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Culturally Embedded Strategies for Lung Cancer Awareness in Hard-to-reach Communities in the Eastern Cape: Insights from Field Observations
Abstract
Lung cancer is the leading cause of cancer death worldwide. The lack of knowledge and awareness about the signs and symptoms of lung cancer often results in late diagnosis in low- and middle-income countries (LMICs). Traditional beliefs, cultural practices, and social norms may influence health-seeking behaviours and contribute to misconceptions about lung cancer. This piece intimates the readers how culturally embedded communication strategies could promote lung cancer awareness in hard-to-reach communities in the Eastern Cape. We found that cultural barriers and challenges in raising awareness about lung cancer exist, highlighting the need for culturally appropriate communication approaches, emphasizing the importance of cultural sensitivity and community engagement. This engagement has implications for future interventions, providing valuable insights into best practices for addressing lung cancer awareness in similar contexts.
1. INTRODUCTION
Lung cancer is one the most distressful diseases linked with high incidence and mortality rates globally, with estimated projections of 29.5 million new cancer cases and 16.5 million cancer-related deaths by 2040 globally, as reported by the World Health Organisation (WHO) [1-4]. Lung cancer is the primary cause of cancer morbidity and mortality, which serves as a severe public health concern globally [1, 2, 4-6]. Lung cancer is the second most diagnosed cancer among women and men, after prostate cancer and breast cancer, in low- and middle-income countries such as Africa and South Africa [2, 3, 5]. Although lung cancer is a worldwide crisis, approximately 57% of new cases occur in low-income countries as compared to developed countries [1]. Men are known to be at the highest risk of contracting lung cancer, although women are also susceptible to lung cancer as well [1, 5].
There are various medical, cultural, spiritual, and traditional methods used to curb lung cancer worldwide [4-8]. However, a gap has been identified that cancer on its own has been given a low priority in the healthcare services and research fields [1]. Despite the dedicated efforts to cancer epidemiology, at times, the statistics for cancer in Africa are often dispersed across various registries, making it challenging to have an updated surveillance system [1].
Lung cancer is a significant public health concern globally, and its impact is particularly pronounced in hard-to-reach communities where access to healthcare services and information is limited [9]. In South Africa, more than 90% of lung cancer patients were presenting with cough as one of the symptoms when diagnosed [2]. In the Eastern Cape region of South Africa, specifically in the O.R. Tambo District, lung cancer poses a considerable burden on the population. These communities face unique challenges, including geographic remoteness, socio- economic disparities, and cultural barriers that hinder effective communication and awareness about lung cancer [7]. It was discovered that most lung cancer patients seek medical care late in the healthcare facilities, resulting in late diagnosis of patients, leading to ineffectiveness of treatment and poor treatment outcomes [2, 9]. Despite preventive measures and early detection strategies, community members' lack of understanding and knowledge often leads to late-stage diagnoses and poorer treatment outcomes [10].
The significance of addressing lung cancer awareness in hard-to-reach communities cannot be overstated. By focusing on the marginalized and underserved popu- lations, ensuring equitable access to information and resources related to lung cancer prevention, early detection, and treatment [11]. Additionally, these commu- nities may have unique cultural beliefs, practices, and perceptions surrounding health and illness, which must be considered to communicate and engage with community members effectively. We can enhance community trust, engagement, and participation by embedding culturally appropriate strategies into lung cancer awareness initiatives. Furthermore, understanding the specific challenges faced by hard-to-reach communities in the Eastern Cape, such as limited healthcare infrastructure and resources, can inform the development of tailored interventions that address the unique needs of these populations.
In this piece, we shed light on the possible strategies that could enhance lung cancer awareness and ultimately improve health outcomes in these communities.
1.1. Cultural Context of Lung Cancer in the Eastern Cape
The Eastern Cape, particularly its far-to-reach communities, is characterized by diverse cultural beliefs, practices, and perceptions related to lung cancer. Understanding these cultural dynamics is crucial for developing effective strategies to enhance lung cancer awareness [12]. Through field observations, this study aims to provide insights into the embedded cultural beliefs and practices that shape the community's understanding of lung cancer. It will explore factors such as traditional healing practices, the stigma surrounding cancer, and the influence of community leaders and trusted individuals in shaping perceptions of the disease. By gaining a comprehensive overview of these cultural aspects, this piece will lay the foundation for designing culturally embedded strategies to effectively raise awareness about lung cancer and promote early detection and prevention behaviors within these far-to-reach communities in the Eastern Cape, which is a diverse landscape influenced by deeply ingrained cultural beliefs and practices. Field observations highlight the existence of misconceptions, stigma, and fear surrounding lung cancer, which hinders efforts to disseminate accurate information and promote early detection behaviors [13].
Traditional healing practices, reliance on community leaders, and a lack of trust in modern healthcare systems further contribute to the challenge of addressing lung cancer awareness [14]. Moreover, the cultural norms of privacy and reluctance to openly discuss health issues pose additional barriers to engaging communities in conversations about lung cancer. Recognizing and understanding these cultural barriers is essential for developing embedded strategies that consider the local context, cultural values, and traditional practices to enhance lung cancer awareness and encourage timely healthcare-seeking behaviors in hard-to-reach commu- nities in the Eastern Cape.
