A qualitative exploration of factors that influenced health literacy among women diagnosed with breast cancer in Kenya during their cancer journey

BackgroundIn Kenya, there are approximately 6,000 new breast cancer (BC) cases annually and 2,550 deaths. Approximately 80% of patients are diagnosed at advanced stages (III–IV), contributing to the high death rate. Research has shown that BC can be cured when discovered early; thus, providing information and improving BC awareness is essential. Health literacy (HL) is an important skill that can shift behaviour towards better breast health and outcomes, yet little is known about HL experiences among Kenyan patients with BC. AimTo explore the experiences and factors that influenced health literacy for women with BC presenting at a public and a private tertiary hospital in an urban area of Kenya.MethodsA qualitative longitudinal approach using serial semi-structured face-to-face interviews from a purposive sample of 11 women, thematically analysed using Colaizzi’s technique. FindingsTwo themes were generated: Information experiences of BC patients and Socio-ecological factors that influenced health literacy. A number of factors influenced HL among patients with BC; these spanned different levels of the SEM and were the forces that influenced how participants accessed, understood and used health information to make decisions in their BC journey. Conclusions This study provides a deeper understanding of the HL concept through the literature review, which showed that globally, HL skills are crucial for all stages of the BC journey. Uniquely the study used the SEM in Kenya, which enabled a focus on the circumstantial factors that explained participant’s HL behaviour and linkages across the three SEM levels. Rather than using the conventional SEM, policy factors as the dominant influencers should be placed at the fore. Finally, the journey model and qualitative longitudinal approach enabled prolonged engagement with participants and was valuable for gaining a deeper understanding of their experiences; this approach can be used for studying other chronic conditions.Keywords: Breast cancer; health literacy; cancer journey; socio-ecological model; Keny