RESEARCH ARTICLE
Expe iences o ce ical cance pa ien s in u al
Ghana: An explo a o y s udy
Cha i y Binka
1
*, Da id Teye Doku
2,3
, Ko i Awusabo-Asa e
3
1School o Public Se ice and Go e nance, Ghana Ins i u e o Managemen and Public Adminis a ion,
Acc a, Ghana, 2School o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland, 3Depa men o
Popula ion and Heal h, Uni e si y o Cape Coas , Cape Coas , Ghana
*[email p o ec ed]
Abs ac
E en hough ce ical cance is qui e a p e alen disease in Ghana, he e is ha dly any s udy
on his disease. This pape sough o explo e he expe iences o ce ical cance pa ien s li -
ing wi h he disease wi h emphasis on hei knowledge abou he disease be o e and a e
he diagnosis. Quali a i e da a we e collec ed h ough in-dep h in e iews wi h ce ical can-
ce pa ien s unde going ea men in a specialised cance ea men heal h acili y in u al
Ghana.
Ce ical cance pa ien s had inadequa e knowledge abou he disease, i s symp oms,
isk ac o s, ea men and p e en ion p io o being diagnosed o he disease. These
pa ien s we e diagnosed la e because hey usually sough ea men elsewhe e be o e
epo ing o heal h acili ies. They expe ienced physical, psychological, economic and social
dis up ions in hei daily li es, which a ec ed hei quali y o li e. I is e iden ha lack o
knowledge abou ce ical cance cons i u es a h ea o i s p e en ion and ea men . In en-
si e heal h educa ion h ough he mass media and communi y heal h p omo ion ou eaches
can be a su e way o c ea ing adequa e knowledge abou ce ical cance in Ghana. T ea -
men and ca e o ce ical cance pa ien s should inco po a e counselling sessions, which
should ake in o conside a ion he di e en le els o dis up ion he women expe ience and
he implica ions o hei wellbeing and managemen o he condi ion.
In oduc ion
Ce ical cance is he hi d mos commonly diagnosed cance wo ldwide and he ou h lead-
ing cause o cance dea hs among women globally [1]. The disease is es ima ed o cause abou
266,000 dea hs annually wo ldwide [2]. O e he pas decades, he incidence o ce ical cance
has howe e educed by a hi d and mo ali y by hal . I has been shown ha he ce ical
sc eening p og amme is associa ed wi h he imp o emen in ce ical cance ea men a es
[3].
In Ghana, i is es ima ed ha abou 3,052 new ce ical cance cases we e eco ded in 2012,
ep esen ing 32.7 pe cen o he o al cance cases among women in he coun y [2]. Ce ical
cance is belie ed o be highly p e en able wi h he use o ce ical cance sc eening ools [4].
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OPEN ACCESS
Ci a ion: Binka C, Doku DT, Awusabo-Asa e K
(2017) Expe iences o ce ical cance pa ien s in
u al Ghana: An explo a o y s udy. PLoS ONE 12
(10): e0185829. h ps://doi.o g/10.1371/jou nal.
pone.0185829
Edi o : Magdalena G ce, Rudje Bosko ic Ins i u e,
CROATIA
Recei ed: Decembe 25, 2016
Accep ed: Sep embe 20, 2017
Published: Oc obe 11, 2017
Copy igh : ©2017 Binka e al. This is an open
access a icle dis ibu ed unde he e ms o he
C ea i e Commons A ibu ion License, which
pe mi s un es ic ed use, dis ibu ion, and
ep oduc ion in any medium, p o ided he o iginal
au ho and sou ce a e c edi ed.
Da a A ailabili y S a emen : All he a ailable da a
o he s udy ha e been p esen ed in he
manusc ip .
Funding: The au ho s ecei ed no speci ic unding
o his wo k.
Compe ing in e es s: The au ho s ha e decla ed
ha no compe ing in e es s exis .
In he ea ly s age, ce ical cance can easily be ea ed. In i s ad anced s age, he ea men o
he disease could be e y challenging o impossible [4]. Owing o low awa eness o ce ical
cance in Ghana, o e 90 pe cen o he cases p esen ed in heal h acili ies end o be a he
ad anced s age whe e he disease has al eady sp ead [5]. Consequen ly, ce ical cance inci-
dence and mo ali y a es in Ghana become one o he highes in he wo ld [6].
