Sociocultural and Religious Influences on Breast Cancer Patients Undergoing Chemotherapy at Ho Teaching Hospital, Ghana

Sociocultural and Religious Influences on Breast Cancer Patients Undergoing Chemotherapy at Ho Teaching Hospital, Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Sociocultural and Religious Influences on Breast Cancer Patients Undergoing Chemotherapy at Ho Teaching Hospital, Ghana Agani Afaya, Donald Babamomba Amenah, Silas Selorm Daniels-Donkor, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8535145/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Despite growing literature on cultural and religious influences on breast cancer diagnosis and treatment choices in Ghana, limited empirical evidence focuses specifically on women undergoing chemotherapy and how these beliefs silhouette their treatment trajectories within tertiary care settings. This study explored the sociocultural and religious influences on breast cancer patients undergoing chemotherapy at Ho Teaching Hospital, Ghana. Methods A qualitative descriptive phenomenological approach was employed. Purposive sampling technique was employed to recruit breast cancer patients undergoing chemotherapy. Face-to-face interviews were conducted, and all interviews were transcribed verbatim. Data were analyzed using Colaizzi’s descriptive phenomenological method. Findings: 14 participants were included in the study. Three major themes emerged: ( 1 ) Knowledge and understanding of breast cancer and chemotherapy, ( 2 ) Sociocultural influences on acceptance of chemotherapy, ( 3 ) Role of religious leaders in acceptance and uptake of chemotherapy. Participants described misconceptions about cancer causation, including beliefs in curses and spiritual attacks, which influenced delays or outright rejections of biomedical care. Religious leaders and faith communities provided encouragement, ongoing prayers, emotional and financial support. Conclusion This study highlights the significant impact of socio-cultural and religious factors on chemotherapy acceptance among breast cancer patients in Ghana. The findings emphasize the need for culturally sensitive patient education, stigma reduction efforts, and collaboration with religious and community leaders. Addressing sociocultural barriers can enhance timely access and adherence to life-saving treatment. Biological sciences/Cancer Health sciences/Health care Health sciences/Oncology Breast Cancer Chemotherapy Sociocultural beliefs Religious Influences Ghana Introduction Currently, breast cancer is the foremost cancer diagnosis and the primary cause of cancer-related mortality in females, significantly contributing to the overall cancer burden. It ranks as the second most frequently diagnosed cancer and the fourth leading cause of cancer-related death in 2022 ( 1 , 2 ). Although breast cancer is a predominant malignancy globally, it has been acknowledged for an extended period that the burden is not uniformly distributed ( 3 , 4 ). Regional and country-specific variations in age demographics, prevalence of risk factors, screening uptake, and healthcare infrastructure contribute to global trends that influence the incidence and mortality of breast cancer in specific contexts ( 2 ). Evidence indicates that the incidence of breast cancer is higher in high-income countries, but disproportionately affects low-income countries with high mortality rates ( 2 ). Reflecting these disparities, Asia records the highest number of new breast cancer cases globally (985,817), followed by Europe (557,532) and North America (306,307), whereas Africa experiences the highest mortality-to-incidence ratio (0.510) ( 5 ), underscoring persistent challenges in timely diagnosis and care. Projections suggest that by 2050, breast cancer incidence will rise to approximately 3.2 million (95% UI: 2.8, 3.6) new cases and 1.1 million (95% UI: 1.0, 1.3) breast cancer-related deaths will occur, representing increases of up to 38% incidence and 68% deaths ( 2 ). In 2021, acknowledging the significant impact of premature breast cancer fatalities worldwide and substantial disparities in breast cancer survival across various locations, the World Health Organization (WHO) initiated the Global Breast Cancer Initiative (GBCI) ( 6 ). The GBCI objective is to achieve a 2.5% reduction in mortality rates, which is expected to avert about 2.5 million deaths from 2020 to 2040. Beliefs concerning breast cancer and its treatment have been so embedded within the culture that they have led some women to refuse, delay, or interrupt treatment( 7 ). It was revealed in a recent study that pastors or the community directly forbade women from having cancer treatment ( 7 ). A plethora of studies among African American women revealed how spiritual, religious, and cultural beliefs impact the delay in diagnosis( 8 ), fear of stigma, and fatalism ( 9 ), and throughout the treatment trajectory ( 10 ). Fear of cancer and taboos were so intense that some women were rejected by their loved ones and community. Women believe that the diagnosis is a punishment or retribution for some wrongdoing that led to their not sharing their diagnosis with their family and going through treatment alone ( 7 ). A study in Ghana by Aziato et al. ( 11 ) revealed that women’s treatment decisions were influenced by significant others and by their faith. Women believed that breast cancer was a Western disease and was treated with orthodox medicine. Following their belief, the women expressed mistrust and suspicion of Western treatment, which led them to believe that traditional treatment is more effective. Due to these beliefs, women who were undergoing chemotherapy sometimes shun these medical procedures for conventional treatment, and the positive effect of treatment was attributed to the conventional treatment. In Ghana, breast cancer treatment is firmly ingrained in sociocultural and religious beliefs ( 12 , 13 ). Evidence indicates that women view breast cancer as a spiritual curse, retribution, bad omen, or fate, which results in social exclusion, stigma, and concealment ( 7 , 12 , 14 ). Family members, religious leaders, and community customs strongly influence treatment decisions, sometimes discouraging the use of chemotherapy in favor of prayer camps or traditional healing practices ( 15 , 16 ). These beliefs can result in delayed initiation of chemotherapy, treatment interruption, or complete abandonment of biomedical care, ultimately worsening clinical outcomes. Although studies in Ghana have documented the cultural and religious influence on breast cancer diagnosis and treatment choices, there is limited empirical evidence focusing specifically on women undergoing chemotherapy and how these beliefs silhouette their treatment trajectories within tertiary care settings. It is therefore essential to understand the cultural and religious influences on chemotherapy, as this phase of treatment is particularly critical, physically draining, emotionally demanding, and highly vulnerable to sociocultural pressures. This study explored the sociocultural and religious influences on breast cancer patients undergoing chemotherapy at Ho Teaching Hospital, Ghana. Methods Study design The study employed a qualitative research design, specifically utilizing a descriptive phenomenological approach. Rooted in Husserl’s philosophical tradition, descriptive phenomenology seeks to capture and describe the essence of lived experiences by systematically analyzing participants’ accounts while bracketing the researcher’s assumptions and presuppositions ( 17 ). Central to this approach is the principle of phenomenological reduction (or epoché ), which involves setting aside prior judgments in order to understand the phenomenon as it is experienced directly by participants ( 17 ). The selection of descriptive phenomenology was intentional and aligned with the objectives of this study, to gain an in-depth understanding of the sociocultural and religious influences shaping breast cancer patients’ acceptance and experiences of chemotherapy. Unlike other qualitative approaches, this approach provides a methodological framework that is particularly well-suited for exploring and unravelling the intricate details of individual experiences without imposing theoretical frameworks a priori. By privileging the first-person perspective, descriptive phenomenology allowed us to uncover the meanings and significance that patients themselves attribute to their treatment experiences. This methodological orientation enabled the exploration of both the breadth and depth of these influences, thereby offering insights into the complex ways in which culture, religion, and personal context shape decision-making and coping during chemotherapy ( 17 , 18 ). To enhance methodological rigor and transparency, the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines ( 19 ), ensuring comprehensive documentation of the research process. Setting and participants The study was conducted at the Ho Teaching Hospital (HTH) in the Volta Region of Ghana. Participants who were undergoing chemotherapy for breast cancer were purposively recruited from the oncology unit. A purposive sampling technique was highly suitable for this study because it enabled us to actively select participants who possessed specific characteristics and experiences relevant to the research objectives( 20 , 21 ). Participants were eligible for this study if they were diagnosed with breast cancer, undergoing chemotherapy, and were willing to provide informed consent. However, individuals who were seriously sick or mentally/psychologically unstable at the time of data collection were excluded. Seriously sick individuals referred to patients who were clinically unstable at the time of data collection, such as those experiencing severe physical debilitation, uncontrolled symptoms, or acute clinical complications that impaired their ability to meaningfully participate in an interview. Similarly, “mentally/psychologically unstable participants” referred to patients presenting with acute emotional distress, cognitive impairment, or psychological instability that could compromise their safety, well-being, or ability to provide informed consent. These determinations were made in consultation with the attending clinicians and palliative care team, who assessed each patient’s physical and psychological fitness prior to recruitment. Recruitment and data collection Recruitment was conducted by two trained research assistants with bachelor’s-level qualifications and prior experience in qualitative research. With support from the clinical team, potential participants were identified, approached in person during their scheduled treatment visits, and provided with information about the study. Those interested were given adequate time to ask questions and consider participation. Written informed consent was obtained before participation, and all participants had the right to withdraw at any stage without consequence. Data was collected through in-depth, face-to-face interviews designed to capture participants’ detailed perspectives and lived experiences ( 22 , 23 ). A semi-structured interview guide, informed by existing literature ( 12 ), was developed to explore key domains, including demographic characteristics, knowledge and understanding of breast cancer and chemotherapy, sociocultural influences, and the role of religious beliefs in treatment acceptance and uptake (see Appendix I for interview guide). Pilot interviews were conducted with two breast cancer patients undergoing chemotherapy at the oncology unit to assess the clarity, cultural appropriateness, flow, and sensitivity of the interview questions. Feedback from these pilot interviews informed minor revisions to the interview guide, including refining question wording, improving sequencing for better conversational flow, and adding probes to elicit deeper exploration of participants’ experiences. Both participants met the inclusion criteria and consented to full participation; therefore, their interviews were included in the final sample. Interviews were scheduled at times convenient for participants and conducted in consulting rooms at the clinic to ensure confidentiality and minimize treatment disruption. Each interview lasted between 30 and 60 minutes and was conducted in English, with data collection spanning a two–month period. All interviews were audio-recorded with participants’ consent and transcribed verbatim. To minimize researcher bias and enhance trustworthiness, interviews were conducted by research assistants who had no prior relationship with participants. Their neutrality strengthened the credibility and accuracy of the data, ensuring that participants’ perspectives were authentically represented. The sample size was determined based on the principle of data saturation, which was assessed iteratively through a concurrent data collection and analytic process ( 24 ). Recruitment continued until no new codes, meanings, or insights relevant to the study aim emerged from subsequent interviews, and the analytical structure was judged to be conceptually stable by the research team. At this point, additional interviews were no longer contributing new information, indicating that saturation had been achieved. Saturation was reached after interviewing 14 participants, consistent with guidance on determining adequacy in qualitative research ( 24 – 26 ). Data Analysis Data were analyzed using Colaizzi’s descriptive phenomenological method ( 27 , 28 ). All interviews were transcribed verbatim by trained research assistants with bachelor’s-level qualifications. The transcripts were then independently reviewed and cross-checked against the audio recordings by the research team to ensure accuracy and completeness, while also facilitating familiarization with the data. PhD-prepared investigators supervised the transcription process and led the analysis. Members of the research team read each transcript multiple times to gain an in-depth understanding of participants’ lived experiences. Significant statements related to sociocultural and religious influences on chemotherapy were identified and extracted. Meanings were then formulated from these statements, maintaining a phenomenological attitude and bracketing prior assumptions. Coding and theme development were conducted collaboratively. At least two researchers independently coded sections of the data, and cross-coding was undertaken to enhance consistency and analytical rigor. The coded meanings were grouped into meaning clusters, which were further organized into subthemes and overarching themes through team discussions and consensus. A comprehensive description and fundamental structure of the phenomenon were subsequently developed. Where feasible, synthesized findings were returned to selected participants for validation, strengthening the credibility of the analysis. Rigor Ensuring rigor in qualitative research requires the deliberate use of methodological strategies that strengthen trustworthiness ( 29 ). This study employed several strategies to enhance trustworthiness by evaluating credibility, dependability, confirmability, and transferability of the findings ( 29 ). Credibility was enhanced through repeated visits to the oncology unit prior to data collection, which allowed the researchers to familiarize themselves with the setting, build rapport, and create a trusting environment that encouraged participants to share detailed experiences during the interviews. Member checking was also utilized, where participants were allowed to review and confirm the accuracy of their transcribed interviews and the preliminary findings. To achieve dependability, the research process was thoroughly documented, including a detailed description of the methodology, data collection, and analysis procedures, as well as maintaining an audit trail. Confirmability was enhanced by reflexivity and peer debriefing. To ensure reflexivity, the researchers practiced continuous self-reflection throughout the study process, recording