A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population

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Despite growing awareness, late presentation and poor health-seeking behaviour remain significant challenges. Understanding the sociocultural factors that shape men’s experiences and decision-making regarding prostate cancer is essential for improving early detection and care. Objective This study explores the perspectives of prostate cancer survivors and men in the general population on prostate cancer, its prevention, treatment and related health-seeking behaviour in rural South African context. Methods This study adopts a qualitative design. Semi-structured interviews conducted with two purposefully sampled groups: prostate cancer survivors (n=15) and men from the general population with no known diagnosis (n=15), in the OR Tambo District OF THE eastern Cape Province, South Africa. Interviews will be conducted in isiXhosa (the local language), audio recorded, transcribes and translated into English. Data will be analysed thematically using NVivo software. Ethical approval has been obtained from the Walter Sisulu University Human Research Ethics Committee (014/2025), with additional permissions granted by the Eastern Cape Provincial Department of health and Nelson Mandela Academic hospital. Conclusion the findings will contribute to a deeper understanding of individual and community-level factors influencing prostate cancer health-seeking behaviour. This study will generate context-specific qualitative evidence to guide public health policy and prostate cancer awareness campaigns in rural African settings, male-friendly community interventions to promote early detection in rural areas, with broader implications for addressing health inequities in non-communicable disease care. 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F1000Research 2026, 15 :58 ( https://doi.org/10.12688/f1000research.172798.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population [version 1; peer review: 1 approved] Xolelwa Ntlongweni https://orcid.org/0000-0001-5549-3752 1-3 , Sibusiso Cyprian Nomatshila 1,2 , Wezile Wilson Chitha 1,3 , Sikhumbuzo Advisor Mabunda https://orcid.org/0000-0001-9458-3742 1,4-6 Xolelwa Ntlongweni https://orcid.org/0000-0001-5549-3752 1-3 , Sibusiso Cyprian Nomatshila 1,2 , Wezile Wilson Chitha 1,3 , Sikhumbuzo Advisor Mabunda https://orcid.org/0000-0001-9458-3742 1,4-6 PUBLISHED 14 Jan 2026 Author details Author details 1 Public Health, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa 2 WSU Society and health research institute, Walter Sisulu university, Mthatha, Eastern Cape, 5117, South Africa 3 WSU Institute for Clinical governance & healthcare administration, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, 5117, South Africa 4 WSU Global Centre for human Resources for health intelligence, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, 5117, South Africa 5 School of Population Health, University of South Wales, South Wales, Sydney, Australia 6 Public Health, The George Institute for Global Health, Camperdown, New South Wales, Australia Xolelwa Ntlongweni Roles: Conceptualization, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation Sibusiso Cyprian Nomatshila Roles: Writing – Review & Editing Wezile Wilson Chitha Roles: Writing – Review & Editing Sikhumbuzo Advisor Mabunda Roles: Methodology, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Sociology of Health gateway. This article is included in the Oncology gateway. Abstract Abstract* Background Prostate cancer is one of the most prevalent cancers among men in South Africa, particularly affecting those in rural and underserved communities. Despite growing awareness, late presentation and poor health-seeking behaviour remain significant challenges. Understanding the sociocultural factors that shape men’s experiences and decision-making regarding prostate cancer is essential for improving early detection and care. Objective This study explores the perspectives of prostate cancer survivors and men in the general population on prostate cancer, its prevention, treatment and related health-seeking behaviour in rural South African context. Methods This study adopts a qualitative design. Semi-structured interviews conducted with two purposefully sampled groups: prostate cancer survivors (n=15) and men from the general population with no known diagnosis (n=15), in the OR Tambo District OF THE eastern Cape Province, South Africa. Interviews will be conducted in isiXhosa (the local language), audio recorded, transcribes and translated into English. Data will be analysed thematically using NVivo software. Ethical approval has been obtained from the Walter Sisulu University Human Research Ethics Committee (014/2025), with additional permissions granted by the Eastern Cape Provincial Department of health and Nelson Mandela Academic hospital. Conclusion the findings will contribute to a deeper understanding of individual and community-level factors influencing prostate cancer health-seeking behaviour. This study will generate context-specific qualitative evidence to guide public health policy and prostate cancer awareness campaigns in rural African settings, male-friendly community interventions to promote early detection in rural areas, with broader implications for addressing health inequities in non-communicable disease care. READ ALL READ LESS Keywords Prostate cancer, Health-seeking behaviour, rural men, cancer awareness, South Africa Corresponding Author(s) Xolelwa Ntlongweni ( [email protected] ) Close Corresponding author: Xolelwa Ntlongweni Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Ntlongweni X et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Ntlongweni X, Nomatshila SC, Chitha WW and Mabunda SA. A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population [version 1; peer review: 1 approved] . F1000Research 2026, 15 :58 ( https://doi.org/10.12688/f1000research.172798.1 ) First published: 14 Jan 2026, 15 :58 ( https://doi.org/10.12688/f1000research.172798.1 ) Latest published: 14 Jan 2026, 15 :58 ( https://doi.org/10.12688/f1000research.172798.1 ) Introduction Prostate cancer is a growing non-communicable disease concern in South Africa and across the African continent. 