Exploring grassroots feedback about cancer challenges in South Africa: a discussion of themes derived from content thematic analysis of 316 photo-narratives

Introduction: Cancer is an important health problem in Africa with projections that incidence could double by 2030. While sparse, the literature on cancer control in African low- and middle-income countries suggests poor cancer planning, overburdened services and poor outcomes. South Africa has established oncology health care services but also has low cancer awareness, poor cancer surveillance and widespread service challenges.Methods: Data for this study was derived from 316 photovoice interviews with cancer patients, families of cancer patients and oncology workers across South Africa. The objectives of the study were to collect first-hand feedback about cancer challenges and to develop recommendations for the improvement of cancer control strategies.Results: 9 themes of cancer challenges were distinguished via thematic content analysis of the photo-narratives. The identified themes of cancer challenges were physical and treatment challenges, emotional, poor services, transport, finances, information, powerlessness, stigma, and schooling challenges.Conclusion: The findings of this study offer the patient and family perspective of cancer challenges as a valid contribution to our body of cancer knowledge. The 9 themes of cancer challenges profile the emotional, physical and social impact of cancer on patients and families, and offer detailed subjective information about problem occurrence in the trajectory of care. Recommendations following from the 9 themes of cancer challenges include training for improved patientcentred care standards, the need for cancer surveillance, innovative and locally appropriate cancer awareness campaigns, private and government health care partnerships and the development of psychosocial services. The advocating of findings and recommendations to influence cancer control strategies in South Africa, is indicated.Keywords: South Africa, cancer challenges, patient-centred care, advocacy, stigm

Evidence-based feedback about emotional cancer challenges experienced in South Africa: A qualitative analysis of 316 photovoice interviews

This study aims to offer evidence-based feedback about the emotional challenges of cancer in South Africa. The action research photovoice methodology was used to capture accounts of cancer-related challenges via 316 face-to-face interviews with cancer patients and family members (n = 286), and oncology support and medical staff (n = 30). The photovoice contributions constituted qualitative data that were analysed according to inductive thematic analysis whereby nine themes of cancer challenges were identified and photovoice images were descriptively summarised from a phenomenological perspective. The emotional challenges theme was the most commonly reported of these themes, and is the focus of this paper. The findings of this study highlighted widespread emotional distress, anxiety, loss, poverty, physical challenges, traumatic impact of a cancer diagnosis, cancer stigma and low patient empowerment in the medical setting. Four main causes of patient emotional isolation in advanced stages of cancer are also identified, and this extends current understanding and offers new direction for clinical management. Recommendations from these findings include the need for the development and inclusion of psychosocial oncology services, best-practice standards of care, distress screening, patient empowerment and the prioritising of training and support for oncology staff in the South African health-care setting