Table 2.

Individual domain findings

INDIVIDUAL DOMAIN
Theme 1: Knowledge and awareness of cancer and breast cancer
Subthemes	Participant quotations
1: Types of cancers	o Brain tumour, womb cancer, breast cancer, throat cancer, blood cancer- FGD 1 o Breast cancer, blood cancer, cervix cancer, stomach cancer, “we name them, but we don’t know how to explain them.”- FGD 2 o Prostate cancer, Breast cancer, Leukaemia- FGD 3 o “It’s cervical, it’s throat, it’s one on the gums, it’s brain tumour, right?”, Leukaemia, Bones cancer, lung cancer,—FGD 4 o “Of the breast”, “Of the blood”, “Of the cervix”, “Of the throat”, “Anal…or what is it…the one of the backside, is it anal or, no, of the rectum or what is it…it goes along with the intestines on the backside whereby you find it hard to poop, there’s one for skin, there’s one for, like thyroid, there’s one for brain”, “On the legs”, “Mouth cancer”- FGD 5
2: Perceived as a deadly disease	o “Cancer is a harmful disease from our bodies”- FGD 1 o “It’s a silent killer”- FGD 2 o “Cancer is uncurable, that’s what I know”- FGD 1,4
3: Cancer causes	o “I don’t really know what causes it, but it is also painful [physical and emotional] because it is just not visible, it is not visible”, “…as black women, we have no idea what causes cancer.”- FGD 1 o “…it’s being said that if there’s a person within the family who has cancer, it spreads, so, it is something that people in that family always get.”- FGD 1 o “The one of the blood…the one of the blood is like, sometimes, it is hereditary…yes, let me say, maybe it starts by, when your blood, yes, the blood one tends to, sometimes, you are born with it…it could be maybe hereditary or just by nature, you’re born with it when you’re a child”- FGD 5 (FGD 2) o “Through infections, I’ve heard so many cases of cervix cancers and most of them they say that they develop from infections.”- FGD 2 o “Me the way I know it, in the body, there are things that are called cells isn’t it, that combine the skin to do whatever, so, when there’s a problem with those cells, they tend to grow in a surprising way…like, let me say like, the skin, the skin grows as you grow right, so you find that at that time, those cells, they grow more than enough…so, that is when they cause problems in the body, then, they eat whatever there where they shouldn’t be.”- FGD 4,6 o “Me I think it’s a disease, it’s one of the diseases that are caused by God…”- FGD 4 o “You were bewitched, got cursed, muthi was used, so, meaning that it is spiritual…they think that it is spiritual because of, you’ve been bewitched”- FGD 2,3,5,6 o “The one of lung cancer I would say that it is caused by cigarette…maybe when you have a problem of the lungs…yes, a cigarette because it has nicotine, it is what can cause you problems.”- FGD 5 o “It’s like, not eating healthy food…and then also by not, it’s like, having a big body, being fat…”-FGD 2, 3, 4, 6 o “If you get an accident and find that your blood ran to your brain, just a blood clot, if it gets inside your brain, you get brain cancer” FGD 5 o “Like I was saying that the likes of flu, and then you find that maybe it causes a rash, when it doesn’t heal, maybe it the one that causes that thing”- FGD 6 o “I tend to hear it being said that like soap, us females…like, when we bath our private parts, we use water that has soap and then that soap can affect us and cause us womb cancers.”- FGD 3 o “Probably, the breast has had enough, plus isn’t it us women, we breastfeed…so, the veins have had enough with taking out that milk”- FGD 6 o “Others are caused by Grandpa’s [Pain medication] …when you drink Grandpa a lot.”- FGD 5 o “Cancer is just a virus that emerges out of nowhere, that’s what I think.”- FGD 2 o “I say that it is caused by bacteria, maybe air pollution what is it…where it is messy, you find that you’re always working there and then you get infections, sometimes, you find that you work hard there, you end up getting after infections.” FGD 2 o “The likes of soil” (edible soil)- FGD 2 o “…then when that sun burns you, you find that it creates other problems for you, or it is cancer”, “I tend to hear that it’s caused by the sun”- FGD 3
4: Signs and symptoms of cancer and BC	o “Especially the womb one [cervical cancer], you see by bleeding endlessly, on your vagina”- FGD 3 o “The one of the stomachs, maybe you find that you’re unable to defecate, there will be blood coming out or maybe your intestines, it’ll be hard for you to digest, for food to be digested”- FGD 5 o “It’s the breasts that are uneven, one becomes big, one becomes small, and when you touch it, you find it has hardened”, “It is with the lump, it’s like, when you touch the breast, there is something inside, it is like a stone, it is hard, and while you press, it pains… you find that even your nipple changes colour or the breast changes colour and it’s painful…so, those are some of the things that…you see.”