their assumptions, viewpoints, and any biases in a reflexive journal. Team meetings were held regularly to critically investigate how researchers’ preconceptions that sociocultural or religious beliefs necessarily interfere with chemotherapy. This reflexive approach minimized potential bias and fostered transparency and integrity throughout the analytical process. To enhance transferability, descriptions of the study context, participants, and findings were provided. This detailed contextual information enabled other researchers and practitioners to determine the applicability of the study's findings to similar settings or populations. Ethical Consideration Ethical clearance for this study was obtained from the University of Health and Allied Science Research Ethics Committee (Approval No. UR199/1125). The study ensured that all research activities adhered to ethical principles, including privacy, confidentiality, safety, respect for participants, beneficence, and non-maleficence. Informed consent was diligently obtained from all participants in the study. Interviews were conducted at convenient times and places to maintain privacy. Confidentiality was rigorously upheld, with all personal information and responses treated with the utmost discretion, ensuring that data collected was anonymized, and no identifying information was divulged in any research reports or publications. Participants' autonomy was highly respected, as their participation in the study was entirely voluntary and they had the unrestricted right to withdraw at any time without facing repercussions. Recognizing that discussing experiences of breast cancer and chemotherapy could evoke emotional distress, interviews were conducted with sensitivity and compassion, and participants were continuously monitored for signs of discomfort. In instances where participants became visibly emotional, interviews were paused to allow reassurance and support, and participants were reminded of their right to discontinue participation. Where needed, individuals were gently referred to the hospital’s palliative care psychosocial support services for additional emotional support. Beneficence underpinned the study's objectives to inform culturally sensitive breast cancer care and to inform measures to improve chemotherapy experiences and adherence. Cultural norms were respected, acknowledging traditional beliefs regarding the treatment of breast cancer, even if they diverged from medical recommendations. Findings A total of 14 participants were included in the study. The participants’ ages ranged from 25 to 52 years, with the majority being in their 30s and 40s. Nine participants were married, and five are single. Most participants (n = 10) were engaged in small businesses, trading, or artisan work, including fashion design, makeup artistry, and baking. Three participants were unemployed, and one participant worked as a bartender. Their monthly incomes varied significantly, ranging from GHS 800 to GHS 7,000, with traders and fashion designers earning relatively higher incomes, and bartenders and small business owners earning the lower wages. Regarding educational attainment, nine participants had a tertiary education, one had secondary education, three had a basic education, and one participant reported having no formal education. A family history of breast cancer was present in six ( 6 ) participants. Table 1 presents the sociodemographic characteristics of participants involved in the study. Table 1 Socio-demographic information of participants Code Age Marital Status Occupation Monthly Income (GHS) Education Level Family History of Breast Cancer 1 50 Married Business Not specified Basic No 2 31 Single Trader 2000 Tertiary Yes 3 31 Single Trader Not specified Basic No 4 40 Married Makeup Artist 3500 Tertiary Yes 5 37 Married Fashion Designer & Makeup Artist 6000–7000 Tertiary Yes 6 25 Single Baker 1500 Tertiary No 7 35 Married Business 1000 Tertiary No 8 38 Married Trader 3000 Tertiary Yes 9 25 Single Baker 1500 Tertiary No 10 33 Single Unemployed Not Specified Secondary No 11 50 Married Trader Not Specified No Formal education Yes 12 52 Married Bar Tender 800 Basic Yes 13 37 Married unemployed Not Specified Tertiary No 14 45 Married unemployed Not Specified Tertiary No Organization of Emerged Themes and Sub-themes Table 2 presents a summary of themes and sub-themes that emerged from the data collected. A total of three ( 3 ) themes and nine ( 9 ) subthemes were derived from the data analysis. Table 2 Presentation of emerged Themes and Sub-Themes Themes Sub-themes 1. Knowledge and Understanding of Breast Cancer and Chemotherapy 1.1 Understanding of Breast Cancer 1.2 Diagnosis and Treatment Options 1.3 Understanding of Chemotherapy 2. Sociocultural Influences on Acceptance of Chemotherapy 2.1 Family Influence 2.2 Community Influence 2.3 Cultural Beliefs 3 Role of Religious Leaders in Acceptance and Uptake of Chemotherapy 3.1 Religious Leaders' Influence 3.2 Religious Beliefs and Practices 3.3 Spiritual Support Theme 1: Knowledge and Understanding of Breast Cancer and Chemotherapy Theme one explored what participants had been told or understood breast cancer and chemotherapy to be. Participants demonstrated a varied understanding of breast cancer and its symptoms, stages, and diagnostic processes, including procedures like biopsies and imaging tests. Participants were aware of treatment options such as chemotherapy, surgery, and radiotherapy, with some sharing personal experiences of combined treatments. Subtheme 1.1: Understanding of Breast Cancer Participants demonstrated varying degrees of understanding of breast cancer. Most described it as an abnormal growth of cells in the breast that could lead to pain, nipple discharge, changes in breast size, and visible alterations in colour and shape. Several participants also identified lumps as a key symptom and connected them to their personal experiences of discovering the disease. A few participants went further to describe the stages of breast cancer, noting its progression from a localized lump to spread within surrounding tissues and eventually to distant organs such as the bones. This awareness reflected not only information received from health professionals but also lived experiences with the illness. I know breast cancer is an abnormal growth of cells in the breast. For me, it started with pain, and sometimes there was discharge. Over time, the whole breast changed in shape and form, and that’s when I really got worried. I knew something inside wasn’t right. (Participant 10) I realized there was a lump in my breast, and initially it was very painful. Then, I noticed the breast itself was changing in size and shape. That was the turning point for me; I could tell it wasn’t something ordinary. (Participant 5) I know of discharge in the breast, changes in the nipple, change of colour of the breast, and lumps. Those are the things people mention, and I experienced some of them myself. (Participant 2) I know there are stages one, two, three, and four. (Participant 13) …stage one is when there’s just a lump, stage two is when it begins to spread, stage three is when it goes into the tissues around the breast, and stage four is when it extends into the bones. That’s how I understand it. (Participant 4) Subtheme 1.2: Diagnosis and Treatment Options Participants discussed their understanding of the diagnostic procedures for breast cancer, describing processes such as biopsy, ultrasound, mammogram, and scans. Many of them had undergone multiple tests, which shaped their understanding of how the disease is confirmed. Beyond diagnosis, participants listed a range of treatment options available, including chemotherapy, surgery, and radiotherapy. Several participants reflected on their own treatment pathways, emphasizing the sequencing of chemotherapy followed by surgery. This combination of diagnostic and treatment knowledge highlighted how personal experiences shaped their understanding of medical care for breast cancer. They did a biopsy for me, took a tissue sample from my breast, and sent it to the lab. That’s how they confirmed the diagnosis. (Participant 14) For me, it wasn’t just one test. They did an ultrasound, a scan, a mammogram, and then the biopsy. It was a long process before they finally told me I had breast cancer. (Participant 1) I know of chemotherapy, surgery, and radiotherapy. In my case, they told me I would have chemotherapy first, then surgery afterward. That’s how they explained it to me. (Participant 12). Subtheme 1.3: Understanding of Chemotherapy Participants expressed awareness of chemotherapy as a treatment procedure used for cancer, often delivered in sessions. They acknowledged both the benefits and the side effects of chemotherapy, describing it as a difficult but necessary process aimed at curing the disease. Participants identified weakness, vomiting, appetite loss, hair loss, darkening of nails, and skin color changes as common side effects, which they personally endured. Several participants also recognized chemotherapy as a staged process involving multiple sessions, usually between six and eight cycles, spaced weeks apart. Their narratives underscored the demanding nature of chemotherapy but also reflected a determination to complete the treatment for the possibility of a cure. Chemotherapy is a treatment given mostly to cancer patients to cure the disease. It comes in sessions, and you have to go through all of them before they say you’re done. For me, each session felt like a big step, because you don’t just do one and finish; it’s a process. You keep going back, even when you feel weak, until the doctors say you’ve completed all the cycles. That’s when you know you’re done with the treatment. (Participant 13) Chemotherapy is a treatment where they use medicine to kill the cancer cells. That’s how they explained it to me, and I’ve come to understand it that way. The doctors said the drugs are very strong, and their job is to destroy the bad cells in the body. So anytime I go for the treatment, I remind myself that even though it makes me weak, it is actually working inside to fight the cancer. (Participant 4) The only benefit, and really the only reason, why someone should do chemotherapy is to cure cancer. That’s what motivated me to endure it, even with all the difficulties. (Participant 2) When you take chemo, you feel weak, you vomit, and eating becomes hard unless you force yourself. For me, it was very difficult to keep food down. I would try to eat something small, but immediately I felt like throwing up. Sometimes, even the smell of food made me nauseous. It was a struggle because I knew I had to eat to keep my strength, but my body simply refused. (Participant 1) My hair fell off, my nails turned dark, and even my skin color changed. It was like I didn’t recognize myself anymore. When I looked in the mirror, it felt like a stranger was staring back at me. The changes were so visible that people around me also noticed and kept asking questions. It affected how I felt about myself, and sometimes I didn’t even want to step outside because of how different I looked. (Participant 5) I was told I had to go through eight cycles, one every three weeks. At first, it sounded endless, and I wondered how I would manage it. Each session left me weak, and before I could recover fully, it was time for the next one. Still, I knew I had to complete it because that was the only way to get better. (Participant 9) Theme 2: Sociocultural Influences on Acceptance of Chemotherapy Subtheme 2.1: Family Influence Family support emerged as a major factor in participants’ acceptance and continuation of chemotherapy. Spouses, siblings, and extended family members provided encouragement, financial resources, and emotional backing. Although families were often initially shocked by the diagnosis, they became a source of resilience for participants. In some cases, husbands strongly urged their wives to begin treatment early, emphasizing its importance for survival. Family support not only reduced the emotional burden but also helped participants manage the costs and physical demands of treatment. At first, my family members were very down, very emotional about my diagnosis. But over time, they supported me emotionally and financially. That encouragement kept me going. (Participant 8) When I was first told about my diagnosis, I was scared and confused. I didn’t know what to do. My husband sat me down and explained that early treatment was the only way forward. He reminded me every day that waiting would make things worse. At first, I felt weak and hesitant, but he kept encouraging me and even accompanied me to the hospital on my first day of chemo. He kept saying, ‘Don’t be afraid, this is the right step.’ Honestly, without his constant support and reassurance, I don’t think I would have had the courage to start the treatment at all. (Participant 12) My sister, my dad’s sister, and even some friends helped me. They provided money when I needed it and gave me emotional strength when I felt weak. Without them, I don’t think I could have gone through the treatment. (Participant 1) Subtheme 2.2: Community Influence Participants described mixed experiences with their communities. While some communities provided encouragement and support, others contributed to stigma and isolation, leaving some participants wishing for an untimely death. Negative perceptions including viewing cancer as a curse, a spiritual affliction, or a death sentence, led to avoidance and discrimination. Such attitudes even affected participants’ livelihoods, as some lost customers after their diagnosis became known. On the other hand, some community members, particularly educated individuals and neighbours, were described as supportive, offering advice, small financial contributions, food, and regular check-ins. This highlighted the dual role of communities in either compounding stigma or offering practical assistance. Some people in my community think breast cancer is not just a sickness but a curse. They believe it is spiritual, that maybe someone has bewitched you or that it is punishment for something. Because of that, they see it as something that prayer or traditional rituals can cure, rather than going through hospital treatment like chemotherapy. (Participant 8) …others even think it’s contagious, so they avoid you. Because of that, I lost my business, customers just stopped coming when they heard about my condition. (Participant 5) People in my community see cancer as a death sentence. Once they find out you have it, they begin to distance themselves, almost as if it’s contagious. They don’t want to come near you, and that kind of rejection makes you feel very alone and isolated, even when you need support the most. (Participant 4) There are educated people in my community who encouraged me to continue with chemotherapy. They would sit me down, talk to me, and give me advice about why I should not stop the treatment. Their words gave me confidence and helped me to see that I was making the right decision by following through with the hospital care. (Participant 11) Even some of my neighbours showed kindness in ways I did not expect. They made small contributions, brought me food, and checked on me regularly. Their support made me feel that I was not completely alone in this journey, and it gave me the strength to continue with the treatment. (Participant 7) Subtheme 2.3: Cultural Beliefs Many participants shared how cultural beliefs influenced their perception of chemotherapy. They were advised against chemotherapy in favour of herbal treatments while attributing breast cancer to curses and spiritual attacks. Participants recalled: Some people advised me not to do chemotherapy. They kept saying the hospital drugs were too strong and would only make me weaker. Instead, they told me to try herbal medicine, because in our community, many people believe herbs can cure almost every sickness. A friend even came to my house with some leaves and roots, showing me how to boil