S Magwaza¹*, G Van Hal¹ and M Hoque²

¹Social Epidemiology and Health Policy, University of Antwerp, Belgium

*Corresponding Author: S Magwaza, Social Epidemiology and Health Policy, University of Antwerp, Belgium.

Received: December 09, 2022; Published: January 19, 2023

Abstract

Aim: To conduct a narrative comparison of knowledge, attitudes, practices (KAP) and associated factors related to colorectal cancer (CRC) screening among health care workers (HCWs) working in South Africa (SA) and Brazil (BR).

Method: We conducted a KAP in South Africa in 2021 (noy yet published)and compared the results to a similar study conducted in Brazil which was identified through literature search of using multiple search engines and met the inclusion criteria (similar objectives, both used cross-sectional study designs, conducted the survey in public health settings, conducted in prior to implementation of CRC national screening programmes, conducted in country that is part of BRICS partnership, focused on KAP of health care workers, focused on CRC ,similar questions included in their data collection tools,). The comparative study was published in 2015. The South African (SA) study was conducted in 21 public health primary health care facilities in the city of Durban located in KwaZulu-Natal province (one of 9 provinces) in South Africa. Whereas the study from Brazil, randomly selected Health units (n = 1 600) across 26 states and the Federal District. There were 109 health care workers that responded to the survey in South Africa and a total of 1 251 that responded to the survey in Brazil. The study data was analysed using SPSS version 28 and SAS v.9.3 for South Africa and Brazil respectively. The narrative comparison used the STROBE checklist and captured data using Microsoft Excel to highlight the comparisons between the two studies.

Results: There were similarities in terms of study design, setting, target population, subject matter, question used for data collection and data analysis. Differences were observed in terms of year of data collection, the data collection methods, study sampling methods, study size and geographic coverage, study. In South Africa, self-administered survey was used while in Brazil, telephonic interviews were conducted. All participants in the facilities were invited to participate in the South African study, whereas, in Brazil, only those that were randomly selected were invited to participate. Random sampling used in BR compared to purposive sampling in SA, with the sample size much smaller than in Brazil. None of participants mentioned outreach CRC screening in SA, and only eleven of the participants reported to have ever conducted CRC screening. Whereas, in BR, four hundred (25%) units conducted outreach CRC screening. Eighty-three (47%) of doctors and 244 (65%) of nurses reported not conducting CRC screening. The South African study setting only included one city (11% coverage), whereas the Brazilian study was conducted in all states and Federation districts (100% coverage).

The results reported from both studies showed that there were differences in knowledge, attitudes and practices of medical doctors and nurses in both countries. The South African study showed that HCWs were less knowledgeable about CRC screening, types of screening tests, and had perceived these tests as less effective than the HCWs in the Brazilian study. The results of both studies had shown statistically significant associations between perceived influence of guidelines and outreach screening services provision. There was also a significant association between perceived influence of guidelines and the screening tests. The CRC screening practice, in SA study, was associated with previous training; working at least 40 hour a week, familiarity with different types of screening tests and perceived influence of NCCF and test to be effective. Whereas, in the Brazilian study screening was associated with gender, age, number of patients seen, clinical experience, start age of routine screening, familiarity of and perceived effectiveness of CRC screening tests. CRC screening in SA study only had significant association with a 40 hour working week, while in the BR study CRC screening has significant association with younger age, more than 5 years clinical experience, working 40 hours per week, solid familiarity with gFBOT and perception of gFBOT as very effective.

Conclusion: The narrative comparison review of the two studies from both countries highlights poor knowledge, attitudes and practices related to CRC screening. This is the first study to compare the KAP study results among HCWs from the two developing countries. It also highlights the importance of raising awareness of CRC burden, policy development, training and health systems preparedness is critical to enable access, uptake and shift health care worker attitudes and practice towards CRC screening.

Keywords: Colorectal Cancer; Cancer Screening; South Africa; Knowledge; Attitude; Practices; Brazil

