducted an evaluability assessment of the breast cancer screening program and a mixed methods study examining perceptions toward breast cancer in Nigeria. The study aimed to describe culturally relevant factors from patient interviews that may be influential and deserve consideration in the OCCF breast cancer screening program and perform an evaluability assessment in partnership with the OCCF to determine if the program is achieving its stated objectives and to adjust OCCF activities to improve outcomes.

The study took place in the screening facility of OCCF in Lagos, Nigeria in the summer of 2015. Program participants were given a survey to determine baseline breast cancer knowledge, at which time demographic data was also collected. After the program, women who agreed to participate in the study were interviewed to identify barriers that may hinder them from being screened or from understanding the seminars, issues and concerns about breast cancer in general, health agency, folk medicine and beliefs about breast cancer, breast cancer screening or breast cancer treatment.

The semi-structured patient interviews and surveys provided insight into social and cultural barriers that influence screening decisions. Religion was the most prominent influence and was shown to have positive and negative effects on breast cancer perceptions. Other major themes were related to family and traditional beliefs. The goal of this section of the study was to create an intervention that resonates with cultural and behavioral norms in the hopes of increasing breast cancer screening uptake.   

Program activity was observed to determine if the program was being implemented as intended as part of the evaluability assessment. The assessment also used staff and program participant interviews, program observation, and document review to develop a logic model for the program. Staff interviews revealed that an evidence based education and screening program model was not used to guide program implementation. There are also no benchmarks to measure outputs or outcomes and evaluation the success of the program. This study provided recommendations to the program organizers on areas for improvement, including steps to alter the program to reach its goals.