A numbe o s udies in Ghana on ce ical cance did no ocus on hose su e ing om he
disease. Ra he , he s udies we e mo e on he p e alence o ce ical cance and sc eening.
None ha e in es iga ed he phenomenon among pa ien s. P e ious s udies emphasized on
inadequa e knowledge o he disease among hei esponden s [7–10]. The low le el o knowl-
edge abou he disease esul s in low up ake o sc eening and ea men [11]. Responden s
we e ound o lack knowledge on he isk ac o s, sc eening se ices, symp oms and ea men
op ions o he disease [8,9,12]. The p esen s udy among ce ical pa ien s he e o e sough o
explo e hei expe iences as well as pa ien s’ knowledge abou he disease p io o diagnosis.
Unde s anding ce ical pa ien s’ expe iences will help in de e mining e ec i e in e en ions
ha can imp o e ca e o ce ical cance pa ien s. The expe ience o he cance pa ien s was
guided by he concep o biog aphical dis up ion [13]. Acco ding o Bu y [13], ch onic dis-
eases b ing abou dis up ion o a pa ien ’s li e ajec o y and biog aphy. In o he wo ds,
ch onic diseases c ea e discon inui y in he li e o pa ien s. He a gues ha he li es o people
li ing wi h a ch onic illness a e dis up ed and ull o unce ain ies. The si ua ion makes hem
ocus on hei bodily su e ings, esul ing in up u es be ween body, sel and socie y [13,14].
Bu y [13] he e o e a gues ha he onse o a ch onic disease b ings pain, su e ing and
dea h o he o e, hings ha a e no mally seen as dis an possibili ies in ones’ li e o pe cei ed
as he p oblem o o he people. As a esul o his su e ing, people’s li e ajec o ies a e dis-
up ed. The concep o biog aphical dis up ion has been used as a concep ual amewo k in
s udying he expe iences o pe sons li ing wi h a numbe o ch onic illnesses such as AIDS
[15], s oke [16], and lung cance [17]. F om hese s udies, ch onic diseases ha e been ound
o dis up he body, social iden i y, social ela ionships, ca ee decision and economic condi-
ion o pa icipan s [16,18]. Based on he p e ious s udies, he biog aphical dis up ion concep
was used o guide his pape .
Ma e ials and me hods
S udy se ing and design
This s udy was conduc ed a he Ba o Ca holic Hospi al in he No h Tongu Dis ic o he
Vol a Region in Ghana. I is he only heal h acili y ha p o ides ce ical cance sc eening and
ea men in a u al en i onmen in he coun y. A quali a i e esea ch me hod was adop ed
o his s udy. The quali a i e app oach was used because i helped o explo e and unde s and
he expe iences o he ce ical cance pa ien s.
S udy popula ion
The s udy popula ion o he s udy comp ised all women who a ended he gynaecology uni o
he heal h acili y and had been diagnosed wi h ce ical cance and had su i ed he disease o
a i s ea ly s age. The esponden s we e ec ui ed based on he ollowing c i e ia: whe he hey
we e diagnosed wi h ce ical cance by he gynaecology uni o he heal h acili y; women who
we e 30 yea s and abo e, and willing o pa icipa e in he s udy. The age ange was in line wi h
he ce ical cance guideline which ecommends ha e e y woman om age 30 o 49 should
a a minimum ha e ce ical cance sc eening a leas once in he li e ime [2]. I has also been
es ablished ha he p e alence o Human Papilloma Vi us (HPV), which is ecognised as he
majo isk ac o o he disease, is highes among women in hei ep oduc i e age and
Expe iences o ce ical cance pa ien s in u al Ghana
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beyond, ollowed by pos -menopausal women [11]. The esponden s included hose who we e
in he ea ly s age o he disease and hose unde going su ge y o ea men . Pa ien s who we e
in li e- h ea ening condi ions and had unde gone emo al o he ce ix ( o al hys e ec omy) a
he ime o he s udy we e, howe e , excluded om he s udy.