and drink them three times a day. At that point, I was already feeling weak and confused, so it was difficult to decide who to listen to. They said the herbs were safer and cheaper than chemotherapy, but deep down, I was not sure. I felt torn between what the community was advising me to do and what the doctors had told me at the hospital. (Participant 1) …in my culture, some people believe that breast cancer is not just a sickness but the result of a curse or a spiritual attack. They think someone might have bewitched you or that the illness comes as punishment for something wrong you did. When people see you with breast cancer, they don’t always think about hospitals or doctors first. Instead, they say you must go to a shrine or see a spiritual healer to break the curse. A few relatives even suggested that I stop chemotherapy and go for prayers and cleansing rituals because they believed the cancer was caused by evil spirits. It was very hard because when people you trust tell you these things, it makes you doubt yourself and the treatment you are receiving. (Participant 8) Other participants noted that their culture did not impose restrictions on seeking medical treatments like chemotherapy. They emphasized the absence of cultural barriers, which allowed them to pursue conventional healthcare options without conflict. …in my ethnic group, there’s no restriction against chemotherapy. We don’t see it as something forbidden because of culture, so I felt free to go ahead with hospital treatment. That freedom made it easier for me to focus on getting the care I needed without feeling like I was breaking any tradition. (Participant 3) Theme 3: Role of Religious Leaders in Acceptance and Uptake of Chemotherapy Religion featured prominently in participants’ accounts of living with breast cancer and making decisions about treatment. Religious leaders, church members, and spiritual practices provided encouragement, financial support, and ongoing prayer. At times, conflicting messages within religious communities shaped participants’ decisions in different ways. Subtheme 3.1: Religious Leaders' Influence Religious leaders such as pastors and spiritual fathers encouraged participants to accept chemotherapy, often framing it as compatible with faith. They also provided prayers, guidance, and financial assistance, with some churches organizing fundraising support. One participant recalled: My pastor encouraged me to go for chemotherapy and prayed for me. He didn’t just tell me to go; he kept assuring me that God would strengthen me through the process. Anytime I felt weak or doubted myself, he reminded me that the treatment and prayer could work together. That support gave me the courage to continue. (Participant 4) Another added : My spiritual father also pushed me to do the treatment. He didn’t just pray for me, he spoke to me about the importance of getting the hospital care. Beyond that, the church supported me financially; they raised money for me through the welfare fund. That financial support really helped because the treatment was expensive, and without it, I would have struggled. (Participant 1) Subtheme 3.2: Religious Beliefs and Practices Not all religious influences were supportive. Some church members advised against chemotherapy, suggesting reliance on prayer or miracle healing. However, in several cases, pastors intervened to counter these messages, while others emphasized that prayer and medical treatment could coexist. Some people in my church told me chemotherapy was not necessary, that prayer alone could heal me. A friend even suggested I travel to Nigeria for miracle healing instead of continuing treatment. (Participant 8) When a few members of the church discouraged me from going through chemotherapy, saying I should rely only on prayer, my pastor stepped in and corrected them. He explained clearly that prayer should go hand-in-hand with medical treatment, not replace it. Hearing him say that gave me confidence and settled my doubts because I realized I could hold onto my faith while still taking the treatment seriously. (Participant 5) In my church, they believe in medical treatment, but also in prayer as a source of strength. My pastor told me I should go for chemo, and prayer would support the process. (Participant 4) Subtheme 3.3: Spiritual Support Participants consistently emphasized the role of prayer and spiritual encouragement in coping with their illness. Pastors and church members offered prayers, visits, and words of encouragement, helping participants to remain strong and maintain hope throughout their treatment. My pastor prays with me regularly and gives me spiritual guidance. He checks in on me, encourages me, and reminds me that God is with me through it all. The church members also pray for me during services and even when they visit me at home. They encourage me to stay strong and not give up. That kind of spiritual support keeps me going, especially on the days when the side effects of chemotherapy make me feel very weak and hopeless. (Participant 5) …the church members visited me often, and whenever they came, they didn’t just pray but also brought food and little things to support me. They would sit with me, talk, and encourage me not to lose hope. Their words and presence reminded me that I wasn’t alone in this fight. Knowing that people cared enough to check on me and keep me company gave me the strength to continue with the treatment. (Participant 7) Discussions This study examined the sociocultural and religious factors influencing breast cancer patients’ acceptance and experiences of chemotherapy at Ho Teaching Hospital in Ghana. While participants demonstrated some awareness of breast cancer symptoms, diagnostic procedures, and the purpose of chemotherapy, substantial gaps persisted regarding its etiology, risk factors, and treatment efficacy. Sociocultural factors, including family encouragement, community perceptions, and prevailing cultural norms, emerged as critical determinants of patients’ willingness and acceptance of initiating and adhering to chemotherapy. These influences operated in both positive and negative directions, with some participants reporting strong support while others experienced stigmatization or discouragement. Religious beliefs and practices were similarly influential, with faith leaders and prayer providing comfort and motivation for some women, whereas reliance on miracle healing led others to question or delay biomedical treatment. Overall, the findings highlighted the dynamic ways in which knowledge, sociocultural expectations, and religious worldviews influenced women’s experiences of cancer care in Ghana. The study found that most participants had a basic understanding of breast cancer, particularly regarding its symptoms, stages, and the need for treatment, but lacked adequate knowledge and awareness of the causes, risk factors, and treatment. These findings are consistent with a study that reported that most breast cancer patients in the United States could correctly identify their symptoms and disease stage ( 30 ); however, African American women had limited knowledge of risk factors, which contributed to poor engagement in preventive healthcare and delayed diagnosis ( 31 ). A study in Ethiopia revealed similar results as women had a general awareness of the signs and progression of breast cancer, but lacked sufficient knowledge about treatment options, which may affect timely decision-making in seeking appropriate care ( 32 , 33 ). Some women only learn about breast cancer after experiencing severe symptoms, often at advanced stages, which significantly reduces their chances of survival ( 33 ). In the same vein, most women do not know that family history and hormonal changes increase breast cancer risk, which leads to a false sense of security among those without visible symptoms ( 32 ). These variations in knowledge across contexts reflect the differences in scope and reach of public health education efforts. In high-resource settings like the U.S., breast cancer awareness campaigns are widespread, whereas in many African countries, educational gaps persist, particularly in rural areas. Thus, while efforts to improve symptom awareness have been successful, more attention is needed in educating women about the risk factors and causes of breast cancer. This could help in promoting early screening behaviors and reducing misconceptions that delay medical intervention. Cultural beliefs and traditional healing practices further contribute to differences in knowledge levels. Participants in this study reported that they were initially reluctant to start chemotherapy because they were told that breast cancer could be the result of a curse, supernatural attack, or punishment from ancestors, leading them to seek spiritual interventions before medical treatment. In Ghana, for instance, while many women recognized the physical symptoms of breast cancer, there are indications that supernatural explanations and spiritual beliefs about the disease still influenced perceptions, which could delay early medical intervention ( 34 ). Furthermore, educational disparities play a significant role in demystifying these cultural and traditional misconceptions of breast cancer among these women. Women with higher education levels demonstrate greater awareness and better understanding of breast cancer, whereas those with less formal education are more likely to rely on community beliefs or traditional medicine before seeking hospital care ( 35 ). These findings emphasize the importance of culturally sensitive health education initiatives that dispel entrenched misconceptions and reinforce the message that chemotherapy complements, rather than contradicts, faith, while highlighting its critical role as a medical intervention for survival. Family and community played a crucial role in facilitating the acceptance of chemotherapy by breast cancer patients. Several participants credited encouragement from loved ones with helping them endure the physical and emotional difficulties associated with treatment. Financial support from family members also eased the burden of treatment costs and transportation expenses. Prior studies confirm that this varied support received by patients improved their adherence to treatment and likely completion of treatment regimens ( 36 – 38 ). However, community responses were not universally supportive. Some participants experienced social withdrawal, gossip, or overt stigma following their diagnosis, which inflicted deep psychological distress and eroded motivation to continue treatment. Others even wish for an untimely death to escape the ongoing shame, social exclusion, and emotional and psychological burden their illness has imposed on them and their families. Stigmatization has been widely reported as a barrier to cancer care in Ghana, where women frequently conceal their illness or abandon treatment due to shame, fear of discrimination, or community pressure to pursue alternative healing ( 39 , 40 ). Such experiences highlight the urgent need for community-wide education and advocacy programs to challenge myths, reduce stigma, and promote positive attitudes toward chemotherapy. Religious leaders play a pivotal role in women’s acceptance of chemotherapy, as their spiritual guidance and encouragement foster resilience and motivate continued care-seeking. The findings in this study revealed that religious leaders reassured participants of the need to keep their faith while seeking care, prayed with them, and even helped raise funds for their treatment, reinforcing their decision to proceed with chemotherapy. These findings align with studies in Nigeria and South Africa, which documented the supportive roles of religious leaders in encouraging medical treatment, offering psychological support, and reinforcing the notion that faith and modern medicine can coexist ( 38 , 41 ). Nevertheless, the influence of religious leaders was not uniformly positive. Certain denominations discouraged chemotherapy, promoting the belief that prayer, fasting, or divine intervention alone could provide healing. Such teachings contribute to delayed presentation to hospitals, often at advanced stages when the disease has already metastasized to other organs, thereby limiting treatment effectiveness and worsening prognoses. Similar patterns have been reported in Nigeria, where pastors encouraged patients to rely solely on faith healing ( 42 ). Likewise, in Ghana, some church groups actively discouraged biomedical treatment and promoted traditional healing methods, leading some women to abandon chemotherapy altogether ( 43 ). These negative religious attitudes perpetuate misconceptions about biomedical care, reinforce distrust in modern medicine, and contribute to poor adherence and adverse outcomes. Taken together, these findings illustrate the ambivalent role of religion in shaping women’s acceptance of chemotherapy. While religious leaders can be strong advocates and powerful allies in reinforcing treatment adherence and providing psychosocial support, they may also act as barriers when religious doctrine is positioned in opposition to modern medicine. To address this tension, there is a critical need for collaborative partnerships between healthcare providers and religious institutions. Public health initiatives that actively engage faith leaders in cancer education and awareness campaigns could harness their influence to normalize chemotherapy, dispel myths, and reframe treatment as consistent with faith. Such efforts hold promise for improving adherence, reducing delays, and ultimately enhancing survival outcomes for women diagnosed with breast cancer in Ghana. Limitations Despite the valuable insights this study has offered, there are notable limitations. Firstly, this study relied on self-reported data from participants, which may introduce biases such as social desirability or recall inaccuracies. Breast cancer patients may overstate or understate their experiences and perceptions due to emotional or psychological factors, potentially affecting the reliability of the findings. Additionally, the study is confined to the Ho Teaching Hospital, which may limit the generalizability of the results to other regions or healthcare settings with different sociocultural and religious contexts. The qualitative nature of the study, while providing in-depth insights, restricts the ability to quantify the extent of sociocultural and religious influences or establish causal relationships. Lastly, logistical challenges, such as scheduling interviews around patients' chemotherapy sessions and ensuring privacy in a busy hospital setting, may impact the depth and quality of data collected. These limitations highlight the need for further research, including mixed-methods or multi-site studies, to address these gaps and provide a broader perspective on the sociocultural and religious influences on breast cancer treatment in Ghana. Conclusion This study highlights the significant impact of socio-cultural and religious factors on chemotherapy acceptance among breast cancer patients in Ghana. While family support encouraged treatment adherence, misconceptions, stigma, and spiritual beliefs often led to delays or rejection of chemotherapy. The role of religious leaders was mixed, with some supporting treatment and others discouraging it in favor of faith healing. These findings emphasize the need for culturally sensitive patient education, stigma reduction efforts, and collaboration with religious and community leaders. Strengthening these areas will enhance chemotherapy acceptance and improve breast cancer treatment outcomes in Ghana. Declarations Acknowledgment Not applicable. Author contributions A.A. and D.B.A. conceived the study and led the data analysis and manuscript drafting. S.S.D., F.K., R.A.T., G.A.Y., K.R., D.B.M., C.G., E.A., and R.A.A. conducted the literature search and contributed to writing the manuscript. All authors critically reviewed the manuscript for important intellectual content, contributed revisions, and approved the final version for submission. Competing interest The authors declare that they have no competing interests in the conception, design, and execution of this study. Data availability The datasets generated and/or analyzed during the current study are not publicly available due to the sensitive and confidential nature of the participants’ personal and medical information, as well as ethical restrictions imposed by the institutional review board. However, de-identified data may be available from the corresponding author on reasonable request and subject to approval by the ethics committee. Ethical approval and consent to participate The researchers sought ethical review and clearance from the Research Ethics Committee of the University of Health and Allied Sciences before commencing data collection. Written informed consent to participate was obtained from all of the participants in the study. The study followed the principles and guidelines of the Declaration of Helsinki. Funding This study did not receive any funding. Consent to publish Not applicable. References Bray, F. et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 74 (3), 229–263 (2024). Kim, J. et al. Global patterns and trends in breast cancer incidence and mortality across 185 countries. Nat. Med. 31 (4), 1154–1162 (2025). Arnold, M. et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast Edinb. Scotl. 