Examining Womens Perception of Cervical Cancer Screening in Uganda - Outline Example

Running Head: CERVICAL CANCER SCREENING IN UGANDA Examining Women’s Perception of Cervical Cancer Screening in Uganda Examining Women’s Perception of Cervical Cancer Screening in Uganda Problem Statement As of today, cervical cancer is the second most common malignancy affecting women worldwide (WHO/ICO, 2010). It has estimated to kill some 7.6 million women a year (WHO, 2011). Though substantial declines in cervical cancer mortality has occurred in some developed countries such as Western Europe, U.S. and Canada, the rate is very different for developing nations (Levi et al, 2000). In some parts of Asia, Africa, and Latin America, for example, it is the leading cancer among women (Murray, & Lopez, 1996). The researcher pondered if the answer lie in the availability of preventative screening programs? However, the researcher discovered that cervical cancer screening has been available in virtually all countries as part of primary care and family planning programs. Uganda was one country that introduced preventative health screening long ago. Nevertheless, after several years, cervical cancer remains the leading cause of death due to cancer among women 15 years of age and older and the mortality rate for this disease has been increasing (WHO/ICO, 2010). Robles (2000) suggested that an explanation for the problem lie in the concept of prevention; and for many women this concept may not be fully understood. Purpose of the Study It became apparent and alarming to the researcher that the prevalence of cervical cancer in Uganda was high (WHO/ICO, 2010). As a human service professional, the researcher began to inquire about the nature of the problem in an attempt to understand the reasons why women who had accessible healthcare failed to obtain these life saving screening tests. The research studies had not looked at the issue of womens reasoning for not seeking cervical cancer screening with a qualitative eye. The purpose of this study is to provide a qualitative approach to the investigation of cervical cancer in Uganda. The phenomenological approach design will discover a Ugandan womans perspective on health and a disease that is unique to her. Cervical cancer can affect her sexuality, gender identity, fertility, and mortality. Discovering the cultural influences that motivate or deter her from seeking screening will add to the existing work already done and those yet to materialise. The ultimate goal is to broaden the possibilities of discovering methods to eradicate this disease. Research Questions The main research question is, would using a qualitative study specifically employing ethnographic techniques discover the reasons why Uganda women fail to seek cervical cancer screening? The objectives of this study are: What are the health beliefs of impoverished Ugandan women? (2) Identify if a relationship exists between cultural role expectations, sexuality issues and health seeking behaviour? (3) Does gender identity have a role in health seeking behaviour? and, (4) Are the choices of health systems a factor in health seeking behaviour? Methodology This study will employ Ethnographic research design to discover the reasons why Uganda women fail to seek cervical cancer screening? Ethnography is one of the oldest forms of qualitative social research. This rich design and methodology is most appropriate for discovering and observing cultures. The aim of this discipline of study has been to identify rules, rituals and beliefs within a given population (Morse, 1992). Ethnography is the research method that befits several areas of study. The first is in the exploration of social occurrences. Second is, in the ability to acquire unstructured data. Third, its design is conducive for research of small number of cases. Finally and most importantly it furnishes a method of studying interpretations of meanings of human behaviour (Hammersley & Atinkson, 1995). Modern ethnographic studies are developing a new ethic and the emergence of ethnography in healthcare is among them. Ethnography within the healthcare arena is valuable for a number of reasons. The cultural perceptions of the people affected by illness, their treatments, and who provide the care are such examples. The value of utilising an ethnographic approach with cervical cancer screening is in its unique ability to discover the cultural influences that act as barriers for Ugandan women seeking this preventative cervical cancer screening tool. Ethnography helps to elucidate womens reactions to cervical cancer screening. This information can then suggest methods of increasing participation, of improving the quality of the service, and of most importance, reducing womens anxiety. Research studies conducted by the nursing profession, specifically transcultural nursing, has taken the lead in utilising ethnography for the discovery of cultural influences. Leininger, as well as many who have employed her sunrise model of transcultural nursing (Leininger, 1991), have demonstrated that culture is a powerful human variable in determining a persons understanding of health and illness. Helman, however, best describes the need for continued research methodology and philosophy that focuses on an individuals perception. He writes, "Culture is a lens through which people view the world" (Helman, 1994, p. 26). If this perception is ignored, such as, ignoring a Ugandan womans belief regarding cervical cancer screening and she decides not to have the screening, the outcome may have detrimental results for her. To "attempt to understand this world as care givers and health promoters, our efforts to convince, change or console others will be ineffective, even harmful" (Brummelhuis & Herdt, 1995, p. 9) Methods Methods that will be used in this ethnographic study to gather data would be participant observation and interviewing. These methods will provide the researcher with the opportunity to observe, listen to, and learn from the member of the subculture why Ugandan women fail to seek cervical cancer screening. The participants in this study would be selected by using purposive sampling technique. Ethical Consideration Approval to conduct the study will be obtained from The Committee for the Protection of Human Subjects. Participants would receive information about the study and those willing to participate in this study would sign the consent form. Participants in the study will be informed that their willingness to participate in the study is voluntary and that they can decide to withdraw from the