Sampling p ocedu e
The sampling echnique adop ed was pu posi e. Thus, only women who had su i ed ce ical
cance o we e li ing wi h he ea ly s age o he disease we e conside ed o he pu pose o he
s udy. In ec ui ing esponden s, he eco ds o pa ien s we e e iewed a he cance egis y o
iden i y pa ien s who had been diagnosed wi h he disease. In o al, 60 pa ien s we e iden i ied
om he hospi al egis e a he ime o he s udy. A e wa d, phone calls we e made o pa ien s
o seek hei pa icipa ion in he s udy. Many could no be eached because hey we e ei he
dead o he elephone numbe s eco ded in he egis e we e inaccu a e. Some o he pa ien s
who we e con ac ed also declined o pa icipa e in he s udy. Consequen ly, only 15 women
ha e ag eed o pa icipa e in he s udy. These women we e all included in he s udy and hei
esponses p o ided e idence o suppo he indings o his s udy.
Da a collec ion
An in-dep h in e iew guide was de eloped o collec da a o he s udy. This comp ised issues
on backg ound cha ac e is ics o esponden s, pe sonal coping s a egies, o ms o suppo
and heal h seeking beha iou o he esponden s. The esponden s we e in e iewed in h ee
Ghanaian languages, namely, Ewe, Twi and Dangme. Th ee emale esea ch assis an s who
we e luen in he h ee languages we e ec ui ed and ained on he con en s o he da a col-
lec ion ins umen and how o e ec i ely conduc he in e iews o ensu e da a quali y and
wi hou comp omising e hical issues.
To ensu e he accu acy o da a collec ed, he esea che s and ield assis an s immedia ely
conduc ed checks wi h he esponden s a e he in e iews o e i y hei us wo hiness. The
in e iews we e also pee e iewed by he esea ch eam.
Da a p ocessing and analysis
The in e iews we e ape- eco ded and ansc ibed in English by esea ch assis an s who we e
na i e speake s o he local languages and luen in he English language. The ansc ip s we e
hen gi en o language expe s in he h ee local languages o e iew and e ise he con en o
ensu e alidi y o indings. The ansc ibed in e iews we e coded and p ocessed wi h he R
so wa e package o Quali a i e Da a Analysis (RQDA) ( e sion R-3.2.2). A hema ic
app oach o quali a i e da a analysis was he e o e applied. This in ol ed gene a ing deduc i e
codes ha eme ged om he in e iews. The esul s we e p esen ed in quo a ions om he
esponden s o suppo he con ex ual analysis and p o ide an oppo uni y o discussion o
he esul s o he s udy.
E hics app o al and consen o pa icipa e
Ins i u ional app o al o he s udy was ob ained om he Ba o Ca holic Hospi al, while he
Ghana Heal h Se ice E hical Re iew Commi ee (GHS-ERC) g an ed clea ance o he wo k.
Responden s we e made o sign a w i en in o med consen o pa icipa e in he s udy. Addi-
ionally, esponden s we e assu ed o anonymi y and con iden iali y o in o ma ion.
Expe iences o ce ical cance pa ien s in u al Ghana
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Resul s
Backg ound cha ac e is ics o ce ical cance pa ien s
The backg ound cha ac e is ics o he 15 ce ical cance pa ien s who pa icipa ed in he s udy
we e summa ised. Ou o he 15 ce ical cance pa ien s, six we e aged 50–59 while ou we e
aged 40–49 and 60 and abo e each. One pa icipan had no o mal educa ion, ou had p i-
ma y school educa ion and eigh had seconda y school educa ion while wo had e ia y edu-
ca ion. Ten ou o he 15 pa ien s we e ma ied while he emaining i e we e di o ced,
sepa a ed o widowed. Also, en we e sel -employed while he es we e unemployed. Nine
pa icipan s had om 4 o 6 child en while h ee had 7 o mo e child en. All he 15 pa ici-
pan s we e Ch is ians. Among he pa ien s, only one indulged in smoking obacco while ou
epo ed aking alcohol.
Knowledge abou ce ical cance
Responden s we e asked wha hey pe cei ed as he causes o he ce ical cance disease. All
he women in e iewed (n = 15) did no know abou ce ical cance p io o diagnosis and
exp essed su p ise a he si ua ion in which hey ound hemsel es. The hemes explo ed on
knowledge o he pa ien s o ce ical cance a e p esen ed in Table 1 below.
The pa ien s said he diagnosis came as a su p ise o hem as hey had no p io knowledge
abou ce ical cance as cap u ed in he esponses below.