66 , 15–23 (2022). Heer, E. et al. Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study. Lancet Glob Health . 8 (8), e1027–e1037 (2020). Freihat, O., Sipos, D. & Kovacs, A. Global burden and projections of breast cancer incidence and mortality to 2050: a comprehensive analysis of GLOBOCAN data. Front Public Health [Internet]. Oct 30 [cited 2025 Dec 29];13:1622954. (2025). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12611818/ Anderson, B. O. et al. The Global Breast Cancer Initiative: a strategic collaboration to strengthen health care for non-communicable diseases. Lancet Oncol. 22 (5), 578–581 (2021). Shewbridge, A., Wiseman, T. & Richardson, A. Treatment Decision-Making in West African Women With Breast Cancer: A Critical Ethnography. Semin Oncol. Nurs. 41 (3), 151878 (2025 June). Gullatte, M. M., Brawley, O., Kinney, A., Powe, B. & Mooney, K. Religiosity, spirituality, and cancer fatalism beliefs on delay in breast cancer diagnosis in African American women. J. Relig. Health . 49 (1), 62–72 (2010). Torres, E., Dixon, C. & Richman, A. R. Understanding the Breast Cancer Experience of Survivors: a Qualitative Study of African American Women in Rural Eastern North Carolina. J. Cancer Educ. Off J. Am. Assoc. Cancer Educ. 31 (1), 198–206 (2016). Lackey, N. R., Gates, M. F. & Brown, G. African American women’s experiences with the initial discovery, diagnosis, and treatment of breast cancer. Oncol. Nurs. Forum . 28 (3), 519–527 (2001). Aziato, L. & Clegg-Lamptey, J. N. A. Breast cancer diagnosis and factors influencing treatment decisions in Ghana. Health Care Women Int. 36 (5), 543–557 (2015). Afaya, A. et al. Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review. BMC Womens Health [Internet]. 2024 May 14 [cited 2025 Dec 25];24(1):288. Available from: https://doi.org/10.1186/s12905-024-03106-y Salisu, W. J., Mirlashari, J., Seylani, K., Varaei, S. & Thorne, S. Fatalism, distrust, and breast cancer treatment refusal in Ghana. Can Oncol Nurs J [Internet]. 2022 Apr 1 [cited 2025 Sept 16];32(2):198–205. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9040785/ Jiang, C. et al. Metaphors and Stigma in Confucian Culture: A Qualitative Study of Cancer Risk Communication Dilemmas for Cascade Screening Among Hereditary Cancer Families From China. Psychooncology [Internet]. 2025 June [cited 2025 Dec 25];34(6):e70205. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12163203/ Anago, E. K. et al. Empty action: two heads are better than one: Spiritual care provision for patients living with advanced cancer in Sub-Saharan Africa: A meta-synthesis. Eur. J. Oncol. Nurs. Off J. Eur. Oncol. Nurs. Soc. 76 , 102854 (2025 June). Mensah, A. B. B. et al. Utilisation of traditional medicine among women diagnosed with breast cancer in Ghana: a descriptive phenomenological study. BMC Complement Med Ther [Internet]. Jan 23 [cited 2025 Sept 8];24(1):50. (2024). Available from: https://doi.org/10.1186/s12906-024-04364-x Morrow, R. Colaizzi’s descriptive phenomenological method. Mensah, A. B. B. et al. Utilisation of traditional medicine among women diagnosed with breast cancer in Ghana: a descriptive phenomenological study. BMC Complement. Med. Ther. 24 (1), 50 (2024). Tong, A., Sainsbury, P. & Craig, J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care J. Int. Soc. Qual. Health Care . 19 (6), 349–357 (2007). Creswell, J. W. & Creswell, J. D. Research Design Qualitative, Quantitative, and Mixed Methods Approaches. [Internet]. 4th Edition. Newbury Park.: SAGE Publications Inc; (2017). Available from: https://www.scirp.org/reference/referencespapers?referenceid=2969274 Creswell, J. Educational Research Planning: Planning, Conducting, and Evaluating Quantitative and Qualitative Research. (2011). Kallio, H., Pietilä, A. M., Johnson, M. & Kangasniemi, M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. J. Adv. Nurs. 72 (12), 2954–2965 (2016). DeJonckheere, M. & Vaughn, L. M. Semistructured interviewing in primary care research: a balance of relationship and rigour. Fam Med. Community Health . 7 (2), e000057 (2019). Saunders, B. et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual. Quant. 52 (4), 1893–1907 (2018). Hennink, M. & Kaiser, B. N. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc. Sci. Med. 1982 . 292 , 114523 (2022). Fusch, P. & Ness, L. Are We There Yet? Data Saturation in Qualitative Research. Qual. Rep. 2015 Sept 7 ;20(9):1408–1416 . Morrow, R. Colaizzi’s descriptive phenomenological method. Beck CT. Paul Colaizzi’s Descriptive Phenomenological Methodology. In: Introduction to Phenomenology: Focus on Methodology [Internet]. SAGE Publications, Inc.; 2021 [cited 2025 Dec 29]. pp. 19–30. Available from: https://methods.sagepub.com/book/mono/introduction-to-phenomenology/chpt/3-paul-colaizzi-s-descriptive-phenomenological-methodology. Guba, E. G. & Lincoln, Y. S. Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. San Francisco, CA, US: Jossey-Bass; xxv, 423 p. (Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches). (1981). Freedman, R. A. et al. Breast cancer knowledge and understanding treatment rationales among diverse breast cancer survivors. Breast Cancer Res. Treat. 196 (3), 623–633 (2022). Jiang, Y., Sereika, S. M., Bender, C. M., Brufsky, A. M. & Rosenzweig, M. Q. Beliefs in Chemotherapy and Knowledge of Cancer and Treatment Among African American Women With Newly Diagnosed Breast Cancer. Oncol. Nurs. Forum . 43 (2), 180–189 (2016). Lankrew Ayalew, T., Wale, B. G., Haile, K. E., Zewudie, B. T. & Feleke, M. G. Health-related quality of life and associated factors among cancer patients in Ethiopia: Systematic review and meta-analysis. PloS One . 17 (12), e0277839 (2022). Mbuka-Ongona, D. & Tumbo, J. M. Knowledge about breast cancer and reasons for late presentation by cancer patients seen at Princess Marina Hospital, Gaborone, Botswana. Afr. J. Prim. Health Care Fam Med. 5 (1), 465 (2013). Afaya, A. et al. Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review. BMC Womens Health . 24 (1), 288 (2024). Obrist, M. et al. Factors related to incomplete treatment of breast cancer in Kumasi, Ghana. Breast Edinb. Scotl. 23 (6), 821–828 (2014). Anyanwu, S. & Egwuonwu, O. Acceptance and adherence to treatment among breast cancer patients in Eastern Nigeria. Breast Edinb. Scotl. 20 (Suppl 2), S51–S53 (2011). Nkenu, N. G., Nsoh, M., Paul, A. J. & Nkondjock, A. Characterizing factors influencing adherence to surgery and chemotherapy amongst women suffering from breast cancer in Mbingo Baptist Hospital Cameroon. Pan Afr. Med. J. 43 , 102 (2022). Kepkey, B., Coetzee, B., Edge, J. & Kagee, A. Factors influencing adherence to chemotherapy amongst breast cancer patients at a tertiary hospital: Healthcare workers’ perspectives. Eur. J. Surg. Oncol. 48 , e237 (2022). Tuck, C. Z., Akparibo, R., Gray, L. A., Aryeetey, R. N. O. & Cooper, R. What influences cancer treatment service access in Ghana? A critical interpretive synthesis. BMJ Open. 12 (10), e065153 (2022). Salisu, W. J., Mirlashari, J., Seylani, K., Varaei, S. & Thorne, S. Fatalism, distrust, and breast cancer treatment refusal in Ghana. Can. Oncol. Nurs. J. 32 (2), 198–205 (2022). Chidebe, R. C. W. et al. Not even my husband knows that I have this [breast cancer]: survivors’ experiences in accessing, navigating and coping with treatment. Support Care Cancer . 32 (2), 112 (2024). Nwakasi, C. et al. He [the doctor] said I should go and wait for my death: Dualities in care and support access among female cancer survivors. J Cancer Policy [Internet]. 2023 Mar [cited 2025 Sept 16];35(100374). Available from: http://www.scopus.com/inward/record.url?scp=85145686720&partnerID=8YFLogxK Mburu, W. et al. Pathways to Breast Cancer Diagnosis and Treatment Among Women in Ghana: A Qualitative Study. Womens Health Rep. New. Rochelle N . 2 (1), 234–244 (2021). Additional Declarations No competing interests reported. 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It ranks as the second most frequently diagnosed cancer and the fourth leading cause of cancer-related death in 2022 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although breast cancer is a predominant malignancy globally, it has been acknowledged for an extended period that the burden is not uniformly distributed (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Regional and country-specific variations in age demographics, prevalence of risk factors, screening uptake, and healthcare infrastructure contribute to global trends that influence the incidence and mortality of breast cancer in specific contexts (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Evidence indicates that the incidence of breast cancer is higher in high-income countries, but disproportionately affects low-income countries with high mortality rates (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Reflecting these disparities, Asia records the highest number of new breast cancer cases globally (985,817), followed by Europe (557,532) and North America (306,307), whereas Africa experiences the highest mortality-to-incidence ratio (0.510) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), underscoring persistent challenges in timely diagnosis and care. Projections suggest that by 2050, breast cancer incidence will rise to approximately 3.2\u0026nbsp;million (95% UI: 2.8, 3.6) new cases and 1.1\u0026nbsp;million (95% UI: 1.0, 1.3) breast cancer-related deaths will occur, representing increases of up to 38% incidence and 68% deaths (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2021, acknowledging the significant impact of premature breast cancer fatalities worldwide and substantial disparities in breast cancer survival across various locations, the World Health Organization (WHO) initiated the Global Breast Cancer Initiative (GBCI) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The GBCI objective is to achieve a 2.5% reduction in mortality rates, which is expected to avert about 2.5\u0026nbsp;million deaths from 2020 to 2040.\u003c/p\u003e \u003cp\u003eBeliefs concerning breast cancer and its treatment have been so embedded within the culture that they have led some women to refuse, delay, or interrupt treatment(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). It was revealed in a recent study that pastors or the community directly forbade women from having cancer treatment (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A plethora of studies among African American women revealed how spiritual, religious, and cultural beliefs impact the delay in diagnosis(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), fear of stigma, and fatalism (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), and throughout the treatment trajectory (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Fear of cancer and taboos were so intense that some women were rejected by their loved ones and community. Women believe that the diagnosis is a punishment or retribution for some wrongdoing that led to their not sharing their diagnosis with their family and going through treatment alone (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA study in Ghana by Aziato et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) revealed that women\u0026rsquo;s treatment decisions were influenced by significant others and by their faith. Women believed that breast cancer was a Western disease and was treated with orthodox medicine. Following their belief, the women expressed mistrust and suspicion of Western treatment, which led them to believe that traditional treatment is more effective. Due to these beliefs, women who were undergoing chemotherapy sometimes shun these medical procedures for conventional treatment, and the positive effect of treatment was attributed to the conventional treatment.\u003c/p\u003e \u003cp\u003eIn Ghana, breast cancer treatment is firmly ingrained in sociocultural and religious beliefs (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Evidence indicates that women view breast cancer as a spiritual curse, retribution, bad omen, or fate, which results in social exclusion, stigma, and concealment (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Family members, religious leaders, and community customs strongly influence treatment decisions, sometimes discouraging the use of chemotherapy in favor of prayer camps or traditional healing practices (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). These beliefs can result in delayed initiation of chemotherapy, treatment interruption, or complete abandonment of biomedical care, ultimately worsening clinical outcomes.\u003c/p\u003e \u003cp\u003eAlthough studies in Ghana have documented the cultural and religious influence on breast cancer diagnosis and treatment choices, there is limited empirical evidence focusing specifically on women undergoing chemotherapy and how these beliefs silhouette their treatment trajectories within tertiary care settings. It is therefore essential to understand the cultural and religious influences on chemotherapy, as this phase of treatment is particularly critical, physically draining, emotionally demanding, and highly vulnerable to sociocultural pressures. This study explored the sociocultural and religious influences on breast cancer patients undergoing chemotherapy at Ho Teaching Hospital, Ghana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe study employed a qualitative research design, specifically utilizing a descriptive phenomenological approach. Rooted in Husserl\u0026rsquo;s philosophical tradition, descriptive phenomenology seeks to capture and describe the \u003cem\u003eessence of lived experiences\u003c/em\u003e by systematically analyzing participants\u0026rsquo; accounts while bracketing the researcher\u0026rsquo;s assumptions and presuppositions (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Central to this approach is the principle of phenomenological reduction (or \u003cem\u003eepoch\u0026eacute;\u003c/em\u003e), which involves setting aside prior judgments in order to understand the phenomenon as it is experienced directly by participants (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The selection of descriptive phenomenology was intentional and aligned with the objectives of this study, to gain an in-depth understanding of the sociocultural and religious influences shaping breast cancer patients\u0026rsquo; acceptance and experiences of chemotherapy. Unlike other qualitative approaches, this approach provides a methodological framework that is particularly well-suited for exploring and unravelling the intricate details of individual experiences without imposing theoretical frameworks a priori.