1 While advancements in screening and early detection have led to improved outcomes in high-income countries, men in low-income countries (LMICs) often continue to present with late-stage diseases due to a combination of system level barriers and personal health seeking behaviours. 2 , 3 Despite national-level cancer awareness efforts, access to prostate cancer screening and early detection services remains inequitable, especially in rural provinces like the Eastern Cape. 4 Rural men face unique challenges when it comes to prostate cancer. Limited health infrastructure, travel distances to health facilities and a lack of targeted public health messaging contribute to delays in diagnosis and treatment. 5 – 7 There is also strong evidence suggesting that socio-cultural factors particularly norms around masculinity, stigma and traditional beliefs play a major role in how men perceive and respond to prostate cancer risk. 8 , 9 For example, fear of emasculation, concerns about sexual function and embarrassment around rectal examinations are frequently cited reasons why men avoid screening. 10 , 11 Prostate cancer does not only affect individuals medically but it also affects their social, emotional and economic wellbeing. Yet, the voices of men, especially survivors from rural areas are underrepresented in the literature. Their experiences of navigating the health system, coping with diagnosis and managing long-term effects of treatment remain poorly understood. Community perceptions about prostate cancer especially among men without a diagnosis are often shaped by hearsay perceptions, traditional views or general lack of awareness. 12 , 13 These perceptions can influence whether men seek preventive care or avoid services until symptoms become severe. 12 , 13 Existing literature on the South African context has mostly focused on epidemiology, risk factors and screening challenges, with less emphasis on lived experiences and health seeking patterns. A few studies have explored men’s reluctance to access services, but few have incorporated both survivor and general population perspectives within the same study, especially in rural districts. 14 Understanding the barriers and motivators from both sides of the spectrum, those who have lived through the illness and those who may be at risk is essential for designing more effective, culturally responsive health promotion strategies. The Eastern Cape Province, more in particular the OR Tambo District provides a critical case study due to its high prostate cancer incidence and rural population profile. 15 For example, Lusikisiki (a region that refers to Nelson Mandela Academic hospital) recorded an incidence (53.1 per 100 000) that was almost two times higher than the global incidence (29.3 per 100 000) in the period between 2013 to 2017. 16 This study responds to the need for qualitative evidence that projects the voices of rural men. By engaging both prostate cancer survivors and men from the general population, this protocol seeks to explore the real-world perceptions, beliefs and behaviours that influence how men understand and respond to prostate cancer. The findings will help inform community-based interventions that are not only evidence-based but also culturally appropriate and rooted in the lived experiences of the target population. Methods Study design Qualitative phenomenological, semi-structured in-depth interviews of prostate cancer survivors will be undertaken to ascertain their lived experiences, perceptions and beliefs on prostate cancer (survivors), and Qualitative exploratory, semi-structured, in-dept interviews will be undertaken among a general population of males to establish their knowledge on prostate cancer and their health seeking behaviour. This will also establish their attitudes towards orchidectomy as a strategy for managing prostate cancer. Study setting The study will take place in the OR Tambo District, located in the Eastern Cape Province of South Africa. This is a rural, predominantly isiXhosa speaking region marked by poverty, high unemployment and limited access to specialist health services. 17 Health-seeking behaviour in the region is often shaped by cultural beliefs, reliance on traditional medicine and systemic challenges such as transport difficulties and long waiting times. 6 , 18 Participants are recruited from both clinical setting. (for survivors), and community-based locations (for general population of men), this includes clinics and public spaces. The entire OR Tambo District has two regional hospitals, 12 district hospitals, 11 community health centres, 49 clinics, 52 health posts and 61 mobiles. All facilities refer cancer patients to the one central Hospital (Nelson Mandela Academic Hospital). 