“I did no e en know any hing abou cance .I knew i was only b eas cance ha can a ec
women.I did no know he e was any hing like ce icalcance .”
(Pa icipan 2, 52 yea s).
“I did no unde s and wha was happening o me because I had no knowledge o he disease.I
did no know he local name o his disease”.
(Pa icipan 13, 47 yea s).
The ce ical cance pa ien s we e no awa e o he ini ial symp oms o he disease. Fo his
eason, hey could no iden i y he cause o hei ailmen un il hey we e diagnosed. Two o he
esponden s exp essed he us a ion hey expe ienced.
“When I was bleeding,I did no know he kind o disease ha was causing ha o happen.I
did no know wha was w ong wi h me and wha has caused his because I had s opped my
Table 1. Knowledge o ce ical cance .
Issue Explana ion
Knowledge abou exis ence o
ce ical cance
All he pa ien s did no know abou he disease be o e diagnosis
Popula ion a isk 13 o he pa ien s did no know he popula ion a isk
Causes 14 o he pa ien s did no know he causes o he disease, only one
men ioned HPV and indisc imina e sex.
Sc eening None o he pa ien s knew abou sc eening op ions
T ea men None o he pa ien s knew abou ea men op ions
Sou ce: Fieldwo k, 2014
h ps://doi.o g/10.1371/jou nal.pone.0185829. 001
Expe iences o ce ical cance pa ien s in u al Ghana
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pe iod o abou ou yea s so when i s a ed coming I was dis u bed.I did no unde s and he
eason why i had come o ha un il I go o he hospi al and was old i was cance ”.
(Pa icipan 5, 50 yea s).
“I did no unde s and why as a woman who had ceased childbea ing,I am beginning o bleed
again wi h aginal discha ge.I did no unde s and so I was always isi ing he hospi al wi h i ”.
(Pa icipan 11, 55 yea s).
Responden s we e asked wha hey pe cei ed as he causes o he ce ical cance . Mos o
hem (n = 13) epo ed ha hey did no know he causes o he disease p io o diagnosis. The
“don’ know” esponses we e as esul o genuine lack o knowledge abou he condi ion and a
con lic be ween hei li es yle and he causes o he diseases hey ha e lea n . Two o he pa -
icipan s men ioned ha i was a e diagnosis ha hey ealised ha he disease could be
caused by indisc imina e sex. They he e o e explained ha indisc imina e sex inc eases he
isk o con ac ing he HPV, which is he main cause o ce ical cance :
“A e I was diagnosed,whene e he e is any ce icalcance p og amme I lis ened,so I go o
know ha he disease is caused by indisc imina e sex and i is a i us.”
(Pa icipan 6, 63 yea s).
The ce ical cance pa ien s go o know abou some o he sc eening and ea men op ions
o he disease a e hey we e diagnosed. They go o know abou he ea men op ions
h ough he heal h pe sonnel. The pa ien s men ioned lying in a “machine”—CT scan, su ge y.
They did now o he o ms o ce ical cance ea men . Thei knowledge abou sc eening cen-
es was limi ed as hei ocus was mo e on ea ing hei condi ion.
“When I came, he doc o had e e ed me o a ce ain hospi al.He handed a le e o me o be
sen o a ce ain hospi al in Acc a whe e I would be ea ed and ha was whe e he esul s
p o ed ha i was cance ”.
(Pa icipan 3, 43 yea s).
“Ini ially,when I came he e, he doc o said because he cance had ad anced,I should go o a
machine a Ko le Bu Hospi al.So when he said ha ,I ag eed bu I old him I was sca ed o he
ope a ion,so I would p e e o go and lie on he machine.”
(Pa icipan 5, 50 yea s).
A ew o he esponden s also men ioned some speci ic ea men op ions ha hey wen
h ough. These ea men op ions ha we e a ailable included su ge y and adio he apy. The
pa ien s, howe e , only go o know abou hese ea men op ions du ing he ea men p o-
cess when he doc o s in o med hem. This is e lec ed in he ollowing s a emen s:
“The doc o sugges ed su ge y as he o he o m o ea men o me and also adio he apy”.
(Pa icipan 7, 59 yea s).
“I was old ha i willbe e ydi icul o hem o ope a e.I was made o lie unde a machine.
