Background
Methods
Design
Study setting
Study participants
Conceptual framework
Data collection
Data analysis
Results
Characteristics | No. | |
---|---|---|
Age (Mean, range) | 37 (18–61) | |
Marital status | In a relationship | 6 |
Not in a relationship | 13 | |
Occupation | Unemployed | 10 |
Employed | 8 | |
No response | 1 | |
Education | 6 years or less | 3 |
7 to 9 years | 7 | |
10 years or more | 9 | |
Otomí speakers | Yes | 9 |
No | 10 | |
Health insurance | Yes | 9 |
No | 10 | |
Monthly family incomea | < 1 minimum salary | 14 |
1- < 3 minimum salaries | 2 | |
≥3 minimum salaries | 3 |
Perceived barriers to early BC diagnosis
Health policy barriers
“…When we had the program, well, that program worked in conjunction with the health center, so the nurses gave us health talks and workshops and taught us how to examine ourselves. Yes, in fact that program was very good, because they also taught us things like healthy eating, how to exercise…” (María 52 years old).
“Since the program disappeared… we no longer have the same attention and in fact, I feel proud of those years, when that program existed…because in those years I went with the doctors and they provided medical care, when they realized that the pain did not decrease, they gave me a referral to see a specialist, a gynecologist, and that’s where my myomas were diagnosed…” (Sandra, 41 years old).
“…Everything changed, now we feel like we’re lost, like we don’t even know where to go, with what doctor we can go. Before, when the program existed, there were members here in the community that organized people and would take them to health workshops and to get medical attention in health centers…” (Teresa, 47 years old).
Social and cultural context barriers
“…If the husbands find them touching their breasts...they question them “why are you doing that? you can’t do that, why are you touching yourself?” I feel like that is machismo… You cannot touch and explore your breasts without being sexualized…” (Cecilia, 28 years old).
“…Yes, oh yes, there are many men who do not let women go to the doctor, that kind of men predominate here. That’s because in our community there is machismo…” (Teresa, 47 years old).
“…So, the context has a lot of influence here, I feel that this community is very conservative, for example, I don’t talk about those things (breast topics) because it is frowned upon, and I know it could be misunderstood ...” (Margarita, 38 years old).
“...I feel that we always have time for everything, except for our health, for example I invited some women to a health talk and they did not go… I think we don’t take care of ourselves, we don’t go to the doctor, always the family first, always the children, always the house, always! What about us? We are always last…” (Verónica, 46 years old).
“… Sometimes we psychologically call disease, so we better not think about it, we better think that it is far away and is not going to touch us, so we don’t get sick…” (Nancy, 50 years old).
“…The people of my community, well, no, they don’t go to the doctor, well I think we all go to the doctor until we feel a lot of pain, as we said, when the problem is already very advanced. I had a neighbor who got sick with cancer, the cancer attacked several systems, organs and she died because nothing could be done, not even with chemo, she went to the doctor too late…”. (Cecilia, 28 years old).
“…Sometimes, we are embarrassed to say we have a disease, we don’t want our neighbors or other people to know. We think that they will judge us, that people will say “if she’s sick, it’s because she surely did something bad and God punished her”…That’s why people don’t say anything when they feel ill... About women with BC or with cervical cancer, many times people say: “she did something wrong, God punished her for that”... It’s better we don’t talk, it’s better we don’t say we’re sick...” (Margarita, 38 years old).
“…It is complicated because cancer “eats you from the inside”, to the point that the entire breast has to be amputated, they have to remove the breast. No, the word is not removal, it is amputation, they amputate the entire breast, which is sometimes hard and difficult to assimilate, imagine a woman without breasts…” (Nancy, 50 years old).
“…Now with the COVID pandemic it is more difficult going to the health center, people ask you “what are you going for?... you will get infected”. (Patricia, 48 years old).
“…So, they gave me the appointment a year and a half later, it took a year and a half for me to see the specialist. When I went a year and a half later, they told me “You need recent studies” and then they sent me to do a tomography a month later, then with the COVID pandemic and restrictions they have not given me the results of the tomography, and until know I’m still waiting to get attention…” (Cecilia, 28 years old).