- FGD 6 o “Under the armpits, especially for the likes of breast cancer, it can be caused by lumps”- FGD 1, 3, 6 o “Your nipple changes, there’s also those discharges that I said come out and it becomes painful…when you feel any discomfort, you will feel that, and there is this thing that they call 6th sense, you listen to your body, your body will tell you when there is something wrong…then go and check it out”-FGD 6 o “Sometimes you’ll see tumors emerging, and lumps on the body and then they cause you a serious disease”- FGD 3…. “It’s mostly said that when you feel yourself, you feel a lump.”- FGD 2 o “When they explain it at times, they say that you don’t feel pain with cancer, but there are symptoms that happen with you. You don’t feel pain but you can feel that there is something like a knob or something but there is no pain, you only feel it when you touch yourself but it’s not painful”-FGD 1, 2
5: Understanding how to prevent cancer	o “So far, they are not visible…they are not visible as in when I get flu, I know that I will get a runny nose and all that…so cancer, I think maybe sometimes if I say I’m sick and I go to the hospital and they do a check-up on me, it is how I will know that I have cancer.”- FGD 1 o “Me I know it as a cyst, like it starts as a sore right, and then it gets pus right, and then when it bursts, that’s what causes that cancer.”- FGD 4
6: Early detection of cancer	o “I think that when you’ve found it early, you are able to confront it, I think when you find it early, you’re able to get a cure early.”- FGD 3, (FGD 1), (FGD 4) o “Even now, children get injected for cervix cancer [HPV vaccination].”- FGD 2 o “I will stay checking myself, even sexually, you try by all means to be protected, using protection and stuff like that.” FGD 2, (FGD 4) o “I say that it can’t be prevented, even this one for the children, they are not sure…okay, no, it can’t be prevented, if you’re supposed to be getting it by that time, even if you can get an injection however many times, drink the pills thereof, you will get it”- FGD 6 o “What is a mammography now?”- FGD 6 o We don’t know it”, “We just hear of it when people talk.”- FGD 4
7: Cancer cure, treatment, and management	o Yes, at the mammogram…let’s say you cry about pains on the breasts, anything that goes with the breast, pain, even when it doesn’t have lumps, you can say “doctor, I’m feeling pain on the breast”…so, they send you for a mammogram, mammogram is the one that will say what is happening…how far is your cancer, is there or is it not there.”- FGD 3 o “If they detect it early, it’s possible that they can remove the lump. And then, even when you go for treatments, you might find that it can, through treatment, it can help you”- FGD 2 o “It can be cured if they find it at an early stage”- FGD 4 o “Those radiations and chemo’s”, “We know of that chemo, that when a person has cancer, it goes by stages…I don’t know how chemo works but we always hear of chemo, that it is the cure for cancer”.—FGD 2 o “…they will see what stage it is on…then there are stages that when they are…or early, it’s like they do radiations, what else is it, the one that burns?”- FGD 3 o “Chemotherapy, “I was saying that they burn those cells because those cells are ones that would’ve grown out of control, they would’ve caused the cancer to be there”- FGD 4 o “…they cut off the affected part.”- FGD 2 (FGD 3), (FGD 4) o “She has healed, but she was helped by some lady from Rockville [an area in Soweto] …they say that she has a traditional mixture for it…they say you buy it, you buy 3 of them for R150-00, you cook them and drink them.” FGD 4…… “When you go to traditional healers, and they give you medicines or going to the doctors.”- FGD 4
8: Language/ Cultural context used in understanding cancer and treatments	o “Siso se sa foleng”- a cyst that doesn’t heal. Siso can also mean a sore, ulcers or abscess o “While growing up, they used to say a cyst that doesn’t heal and eats you”- FGD 3, 4, 5, 6 o “Cancer is known as kankere and/or mofese in Sesotho, and it is known as Mdlavuza, isifo semhlaza, and/or isifo se phepha in isiZulu & isiXhosa. It is treated with traditional mixtures/herbs called Imbiza (plural), or mbiza (singular) in isiZulu and isiXhosa, and is called Dipitsa (plural), or pitsa in Sesotho. Mbiza is more common as it is also used by non-Zulu & Xhosa speaking people o “Cancer is like…what can I say, it’s a small worm, it eats… It’s like, it’s this worm…yoh, it’s a small-ish worm that is small, but you won’t be able to see it…yes, it moves around on your body, then, wherever it is that it stops, it eats”- FGD 5, 6 o “We mean to go and get burnt, to go so that they can burn her.”- FGD 4 o …it’s been said that they burn the breasts and check if they are coming alright.”- FGD 1 o …they prevent it by burning it…”- FGD 5
9: Language as a barrier in communication	o “Me most of the times, if I see that they are saying words that I can’t understand in English, me I ask them to explain to me what they mean”- FGD 4