19 According to the Eastern Cape Cancer Incidence Report 2013-2017, the incidence of prostate cancer is highest in Lusikisiki (53.1%), and Flagstaff (14.1%), this constitutes 88% of the total prostate cancer cases to originate from the OR Tambo District. This is why this study will be conducted in this district. Population and sampling The study population consists of two sub-populations: First, prostate cancer survivors who were diagnosed and/or treated at Nelson Mandela Academic Hospital or affiliated facilities. Diagnosis should have been made at least six months before the date of interview to ensure that they would have had an opportunity to explore the different treatment options. The sub-study will employ a purposive sampling method; and will also target data saturation to ensure an adequate sample size is achieved. This will allow the gathering of comprehensive insights that might not be captured if the sampling would stop at a predetermined sample size. This sampling strategy will also ensure the validity and richness of the study on cancer patients. Second, adult males from the general population with no known history of prostate cancer. Persons born as males, with no known prostatectomy and over 40 years of age who reside in the OR Tambo district will be interviewed in their place of residence. Thios will us a purposive sampling method where researchers will sample until a point of saturation is reached. This will ensure that the data collected is rich and diverse enough to fully understand the experiences of the men who will sampled. Participants will be purposefully samples to ensure there’s variations in age, location (rural vs peri-urban), and exposure to healthcare. For communities that are hard to reach, snowball sampling may be used to reach more participants. A target of 15 participants per group will be recruited. Inclusion criteria 1. For Prostate cancer survivors: • Patients who were diagnosed with Prostate cancer with confirmed pathology results of a prostate cancer diagnosis. • Diagnosis should have been made at least six months before the date of interview. 2. For males in general population: • Persons born as males, and over 40 years of age. • Must reside in the OR Tambo district will be interviewed in their place of residence. Exclusion criteria • Men who are cognitively impaired (who do not have capacity to consent). • Men who are visibly under the influence of alcohol or cannabis. • Patients who are medically unfit to consent. • Men who are undergoing palliative treatment (for the survivors), they may be in severe pain and experiencing severe complications. • Males with a known prostatectomy. Data collection Data will be conducted in isiXhosa by the first author (XN). Interviews will be conducted in the place of residence accompanied by male members of the research team and will last approximately 45-60 minutes. An interview guide (Appendix A) will be used to cover personal experiences and perceptions, discrepancies between behaviour and health-seeking practices, awareness of surgical strategies for cancer prevention and community-0basd health education. The instrument has been systematically designed to gather comprehensive data on demographic characteristics, cultural norms and values, personal experiences and perceptions, discrepancies between behaviour and health seeking practices, awareness of surgical strategies for cancer prevention and community-based health education. The instrument has been systematically designed to gather comprehensive data on demographic characteristics, cultural norms and values, personal experiences and perceptions, discrepancies between behaviour and health seeking practices, awareness of surgical strategies for cancer prevention, and community-based health education. The key variables assessed by the interview guide include cultural norms and values, health-seeking behaviour, perceptions of healthcare services, acceptance of cancer prevention strategies and the impact of community education initiatives. Qualitative exploratory, semi-structured, in-depth interviews will also be undertaken among a general population of males to establish their knowledge on prostate cancer and their health seeking behaviour (Appendix B). This sub-study will also establish their attitudes towards orchidectomy as a strategy for managing prostate cancer. The interview guide has been structured to comprehensively explore the norms, values, experiences and perceptions of men, with a focus on identifying the gap between their behaviour and health practices. The guide will be divided into specific sections, each targeting key areas of interest. The first section will gather demographic information, followed by an exploration of cultural norms ad values that will influence men’s attitudes towards health. Subsequent sections will delve into their personal experiences and perceptions of healthcare, particularly in relation to seeking health care. Another critical area of exploration will be the acceptance of surgical strategies used to manage prostate cancer, assessing how these interventions are perceived by men in the general population. Audio recordings will be supplemented by field notes to preserve the exact language. The interviews will be conducted in isiXhosa, with verbatim transcriptions. These transcriptions will undergo a process of translation and subsequent back-translation to ensure accuracy and fidelity to the original content. Reporting will use the Consolidated criteria for reporting qualitative research (COREQ). 20 This study protocol has been previously posted as a preprint on OSF and medrxiv. 21 , 22 Informed consent All participants will be provided with detailed information about the study objectives and procedures. Written informed consent will be obtained from all participants prior to data collection. Participants will be informed that their participation is voluntary and that they can withdraw at any time without penalty. For participants who are unable to provide written consent, verbal consent will be obtained in the presence of a witness (a member of the research team) and this will be documented, dated and timed, according to the ethical guidelines. Trustworthiness To ensure rigor several strategies will have to be employed to enhance trustworthiness and credibility of the findings following principles outlined by Ritchie 21 Namely: 1. Trustworthiness: This will involve clearly documenting the research process and ensuring transparency in data collection and analysis 2. Audit trail: An audit trail will be maintained throughout the study, this will provide a detailed account of all research decisions, data collection and data anlysis procedures. This documentation will allow others to follow the research process and assess the consistency and dependability of the findings. 