\u003c/p\u003e \u003cp\u003eBy privileging the first-person perspective, descriptive phenomenology allowed us to uncover the meanings and significance that patients themselves attribute to their treatment experiences. This methodological orientation enabled the exploration of both the breadth and depth of these influences, thereby offering insights into the complex ways in which culture, religion, and personal context shape decision-making and coping during chemotherapy (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). To enhance methodological rigor and transparency, the study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), ensuring comprehensive documentation of the research process.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and participants\u003c/h3\u003e\n\u003cp\u003eThe study was conducted at the Ho Teaching Hospital (HTH) in the Volta Region of Ghana. Participants who were undergoing chemotherapy for breast cancer were purposively recruited from the oncology unit. A purposive sampling technique was highly suitable for this study because it enabled us to actively select participants who possessed specific characteristics and experiences relevant to the research objectives(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Participants were eligible for this study if they were diagnosed with breast cancer, undergoing chemotherapy, and were willing to provide informed consent. However, individuals who were seriously sick or mentally/psychologically unstable at the time of data collection were excluded. Seriously sick individuals referred to patients who were clinically unstable at the time of data collection, such as those experiencing severe physical debilitation, uncontrolled symptoms, or acute clinical complications that impaired their ability to meaningfully participate in an interview. Similarly, \u0026ldquo;mentally/psychologically unstable participants\u0026rdquo; referred to patients presenting with acute emotional distress, cognitive impairment, or psychological instability that could compromise their safety, well-being, or ability to provide informed consent. These determinations were made in consultation with the attending clinicians and palliative care team, who assessed each patient\u0026rsquo;s physical and psychological fitness prior to recruitment.\u003c/p\u003e\n\u003ch3\u003eRecruitment and data collection\u003c/h3\u003e\n\u003cp\u003eRecruitment was conducted by two trained research assistants with bachelor\u0026rsquo;s-level qualifications and prior experience in qualitative research. With support from the clinical team, potential participants were identified, approached in person during their scheduled treatment visits, and provided with information about the study. Those interested were given adequate time to ask questions and consider participation. Written informed consent was obtained before participation, and all participants had the right to withdraw at any stage without consequence.\u003c/p\u003e \u003cp\u003eData was collected through in-depth, face-to-face interviews designed to capture participants\u0026rsquo; detailed perspectives and lived experiences (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). A semi-structured interview guide, informed by existing literature (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), was developed to explore key domains, including demographic characteristics, knowledge and understanding of breast cancer and chemotherapy, sociocultural influences, and the role of religious beliefs in treatment acceptance and uptake (see \u003cb\u003eAppendix I\u003c/b\u003e for interview guide). Pilot interviews were conducted with two breast cancer patients undergoing chemotherapy at the oncology unit to assess the clarity, cultural appropriateness, flow, and sensitivity of the interview questions. Feedback from these pilot interviews informed minor revisions to the interview guide, including refining question wording, improving sequencing for better conversational flow, and adding probes to elicit deeper exploration of participants\u0026rsquo; experiences. Both participants met the inclusion criteria and consented to full participation; therefore, their interviews were included in the final sample.\u003c/p\u003e \u003cp\u003eInterviews were scheduled at times convenient for participants and conducted in consulting rooms at the clinic to ensure confidentiality and minimize treatment disruption. Each interview lasted between 30 and 60 minutes and was conducted in English, with data collection spanning a two\u0026ndash;month period. All interviews were audio-recorded with participants\u0026rsquo; consent and transcribed verbatim. To minimize researcher bias and enhance trustworthiness, interviews were conducted by research assistants who had no prior relationship with participants. Their neutrality strengthened the credibility and accuracy of the data, ensuring that participants\u0026rsquo; perspectives were authentically represented. The sample size was determined based on the principle of data saturation, which was assessed iteratively through a concurrent data collection and analytic process (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Recruitment continued until no new codes, meanings, or insights relevant to the study aim emerged from subsequent interviews, and the analytical structure was judged to be conceptually stable by the research team. At this point, additional interviews were no longer contributing new information, indicating that saturation had been achieved. Saturation was reached after interviewing 14 participants, consistent with guidance on determining adequacy in qualitative research (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using Colaizzi\u0026rsquo;s descriptive phenomenological method (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). All interviews were transcribed verbatim by trained research assistants with bachelor\u0026rsquo;s-level qualifications. The transcripts were then independently reviewed and cross-checked against the audio recordings by the research team to ensure accuracy and completeness, while also facilitating familiarization with the data.\u003c/p\u003e \u003cp\u003ePhD-prepared investigators supervised the transcription process and led the analysis. Members of the research team read each transcript multiple times to gain an in-depth understanding of participants\u0026rsquo; lived experiences. Significant statements related to sociocultural and religious influences on chemotherapy were identified and extracted. Meanings were then formulated from these statements, maintaining a phenomenological attitude and bracketing prior assumptions.\u003c/p\u003e \u003cp\u003eCoding and theme development were conducted collaboratively. At least two researchers independently coded sections of the data, and cross-coding was undertaken to enhance consistency and analytical rigor. The coded meanings were grouped into meaning clusters, which were further organized into subthemes and overarching themes through team discussions and consensus. A comprehensive description and fundamental structure of the phenomenon were subsequently developed. Where feasible, synthesized findings were returned to selected participants for validation, strengthening the credibility of the analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRigor\u003c/h3\u003e\n\u003cp\u003eEnsuring rigor in qualitative research requires the deliberate use of methodological strategies that strengthen trustworthiness (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This study employed several strategies to enhance trustworthiness by evaluating credibility, dependability, confirmability, and transferability of the findings (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Credibility was enhanced through repeated visits to the oncology unit prior to data collection, which allowed the researchers to familiarize themselves with the setting, build rapport, and create a trusting environment that encouraged participants to share detailed experiences during the interviews. Member checking was also utilized, where participants were allowed to review and confirm the accuracy of their transcribed interviews and the preliminary findings. To achieve dependability, the research process was thoroughly documented, including a detailed description of the methodology, data collection, and analysis procedures, as well as maintaining an audit trail. Confirmability was enhanced by reflexivity and peer debriefing. To ensure reflexivity, the researchers practiced continuous self-reflection throughout the study process, recording their assumptions, viewpoints, and any biases in a reflexive journal. Team meetings were held regularly to critically investigate how researchers\u0026rsquo; preconceptions that sociocultural or religious beliefs necessarily interfere with chemotherapy. This reflexive approach minimized potential bias and fostered transparency and integrity throughout the analytical process. To enhance transferability, descriptions of the study context, participants, and findings were provided. This detailed contextual information enabled other researchers and practitioners to determine the applicability of the study's findings to similar settings or populations.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration\u003c/h2\u003e \u003cp\u003eEthical clearance for this study was obtained from the University of Health and Allied Science Research Ethics Committee (Approval No. UR199/1125). The study ensured that all research activities adhered to ethical principles, including privacy, confidentiality, safety, respect for participants, beneficence, and non-maleficence. Informed consent was diligently obtained from all participants in the study. Interviews were conducted at convenient times and places to maintain privacy. Confidentiality was rigorously upheld, with all personal information and responses treated with the utmost discretion, ensuring that data collected was anonymized, and no identifying information was divulged in any research reports or publications. Participants' autonomy was highly respected, as their participation in the study was entirely voluntary and they had the unrestricted right to withdraw at any time without facing repercussions.\u003c/p\u003e \u003cp\u003e Recognizing that discussing experiences of breast cancer and chemotherapy could evoke emotional distress, interviews were conducted with sensitivity and compassion, and participants were continuously monitored for signs of discomfort. In instances where participants became visibly emotional, interviews were paused to allow reassurance and support, and participants were reminded of their right to discontinue participation. Where needed, individuals were gently referred to the hospital\u0026rsquo;s palliative care psychosocial support services for additional emotional support. Beneficence underpinned the study's objectives to inform culturally sensitive breast cancer care and to inform measures to improve chemotherapy experiences and adherence. Cultural norms were respected, acknowledging traditional beliefs regarding the treatment of breast cancer, even if they diverged from medical recommendations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eA total of 14 participants were included in the study. The participants\u0026rsquo; ages ranged from 25 to 52 years, with the majority being in their 30s and 40s. Nine participants were married, and five are single. Most participants (n\u0026thinsp;=\u0026thinsp;10) were engaged in small businesses, trading, or artisan work, including fashion design, makeup artistry, and baking. Three participants were unemployed, and one participant worked as a bartender. Their monthly incomes varied significantly, ranging from GHS 800 to GHS 7,000, with traders and fashion designers earning relatively higher incomes, and bartenders and small business owners earning the lower wages. Regarding educational attainment, nine participants had a tertiary education, one had secondary education, three had a basic education, and one participant reported having no formal education. A family history of breast cancer was present in six (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) participants. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the sociodemographic characteristics of participants involved in the study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic information of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCode\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMonthly Income (GHS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFamily History of Breast Cancer\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBasic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTrader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTrader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBasic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMakeup Artist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFashion Designer \u0026amp; Makeup Artist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6000\u0026ndash;7000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTrader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot Specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTrader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot Specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo Formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBar Tender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBasic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eunemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot Specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eunemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot Specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eOrganization of Emerged Themes and Sub-themes\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a summary of themes and sub-themes that emerged from the data collected. A total of three (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) themes and nine (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) subthemes were derived from the data analysis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePresentation of emerged Themes and Sub-Themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1. Knowledge and Understanding of Breast Cancer and Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1 Understanding of Breast Cancer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.2 Diagnosis and Treatment Options\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3 Understanding of Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2. Sociocultural Influences on Acceptance of Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1 Family Influence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.2 Community Influence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3 Cultural Beliefs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3 Role of Religious Leaders in Acceptance and Uptake of Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1 Religious Leaders' Influence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2 Religious Beliefs and Practices\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.3 Spiritual Support\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Knowledge and Understanding of Breast Cancer and Chemotherapy\u003c/h2\u003e \u003cp\u003eTheme one explored what participants had been told or understood breast cancer and chemotherapy to be. Participants demonstrated a varied understanding of breast cancer and its symptoms, stages, and diagnostic processes, including procedures like biopsies and imaging tests. Participants were aware of treatment options such as chemotherapy, surgery, and radiotherapy, with some sharing personal experiences of combined treatments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1.1: Understanding of Breast Cancer\u003c/h2\u003e \u003cp\u003eParticipants demonstrated varying degrees of understanding of breast cancer. Most described it as an abnormal growth of cells in the breast that could lead to pain, nipple discharge, changes in breast size, and visible alterations in colour and shape. Several participants also identified lumps as a key symptom and connected them to their personal experiences of discovering the disease. A few participants went further to describe the stages of breast cancer, noting its progression from a localized lump to spread within surrounding tissues and eventually to distant organs such as the bones. This awareness reflected not only information received from health professionals but also lived experiences with the illness.