Health services organization
“There are many times that I don’t know if it’s because of their profession or because they feel superior to us, they treat us badly. I mean, I have felt abuse, we all have experienced that, doctors even make fun of us…for example, when my children were born, they examined me, but it was a horrible examination, I mean they put their hands inside, they laughed…they even made fun of me. So I ask myself why? Why do they treat us like that?” (Margarita, 38 years old).
“I went for a consultation and they told me “come back in 8 days” so, the truth is, I was really upset because I really needed the service. But no, they told me to return in 8 days, so I wanted to report them for the bad attention, not just for me, but for the others because I have heard other people’s experiences. The truth is that it is unfair, they should work and serve with joy because they receive a salary” (Nancy, 50 years old).
“In the health center they don’t speak Otomí, if you speak in Otomí, they get angry, because they don’t understand…for example, there are elderly people who speak perfect Otomi, and they have to go with someone to translate, doctors say “Oh I didn’t understand you, a family member must come with you to translate”. They get angry” (Patricia, 48 years old).
“You have to go very early to get a voucher so that you can receive a consultation and you have to see if there are enough vouchers, because sometimes they just give a limited amount and if you don’t get one you have to go the next day and the next day to try to get one” (Sonia, 42 years old).
“…I had to go to the emergency room and that’s when they treated me. Then they told me “no, you have to go to your health center, and they have to give you a referral pass so that we can continue treating you”. So, I went back to my health center and they gave me the referral to the specialist a year and a half later…” (Cecilia, 28 years old).
“I wanted to go back to the hospital, make my appointment again, but many commented that now you have to pay, many are commenting that now you have to pay even for the medicine” (Alejandra, 42 years old).
“To get there we go in public transport, in a community taxi, for example to get to the Jiquipilco hospital, we have to go up the hill and from the hill we have to transfer to another community) (Nancy, 50 years old).
Interpersonal barriers
“And sometimes, as we said before, the opinion of the husbands, of the family, influences the women too much, it really influences them a lot… maybe they want to go to the doctor, but if they are told “oh, don’t go , there is a neighbor who was cured with such thing (natural medicine), take this, go with a “healer”” so I think they don’t go to the doctor because of that” (Yolanda, 26 years old).
Individual barriers
“I think that although we have heard about BC, we need a lot of information, especially in BC, because for example, the test for cervical cancer is much more feasible, we know about the Pap smear” (Alejandra, 42 years old).
“They have told us to explore our breasts ourselves, but how do we have to check them? We practically don’t know, maybe we touch a deformity but we don’t know if it is dangerous or not” (Teresa, 47 years old).
“Because yes, fear usually paralyzes you, right? You say “Oh no, maybe I feel something and I’m imagining the worst…you don’t want to know…there are many people who, despite the fact that maybe it is something very simple, find it very difficult to go to the doctor. Yes, going for treatment, going for a check-up, maybe it is not serious, but maybe they are already thinking that it is something fatal” (Margarita, 50 years old).
Perceived facilitators to early BC diagnosis
Social cultural level
Health services organization
“It is very important that when we go to the health center we can be served, and that the doctors tell us what we should do, and it is also very important to be treated nicely so that we can trust doctors, and we are able to talk to them about what we feel or need.” (Alejandra, 42 years old).
Interpersonal facilitators
“It is important for women who have had it (cancer) that they talk about their experience because sometimes we see it on television but it is not the same, but if you know someone who had it and she talks about their story, how they lived it, that makes us more aware” (Maribel, 35 years old).
Individual facilitators
“Um, cancer are tumors that are in your body, something dark that grows inside you and can contaminate your entire body” (Participant, 47 years old)“You have to go to the doctor, because we always leave it for later, but then, sometimes, with the passage of time, and when you want to go to the doctor, well... it’s too late, it turns too complicated for you and that’s it” (María, 52 years old).