3. Peer checking: To enhance credibility and reduce researcher bias, peer checking will be employed. Colleagues with expertise in qualitative research and prostate cancer will review the data and preliminary findings to provide feedback and ensure that the interpretations are sound and unbiased. Furthermore, original audio-recordings will be transcribed into isiXhosa, the local language; transcripts translated into English by a [professional interpreter; and back-translated into isiXhosa by another independent language expert. Consensus will be sought by having the two language experts and the principal author (XN) listening to the original transcripts and making references to fieldnotes to correct discrepancies. 4. Member checking: After data analysis, member checking will be conducted by sharing preliminary findings with a subset of participants. This will allow participants to confirm the accuracy of the interpretations and provide additional insights, this will enhance the credibility of the results. 5. Triangulation: By comparing data from the two sub-studies and supplement with their respective field notes thus ensuring that the findings are consistent and reliable across multiple points. Reflexivity Customary to qualitative study research, this study will disclose reflexivity of the principal researcher (XN) and interviewer as a black, South African female of the amaXhosa tribe who is married with male children, she has intricate knowledge of the cultural practices of the community. The researcher is a health promoter and a researcher with public health training. In this culture where participants will be interviewed, it is difficult to openly discuss male sexual organs and male sexuality when conversing with males or elders. The Researcher will therefore have to overcome the cultural barriers and stereotypes of being perceived to be wanting to be treated differently because of her education and perceived socio-economic status when undertaking this research. Having been raised in rural areas of the Eastern Cape, the researcher possesses an understanding of the social cues specific to amaXhosa men. The co-authors are males, two of whom are medical doctors (SAM and WWC) and two of whom (SCN and WWC) are familiar with cultural practices from the population being interviewed. Data analysis Interpretative phenomenological analysis (IPA) and thematic analysis will be utilised. Transcribed data will be exported to NVIVO 14 for analysis. Thematic coding will be used to identify themes within the data. Inductive analyses will be used to help develop themes which emerge from the data. Themes will be derived using a six steps approach of familiarisation, coding, theme development, review of themes, defining of themes and reporting. Rich data will be represented by having multiple direct quotes from participants. Data will be summarised using graphs and Tables. Dissemination The findings from this study will be shared using a multi-level dissemination strategy to ensure accessibility and impact across academic, clinical and community audiences. At academic level, results will be submitted for publication in peer-reviewed, open-access journals such as F1000, enabling broad access for researchers and clinicians worldwide. Findings will also be presented at national and international conferences. Beyond academia, key results will be communicated to healthcare professionals and policy makers through seminars and stakeholder engagements, while community-level dissemination will include simplified summaries and outreach activities to raise awareness and foster informed decision-making among the public. Study status Ethical approval for this study has been obtained; participant recruitment and data collection has not yet begun. Discussion Ethical considerations This study has received ethical approval from the Human Research Ethics Committee of the Faculty of Medicine and Health Sciences at Walter Sisulu University (Reference Number: 014/2025). Additionally, access approval is granted by the Eastern CAPE provincial Research Committee (Reference Number: EC_202503_009) and the Nelson Mandela Academic Hospital. There will be no personal information that could be used to re-identify individuals. These measures will be taken to protect the data and safeguard patient information. For the other sub-studies where primary data will be collected will be obtained from participants before data collection. Confidentiality will be maintained by anonymising participants through unique identifiers, and all personal information will be de-identified prior to analysis. Explicit consent for recording will be obtained, and participants will be assured that their responses will remain confidential. Data will be stored and will be password protected. Only the Principal investigator will have access to the data. The records will be kept for five (5) years after completion of the study. Participants will be informed of their right to withdraw at any stage without repercussions. Data availability Underlying data No data associated with this article. This is a study protocol and does not include datasets or analysed results. Upon completion of the study, the data will be made available in accordance with the ethical approvals and policies of the Walter Sisulu University ethics committee. This study protocol has been previously posted as a preprint on OSF and medrxiv. 