Leveraging cultural strengths and assets in hard-to-reach communities in the Eastern Cape will enhance communication strategies on lung cancer awareness. In this piece, we emphasise the importance of community networks, traditional healers, and community leaders as influential figures who can play a pivotal role in dis- seminating health information. The rich cultural heritage, including storytelling, traditional ceremonies, and commu- nity gatherings, can be harnessed to create culturally relevant and engaging communication campaigns [15]. Embracing these cultural strengths and assets, healthcare providers and organizations can build trust, establish meaningful connections, and deliver critical messages about lung cancer prevention, early detection, and available healthcare services. Understanding and incor- porating cultural values, beliefs, and practices into communication strategies can enhance their effectiveness and increase community engagement in addressing lung cancer awareness in hard-to-reach communities in the Eastern Cape.
1.2. Culturally Embedded Strategies to Enhance Lung Cancer Awareness
Some social activities include but not limited to community engagement sessions, incorporating traditional storytelling, local music, and dance to captivate the audience and create a conducive environment for dialogue. These sessions allowed community members to share their experiences, perceptions, and concerns about lung cancer. Additionally, cultural events and festivals were utilized to disseminate information about lung cancer, incorporating educational materials in local languages and using visual aids that resonated with the community's cultural context. The involvement of respected community leaders, traditional healers, and regional healthcare workers played a crucial role in gaining community trust and ensuring the credibility of the information shared. These strategies helped to break down barriers, foster open conversations, and promote a deeper understanding of lung cancer among community members, ultimately contributing to increased awareness and improved healthcare-seeking behaviors.
The field observations provided valuable examples of culturally appropriate communication approaches and techniques that effectively enhanced lung cancer awareness in hard-to-reach communities in the Eastern Cape. One such approach was utilizing community health workers and health promoters trained to deliver culturally sensitive messages about the prevention and early detection of lung cancer. These community health workers were well-respected and trusted members of the community, allowing for meaningful interactions and disseminating information in a relatable manner. Addi- tionally, storytelling was a powerful tool to convey important messages, with local narratives and personal experiences shared to engage community members emotionally and connect to the topic. Using visual aids, such as culturally relevant images and illustrations, further enhanced understanding and retention of the information. Furthermore, considering local dialects and expressions, culturally specific language and terminology were utilized to ensure effective communication. By employing these culturally appropriate approaches and techniques, the study successfully fostered a deeper level of engagement and comprehension among community members, leading to increased awareness and informed decision-making regarding lung cancer.
This piece highlights the crucial role of community leaders and influencers in disseminating information and enhancing lung cancer awareness in hard-to-reach communities in the Eastern Cape. These influential individuals, including traditional leaders, religious leaders, and respected community members, served as trusted messengers and advocates for the cause. Their endor- sement and active participation in awareness campaigns and discussions played a significant role in mobilizing community members and garnering their attention. Their involvement also helped overcome resistance to change and facilitate open dialogue on a sensitive topic like lung cancer. Moreover, community leaders and influencers were instrumental in facilitating community engagement activities, such as town hall meetings, group discussions, and community-based events, where they actively encouraged participation and created a safe space for sharing experiences and concerns.
The note shed light on the significant engagement with traditional healers and other cultural intermediaries in enhancing lung cancer awareness in hard-to-reach communities in the Eastern Cape. As respected community members, traditional healers hold a prominent role in the local healthcare system and are entrusted with addressing health concerns, including cancer-related ones [16]. Recognizing their influence and expertise, the study emphasized the importance of establishing collaborative partnerships with traditional healers and involving them in awareness initiatives. Through dialogue and education, traditional healers were provided accurate and culturally sensitive information about lung cancer, its risk factors, symptoms, and available medical treatments. This engagement fostered mutual understanding and paved the way for other cultural intermediaries, such as community elders, cultural performers, and community health workers, to bridge the gap between modern healthcare systems, traditional beliefs, and practices [17]. Their involvement helped to overcome cultural resistance, dispel myths and misconceptions, and promote the acceptance of Western medical approaches in the context of lung cancer.
1.3. Insights and Impact of the Culturally Embedded Awareness Strategies
We observed increased awareness and knowledge about lung cancer, its risk factors, and available preventive measures through these strategies. Moreover, the cultural strategy fostered a sense of trust and credibility among community members, as the information was culturally appropriate and aligned with their beliefs, practices, and values. This led to improved acceptance of Western medical approaches and increased utilization of healthcare services for lung cancer screening and early detection. The outcomes of these cultural strategies highlight their potential for enhancing lung cancer awareness, reducing disparities, and ultimately improving health outcomes in hard-to-reach communities in the Eastern Cape. The observations emphasize the signi- ficance of incorporating cultural perspectives and leveraging existing community structures to implement health interventions successfully.
