Behavioural science in cancer control

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Published: 17 Nov 2017
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Dr Melissa Wallace - Cancer Association of South Africa, Johannesburg, South Africa

Dr Wallace speaks with ecancer at AORTIC 2017 about the human behavioural aspects behind effective cancer control interventions.

She notes how aspects of human choice influence uptake of otherwise biomedical interventions, including vaccinations, and considers barriers to cancer control across Africa. 

Dr Wallace goes on to consider possible social and policy changes that might encourage responses, and how communications research plays an essential part alongside healthcare provision in understanding public mood, expectations and outcomes.

I’m talking about the role of behavioural science in cancer control. I myself am trained as a health psychologist so this is my area of interest and expertise. I’m making the case for the role of behavioural science in cancer control in that it’s actually fundamental and a key component for the success of any cancer control intervention. A lot of the interventions may seem like biomedical interventions, for example cervical screening or the HPV vaccine or cancer treatment, but all of those things actually rely on human behaviour for them to be successful. If women aren’t prepared to go for a screening for whatever reason or let their daughter have the vaccine or people are not adhering to treatment then all of those interventions will fail. So unless we pay careful attention to social behavioural factors interventions won’t be successful.

So behavioural science is really about trying to understand why and how humans behave and then looking at how we can intervene to improve things for them, for their wellbeing.

What measures can be taken to prevent cancers in general?

Of course a lot of cancers are caused by lifestyle related factors so there’s a lot of work that can go on in prevention. So if we think about tobacco and diet and obesity and alcohol consumption, those are all key risk factors for many of the cancers. So trying to change behaviour around tobacco use, of course, trying to get people to exercise more and eat a better diet, those would all be behaviours that we try to change. Also on the prevention side uptake of screening and uptake of vaccination where available.

Are there cultural barriers often faced in an African setting?

Yes, definitely. There are a lot of contextual social economic issues or barriers, I suppose, in Africa, more so than in developed world countries. For example, take the example of someone trying to access screening – firstly the healthcare infrastructure may not be as good, it more than likely won’t be as good which means longs waiting times. The proximity to the clinic is a barrier, potentially, to someone uptaking screening. Also things like people’s beliefs and understanding of cervical cancer, so knowledge and awareness is often quite poor, particularly in rural areas. So that, as a starting point, needs to be addressed. If people aren’t even understanding their risk or the importance of screening or vaccination then that’s your first barrier. But then there are lots of other barriers along the way and other beliefs and cultural beliefs and misconceptions as well. So it does feel like there are more challenges, certainly in an African setting in terms of changing behaviour.

Can you give examples of how we might change that behaviour?

One of the things that I talk about in my presentation is the fact that we have not actually in Africa made use of the many behavioural change theories that are already in existence. They’ve been criticized to some extent because they focus so much on the individual without taking the social and contextual issues into account but there are some that do. All of those things need to be considered when we’re looking at changing behaviour. So there are constructs that have been shown to influence behaviour like the way people think about their risk, their risk perception, what they believe to be the social norms in their environment - what are other people doing that are like me? How at risk am I? What do I think about the intervention that’s being offered, do I think it works or not? Those kind of beliefs and thought processes can be manipulated and changed through information and other interventions.

But then you also probably need to look at some of the other factors like there are a lot of gender related issues in Africa so you may need to look at the role of the spouse in a woman attending for screening, if she doesn’t have spousal support then that can be a barrier so you may need to intervene with other key people in her environment. So you need to address things at multiple levels; policy changes may be required, other structural interventions as well.

What’s the best way of conveying information?

There are lots of different ways and that requires research as well. So you would need to look at a particular… because each community, each country, each place is going to be a little bit different in terms of what their needs are. So you would need to do some informative research at the start to look at what is going to be the best way to communicate with this population, what are the literacy levels? Do we want written information, do we want radio information? I would recommend focus groups and interviews with stakeholders in the beginning to look at what they want, what they think is going to work for them. So the healthcare providers need to input in that but also the people who are going to be receiving the message. So it’s quite a long process but if you’re going to do it properly and you want it work then that’s how you do it.

How do you tackle things like large wealthy tobacco companies?

That’s where, certainly from our side, we have an advocacy role as well. So we do lobby for legislation changes and push back and we are included in a lot of the forums and the meetings with our National Department of Health and local provincial Department of Health to make sure that these things stay on the agenda and that changes are pushed through. Actually tobacco is an example in South Africa, we have really good legislation around that.

Anything else important to mention?

One of the big issues in Africa as well is that there’s not actually a lot of behavioural science expertise and we really need to focus on building capacity in that area. So I’m not suggesting that we need to train a whole lot more psychologists but there are people who are working, like nurses and other people, lay trained healthcare workers, who could also be upskilled around behaviour change theory and information and that would really help.