21 , 22 Extended data Zenodo. A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population. https://doi.org/10.5281/zenodo.18161758 . 23 This project contains the following extended data: • Appendix A • Appendix B Data is available under the terms of the Creative Commons Attribution 4.0 International . Acknowledgements The authors would like to express their gratitude and appreciation to the Walter Sisulu University Health Sciences Research Ethics and Scientific Review committee for their guidance. A special thanks to the Walter Sisulu University School of Public health housed within the Faculty of Medicine and Health Sciences for providing support. References 1. Shad H, Dlamini S, Ndlovu N: Prostate cancer in Africa: incidence, mortality and the need for improved health system responses. S. Afr. Med. J. 2024; 114 (4): 1956–1960. 2. Rawla P: Epidemiology of prostate cancer. World. J. Oncol. 2019; 10 (2): 63–89. PubMed Abstract | Publisher Full Text 3. Miller DB, Markt SC, Nguyen CT, et al. : Prostate cancer screening and young black men: can early communication avoid later health disparities? J. Cancer Educ. 2022; 37 (5): 1460–1465. PubMed Abstract | Publisher Full Text 4. Ramaliba TM, Sithole N, Somdyala NIM: Prostate cancer patterns and trends in the Eastern Cape Province of South Africa, 1998-2017. Front. Public Health. 2022; 10 : article 882586. Publisher Full Text 5. National Cancer Registry: Cancer in South Africa: Annual Report 2019. Pretoria: National Institute for Occupational Health; 2019; 302. 6. Day C, Gray A, Padarath A: South African health Review 2019. Durban: Health Systems Trust; 2020. 7. Gqaleni N, Moodley I, Kruger H, et al. : Rural healthcare in South Africa: Challenges and solutions. S. Afr. Fam. Pract. 2020; 62 (1): a5078. 8. Jacobs R, Matlakala FK, Mulaudzi FM: Cultural beliefs of African Men: Implications for prostate cancer screening. Curations. 2020; 42 (1): a2014. 307. 9. Mulaudzi FM, Maputle MS, Lebese RT, et al. : Indigenous health beliefs and practices in prostate cancer screening among African men in Limpopo Province. Curations. 2019; 42 (1): a1900. 10. Cassim N, Ahmad A, Wadee R, et al. : Prostate cancer age-standardised incidence between 2006 and 2016 in Gauteng province, South Africa: A laboratory data-based analysis. S. Afr. Med. J. 2021; 111 (1): 26–32. 312. 11. Naandi H, Kirya F, Galukande M, et al. : Knowledge, attitudes and practices of Ugandan men regarding prostate cancer. Afr. J. Urol. 2013; 19 (4): 165–170. 12. Hoffman A, Amiel GE: The Impact of PSMA PET/CT on Modern Prostate Cancer Management and Decision Mak- ing – The urological Perspective. Cancers. 2023; 15 (13): 3402. 13. Okonofua F: Men’s health in sub-Saharan Africa: Challenges and opportunities. Glob. Health Action. 2022; 15 (1): 2032368. 14. Sithole N, Makhubele J, Rikhotso L: Men’s health-seeking behaviour in rural communities. A social work perspec- tive. J. Soc. Dev. Afr. 2021; 36 (2): 57–75. 15. Eastern Cape Department of Health: Eastern Cape cancer Registry Report: 2013-2017. Bisho: Epidemiology and Surveil- lance Directorate, Eastern Cape Department of Health. OR Tambo District municipality, 2020. District Profile.2020. 16. OR Tambo District Municipality: Eastern Cape, South Africa. 17. Jacobs R, Matlakala FK, Mulaudzi FM: Cultural beliefs of African men: Implications for prostate cancer screening. Curations. 2020; 43 (1): A2014. 324. 18. Eastern Cape Department of Health: OR Tambo Health District Health Plan and Profile 2020/2021. Bisho: Eastern Cape Department of health, Health Systems Planning and Monitoring Directorate; 2020. 19. Tong A, Sainsbury P, Craig K: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care. 2007; 19 (6): 349–357. PubMed Abstract 20. Ritchie J, Lewis J, Nicholls CM, et al. : Qualitative research practice: A guide for social science students and researchers. London: Sage; 2nd ed. 2013. 21. Ntlongweni X: A protocol on perspectives and health-seeking behaviours of men on prostate cancer in rural South Africa: a qualitative study of survivors and the general population [preprint]. OSF. 2025 Oct 7. Reference Source 22. Ntlongweni X, Nomatshila SC, Chitha WW, et al. : medRxiv. 2025.04.02.25325151. Publisher Full Text 23. Ntlongweni X: A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population. Zenodo. 2026. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 14 Jan 2026 ADD YOUR COMMENT Comment Author details Author details 1 Public Health, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa 2 WSU Society and health research institute, Walter Sisulu university, Mthatha, Eastern Cape, 5117, South Africa 3 WSU Institute for Clinical governance & healthcare administration, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, 5117, South Africa 4 WSU Global Centre for human Resources for health intelligence, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, 5117, South Africa 5 School of Population Health, University of South Wales, South Wales, Sydney, Australia 6 Public Health, The George Institute for Global Health, Camperdown, New South Wales, Australia Xolelwa Ntlongweni Roles: Conceptualization, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation Sibusiso Cyprian Nomatshila Roles: Writing – Review & Editing Wezile Wilson Chitha Roles: Writing – Review & Editing Sikhumbuzo Advisor Mabunda Roles: Methodology, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 14 Jan 2026, 15:58 https://doi.org/10.12688/f1000research.172798.1 Copyright © 2026 Ntlongweni X et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Ntlongweni X, Nomatshila SC, Chitha WW and Mabunda SA. A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population [version 1; peer review: 1 approved] . F1000Research 2026, 15 :58 ( https://doi.org/10.12688/f1000research.172798.