study at any time and for any reason without penalty. Participants will be informed that there is no known risk or direct benefits associated with their participation in the study. Participants will sign a written consent form acknowledging their understanding of the role of a participant and their willingness to voluntarily participate in the research study. The participants will also receive a copy of the consent form. Throughout the research process, strict adherence to confidentiality will be maintained. This project and related presentations will contain direct quotes from the participants interviews without identifying the participant’s identity. The audio-taped interviews will be transcribed by the researcher. Audio-tapes and transcripts will be stored for three years after completion of the study. For the purpose of an audit, a copy of each transcript and audio-tape will be kept in a locked box in a secure location at the researchers home accessible only to the researcher for a period of three years, at which time the contents will be destroyed. Participants will be informed that a copy of the completed thesis will be available for review. Reliability and Validity Reliability and validity are the two most contentious criteria for evaluating qualitative research since they are more suitable to a quantitative approach (Beck, 1993). Presently, trustworthiness is considered the "gold standard" for the measurement of scientific worth. In most instances, rigor in qualitative research designs such as ethnography has been inappropriately judged using quantitative criteria (internal and external validity, reliability, and objectivity) that privileges narrowness, conciseness, and objectivity (Bums & Grove, 1997). Instead, trustworthiness in qualitative research methods including ethnography should be based on "openness, scrupulous adherence to a philosophical perspective, thoroughness in collecting data, and consideration of all the data in the subjective theory development phase" (Bums & Grove, 1997 p.70). It should also be based on how the researchers conclusions logically match up with the data collected and whether the data furthers understanding of the phenomena under study. Establishing trustworthiness in ethnographic research requires the researcher to identify ways to ensure the reader can see clear links between data and conclusions. This is accomplished through evaluation for credibility, transferability, dependability and confirmability. Credibility refers to direct sources of evidence or information from the participants within their environmental contexts of their "truths" held firmly as believable to them (Lincoln & Guba, 1985). Through prolonged engagement, the researcher gives us the data rich with detail. In addition, the persistent observation in ethnography both as participant and observer has reinforced the findings as described. To be able to identify the issues, the thoughts behind such themes as self-worth, fear and trust, and to validate their meaning provides the thick description sought in ethnographic research. As each participant would be a willing participant in the study and have no personal gain by participating in the study, this provides the ground work for credibility. Whether the researcher or the reader identifies flaws to the information provided does not negate the validity that the participant believes exists in the information and therefore reinforces the credibility of the information. Confirmability refers to documented verbatim statements and direct observational evidence from informants, situations, and others who firmly and knowingly confirm the findings through audit trails. Feedback by participants as data sources and use of an auditor to review field notes for possible problems will provide sufficient data to support the themes. Participants, would be asked to review the notes and/or findings related to their interviews for confirmability. Review of the themes, ideas as it related to the findings, and discussion of the patterns and issues related to adherence will reinforce the confirmability. To further ensure trustworthiness of this study an argumentative validation approach would be employed. An expert in the field of qualitative research would critique the procedures and data collected in this study. An expert would review samples of the data collected and address the reliability and validity of the findings. Literature Review Plan The researcher would begin an extensive review of the literature on the Ugandan problem with cervical cancer in order to uncover what conclusions and recommendations the researchers have discovered. The following research articles have already been identified by researcher. Cost-effectiveness of cervical-cancer screening in five developing countries by Goldie et al. (2005) Survival of cervix cancer patients in Kampala, Uganda: 1995–1997 by Wabinga et al. (2003) References Beck. C. T. (1993). Qualitative Research: The evaluation of its credibility, fittingness and auditability. Western Journal of Nursing Research. 15(2), 263-266. Brummelhuis, H., & Herdt, G. (1995). Culture and sexual risk: anthropological perspectives on AIDS. Amsterdam: Gordon and Breach Publishers. Bums, N., & Grove, S. (1997). The practice of nursing research. Philadelphia: W.B. Saunders Company. Hammersley, M., & Atkinson, P. (1995). Ethnography: Principles in practice. London: Routledge. Helman, C. (1994). Culture, health and illness. Oxford, U.K.: Butterworth & Heinemann. Leininger, M. (1991). Cultural care diversity & universality: A theory of nursing. National League of Nursing: New York. Levi, F., Lucchini, F.,Negri, E., Franceschi, S., & la Vecchia (2000). Cervical cancer mortality in young women in Europe: Patterns and trends. European Journal of Cancer, 36 (17) ,2266-7l. Lincoln, Y. S. & Guba, E. G. (1985). Establishing trustworthiness, In Y.S. Lincoln & E G. Guba (Eds.) Naturalistic Inquiry (pp. 289-331). Newbury Park, London. Sage. Morse, J. (1992). Qualitative health research. Newbury Park, California: Sage. Robles, S. (2000). Pan American Health Organization, Pan American Sanitary Bureau, World Health Organization, 525 23rd Street, N.W. Washington, DC 20037-2895, USA. World Health Organization (2010). Human Papillomavirus and Related Cancers. Information Retrieved November 15, 2011 from http://apps.who.int/hpvcentre/statistics/dynamic/ico/country_pdf/UGA.pdf?CFID=4005139&CFTOKEN=50211239 World Health Organization (2011). Cancer Fact sheet N°297. Information Retrieved November 15, 2011 from http://www.who.int/mediacentre/factsheets/fs297/en/ Read More