Role of gender in perspectives of discrimination, stigma, and attitudes relative to cervical cancer in rural Sénégal
Open Access
- 28 April 2020
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 15 (4), e0232291
- https://doi.org/10.1371/journal.pone.0232291
Abstract
Cervical cancer is the leading cause of female cancer deaths in Sénégal which is ranked 17th in incidence globally, however, the screening rate there is very low. Nuanced gendered perceptions and health behaviors of both women and men play a significant role in women’s health. Our study analyzed gender differences on perceptions of gender roles, discrimination, cancer attitudes, cancer stigma, and influences in healthcare decision making within our study population to inform ongoing cervical cancer prevention work in the rural region of Kédougou, Sénégal. We conducted a cross-sectional survey of 158 participants, 101 women and 57 men (ages 30–59) across nine non-probability-sampled communities from October 2018 through February 2019. Bivariate analysis was conducted to assess gender differences across all variables. We also conducted analyses to determine whether there were significant differences in beliefs and attitudes, by screening behavior and by education. We found significant gender differences regarding the perception of a woman’s role (P < 0.001) and a man’s role (P = 0.007) as well as in the everyday discrimination questions of “decreased respect by spouse” (P < 0.001). Regarding cancer stigma, among women, 18.00% disagreed and 10.00% strongly disagreed while among men, 3.6% disagreed and 1.8% strongly disagreed that “If I had cancer, I would want my family to know that I have it.” When making decisions about one’s healthcare, women are more likely than men to trust social contacts such as their spouse (46.5% vs 5.3%, p < 0.001) while men are more likely than women to trust health service personnel such as a nurse (50.9% vs 18.8%, p < 0.001). Furthermore, men and women were both more likely to state that men have the final decision regarding the healthcare decisions of women (p < 0.001). Our data reveal structural disadvantages for women within our study population as well as gender differences in the adapted everyday discrimination scale and cancer stigma scale. Higher rates of both personal and perceived cancer stigma among women has profound implications for how population and community level communication strategies for cancer prevention and control should be designed. Efforts to advance the goal of the elimination of cervical cancer should, in the short-term, seek to gain a more profound understanding of the ways that gender, language, and other social determinants impact negative social influences and other barriers addressable through interventions. Social and behavior change communication may be one approach that can focus both on education while seeking to leverage the social influences that exist in achieving immediate and long-term goals.Funding Information
- Fogarty International Center (K01TW010494)
This publication has 33 references indexed in Scilit:
- Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic reviewReproductive Health, 2013
- HPV vaccine acceptability among men: a systematic review and meta-analysisSexually Transmitted Infections, 2013
- The effect of women's decision-making power on maternal health services uptake: evidence from PakistanHealth Policy and Planning, 2012
- Social Influence as a Driver of Engagement in a Web-Based Health InterventionJournal of Medical Internet Research, 2012
- A Meta-analysis of Gender Differences in Attitudes Toward Seeking Professional Psychological HelpJournal of American College Health, 2010
- A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptabilityVaccine, 2010
- Closing the gap in a generation: health equity through action on the social determinants of healthThe Lancet, 2008
- Differences in HIV vaccine acceptability between gendersAIDS Care, 2008
- The CITI Program: An International Online Resource for Education in Human Subjects Protection and the Responsible Conduct of ResearchAcademic Medicine, 2007
- Determinants of Cancer Disparities: Barriers to Cancer Screening, Diagnosis, and TreatmentSurgical Oncology Clinics of North America, 2005