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 14 Jan 2026 Views 0 Cite How to cite this report: Pradhan A. Reviewer Report For: A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population [version 1; peer review: 1 approved] . F1000Research 2026, 15 :58 ( https://doi.org/10.5256/f1000research.190555.r454939 ) The direct URL for this report is: https://f1000research.com/articles/15-58/v1#referee-response-454939 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Feb 2026 Abhimanyu Pradhan , Manipal Academy of Higher Education,, Manipal, Karnataka, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.190555.r454939 This manuscript presents a qualitative study protocol investigating the perspectives and health-seeking behaviours of men regarding prostate cancer in the OR Tambo District of the Eastern Cape, South Africa. The study proposes conducting semi-structured, in-depth interviews with two groups: (1) ... Continue reading READ ALL This manuscript presents a qualitative study protocol investigating the perspectives and health-seeking behaviours of men regarding prostate cancer in the OR Tambo District of the Eastern Cape, South Africa. The study proposes conducting semi-structured, in-depth interviews with two groups: (1) prostate cancer survivors (n=15) and (2) men from the general population aged over 40 years without a diagnosis of prostate cancer (n=15). The study aims to explore sociocultural beliefs, awareness, attitudes toward screening and treatment (including orchidectomy), and barriers influencing early detection and care-seeking in a rural African context. Data will be collected in isiXhosa, transcribed, translated, and analysed using qualitative methods supported by NVivo software. Ethical approval has been obtained, and several strategies to ensure trustworthiness are described. The topic is highly relevant given the disproportionate burden of prostate cancer in rural South Africa and the documented challenges surrounding late presentation and cultural barriers to screening. 1. Is the rationale for, and objectives of, the study clearly described? Answer: Yes The rationale for the study is clearly articulated. The authors effectively highlight the public health importance of prostate cancer in rural South Africa, emphasizing delayed presentation, limited access to screening, and sociocultural barriers influencing men’s health-seeking behaviour. The literature gap—particularly the limited qualitative exploration of rural men's lived experiences and comparative perspectives between survivors and the general population—is well described. The study objectives are clearly stated and logically derived from the identified gap. No major revisions are required in this section. 2. Is the study design appropriate for the research question? Answer: Partly The overall qualitative design using semi-structured in-depth interviews is appropriate for exploring beliefs, perceptions, and lived experiences. Including both survivors and the general population is a strength and allows for broader contextual understanding. However, there are methodological concerns that must be addressed to ensure scientific coherence: Major Issue 1 – Clarification of Analytic Approach (Must Be Addressed) The manuscript refers to: A phenomenological design, Interpretative Phenomenological Analysis (IPA), Thematic analysis. These approaches are conceptually related but methodologically distinct. IPA is a specific analytic framework grounded in phenomenology, whereas thematic analysis is a broader and more flexible analytic method. The manuscript does not clearly explain whether IPA will be used exclusively, whether reflexive thematic analysis will be used instead, or how both approaches will be combined. The authors must: Clearly specify the primary analytic framework, Justify the choice, Ensure consistency between the stated study design and analytic method. Without this clarification, the methodological foundation lacks coherence. Major Issue 2 – Integration of the Two Participant Groups (Must Be Addressed) The protocol describes two sub-studies (survivors and the general population) but does not clearly explain how findings will be integrated. The authors should clarify: Whether a shared coding framework will be applied to both groups, Whether cross-group comparisons will be conducted, Or whether analyses will remain separate and then synthesised narratively. This clarification is necessary for analytic transparency and rigor. 3. Are sufficient details of the methods provided to allow replication by others? Answer: Partly The manuscript provides substantial methodological detail, including setting, sampling strategy, interview procedures, translation/back-translation, trustworthiness measures, and ethical considerations. However, several clarifications would improve replicability: Issue 1 – Sample Size Justification The target of 15 participants per group is stated, but the manuscript does not sufficiently justify this number in relation to the chosen qualitative approach. If IPA is used, smaller homogeneous samples are often recommended. If thematic analysis is used, saturation principles may justify the sample. The authors should: Provide a methodological justification for the proposed sample size, Describe how data saturation will be operationally defined and assessed. Issue 2 – Operational Definition of Saturation The term “saturation” is mentioned but not defined. The authors should specify: Whether they are using code saturation or meaning saturation, How they will determine when no new themes are emerging, Whether interim analysis will guide recruitment. Issue 3 – Data Management Details While password protection is mentioned, additional details would enhance transparency: How digital files will be encrypted, Who will have access to identifiable data, How transcripts will be anonymised and stored. These issues do not invalidate the protocol but should be clarified to improve methodological rigor. 