I was hen gi en injec ion and he ea e ,I was ope a ed upon and became okay.
(Pa icipan 8, 62 yea s).
Expe iences o ce ical cance pa ien s in u al Ghana
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Illness expe ience and biog aphical dis up ion
The symp oms ce ical cance pa ien s expe ienced signi ied he beginning o hei biog aphi-
cal dis up ion. The dis up ions we e a ou le els: physical, psychological, economic and
social. These a e discussed below.
Physical dis up ion. The symp oms o ce ical cance a ec ed he bodies o hese
pa ien s. Mos o he women epo ed u he dis up ions o hei physical body du ing ea -
men . The dis up ions we e in e ms o body pains, cessa ion o sexual ac i i y, loss o appe i e,
immobili y and loss o sleep. The women expe ienced pains in hei agina, wais , and en i e
body. Table 2 ep esen s he hemes p o iding explana ion o physical dis up ions expe ienced
by he ce ical cance pa ien s.
Fo some o he women, he pains we e so se e e ha hey had o be egula ly gi en injec-
ions o educe i .
“I el some pains in my agina and he doc o ins uc ed ha I should be gi en injec ion o
educe he pains.I was always in pain,my leg,e e y hing,e e ypa .”
(Pa icipan 11, 55 yea s).
Ano he physical dis up ion he women expe ienced was in hei sexual li e. Fou o he
women epo ed ha hey s opped engaging in sexual ac i i y because hey bled and el pains
du ing sex.
“I bled om he agina any ime I had sexual in e cou se.So I decided no o ge mysel
in ol ed in any.”
(Pa icipan 4, 44 yea s).
Th ee women epo ed loss o appe i e due o ce ical cance . Two o he women could no
ea well while one had no in e es in ood. Acco ding o hem, ood smel bad and was as eless.
The ac o ea ing was seen as a bu den. Ano he physical dis up ion women expe ienced was
immobili y. The women could no mo e a ound o ea o soiling hemsel es because o
excessi e bleeding. Fo example, h ee women said hey we e a aid o go ou o hei homes
because hey ea ed bleeding and soiling hemsel es in public. Some o he women could also
no walk because hey el pains in hei legs and body. Acco ding o se en o he women he
d ugs p esc ibed o hem made hem dizzy and p e en ed hem om mo ing a ound.
“I el pains in my legs.I could no walk.The d ugs gi en o me a Ko le-Bu [one o he eaching
hospi als] also weakened me and I could no do any hing.”
(Pa icipan 8, 62 yea s).
Table 2. Physical dis up ion expe ienced by women.
Issue Explana ion
Body pains Uncom o able eeling in he lowe abdomen
No sex Pain du ing sex
Loss o appe i e Unwell, s essed, inabili y o ea
Immobili y Inabili y o walk a ound like any o he no mal human beings due o incessan bleeding
Loss o sleep Inabili y o sleep due o bodily pains
Sou ce: Fieldwo k, 2014
h ps://doi.o g/10.1371/jou nal.pone.0185829. 002
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The women also epo ed loss o sleep as dis up ion hey expe ienced. Fo some o he
women hey could no sleep and o he s had o wake up in e mi en ly o change hei sani a y
owels.
The physical dis up ion women expe ienced spanned ac oss symp oma ic, diagnosis, ea -
men and pos ea men pe iods.
Psychological dis up ion. The women expe ienced psychological dis up ion in ou
phases: when hey saw he disease symp oms, when hey ecei ed diagnosis, du ing ea men
and a e ea men . These dis up ions we e clus e ed in o h ee a eas; namely, nega i e emo-
ions, ea o dea h and anxie y. Acco ding o h ee pa ien s, when hey no iced he symp oms
o he disease, hey became sad and ea ul. They we e a aid o he blood hey cons an ly saw
in hei unde wea and wonde ed wha could ha e been happening o hem.
Some o he women also el sad ha some hing as emba assing as ha was happening o
hem. Table 3 ep esen s he hemes o he psychological dis up ions expe ienced by he
women.
The pa ien s expe ienced a lo o psychological dis up ion when hey we e i s diagnosed
o he disease. The women epo ed wo y, anguish, despe a ion and loss o hope. Fo some o
hese women, hey knew ha ce ical cance was a deadly disease, and hough hey we e
going o die immedia ely. One woman expe ienced psychological dis up ion because she was
hoping ha he condi ion was ib oid bu no ce ical cance .