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI know breast cancer is an abnormal growth of cells in the breast. For me, it started with pain, and sometimes there was discharge. Over time, the whole breast changed in shape and form, and that\u0026rsquo;s when I really got worried. I knew something inside wasn\u0026rsquo;t right. (Participant 10)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI realized there was a lump in my breast, and initially it was very painful. Then, I noticed the breast itself was changing in size and shape. That was the turning point for me; I could tell it wasn\u0026rsquo;t something ordinary. (Participant 5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI know of discharge in the breast, changes in the nipple, change of colour of the breast, and lumps. Those are the things people mention, and I experienced some of them myself. (Participant 2)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eI know there are stages one, two, three, and four. (Participant 13)\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026hellip;stage one is when there\u0026rsquo;s just a lump, stage two is when it begins to spread, stage three is when it goes into the tissues around the breast, and stage four is when it extends into the bones. That\u0026rsquo;s how I understand it. (Participant 4)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1.2: Diagnosis and Treatment Options\u003c/h2\u003e \u003cp\u003eParticipants discussed their understanding of the diagnostic procedures for breast cancer, describing processes such as biopsy, ultrasound, mammogram, and scans. Many of them had undergone multiple tests, which shaped their understanding of how the disease is confirmed. Beyond diagnosis, participants listed a range of treatment options available, including chemotherapy, surgery, and radiotherapy. Several participants reflected on their own treatment pathways, emphasizing the sequencing of chemotherapy followed by surgery. This combination of diagnostic and treatment knowledge highlighted how personal experiences shaped their understanding of medical care for breast cancer.\u003c/p\u003e \u003cp\u003e \u003cem\u003eThey did a biopsy for me, took a tissue sample from my breast, and sent it to the lab. That\u0026rsquo;s how they confirmed the diagnosis. (Participant 14)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eFor me, it wasn\u0026rsquo;t just one test. They did an ultrasound, a scan, a mammogram, and then the biopsy. It was a long process before they finally told me I had breast cancer. (Participant 1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI know of chemotherapy, surgery, and radiotherapy. In my case, they told me I would have chemotherapy first, then surgery afterward. That\u0026rsquo;s how they explained it to me. (Participant 12).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 1.3: Understanding of Chemotherapy\u003c/h2\u003e \u003cp\u003eParticipants expressed awareness of chemotherapy as a treatment procedure used for cancer, often delivered in sessions. They acknowledged both the benefits and the side effects of chemotherapy, describing it as a difficult but necessary process aimed at curing the disease. Participants identified weakness, vomiting, appetite loss, hair loss, darkening of nails, and skin color changes as common side effects, which they personally endured. Several participants also recognized chemotherapy as a staged process involving multiple sessions, usually between six and eight cycles, spaced weeks apart. Their narratives underscored the demanding nature of chemotherapy but also reflected a determination to complete the treatment for the possibility of a cure.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eChemotherapy is a treatment given mostly to cancer patients to cure the disease. It comes in sessions, and you have to go through all of them before they say you\u0026rsquo;re done. For me, each session felt like a big step, because you don\u0026rsquo;t just do one and finish; it\u0026rsquo;s a process. You keep going back, even when you feel weak, until the doctors say you\u0026rsquo;ve completed all the cycles. That\u0026rsquo;s when you know you\u0026rsquo;re done with the treatment. (Participant 13)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eChemotherapy is a treatment where they use medicine to kill the cancer cells. That\u0026rsquo;s how they explained it to me, and I\u0026rsquo;ve come to understand it that way. The doctors said the drugs are very strong, and their job is to destroy the bad cells in the body. So anytime I go for the treatment, I remind myself that even though it makes me weak, it is actually working inside to fight the cancer. (Participant 4)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eThe only benefit, and really the only reason, why someone should do chemotherapy is to cure cancer. That\u0026rsquo;s what motivated me to endure it, even with all the difficulties. (Participant 2)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eWhen you take chemo, you feel weak, you vomit, and eating becomes hard unless you force yourself. For me, it was very difficult to keep food down. I would try to eat something small, but immediately I felt like throwing up. Sometimes, even the smell of food made me nauseous. It was a struggle because I knew I had to eat to keep my strength, but my body simply refused. (Participant 1)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eMy hair fell off, my nails turned dark, and even my skin color changed. It was like I didn\u0026rsquo;t recognize myself anymore. When I looked in the mirror, it felt like a stranger was staring back at me. The changes were so visible that people around me also noticed and kept asking questions. It affected how I felt about myself, and sometimes I didn\u0026rsquo;t even want to step outside because of how different I looked. (Participant 5)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI was told I had to go through eight cycles, one every three weeks. At first, it sounded endless, and I wondered how I would manage it. Each session left me weak, and before I could recover fully, it was time for the next one. Still, I knew I had to complete it because that was the only way to get better. (Participant 9)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Sociocultural Influences on Acceptance of Chemotherapy\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003eSubtheme 2.1: Family Influence\u003c/h2\u003e \u003cp\u003eFamily support emerged as a major factor in participants\u0026rsquo; acceptance and continuation of chemotherapy. Spouses, siblings, and extended family members provided encouragement, financial resources, and emotional backing. Although families were often initially shocked by the diagnosis, they became a source of resilience for participants. In some cases, husbands strongly urged their wives to begin treatment early, emphasizing its importance for survival. Family support not only reduced the emotional burden but also helped participants manage the costs and physical demands of treatment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eAt first, my family members were very down, very emotional about my diagnosis. But over time, they supported me emotionally and financially. That encouragement kept me going. (Participant 8)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eWhen I was first told about my diagnosis, I was scared and confused. I didn\u0026rsquo;t know what to do. My husband sat me down and explained that early treatment was the only way forward. He reminded me every day that waiting would make things worse. At first, I felt weak and hesitant, but he kept encouraging me and even accompanied me to the hospital on my first day of chemo. He kept saying, \u0026lsquo;Don\u0026rsquo;t be afraid, this is the right step.\u0026rsquo; Honestly, without his constant support and reassurance, I don\u0026rsquo;t think I would have had the courage to start the treatment at all. (Participant 12)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eMy sister, my dad\u0026rsquo;s sister, and even some friends helped me. They provided money when I needed it and gave me emotional strength when I felt weak. Without them, I don\u0026rsquo;t think I could have gone through the treatment. (Participant 1)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2.2: Community Influence\u003c/h2\u003e \u003cp\u003eParticipants described mixed experiences with their communities. While some communities provided encouragement and support, others contributed to stigma and isolation, leaving some participants wishing for an untimely death. Negative perceptions including viewing cancer as a curse, a spiritual affliction, or a death sentence, led to avoidance and discrimination. Such attitudes even affected participants\u0026rsquo; livelihoods, as some lost customers after their diagnosis became known. On the other hand, some community members, particularly educated individuals and neighbours, were described as supportive, offering advice, small financial contributions, food, and regular check-ins. This highlighted the dual role of communities in either compounding stigma or offering practical assistance.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eSome people in my community think breast cancer is not just a sickness but a curse. They believe it is spiritual, that maybe someone has bewitched you or that it is punishment for something. Because of that, they see it as something that prayer or traditional rituals can cure, rather than going through hospital treatment like chemotherapy. (Participant 8)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026hellip;others even think it\u0026rsquo;s contagious, so they avoid you. Because of that, I lost my business, customers just stopped coming when they heard about my condition. (Participant 5)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003ePeople in my community see cancer as a death sentence. Once they find out you have it, they begin to distance themselves, almost as if it\u0026rsquo;s contagious. They don\u0026rsquo;t want to come near you, and that kind of rejection makes you feel very alone and isolated, even when you need support the most. (Participant 4)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eThere are educated people in my community who encouraged me to continue with chemotherapy. They would sit me down, talk to me, and give me advice about why I should not stop the treatment. Their words gave me confidence and helped me to see that I was making the right decision by following through with the hospital care. (Participant 11)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eEven some of my neighbours showed kindness in ways I did not expect. They made small contributions, brought me food, and checked on me regularly. Their support made me feel that I was not completely alone in this journey, and it gave me the strength to continue with the treatment. (Participant 7)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 2.3: Cultural Beliefs\u003c/h2\u003e \u003cp\u003eMany participants shared how cultural beliefs influenced their perception of chemotherapy. They were advised against chemotherapy in favour of herbal treatments while attributing breast cancer to curses and spiritual attacks. Participants recalled:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eSome people advised me not to do chemotherapy. They kept saying the hospital drugs were too strong and would only make me weaker. Instead, they told me to try herbal medicine, because in our community, many people believe herbs can cure almost every sickness. A friend even came to my house with some leaves and roots, showing me how to boil and drink them three times a day. At that point, I was already feeling weak and confused, so it was difficult to decide who to listen to. They said the herbs were safer and cheaper than chemotherapy, but deep down, I was not sure. I felt torn between what the community was advising me to do and what the doctors had told me at the hospital. (Participant 1)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026hellip;in my culture, some people believe that breast cancer is not just a sickness but the result of a curse or a spiritual attack. They think someone might have bewitched you or that the illness comes as punishment for something wrong you did. When people see you with breast cancer, they don\u0026rsquo;t always think about hospitals or doctors first. Instead, they say you must go to a shrine or see a spiritual healer to break the curse. A few relatives even suggested that I stop chemotherapy and go for prayers and cleansing rituals because they believed the cancer was caused by evil spirits. It was very hard because when people you trust tell you these things, it makes you doubt yourself and the treatment you are receiving. (Participant 8)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOther participants noted that their culture did not impose restrictions on seeking medical treatments like chemotherapy. They emphasized the absence of cultural barriers, which allowed them to pursue conventional healthcare options without conflict.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026hellip;in my ethnic group, there\u0026rsquo;s no restriction against chemotherapy. We don\u0026rsquo;t see it as something forbidden because of culture, so I felt free to go ahead with hospital treatment. That freedom made it easier for me to focus on getting the care I needed without feeling like I was breaking any tradition. (Participant 3)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Role of Religious Leaders in Acceptance and Uptake of Chemotherapy\u003c/h2\u003e \u003cp\u003eReligion featured prominently in participants\u0026rsquo; accounts of living with breast cancer and making decisions about treatment. Religious leaders, church members, and spiritual practices provided encouragement, financial support, and ongoing prayer. At times, conflicting messages within religious communities shaped participants\u0026rsquo; decisions in different ways.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 3.1: Religious Leaders' Influence\u003c/h2\u003e \u003cp\u003eReligious leaders such as pastors and spiritual fathers encouraged participants to accept chemotherapy, often framing it as compatible with faith. They also provided prayers, guidance, and financial assistance, with some churches organizing fundraising support. One participant recalled:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eMy pastor encouraged me to go for chemotherapy and prayed for me. He didn\u0026rsquo;t just tell me to go; he kept assuring me that God would strengthen me through the process. Anytime I felt weak or doubted myself, he reminded me that the treatment and prayer could work together. That support gave me the courage to continue. (Participant 4)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e\u003cem\u003eAnother added\u003c/em\u003e:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eMy spiritual father also pushed me to do the treatment. He didn\u0026rsquo;t just pray for me, he spoke to me about the importance of getting the hospital care. Beyond that, the church supported me financially; they raised money for me through the welfare fund. That financial support really helped because the treatment was expensive, and without it, I would have struggled. (Participant 1)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eSubtheme 3.2: Religious Beliefs and Practices\u003c/h2\u003e \u003cp\u003eNot all religious influences were supportive. Some church members advised against chemotherapy, suggesting reliance on prayer or miracle healing. However, in several cases, pastors intervened to counter these messages, while others emphasized that prayer and medical treatment could coexist.