Effectiveness of communication in promoting utilisation of breast cancer screening services among women working in Anganwadi centres

Abstract

ABSTRACT Background: Breast cancer is the most common cancer among females, worldwide. Cancer screening in developing countries is mainly opportunistic type, characterized by low coverage and over-screening of women with increased access to health care services. This study was thus designed to understand the various factors preventing the participation and utilization of breast cancer screening, thereby study the different approaches for encouraging their participation and also the effectiveness of different ways of communication to Anganwadi Workers (AWW) and Anganwadi Helpers (AWH) in increasing breast cancer screening uptake at cancer screening camps. Settings and Design: It was a mixed-method study design among Anganwadi workers and helpers. Methods and Material: The study included 376 Anganwadi workers working in Kolar and Bangarpete Talukas. The trained Anganwadi supervisor followed by the respective PHC medical officer (in the intervention group) invited the AWW and AWH for breast cancer screening and only through Anganwadi supervisor (in control group). Those women (AWW and AWH) who did not attend the breast cancer screening camp were listed and contacted through mobile phone to find out the reasons for the same. Statistical Analysis Used: The data were analysed using SPSS statistics version 22; Chi-square and logistic regression were used to test significance. Results: There were 186 subjects in the intervention and 190 subjects in the control group. The mean (SD) age in intervention and control groups was 43.7 (8.5) and 44.2 (8.7) years, respectively. Amongst the 376 women (AWW and AWH) invited for the breast cancer screening service from both the groups, a total of 238 (63.2%) of them attended screening camp. The screening uptake was more in the intervention group (73.4%) compared with the control group (53.6%). This difference across the two groups (20%) was found to be statistically significant. The sub-category ‘anxiety’ (31.9%) was reported to be the highest barrier and least was in the sub-category ‘no replacement’ (4.3%). The sub-categories are also supported by verbatim quotes. Conclusions: The uptake of screening was more in the intervention group (73.4%) compared with the control group (53.6%). This difference of 20% was found to be statistically significant on univariate analysis (P < 0.001). After adjusting for confounders, it was found that both the approaches were equally effective.