“The day I go o know I had ce icalcance ,I was de as a ed.Bu I ga he ed cou age and
aised my wo hands and made a passiona e eques o sa e me so ha I could con inue doing
my wo k.I p ayed in my head bu I aised my hand in on o he doc o .”
(Pa icipan 6, 63 yea s).
“I el sad,because o he cance .I hough i was ib oid a i s .”
(Pa icipan 9, 49 yea s).
Acco ding o some, hey spen a lo o ime hinking abou he disease a e hey had been
diagnosed. Thei hough s we e ocused on why such a hing had happened o hem, and he
po en ial cos he ea men would b ing o hem. Acco ding o wo o he women, some imes,
hey would hink abou he si ua ion so much ha hey could no hea o he s when hey we e
speaking wi h hem.
“I kep hinking,abou he disease.Why should a young lady like me ha e his disease?Wha
am I going o do now?Can I e en pay?Some imes,I do no e en hea when people call my
name”.
(Pa icipan 1, 34 yea s).
Table 3. Psychological dis up ion expe ienced by ce ical cance pa ien s.
Issue Explana ion
Nega i e
emo ions
Sadness, sel -disgus , wo y, despe a ion, bad eeling, con usion, loss o hope, isola ed,
ea s and auma.
Fea Fea o he u u e, ea o dea h, ea o he unknown, ea men e icacy, ea o cos o
ea men , ea o ecu ence.
Thinking Thinking abou li e a e ea men
Sou ce: Fieldwo k, 2014
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Du ing ea men , he women also expe ienced psychological dis up ion. The women had
bad eelings and c ied. They we e sca ed o he ea men me hods, he po en ial esul s and
side e ec s. One woman men ioned ha when she was aken o he hea e and she saw he
nume ous kni es and machines ha we e going o be used on he , she became sad and begun
o c y. Some o he women also saw he CT scan as a co in and his auma ised hem and
inc eased hei ea o dea h.
“.I was made o sleep unde a machine.When I go he e,i was sca y,i was like a co in.”
(Pa icipan 8, 62 yea s).
The women expe ienced psychological dis up ion e en a e ea men . The women we e
a aid ha he disease migh ecu . Acco ding o ou o he women, hey p ayed cons an ly
ha he pain and oubles hey had expe ienced should no ecu . In summa y, he pa ien s
expe ienced nega i e emo ions and expe iences a ou le els, namely, symp oms, diagnosis,
ea men and pos ea men . To he women, ce ical cance is a disease ha has a ne e -end-
ing psychological dis up ion once i commences.
Economic dis up ion. The ce ical cance pa ien s also expe ienced economic dis up ion
in e ms o hei inabili y o wo k, educ ion in income, medical bills, loss o asse and indeb -
edness. They had o go o hospi al and could no us o he s o handle hei businesses, lead-
ing o hei collapse. Fo ins ance, wo esponden s epo ed ha hey could no ha es om
hei a m because hey we e on admission, leading o losses. In all, mos o he women (n = 9)
los hei businesses:
“All my wo k collapsed because I canno do i on my own.Now,I can no longe wo k ac i ely
and my abili y o walk is also no as as as i used o be.”
(Pa icipan 15, 60 yea s).
As a esul o hei inabili y o wo k ac i ely as hey used o, hei income s eam was dis-
up ed; ye , hey had o pay heal hca e bills. The women epo ed spending be ween GHC
300.00 (75 USD) and GHC 10, 000.00 (2500 USD) o ea men . Due o he expensi e heal h-
ca e bill h ee women sold hei asse s and en women ook loans. Fo hose who sold hei
asse s hey complained o losing alue as hey sold o less han he cos p ice o he asse hey
ha e in hei possession:
“I was so sick I could no wo k,bu I needed money o pay my bills.So I sold my land.I was a
di icul decision bu I had o ake i .Un o una ely, he buye no iced ha I needed he money
so he o e ed me less han he ma ke p ice.”
(Pa icipan 1, 34 yea s).