4. Are the datasets clearly presented in a usable and accessible format? Answer: Not applicable As this is a study protocol, no datasets are presented. The authors appropriately indicate that data will become available after study completion in accordance with ethical policies. Points That Must Be Addressed for Scientific Soundness Clarify and align the analytic framework (IPA vs thematic analysis). Clearly describe how findings from the two participant groups will be integrated analytically. Provide justification for the sample size and clearly explain how saturation will be determined. These issues are essential for ensuring methodological coherence and transparency. Minor Suggestions The manuscript would benefit from professional language editing to address minor typographical errors and repeated sentences in the data collection section. The rationale for focusing specifically on orchidectomy could be further strengthened. A brief statement outlining anticipated limitations (e.g., transferability beyond OR Tambo District) would enhance completeness. Overall Evaluation This protocol addresses a significant and underexplored public health issue and has strong potential to contribute meaningful qualitative evidence to prostate cancer awareness and culturally responsive intervention strategies in rural South Africa. With clarification of the analytic framework, integration strategy, and sampling justification, the manuscript will meet the standards required for methodological rigor and transparency. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public Health, Medical Imaging, Radiology, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Pradhan A. Reviewer Report For: A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population [version 1; peer review: 1 approved] . F1000Research 2026, 15 :58 ( https://doi.org/10.5256/f1000research.190555.r454939 ) The direct URL for this report is: https://f1000research.com/articles/15-58/v1#referee-response-454939 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 04 Mar 2026 Xolelwa Ntliziywana , Public Health, Walter Sisulu University, Mthatha, 5117, South Africa 04 Mar 2026 Author Response The comments are well received and will be incorporated into the protocol once feedback from the second reviewer has been received and all comments have been consolidated. Thank you ... Continue reading The comments are well received and will be incorporated into the protocol once feedback from the second reviewer has been received and all comments have been consolidated. Thank you once again. The comments are well received and will be incorporated into the protocol once feedback from the second reviewer has been received and all comments have been consolidated. Thank you once again. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 04 Mar 2026 Xolelwa Ntliziywana , Public Health, Walter Sisulu University, Mthatha, 5117, South Africa 04 Mar 2026 Author Response The comments are well received and will be incorporated into the protocol once feedback from the second reviewer has been received and all comments have been consolidated. Thank you ... Continue reading The comments are well received and will be incorporated into the protocol once feedback from the second reviewer has been received and all comments have been consolidated. Thank you once again. The comments are well received and will be incorporated into the protocol once feedback from the second reviewer has been received and all comments have been consolidated. Thank you once again. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 14 Jan 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 14 Jan 26 read Abhimanyu Pradhan , Manipal Academy of Higher Education,, Manipal, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Pradhan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Feb 2026 | for Version 1 Abhimanyu Pradhan , Manipal Academy of Higher Education,, Manipal, Karnataka, India 0 Views copyright © 2026 Pradhan A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript presents a qualitative study protocol investigating the perspectives and health-seeking behaviours of men regarding prostate cancer in the OR Tambo District of the Eastern Cape, South Africa. The study proposes conducting semi-structured, in-depth interviews with two groups: (1) prostate cancer survivors (n=15) and (2) men from the general population aged over 40 years without a diagnosis of prostate cancer (n=15). The study aims to explore sociocultural beliefs, awareness, attitudes toward screening and treatment (including orchidectomy), and barriers influencing early detection and care-seeking in a rural African context. Data will be collected in isiXhosa, transcribed, translated, and analysed using qualitative methods supported by NVivo software. Ethical approval has been obtained, and several strategies to ensure trustworthiness are described. The topic is highly relevant given the disproportionate burden of prostate cancer in rural South Africa and the documented challenges surrounding late presentation and cultural barriers to screening. 1. Is the rationale for, and objectives of, the study clearly described? Answer: Yes The rationale for the study is clearly articulated. The authors effectively highlight the public health importance of prostate cancer in rural South Africa, emphasizing delayed presentation, limited access to screening, and sociocultural barriers influencing men’s health-seeking behaviour. The literature gap—particularly the limited qualitative exploration of rural men's lived experiences and comparative perspectives between survivors and the general population—is well described. The study objectives are clearly stated and logically derived from the identified gap. No major revisions are required in this section. 