References

1. Bray F., et al. “Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries”. CA: A Cancer Journal for Clinicians 68 (2018): 394-424.
2. Dekker E., et al. “Colorectal cancer”. The Lancet10207 (2019): 1467-1480.
3. Sung H., et al. “Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries”. CA: A Cancer Journal for Clinicians3 (2021): 209-249.
4. Globocan Report Colorectal Cancer Country Sheet South Africa. WHO, Geneva, (2020).
5. Awedew AF., et al. “Burden and trend of colorectal cancer in 54 countries of Africa 2010-2019: a systematic examination for Global Burden of Disease”. BMC Gastroenterology 22 (2022): 204.
6. Moura AR., et al. “Trends in the incidence and mortality of colorectal cancer in a brazilian city”. BMC Research Notes 13 (2020): 560 (2020).
7. Graham A., et al. “Estimating the incidence of colorectal cancer in Sub-Saharan Africa: A systematic analysis”. Journal of Global Health2 (2012): 020404.
8. Estimativa/2020. Incidência de Câncer no Brasil. Rio de Janeiro: Ministério da Saúde (2019): 120.
9. Guimarães DP., et al. “The Performance of Colorectal Cancer Screening in Brazil: The First Two Years of the Implementation Program in Barretos Cancer Hospital”. Cancer Prevention Research (Phila)2 (2021): 241-252.
10. Ladabaum U., et al. “Strategies for Colorectal Cancer Screening”. Gastroenterology2 (2020): 418-432.
11. Lambert R., et al. “Mass screening for colorectal cancer is not justified in most developing countries”. International Journal of Cancer2 (2009): 253-256.
12. Department of Health. The National Cancer Control Framework (NCCF) 2017-2022. Pretoria, South Africa.
13. Cuschieri S. “The STROBE guidelines”. Saudi Journal of Anaesthesia 13 (2019): S31-S34.
14. Magwaza S., et al. “National Cancer Control Plans: Comparative Analysis between South Africa and Brazil Focusing on Colorectal Cancer Control”. Journal of Gastrointestinal and Digestive System 10 (2020): 627.
15. Magwaza S., et al. “Comparison of Colorectal Cancer Burden: Opportunity for Sharing Lessons and Expand Partnership in Health Care in Two BRICS Countries”. Journal of Gastrointestinal and Digestive System 626 (2020): 2.
16. Magwaza S., et al. “Health Care Worker knowledge, attitudes, and practices related to colorectal cancer control in South Africa (Grey literature)”.
17. Perin D M., et al. “Providers' knowledge, attitudes, and practices related to colorectal cancer control in Brazil”. Preventive Medicine 81 (2015): 373-379.
18. Florindo AA., et al. “Physical activity counselling in primary health care in Brazil: a national study on prevalence and associated factors”. BMC Public Health1 (2013): 1-10.
19. Stormo AR., et al. “Cervical cancer-related knowledge, attitudes, and practices of health professionals working in Brazil’s network of primary care units”. Oncologist 2013-0318 (2014).
20. SAS Institute Inc. SAS/IML® 14.1 User’s Guide. Cary NSII (2021).
21. Ooi CY., et al. “Knowledge and practice of colorectal cancer screening in an urban setting: cross-sectional survey of primary care physicians in government clinics in Malaysia”. Singapore Medical Journal11 (2019): 596-604.
22. Schreuders EH., et al. “Colorectal cancer screening: a global overview of existing programmes”. Gut 10 (2015): 1637-1649.
23. Taş F., et al. “The effect of knowledge and health beliefs about colorectal cancer on screening behaviour”. Journal of Clinical Nursing 23-24 (2019): 4471-4477.
24. Tfaily MA., et al. “Awareness of Colorectal Cancer and Attitudes Towards Its Screening Guidelines in Lebanon”. Annals of Global Health1 (2019): 75.
25. Castiglione G., et al. “Screening for colorectal cancer by fecal occult blood test: comparison of immunochemical tests”. Journal of Medical Screening 7 (2000): 35-37.
26. Bouter C., et al. “The 'ins and outs' of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit”. South African Medical Journal 12 (2020): 1186-1190.
27. Huang RL., et al. “Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: a cross-sectional study”. BMJ Open7 (2021): e045168.
28. Mosli M., et al. “Knowledge, attitude, and practices of primary health care physicians toward colorectal cancer screening”. Saudi Journal of Gastroenterology 23 (2017): 330.
29. Mahmoud M., et al. “Knowledge, Attitude and Practice of Physicians Regarding Screening of Colorectal Cancer in Qatar: A Cross-Sectional Survey”. Advances in Medical Education and Practice 11 (2020): 843-850.
30. Al-Thafar A K., et al. “Knowledge Attitude and Practice of Colorectal Cancer among School Teachers in Al-Ahsa Saudi Arabia”. Asian Pacific Journal of Cancer Prevention: APJCP10 (2017): 2771-2774.
31. Al Mutawah MR., et al. “Knowledge, Attitude, and Practice toward Colorectal Cancer Screening among Primary Health-care Physicians in Alhasa Area, 2018”. International Journal of Scientific Study8 (2018).
32. Soylar, P., et al. “Knowledge, attitude, and practice regarding cancer screening tests among health workers in a university hospital in Turkey”. Journal of Cancer Education (2019): 1-6.
33. National Cancer Institute. Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access. A Report from the President s Cancer Panel to the President of the United States. Bethesda (MD): President s Cancer Panel; February 2022, USA (2022).
34. Thomson SR and Katsidzira L. “Quality in colonoscopy”. In: Cassimjee I, ed. Proceedings of the 27th Wits Biennial Surgical Symposium: Improving Surgical Care in 2020 and Beyond. Johannesburg: Wits, (2020): 143-149.
35. Ntombela XH., et al. “Is the clinicopathological pattern of colorectal carcinoma similar in the state and private healthcare systems of South Africa? Analysis of a Durban colorectal cancer database”. Tropical Doctor 4 (2017): 360-364.
36. Kaminski MF., et al. “Optimizing the Quality of Colorectal Cancer Screening Worldwide”. Gastroenterology2 (2020): 404-417.
37. Levin TR., et al. “Effects of organized colorectal cancer screening on cancer incidence and mortality in a large community-based population”. Gastroenterology 155 (2018): 1383-1391.e5.
38. Bruwer Z., et al. “A mobile colonoscopic unit for lynch syndrome: trends in surveillance uptake and patient experiences of screening in a developing country”. Journal of Genetic Counseling (2013): 125-137.
39. Navarro M., et al. “Colorectal cancer population screening programmes worldwide in 2016: an update”. World Journal of Gastroenterology 23 (2017): 3632-3642.

Citation

Citation: S Magwaza., et al. “Narrative Comparison Analysis of Colorectal Cancer Knowledge, Attitudes, and Practices of Health Care Workers in South Africa and Brazil". Acta Scientific Gastrointestinal Disorders 6.2 (2023): 03-15.

Copyright

Copyright: © 2022 S Magwaza., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.