A step toward timely referral and early diagnosis of cancer: Implementation and impact on knowledge of a primary care-based training program in Botswana
<p><strong>Introduction:</strong> Health system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and medi...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Frontiers Media
2018
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| _version_ | 1826262703182708736 |
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| author | Tapela, N Peluso, M Kohler, R Setlhako, I Botebele, K Gabegwe, K Nkele, I Narasimhamurthy, M Mmalane, M Grover, S Barak, T Shulman, L Lockman, S Dryden-Peterson, S |
| author_facet | Tapela, N Peluso, M Kohler, R Setlhako, I Botebele, K Gabegwe, K Nkele, I Narasimhamurthy, M Mmalane, M Grover, S Barak, T Shulman, L Lockman, S Dryden-Peterson, S |
| author_sort | Tapela, N |
| collection | OXFORD |
| description | <p><strong>Introduction:</strong> Health system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and median time from first health facility visit for cancer-related symptoms to specialty cancer care was 160 days (IQR 59–653). We describe the implementation and early outcomes of training targeting primary care providers, which is a part of a multi-component implementation study in Kweneng-East district aiming to enhance timely diagnosis of cancers.</p> <p><strong>Methods:</strong> Health-care providers from all public facilities within the district were invited to participate in an 8-h intensive short-course program developed by a multidisciplinary team and adapted to the Botswana health system context. Participants’ performance was assessed using a 25-multiple choice question tool, with pre- and post-assessments paired by anonymous identifier. Statistical analysis with Wilcoxon signed-rank test to compare performance at the two time points across eight sub-domains (pathophysiology, epidemiology, social context, symptoms, evaluation, treatment, documentation, follow-up). Linear regression and negative binomial modeling were used to determine change in performance. Participants’ satisfaction with the program was measured on a separate survey using a 5-point Likert scale.</p> <p><strong>Results:</strong> 176 participants attended the training over 5 days in April 2016. Pooled linear regression controlling for test version showed an overall performance increase of 16.8% after participation (95% CI 15.2–18.4). Statistically significant improvement was observed for seven out of eight subdomains on test A and all eight subdomains on test B. Overall, 71 (40.3%) trainees achieved a score greater than 70% on the pretest, and 161 (91.5%) did so on the posttest. Participants reported a high degree of satisfaction with the training program’s content and its relevance to their daily work.</p> <p><strong>Conclusion:</strong> We describe a successfully implemented primary health care provider-focused training component of an innovative intervention aiming to reduce health systems delays in cancer diagnosis in sub-Saharan Africa. The training achieved district-wide participation, and improvement in the knowledge of primary health-care providers in this setting.</p> |
| first_indexed | 2024-03-06T19:40:16Z |
| format | Journal article |
| id | oxford-uuid:206db0da-afd2-4443-9939-9d2a63b2df72 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T19:40:16Z |
| publishDate | 2018 |
| publisher | Frontiers Media |
| record_format | dspace |
| spelling | oxford-uuid:206db0da-afd2-4443-9939-9d2a63b2df722022-03-26T11:27:35ZA step toward timely referral and early diagnosis of cancer: Implementation and impact on knowledge of a primary care-based training program in BotswanaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:206db0da-afd2-4443-9939-9d2a63b2df72EnglishSymplectic Elements at OxfordFrontiers Media2018Tapela, NPeluso, MKohler, RSetlhako, IBotebele, KGabegwe, KNkele, INarasimhamurthy, MMmalane, MGrover, SBarak, TShulman, LLockman, SDryden-Peterson, S<p><strong>Introduction:</strong> Health system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and median time from first health facility visit for cancer-related symptoms to specialty cancer care was 160 days (IQR 59–653). We describe the implementation and early outcomes of training targeting primary care providers, which is a part of a multi-component implementation study in Kweneng-East district aiming to enhance timely diagnosis of cancers.</p> <p><strong>Methods:</strong> Health-care providers from all public facilities within the district were invited to participate in an 8-h intensive short-course program developed by a multidisciplinary team and adapted to the Botswana health system context. Participants’ performance was assessed using a 25-multiple choice question tool, with pre- and post-assessments paired by anonymous identifier. Statistical analysis with Wilcoxon signed-rank test to compare performance at the two time points across eight sub-domains (pathophysiology, epidemiology, social context, symptoms, evaluation, treatment, documentation, follow-up). Linear regression and negative binomial modeling were used to determine change in performance. Participants’ satisfaction with the program was measured on a separate survey using a 5-point Likert scale.</p> <p><strong>Results:</strong> 176 participants attended the training over 5 days in April 2016. Pooled linear regression controlling for test version showed an overall performance increase of 16.8% after participation (95% CI 15.2–18.4). Statistically significant improvement was observed for seven out of eight subdomains on test A and all eight subdomains on test B. Overall, 71 (40.3%) trainees achieved a score greater than 70% on the pretest, and 161 (91.5%) did so on the posttest. Participants reported a high degree of satisfaction with the training program’s content and its relevance to their daily work.</p> <p><strong>Conclusion:</strong> We describe a successfully implemented primary health care provider-focused training component of an innovative intervention aiming to reduce health systems delays in cancer diagnosis in sub-Saharan Africa. The training achieved district-wide participation, and improvement in the knowledge of primary health-care providers in this setting.</p> |
| spellingShingle | Tapela, N Peluso, M Kohler, R Setlhako, I Botebele, K Gabegwe, K Nkele, I Narasimhamurthy, M Mmalane, M Grover, S Barak, T Shulman, L Lockman, S Dryden-Peterson, S A step toward timely referral and early diagnosis of cancer: Implementation and impact on knowledge of a primary care-based training program in Botswana |
| title | A step toward timely referral and early diagnosis of cancer: Implementation and impact on knowledge of a primary care-based training program in Botswana |
| title_full | A step toward timely referral and early diagnosis of cancer: Implementation and impact on knowledge of a primary care-based training program in Botswana |
| title_fullStr | A step toward timely referral and early diagnosis of cancer: Implementation and impact on knowledge of a primary care-based training program in Botswana |
| title_full_unstemmed | A step toward timely referral and early diagnosis of cancer: Implementation and impact on knowledge of a primary care-based training program in Botswana |
| title_short | A step toward timely referral and early diagnosis of cancer: Implementation and impact on knowledge of a primary care-based training program in Botswana |
| title_sort | step toward timely referral and early diagnosis of cancer implementation and impact on knowledge of a primary care based training program in botswana |
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