2. Is the study design appropriate for the research question? Answer: Partly The overall qualitative design using semi-structured in-depth interviews is appropriate for exploring beliefs, perceptions, and lived experiences. Including both survivors and the general population is a strength and allows for broader contextual understanding. However, there are methodological concerns that must be addressed to ensure scientific coherence: Major Issue 1 – Clarification of Analytic Approach (Must Be Addressed) The manuscript refers to: A phenomenological design, Interpretative Phenomenological Analysis (IPA), Thematic analysis. These approaches are conceptually related but methodologically distinct. IPA is a specific analytic framework grounded in phenomenology, whereas thematic analysis is a broader and more flexible analytic method. The manuscript does not clearly explain whether IPA will be used exclusively, whether reflexive thematic analysis will be used instead, or how both approaches will be combined. The authors must: Clearly specify the primary analytic framework, Justify the choice, Ensure consistency between the stated study design and analytic method. Without this clarification, the methodological foundation lacks coherence. Major Issue 2 – Integration of the Two Participant Groups (Must Be Addressed) The protocol describes two sub-studies (survivors and the general population) but does not clearly explain how findings will be integrated. The authors should clarify: Whether a shared coding framework will be applied to both groups, Whether cross-group comparisons will be conducted, Or whether analyses will remain separate and then synthesised narratively. This clarification is necessary for analytic transparency and rigor. 3. Are sufficient details of the methods provided to allow replication by others? Answer: Partly The manuscript provides substantial methodological detail, including setting, sampling strategy, interview procedures, translation/back-translation, trustworthiness measures, and ethical considerations. However, several clarifications would improve replicability: Issue 1 – Sample Size Justification The target of 15 participants per group is stated, but the manuscript does not sufficiently justify this number in relation to the chosen qualitative approach. If IPA is used, smaller homogeneous samples are often recommended. If thematic analysis is used, saturation principles may justify the sample. The authors should: Provide a methodological justification for the proposed sample size, Describe how data saturation will be operationally defined and assessed. Issue 2 – Operational Definition of Saturation The term “saturation” is mentioned but not defined. The authors should specify: Whether they are using code saturation or meaning saturation, How they will determine when no new themes are emerging, Whether interim analysis will guide recruitment. Issue 3 – Data Management Details While password protection is mentioned, additional details would enhance transparency: How digital files will be encrypted, Who will have access to identifiable data, How transcripts will be anonymised and stored. These issues do not invalidate the protocol but should be clarified to improve methodological rigor. 4. Are the datasets clearly presented in a usable and accessible format? Answer: Not applicable As this is a study protocol, no datasets are presented. The authors appropriately indicate that data will become available after study completion in accordance with ethical policies. Points That Must Be Addressed for Scientific Soundness Clarify and align the analytic framework (IPA vs thematic analysis). Clearly describe how findings from the two participant groups will be integrated analytically. Provide justification for the sample size and clearly explain how saturation will be determined. These issues are essential for ensuring methodological coherence and transparency. Minor Suggestions The manuscript would benefit from professional language editing to address minor typographical errors and repeated sentences in the data collection section. The rationale for focusing specifically on orchidectomy could be further strengthened. A brief statement outlining anticipated limitations (e.g., transferability beyond OR Tambo District) would enhance completeness. Overall Evaluation This protocol addresses a significant and underexplored public health issue and has strong potential to contribute meaningful qualitative evidence to prostate cancer awareness and culturally responsive intervention strategies in rural South Africa. With clarification of the analytic framework, integration strategy, and sampling justification, the manuscript will meet the standards required for methodological rigor and transparency. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Public Health, Medical Imaging, Radiology, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 04 Mar 2026 Xolelwa Ntliziywana, Public Health, Walter Sisulu University, Mthatha, 5117, South Africa The comments are well received and will be incorporated into the protocol once feedback from the second reviewer has been received and all comments have been consolidated. Thank you once again. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Pradhan A. Peer Review Report For: A protocol on Perspectives and Health-Seeking Behaviours of men on Prostate Cancer in Rural South Africa: A Qualitative study of survivors and the general population [version 1; peer review: 1 approved] . F1000Research 2026, 15 :58 ( https://doi.org/10.5256/f1000research.190555.r454939) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-58/v1#referee-response-454939 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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