In Southern Africa, people with breast, cervical, or colorectal cancer are typically diagnosed only after their symptoms have become severe, leading to far worse outcomes. This research group will develop two digital tools to speed up that process: one for primary care providers to help them assess and refer patients with possible cancer, and another for the general public to encourage earlier symptom recognition and help-seeking. The team will first map the current delays—from when a person first notices symptoms to when they receive a diagnosis—in Zimbabwe and South Africa, and identify what drives those delays. They will then test both tools in real-world settings to see if they are practical, affordable, and culturally acceptable. If successful, the e-Tools could shift cancer diagnosis in these countries from late-stage, when treatment is less effective, to earlier stages, when survival rates are higher. The work also provides baseline data on diagnostic intervals and patient costs that health systems currently lack, offering a foundation for broader cancer control efforts across the region.
View original technical description
Research question: Can we use innovative approaches with digital technologies in primary care and public health to advance early diagnosis of breast, cervical and colorectal cancer in Southern Africa? Background: By 2030 an estimated 24 million people worldwide will develop cancer and 13 million people will die annually from cancer, with 75% of deaths in low-and middle-income countries (LMICs). Cervical, breast and colorectal cancer are common in LMICs. In Southern Africa, people with symptoms of these cancers are diagnosed when they self-present to a health facility, usually at an advanced stage with associated poor outcomes. A key goal of comprehensive cancer control is a shift to earlier stage at diagnosis. Aims and objectives: To advance early diagnosis of these cancers we will: • Assess the time intervals from symptom awareness to referral and diagnosis and factors influencing these intervals in Zimbabwe (low-income country) and South Africa (SA) (upper middle-income country) (Workstream 1). • Develop two e-Tools that promote more timely presentation and referral: a symptom assessment and management e-Tool for primary care providers and a symptom appraisal and help-seeking e-Tool for the public (Workstream 2) • Evaluate the e-Tools to ensure that they are operationally and economically feasible and equitable, socio-culturally acceptable and support timely referral (Workstream 3). Methods: The Model of Pathways to Treatment and the MRC complex intervention framework underpin the research. Data will be collected from public sector facilities in two provinces in each country: Workstream 1: in-depth interviews with health facility managers, providers, and health facility assessments, and cross-sectional survey of patients with breast, cervical or colorectal symptoms or those recently diagnosed. Data on pathways to diagnosis and health expenditure will be collected. Workstream 2: e-Tool content developed by expert advisory groups, and software development for the tools with iterative prototype usability testing. Workstream 3: (A) Primary care provider e-Tool: a pragmatic, type 2 hybrid effectiveness-implementation pilot study, with a ‘before-and-after’ study design, to evaluate whether its use impacts the primary care, pre-diagnostic and total diagnostic intervals; a process evaluation of implementing the e-Tool; in-depth interviews with primary care providers to assess usability, subjective experiences and challenges with the e-Tool; a cross-sectional survey to measure provider knowledge before and after intervention implementation; (B) Public e-Tool: focus group discussions with community participants to evaluate usefulness of the public e-Tool and barriers to use; a cost-effectiveness analysis of the provider e-Tool. Timelines: Workstream 1: months 1–24; Workstream 2: months 13-48; Workstream 3: months 25-48. Anticipated impact and dissemination: Results will be disseminated through peer-reviewed publications in high-impact journals and conference presentations, as well as local stakeholder meetings, press and media. Impact will include: baseline data on key time intervals in the pathway to breast, cervical and colorectal cancer diagnosis in each country, the key factors influencing these intervals and patient health costs; an e-Tool for primary care providers to support assessment and referral patients presenting with possible cancer; an e-Tool for public use to promote symptom appraisal and help-seeking.
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know