In this piece, through field observations, we explored the existing level of understanding, beliefs, and perceptions related to lung cancer among community members. The assessment revealed a significant lack of knowledge and awareness about the disease, its risk factors, and preventive measures. Cultural beliefs and practices, as well as limited access to health information, were identified as barriers to understanding and addressing lung cancer in these communities. The insights underscore the urgent need for targeted interventions to improve community knowledge and awareness about lung cancer in culturally appropriate ways. By addressing gaps in understanding and dispelling misconceptions, it is possible to empower individuals within these communities to make informed decisions regarding their lung health. The assessment is a crucial foundation for developing and implementing effective strategies to enhance lung cancer awareness and prevention in hard-to-reach communities in the Eastern Cape.
This paper provides valuable insights and identifies lessons learned for future interventions in similar contexts. Firstly, understanding and respecting local cultural beliefs, practices, and perceptions cannot be overstated. By tailoring communication strategies to align with cultural norms and values, interventions can effectively engage community members and bridge knowledge gaps [18]. Secondly, the involvement of community leaders and influencers proved instrumental in disseminating information and garnering community trust. Their role as trusted intermediaries can significantly impact the acceptance and uptake of health messages. Additionally, the engagement with traditional healers and other cultural intermediaries demonstrated the potential for collaboration and partnership to integrate traditional knowledge with modern healthcare practices. Lastly, the assessment highlighted the need for ongoing monitoring and evaluation to assess the effectiveness and outcomes of interventions, allowing for continuous improvement and adaptation.
| Domain | Practical Activity |
|---|---|
| Prioritize community engagement | Community involvement is crucial for the success of culturally embedded strategies. To ensure cultural relevance and acceptance, engage community leaders, influencers, and traditional healers in the planning and implementation of awareness campaigns. This will help build trust in the community by demonstrating respect for cultural traditions and values. Establish ongoing relationships and maintain open communication channels to foster collaboration and mutual understanding. |
| Tailored communication approaches | Develop communication materials and messages that align with the target communities' cultural beliefs, practices, and perceptions. Utilize local languages, symbols, and storytelling techniques to convey information about lung cancer and prevention measures effectively. |
| Collaboration with healthcare providers | Forge partnerships with local healthcare providers to integrate culturally embedded strategies into healthcare services. This collaboration can facilitate access to screening, diagnosis, and treatment options for individuals in hard-to-reach communities. |
| Train healthcare professionals | Provide training to healthcare professionals on cultural competency and sensitivity to enhance their ability to deliver culturally appropriate care. This will enable them to communicate effectively with patients and address their concerns and beliefs. |
| Share best practices | Share the insights and lessons from implementing culturally embedded strategies with other organizations and stakeholders in similar contexts. Promote collaboration and knowledge exchange to advance culturally responsive health promotion and disease prevention approaches. This will pave the way for frequent assessment of the effectiveness of the implemented strategy and make necessary adjustments based on community feedback and evolving needs. Monitor changes in knowledge, attitudes, and behaviors related to lung cancer to ensure the sustainability and impact of the interventions |
CONCLUSION
The piece reflects on identified cultural barriers and challenges in raising awareness about lung cancer, highlighting the need for culturally appropriate communication approaches. The engagement with community leaders, influencers, and traditional healers proved effective in disseminating information and bridging the gap between modern healthcare practices and traditional beliefs. Community knowledge and awareness assessment revealed the importance of targeted interventions to address specific knowledge gaps. The study contributes to the growing body of research on culturally tailored approaches. It is a foundation for developing effective strategies to improve health outcomes in underserved communities in the Eastern Cape and beyond.
Therefore, raising awareness of lung cancer risk factors and screening services in hard-to-reach communities, coupled with improved quality of healthcare services and access, are vital to advancing the possibilities of cure and survival. Further research can explore additional cultural strategies, evaluate long-term out- comes, and identify new approaches to effectively reach and engage these communities. Collaboration between researchers, healthcare providers, community leaders, and policymakers is crucial for sharing experiences, best practices, and resources. This collaborative effort can lead to developing comprehensive and tailored interventions that empower hard-to-reach communities with the knowledge and resources necessary to prevent, detect, and manage lung cancer effectively to reduce health disparities and improving lung cancer outcomes in these underserved populations.
Recommendations for implementing culturally embedded strategies (Table 1).
AUTHORS’ CONTRIBUTION
It is hereby acknowledged that all authors have accepted responsibility for the manuscript's content and consented to its submission. OO is the mentor to both K.N. at Walter Sisulu University and M.F.M at Sefako Makgatho Health Sciences University. They have meticulously reviewed the piece and unanimously approved the final version of the manuscript.
LIST OF ABBREVIATIONS
| WHO | = World Health Organisation |
| LMICs | = Low- and Middle-income Countries |
FUNDING
OO's research-protected time was partly supported by the Incentive Funding for Rated Researchers' Grant from the National Research Foundation (No:132385). The content and findings reported/illustrated are the sole deduction, view, and responsibility of the researcher and do not reflect the official position and sentiments of the funders.
