Silence among Afro Caribbean men diagnosed with prostate cancer in Trinidad and Tobago : a grounded theory study.

Background: Prostate cancer (PCa) is the leading cause of death among Afro-Caribbean men in Trinidad and Tobago (TT). TT is listed as one among countries with the highest PCa mortality rates in the world (Hosein et al., 2016). A systematic review undertaken explored men’s cultural beliefs about prostate symptoms and help-seeking behaviours, which revealed a dearth of knowledge of Afro-Caribbean men and PCa (King-Okoye et al., 2017). This study aims to explore men and partners experiences along care pathways for PCa in TT, including the beliefs and meanings men associate with their illness and its presentation. Methods: Utilising Straussian grounded theory, semi-structured and focus-group interviews were conducted with men (n= 51) diagnosed with PCa and partners (n=16) at four (urology & oncology) centres throughout TT in 2015-2016. Results: Five categories: ‘Disrupting the Self’, ‘Disconnected to Health Services’, ‘The Silent Wall’, ‘Blame and Distrust’ and ‘Breaking the Silence’ and a core category, ‘Silence among Afro-Caribbean men’ (SAACM) were generated from the data. These connect with men’s late presentation of PCa at emergency services with severe and life-limiting symptoms associated with high mortality rates for this disease. The main reasons underlying men’s late presentation to health services with debilitating symptoms, concern masculinity norms, lack of awareness and knowledge of early stage PCa, cultural beliefs and practices and perceptions of an uncaring health system. These heavily influenced men’s ability to access care and move through routes to diagnosis for PCa in TT. Conclusion: The SAACM offers unique insight into identifying how men’s cultural beliefs, hegemonic masculinity and lack of knowledge and awareness of the prostate and PCa resulted in delays in help-seeking and subsequently late diagnosis. A better understanding of men and their partners’ experiences along routes to diagnosis for PCa can target specific public health messages to address barriers to early diagnosis for men. Key words: Trinidad and Tobago, experiences, beliefs, culture, silenc