Stakeholder Perspectives on Provider-Initiated Clinical Breast Examination and Patient Navigation in Ethiopian General Hospitals: Situational Analysis for Implementation Study

Abstract

PURPOSE: Delays in presentation, diagnosis, and treatment present common challenges in breast cancer care in Ethiopia. However, few interventions have been implemented aimed at addressing the issue in the country. To tackle this problem, we conducted a situational assessment to gather general information on the health care infrastructure and workforce and to explore the potential opportunities and challenges for implementing clinical breast examination (CBE) and patient navigation (PN) intervention in Ethiopia. METHODS: A qualitative study was conducted at six general hospitals. A total of 18 in-depth interviews and nine focus group discussions were conducted based on the Consolidated Framework for Implementation Research (CFIR) approach with regional health officials, medical directors, clinical staff, eligible women, and breast cancer survivors. The data were deductively coded and thematically analyzed. RESULTS: From the five major domains of the CFIR, 17 constructs were developed from the narration of the stakeholders. Several factors were identified as opportunities for implementation: the presence of national breast cancer guidelines, a supportive environment from regional and Ministry of Health, experience of working with the community, teamwork experience, and the existence of a community health extension program. The challenges mentioned included a lack of adequate diagnostic facilities, security issues, limited cancer-trained professionals, staff turnover, negative perceptions about cancer in the community, staff workload, and the need for training and logistics. CONCLUSION: The stakeholders recognized that implementing provider-initiated CBE and navigation is an acceptable and feasible initiative that can be performed in the study hospitals using the existing infrastructure and human resources. Collaboration, community engagement, continuous monitoring, and evaluation are vital for successful implementation.