Abou i e o he women ook loans o inance hei heal hca e. The women bo owed
be ween GHC100.00 (25 USD) and GHC6, 000.00 (1500 USD). They ook loans om bo h o -
mal (banks and mic o inance) and in o mal sou ce ( iends and ela i es). Fo hose who ook
loans om mic o inance ins i u ions, hey had o pay abou 40 pe cen in e es on he loans
hey ook. Some women los hei jobs and/o had a educ ion in income; ye , had expensi e
medical bills o pay. Some esponden s sold hei asse s and ook loans wi h huge se icing
and became indeb ed o he bank.
Social dis up ion due o ce ical cance . B eak-up o social ela ionships was one o he
dis up ions expe ienced by ce ical cance pa ien s. Some o he women explained ha hei
Expe iences o ce ical cance pa ien s in u al Ghana
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pa ne s dese ed hem and one o he women also had a dis up ed ela ionship wi h he
b o he . Some o hem epo ed ha hei pa ne s le hem because hey could no longe
endu e ha ing sex wi h hem. The women said hey el disappoin ed wi hou he emo ional
and he inancial o hei pa ne s du ing hei ea men . A woman also epo ed s ained
ela ionship wi h he b o he because o he disease. The b o he el ha he was spending oo
much money on he and he e o e decided o abandon he .
“Because o he disease,my husband wen o ma y ano he woman and le me.”
(Pa icipan 4, 44 yea s).
“None o my amily membe s suppo ed me.E en my own sibling who comes a e me did no
mind me anymo e.He said he had spen i e imes al eady so he would no spend money o
ake ca e o me again because my mo he and my a he did no lea e him any inhe i ance o
all on”
(Pa icipan 11, 55 yea s).
Discussion
The s udy ound ha mos o he women did no know abou he disease be o e and e en a e
diagnosis. They lacked knowledge on he causes, isk ac o s, p e en ion me hods and ea -
men op ions. The low le el o ce ical cance knowledge among women has been epo ed in
a numbe o o he s udies. S udies such as F ancis e al. [19], Ndikom and O i [20], Abiodun
e al. [21], and Williams [22] ha e also epo ed simila indings. They ound li le o no awa e-
ness abou he disease among pa ien s be o e hey we e diagnosed. This limi ed knowledge
abou he ce ical cance disease may be as a esul o low o lack o in ensi e educa ion o sen-
si isa ion on he disease among women in Ghana [8]. Consequen ly, he low le el o knowledge
may lead o low up ake o sc eening se ices [21]. This ‘heal h seeking beha iou ’ may esul in
la e iden i ica ion o he disease and may delay in consul ing o hodox heal h p ac i ione s o
ea men . Illness no i ica ion was he i s expe ience women had o ce ical cance . The
women expe ienced pe sis en bleeding, bodily pains, bodily discom o and aginal discha ge.
Some o he esponden s expe ienced mul iple o hese bodily symp oms. Since mos o he
women did no know abou he ce ical cance be o e hey we e in ec ed, mos o hem used
he changes hey expe ienced in hei body o de ec ha some hing was w ong wi h hem.
This is consis en wi h o he s udies ha ha e sugges ed ha a subjec i e expe ience h ough
he p ocess o ‘body-lis ening’ shaped disease no i ica ion and expe ience [23]. The women’s
expe ience could be desc ibed as biog aphical dis up ion as a esul o he disease. The expe i-
ences o he women could be iewed in e ms o physical, psychological, economic and social
dis up ion as a esul o he disease. Ch onic illnesses ha e been conside ed as an en y in o a
new social a ena [13].
The ini ia ion in o he ce ical cance encoun e could explain he dis up ion he women
expe ienced. Physical dis up ion was expe ienced by he pa ien s h ough pains in nume ous
pa s o he body including he abdomen, wais and agina. The inabili y o mo e and engage
in hei usual daily ac i i ies was also o conce n o he pa ien s. The pa ien s also expe ienced
psychological dis up ion because hey we e in c i ical si ua ion o g ea unce ain y. This was
compounded by he s igma a ached o he disease and hei igno ance o he s a e hey ind
hemsel es, which led o he ea and hiding hei disease s a us. A p e ious s udy ound simi-
la expe iences among pe sons li ing wi h diabe es [24]. Also, he unce ain knowledge abou
Expe iences o ce ical cance pa ien s in u al Ghana
PLOS ONE | h ps://doi.o g/10.1371/jou nal.pone.0185829 Oc obe 11, 2017 9 / 12