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eSome people in my church told me chemotherapy was not necessary, that prayer alone could heal me. A friend even suggested I travel to Nigeria for miracle healing instead of continuing treatment. (Participant 8)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eWhen a few members of the church discouraged me from going through chemotherapy, saying I should rely only on prayer, my pastor stepped in and corrected them. He explained clearly that prayer should go hand-in-hand with medical treatment, not replace it. Hearing him say that gave me confidence and settled my doubts because I realized I could hold onto my faith while still taking the treatment seriously. (Participant 5)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eIn my church, they believe in medical treatment, but also in prayer as a source of strength. My pastor told me I should go for chemo, and prayer would support the process. (Participant 4)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eSubtheme 3.3: Spiritual Support\u003c/h2\u003e \u003cp\u003e Participants consistently emphasized the role of prayer and spiritual encouragement in coping with their illness. Pastors and church members offered prayers, visits, and words of encouragement, helping participants to remain strong and maintain hope throughout their treatment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eMy pastor prays with me regularly and gives me spiritual guidance. He checks in on me, encourages me, and reminds me that God is with me through it all. The church members also pray for me during services and even when they visit me at home. They encourage me to stay strong and not give up. That kind of spiritual support keeps me going, especially on the days when the side effects of chemotherapy make me feel very weak and hopeless. (Participant 5)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026hellip;the church members visited me often, and whenever they came, they didn\u0026rsquo;t just pray but also brought food and little things to support me. They would sit with me, talk, and encourage me not to lose hope. Their words and presence reminded me that I wasn\u0026rsquo;t alone in this fight. Knowing that people cared enough to check on me and keep me company gave me the strength to continue with the treatment. (Participant 7)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis study examined the sociocultural and religious factors influencing breast cancer patients\u0026rsquo; acceptance and experiences of chemotherapy at Ho Teaching Hospital in Ghana. While participants demonstrated some awareness of breast cancer symptoms, diagnostic procedures, and the purpose of chemotherapy, substantial gaps persisted regarding its etiology, risk factors, and treatment efficacy. Sociocultural factors, including family encouragement, community perceptions, and prevailing cultural norms, emerged as critical determinants of patients\u0026rsquo; willingness and acceptance of initiating and adhering to chemotherapy. These influences operated in both positive and negative directions, with some participants reporting strong support while others experienced stigmatization or discouragement. Religious beliefs and practices were similarly influential, with faith leaders and prayer providing comfort and motivation for some women, whereas reliance on miracle healing led others to question or delay biomedical treatment. Overall, the findings highlighted the dynamic ways in which knowledge, sociocultural expectations, and religious worldviews influenced women\u0026rsquo;s experiences of cancer care in Ghana.\u003c/p\u003e \u003cp\u003eThe study found that most participants had a basic understanding of breast cancer, particularly regarding its symptoms, stages, and the need for treatment, but lacked adequate knowledge and awareness of the causes, risk factors, and treatment. These findings are consistent with a study that reported that most breast cancer patients in the United States could correctly identify their symptoms and disease stage (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e); however, African American women had limited knowledge of risk factors, which contributed to poor engagement in preventive healthcare and delayed diagnosis (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). A study in Ethiopia revealed similar results as women had a general awareness of the signs and progression of breast cancer, but lacked sufficient knowledge about treatment options, which may affect timely decision-making in seeking appropriate care (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Some women only learn about breast cancer after experiencing severe symptoms, often at advanced stages, which significantly reduces their chances of survival (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In the same vein, most women do not know that family history and hormonal changes increase breast cancer risk, which leads to a false sense of security among those without visible symptoms (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). These variations in knowledge across contexts reflect the differences in scope and reach of public health education efforts. In high-resource settings like the U.S., breast cancer awareness campaigns are widespread, whereas in many African countries, educational gaps persist, particularly in rural areas. Thus, while efforts to improve symptom awareness have been successful, more attention is needed in educating women about the risk factors and causes of breast cancer. This could help in promoting early screening behaviors and reducing misconceptions that delay medical intervention.\u003c/p\u003e \u003cp\u003eCultural beliefs and traditional healing practices further contribute to differences in knowledge levels. Participants in this study reported that they were initially reluctant to start chemotherapy because they were told that breast cancer could be the result of a curse, supernatural attack, or punishment from ancestors, leading them to seek spiritual interventions before medical treatment. In Ghana, for instance, while many women recognized the physical symptoms of breast cancer, there are indications that supernatural explanations and spiritual beliefs about the disease still influenced perceptions, which could delay early medical intervention (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Furthermore, educational disparities play a significant role in demystifying these cultural and traditional misconceptions of breast cancer among these women. Women with higher education levels demonstrate greater awareness and better understanding of breast cancer, whereas those with less formal education are more likely to rely on community beliefs or traditional medicine before seeking hospital care (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). These findings emphasize the importance of culturally sensitive health education initiatives that dispel entrenched misconceptions and reinforce the message that chemotherapy complements, rather than contradicts, faith, while highlighting its critical role as a medical intervention for survival.\u003c/p\u003e \u003cp\u003eFamily and community played a crucial role in facilitating the acceptance of chemotherapy by breast cancer patients. Several participants credited encouragement from loved ones with helping them endure the physical and emotional difficulties associated with treatment. Financial support from family members also eased the burden of treatment costs and transportation expenses. Prior studies confirm that this varied support received by patients improved their adherence to treatment and likely completion of treatment regimens (\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). However, community responses were not universally supportive. Some participants experienced social withdrawal, gossip, or overt stigma following their diagnosis, which inflicted deep psychological distress and eroded motivation to continue treatment. Others even wish for an untimely death to escape the ongoing shame, social exclusion, and emotional and psychological burden their illness has imposed on them and their families. Stigmatization has been widely reported as a barrier to cancer care in Ghana, where women frequently conceal their illness or abandon treatment due to shame, fear of discrimination, or community pressure to pursue alternative healing (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Such experiences highlight the urgent need for community-wide education and advocacy programs to challenge myths, reduce stigma, and promote positive attitudes toward chemotherapy.\u003c/p\u003e \u003cp\u003eReligious leaders play a pivotal role in women\u0026rsquo;s acceptance of chemotherapy, as their spiritual guidance and encouragement foster resilience and motivate continued care-seeking. The findings in this study revealed that religious leaders reassured participants of the need to keep their faith while seeking care, prayed with them, and even helped raise funds for their treatment, reinforcing their decision to proceed with chemotherapy. These findings align with studies in Nigeria and South Africa, which documented the supportive roles of religious leaders in encouraging medical treatment, offering psychological support, and reinforcing the notion that faith and modern medicine can coexist (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNevertheless, the influence of religious leaders was not uniformly positive. Certain denominations discouraged chemotherapy, promoting the belief that prayer, fasting, or divine intervention alone could provide healing. Such teachings contribute to delayed presentation to hospitals, often at advanced stages when the disease has already metastasized to other organs, thereby limiting treatment effectiveness and worsening prognoses. Similar patterns have been reported in Nigeria, where pastors encouraged patients to rely solely on faith healing (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Likewise, in Ghana, some church groups actively discouraged biomedical treatment and promoted traditional healing methods, leading some women to abandon chemotherapy altogether (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). These negative religious attitudes perpetuate misconceptions about biomedical care, reinforce distrust in modern medicine, and contribute to poor adherence and adverse outcomes.\u003c/p\u003e \u003cp\u003eTaken together, these findings illustrate the ambivalent role of religion in shaping women\u0026rsquo;s acceptance of chemotherapy. While religious leaders can be strong advocates and powerful allies in reinforcing treatment adherence and providing psychosocial support, they may also act as barriers when religious doctrine is positioned in opposition to modern medicine. To address this tension, there is a critical need for collaborative partnerships between healthcare providers and religious institutions. Public health initiatives that actively engage faith leaders in cancer education and awareness campaigns could harness their influence to normalize chemotherapy, dispel myths, and reframe treatment as consistent with faith. Such efforts hold promise for improving adherence, reducing delays, and ultimately enhancing survival outcomes for women diagnosed with breast cancer in Ghana.\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eDespite the valuable insights this study has offered, there are notable limitations. Firstly, this study relied on self-reported data from participants, which may introduce biases such as social desirability or recall inaccuracies. Breast cancer patients may overstate or understate their experiences and perceptions due to emotional or psychological factors, potentially affecting the reliability of the findings. Additionally, the study is confined to the Ho Teaching Hospital, which may limit the generalizability of the results to other regions or healthcare settings with different sociocultural and religious contexts. The qualitative nature of the study, while providing in-depth insights, restricts the ability to quantify the extent of sociocultural and religious influences or establish causal relationships. Lastly, logistical challenges, such as scheduling interviews around patients' chemotherapy sessions and ensuring privacy in a busy hospital setting, may impact the depth and quality of data collected. These limitations highlight the need for further research, including mixed-methods or multi-site studies, to address these gaps and provide a broader perspective on the sociocultural and religious influences on breast cancer treatment in Ghana.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the significant impact of socio-cultural and religious factors on chemotherapy acceptance among breast cancer patients in Ghana. While family support encouraged treatment adherence, misconceptions, stigma, and spiritual beliefs often led to delays or rejection of chemotherapy. The role of religious leaders was mixed, with some supporting treatment and others discouraging it in favor of faith healing. These findings emphasize the need for culturally sensitive patient education, stigma reduction efforts, and collaboration with religious and community leaders. Strengthening these areas will enhance chemotherapy acceptance and improve breast cancer treatment outcomes in Ghana.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.A. and D.B.A. conceived the study and led the data analysis and manuscript drafting. S.S.D., F.K., R.A.T., G.A.Y., K.R., D.B.M., C.G., E.A., and R.A.A. conducted the literature search and contributed to writing the manuscript. All authors critically reviewed the manuscript for important intellectual content, contributed revisions, and approved the final version for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests in the conception, design, and execution of this study.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to the sensitive and confidential nature of the participants\u0026rsquo; personal and medical information, as well as ethical restrictions imposed by the institutional review board. However, de-identified data may be available from the corresponding author on reasonable request and subject to approval by the ethics committee.\u003c/p\u003e\n\n\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers sought ethical review and clearance from the Research Ethics Committee of the University of Health and Allied Sciences before commencing data collection. Written informed consent to participate was obtained from all of the participants in the study. The study followed the principles and guidelines of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray, F. et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. \u003cem\u003eCA Cancer J. Clin.\u003c/em\u003e \u003cb\u003e74\u003c/b\u003e (3), 229\u0026ndash;263 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim, J. et al. Global patterns and trends in breast cancer incidence and mortality across 185 countries. \u003cem\u003eNat. Med.\u003c/em\u003e \u003cb\u003e31\u003c/b\u003e (4), 1154\u0026ndash;1162 (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArnold, M. et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. \u003cem\u003eBreast Edinb. Scotl.\u003c/em\u003e \u003cb\u003e66\u003c/b\u003e, 15\u0026ndash;23 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeer, E. et al. Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study. \u003cem\u003eLancet Glob Health\u003c/em\u003e. \u003cb\u003e8\u003c/b\u003e (8), e1027\u0026ndash;e1037 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreihat, O., Sipos, D. \u0026amp; Kovacs, A. Global burden and projections of breast cancer incidence and mortality to 2050: a comprehensive analysis of GLOBOCAN data. Front Public Health [Internet]. Oct 30 [cited 2025 Dec 29];13:1622954. (2025). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC12611818/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC12611818/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson, B. O. et al. The Global Breast Cancer Initiative: a strategic collaboration to strengthen health care for non-communicable diseases. \u003cem\u003eLancet Oncol.\u003c/em\u003e \u003cb\u003e22\u003c/b\u003e (5), 578\u0026ndash;581 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShewbridge, A., Wiseman, T. \u0026amp; Richardson, A. Treatment Decision-Making in West African Women With Breast Cancer: A Critical Ethnography. \u003cem\u003eSemin Oncol. Nurs.\u003c/em\u003e \u003cb\u003e41\u003c/b\u003e (3), 151878 (2025 June).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGullatte, M. M., Brawley, O., Kinney, A., Powe, B. \u0026amp; Mooney, K. Religiosity, spirituality, and cancer fatalism beliefs on delay in breast cancer diagnosis in African American women. \u003cem\u003eJ. Relig. Health\u003c/em\u003e. \u003cb\u003e49\u003c/b\u003e (1), 62\u0026ndash;72 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorres, E., Dixon, C. \u0026amp; Richman, A. R. Understanding the Breast Cancer Experience of Survivors: a Qualitative Study of African American Women in Rural Eastern North Carolina. \u003cem\u003eJ. Cancer Educ. Off J. Am. Assoc. Cancer Educ.\u003c/em\u003e \u003cb\u003e31\u003c/b\u003e (1), 198\u0026ndash;206 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLackey, N. R., Gates, M. F. \u0026amp; Brown, G. African American women\u0026rsquo;s experiences with the initial discovery, diagnosis, and treatment of breast cancer. \u003cem\u003eOncol. Nurs. Forum\u003c/em\u003e. \u003cb\u003e28\u003c/b\u003e (3), 519\u0026ndash;527 (2001).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAziato, L. \u0026amp; Clegg-Lamptey, J. N. A. Breast cancer diagnosis and factors influencing treatment decisions in Ghana. \u003cem\u003eHealth Care Women Int.\u003c/em\u003e \u003cb\u003e36\u003c/b\u003e (5), 543\u0026ndash;557 (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfaya, A. et al. Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review. BMC Womens Health [Internet]. 2024 May 14 [cited 2025 Dec 25];24(1):288. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12905-024-03106-y\u003c/span\u003e\u003cspan address=\"10.1186/s12905-024-03106-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalisu, W. J., Mirlashari, J., Seylani, K., Varaei, S. \u0026amp; Thorne, S. Fatalism, distrust, and breast cancer treatment refusal in Ghana. Can Oncol Nurs J [Internet]. 2022 Apr 1 [cited 2025 Sept 16];32(2):198\u0026ndash;205. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9040785/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9040785/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang, C. et al. Metaphors and Stigma in Confucian Culture: A Qualitative Study of Cancer Risk Communication Dilemmas for Cascade Screening Among Hereditary Cancer Families From China. Psychooncology [Internet]. 2025 June [cited 2025 Dec 25];34(6):e70205. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC12163203/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC12163203/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnago, E. K. et al. Empty action: two heads are better than one: Spiritual care provision for patients living with advanced cancer in Sub-Saharan Africa: A meta-synthesis. \u003cem\u003eEur. J. Oncol. Nurs. Off J. Eur. Oncol. Nurs. Soc.\u003c/em\u003e \u003cb\u003e76\u003c/b\u003e, 102854 (2025 June).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMensah, A. B. B. et al. Utilisation of traditional medicine among women diagnosed with breast cancer in Ghana: a descriptive phenomenological study. BMC Complement Med Ther [Internet]. Jan 23 [cited 2025 Sept 8];24(1):50. (2024). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12906-024-04364-x\u003c/span\u003e\u003cspan address=\"10.1186/s12906-024-04364-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorrow, R. Colaizzi\u0026rsquo;s descriptive phenomenological method.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMensah, A. B. B. et al. Utilisation of traditional medicine among women diagnosed with breast cancer in Ghana: a descriptive phenomenological study. \u003cem\u003eBMC Complement. Med. Ther.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e (1), 50 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTong, A., Sainsbury, P. \u0026amp; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. \u003cem\u003eInt. J. Qual. Health Care J. Int. Soc. Qual. Health Care\u003c/em\u003e. \u003cb\u003e19\u003c/b\u003e (6), 349\u0026ndash;357 (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell, J. W. \u0026amp; Creswell, J. D. Research Design Qualitative, Quantitative, and Mixed Methods Approaches. [Internet]. 4th Edition. Newbury Park.: SAGE Publications Inc; (2017). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.scirp.org/reference/referencespapers?referenceid=2969274\u003c/span\u003e\u003cspan address=\"https://www.scirp.org/reference/referencespapers?referenceid=2969274\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell, J. Educational Research Planning: Planning, Conducting, and Evaluating Quantitative and Qualitative Research. (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKallio, H., Pietil\u0026auml;, A. M., Johnson, M. \u0026amp; Kangasniemi, M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. \u003cem\u003eJ. Adv. Nurs.\u003c/em\u003e \u003cb\u003e72\u003c/b\u003e (12), 2954\u0026ndash;2965 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeJonckheere, M. \u0026amp; Vaughn, L. M. Semistructured interviewing in primary care research: a balance of relationship and rigour. \u003cem\u003eFam Med. Community Health\u003c/em\u003e. \u003cb\u003e7\u003c/b\u003e (2), e000057 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaunders, B. et al. Saturation in qualitative research: exploring its conceptualization and operationalization. \u003cem\u003eQual. Quant.\u003c/em\u003e \u003cb\u003e52\u003c/b\u003e (4), 1893\u0026ndash;1907 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHennink, M. \u0026amp; Kaiser, B. N. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. \u003cem\u003eSoc. Sci. Med. 1982\u003c/em\u003e. \u003cb\u003e292\u003c/b\u003e, 114523 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFusch, P. \u0026amp; Ness, L. Are We There Yet? Data Saturation in Qualitative Research. \u003cem\u003eQual. Rep. 2015 Sept\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e;20(9):1408\u0026ndash;1416 .\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorrow, R. Colaizzi\u0026rsquo;s descriptive phenomenological method.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck CT. Paul Colaizzi\u0026rsquo;s Descriptive Phenomenological Methodology. In: Introduction to Phenomenology: Focus on Methodology [Internet]. SAGE Publications, Inc.; 2021 [cited 2025 Dec 29]. pp. 19\u0026ndash;30. Available from: https://methods.sagepub.com/book/mono/introduction-to-phenomenology/chpt/3-paul-colaizzi-s-descriptive-phenomenological-methodology.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuba, E. G. \u0026amp; Lincoln, Y. S. Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. San Francisco, CA, US: Jossey-Bass; xxv, 423 p. (Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches). (1981).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreedman, R. A. et al. Breast cancer knowledge and understanding treatment rationales among diverse breast cancer survivors. \u003cem\u003eBreast Cancer Res. Treat.\u003c/em\u003e \u003cb\u003e196\u003c/b\u003e (3), 623\u0026ndash;633 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang, Y., Sereika, S. M., Bender, C. M., Brufsky, A. M. \u0026amp; Rosenzweig, M. Q. Beliefs in Chemotherapy and Knowledge of Cancer and Treatment Among African American Women With Newly Diagnosed Breast Cancer. \u003cem\u003eOncol. Nurs. Forum\u003c/em\u003e. \u003cb\u003e43\u003c/b\u003e (2), 180\u0026ndash;189 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLankrew Ayalew, T., Wale, B. G., Haile, K. E., Zewudie, B. T. \u0026amp; Feleke, M. G. Health-related quality of life and associated factors among cancer patients in Ethiopia: Systematic review and meta-analysis. \u003cem\u003ePloS One\u003c/em\u003e. \u003cb\u003e17\u003c/b\u003e (12), e0277839 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbuka-Ongona, D. \u0026amp; Tumbo, J. M. Knowledge about breast cancer and reasons for late presentation by cancer patients seen at Princess Marina Hospital, Gaborone, Botswana. \u003cem\u003eAfr. J. Prim. Health Care Fam Med.\u003c/em\u003e \u003cb\u003e5\u003c/b\u003e (1), 465 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfaya, A. et al. Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review. \u003cem\u003eBMC Womens Health\u003c/em\u003e. \u003cb\u003e24\u003c/b\u003e (1), 288 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObrist, M. et al. Factors related to incomplete treatment of breast cancer in Kumasi, Ghana. \u003cem\u003eBreast Edinb. Scotl.\u003c/em\u003e \u003cb\u003e23\u003c/b\u003e (6), 821\u0026ndash;828 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnyanwu, S. \u0026amp; Egwuonwu, O. Acceptance and adherence to treatment among breast cancer patients in Eastern Nigeria. \u003cem\u003eBreast Edinb. Scotl.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e (Suppl 2), S51\u0026ndash;S53 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNkenu, N. G., Nsoh, M., Paul, A. J. \u0026amp; Nkondjock, A. Characterizing factors influencing adherence to surgery and chemotherapy amongst women suffering from breast cancer in Mbingo Baptist Hospital Cameroon. \u003cem\u003ePan Afr. Med. J.\u003c/em\u003e \u003cb\u003e43\u003c/b\u003e, 102 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKepkey, B., Coetzee, B., Edge, J. \u0026amp; Kagee, A. Factors influencing adherence to chemotherapy amongst breast cancer patients at a tertiary hospital: Healthcare workers\u0026rsquo; perspectives. \u003cem\u003eEur. J. Surg. Oncol.\u003c/em\u003e \u003cb\u003e48\u003c/b\u003e, e237 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTuck, C. Z., Akparibo, R., Gray, L. A., Aryeetey, R. N. O. \u0026amp; Cooper, R. What influences cancer treatment service access in Ghana? A critical interpretive synthesis. \u003cem\u003eBMJ Open.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (10), e065153 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalisu, W. J., Mirlashari, J., Seylani, K., Varaei, S. \u0026amp; Thorne, S. Fatalism, distrust, and breast cancer treatment refusal in Ghana. \u003cem\u003eCan. Oncol. Nurs. J.\u003c/em\u003e \u003cb\u003e32\u003c/b\u003e (2), 198\u0026ndash;205 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChidebe, R. C. W. et al. Not even my husband knows that I have this [breast cancer]: survivors\u0026rsquo; experiences in accessing, navigating and coping with treatment. \u003cem\u003eSupport Care Cancer\u003c/em\u003e. \u003cb\u003e32\u003c/b\u003e (2), 112 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNwakasi, C. et al. He [the doctor] said I should go and wait for my death: Dualities in care and support access among female cancer survivors. J Cancer Policy [Internet]. 2023 Mar [cited 2025 Sept 16];35(100374). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.scopus.com/inward/record.url?scp=85145686720\u0026amp;partnerID=8YFLogxK\u003c/span\u003e\u003cspan address=\"http://www.scopus.com/inward/record.url?scp=85145686720\u0026amp;partnerID=8YFLogxK\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMburu, W. et al. Pathways to Breast Cancer Diagnosis and Treatment Among Women in Ghana: A Qualitative Study. \u003cem\u003eWomens Health Rep. New. Rochelle N\u003c/em\u003e. \u003cb\u003e2\u003c/b\u003e (1), 234\u0026ndash;244 (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast Cancer, Chemotherapy, Sociocultural beliefs, Religious Influences, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-8535145/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8535145/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Despite growing literature on cultural and religious influences on breast cancer diagnosis and treatment choices in Ghana, limited empirical evidence focuses specifically on women undergoing chemotherapy and how these beliefs silhouette their treatment trajectories within tertiary care settings. This study explored the sociocultural and religious influences on breast cancer patients undergoing chemotherapy at Ho Teaching Hospital, Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative descriptive phenomenological approach was employed. Purposive sampling technique was employed to recruit breast cancer patients undergoing chemotherapy. Face-to-face interviews were conducted, and all interviews were transcribed verbatim. Data were analyzed using Colaizzi\u0026rsquo;s descriptive phenomenological method.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003e14 participants were included in the study. Three major themes emerged: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Knowledge and understanding of breast cancer and chemotherapy, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Sociocultural influences on acceptance of chemotherapy, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Role of religious leaders in acceptance and uptake of chemotherapy. Participants described misconceptions about cancer causation, including beliefs in curses and spiritual attacks, which influenced delays or outright rejections of biomedical care. Religious leaders and faith communities provided encouragement, ongoing prayers, emotional and financial support.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the significant impact of socio-cultural and religious factors on chemotherapy acceptance among breast cancer patients in Ghana. The findings emphasize the need for culturally sensitive patient education, stigma reduction efforts, and collaboration with religious and community leaders. Addressing sociocultural barriers can enhance timely access and adherence to life-saving treatment.\u003c/p\u003e","manuscriptTitle":"Sociocultural and Religious Influences on Breast Cancer Patients Undergoing Chemotherapy at Ho Teaching Hospital, Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-27 12:06:51","doi":"10.21203/rs.3.rs-8535145/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-25T15:26:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315593274892855574041803301144412069352","date":"2026-04-22T19:38:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336805106986380529177782841518870409112","date":"2026-04-22T08:52:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99003723185999552065538165489264562506","date":"2026-04-20T05:23:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-19T14:27:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-19T14:05:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-09T10:41:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-07T22:18:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-01-07T22:12:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d378bbb-5f33-4445-88ee-724e73f60df8","owner":[],"postedDate":"April 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":67008080,"name":"Biological sciences/Cancer"},{"id":67008081,"name":"Health sciences/Health care"},{"id":67008082,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2026-04-27T12:06:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-27 12:06:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8535145","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8535145","identity":"rs-8535145","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}