Abstract
Background
Prostate cancer (PCa) awareness and knowledge among men in Vhembe District, Limpopo Province, South Africa, remain inadequately studied despite the high local burden of the disease. This study investigates the knowledge, attitudes, practices, cultural beliefs, and perceived risk of PCa among men aged 40 and above in selected villages under the Mphaphuli and Niani tribal authorities.
Methods
A quantitative survey was conducted with 431 men, utilizing a questionnaire adapted from the African Women Awareness of Cancer (AWACAN) tool. The questionnaire, translated into Tshivenda, assessed socio-demographic data, awareness, knowledge of risk factors and symptoms, health-seeking behavior, and barriers to seeking medical help.
Results
The study revealed that 51.3% of participants had heard of PCa, while 48.7% had not. Awareness varied significantly with age, relationship status, education level, and language. Older men and those with higher education levels were more knowledgeable about PCa. Clinics, hospitals, and media were the primary sources of information. Misconceptions about risk factors were prevalent, with 24.0% of men indicating a preference for traditional healers for PCa symptoms. Barriers to medical help included fear of the disease, procedural fears, and cultural taboos. Multivariate analysis identified significant factors associated with PCa knowledge, including age, language, access to tap water, and cell phone ownership.
Conclusion
These findings underscore the importance of targeted educational interventions considering sociodemographic and cultural contexts. Future public health initiatives should focus on bridging the gap between traditional and modern medical practices to enhance health outcomes in the Vhembe District and similar settings.
Keywords: Prostate Cancer, Men, KAP Survey, Cultural Beliefs, Vhembe District, South Africa
Introduction
Prostate cancer (PCa) is one of the leading causes of cancer-related deaths among men globally. In 2022, there were 103,050 new cases of PCa, constituting 20.4% of all male cancer diagnoses, ranking PCa as having the fourth highest incidence rate among all cancers globally [1]. In Southern Africa, PCa was the most diagnosed cancer among males in 2022, accounting for 24.5% of all new male cancer cases, 5790 deaths, ranking it as the third major cause of cancer death in males [1]. Prostate cancer incidence and mortality rates vary widely due to detection practices, treatment availability, and genetics [2, 3]. Recent trends show stabilization or decline in many countries, driven by reduced PSA testing and improved treatments, especially in high-income countries [4]. While PCa cases are projected to double by 2040, research mainly focuses on men of European heritage, despite significant ethnic differences [5].
In Africa, high PCa mortality rates are exacerbated by late diagnoses and limited access to advanced treatments [6]. Urgent improvements in healthcare infrastructure, education, and early detection are needed to address the rising burden and prevent high mortality rates [4]. These interventions should include education, outreach, shifting to early-stage diagnosis, and curative treatments [5]. However, research disparities highlight the need for more focus on African populations [7].
A review of studies in sub-Saharan Africa (SSA) found the most common barrier to PCa screening to be a lack of knowledge, followed by perceptions, attitudes, and beliefs [8]. Beliefs that cancer is incurable predominated, while some men had fatalistic views on cancer and would rather not know about it [8], similar to views among rural and urban adults in the USA [9]. Some men viewed PCa as sexually transmitted or a consequence of excessive sexual activity, with older men believing their ceased sexual activity exempted them from risk, while fears of screening pain and religious prohibitions further influenced attitudes towards screening [8]. Low levels of education have been associated with low levels of PCa knowledge and the likelihood of screening [10, 11]. Factors enhancing information seeking regarding screening and PCa risk included family and social support, celebrity endorsements, and media with targeted information [12].
In a study in the Limpopo Province of South Africa, 64.1% of the study population exhibited inadequate knowledge about PCa [13]. Many individuals do not undergo necessary screenings, with 96.7% of respondents who had never had a PSA test, although 53.1% expressed willingness to undergo the test [13]. In a separate study in the Gauteng Province of South Africa, 91.7% of men had heard about PCa, with significant associations between knowledge and factors such as age (p ≤ 0.001) [14]. Health status was a predictor of awareness, while both age and health status predicted attitudes towards PC among men, especially in Gauteng [14].
In the study involving primary health care providers, 40.0% demonstrated poor practices, which were linked with negative perceptions of prostate cancer [15]. Nurses and community health workers were found to have poor knowledge regarding prostate cancer, with non-participation in prostate cancer-related continuing medical education being linked with poor knowledge (p < 0.001) [15]. Most healthcare providers exhibited neutral attitudes (58.6%), and a negative attitude was significantly associated with not participating in prostate cancer-related continuing medical education (p = 0.047) [13, 15]. Rural community-based programmes and heightened awareness campaigns are needed to conscientize men about the risk factors, symptoms, diagnosis, and treatment of PC in rural areas of Limpopo. [13].
Previous studies have highlighted the lack of knowledge and the influence of cultural beliefs and attitudes as major barriers to PCa screening in sub-Saharan Africa [16, 17]. Additionally, healthcare provider practices and attitudes, as well as community-level factors such as education and social support, play critical roles in shaping men’s perceptions and behaviors regarding PCa [18, 19]. Given these complexities and grounded in the Health Belief Model, this study aims to investigate the knowledge, attitudes, practices, cultural beliefs, and perceived risk of PCa among men to provide an understanding of the factors influencing PCa awareness and screening behaviors in these communities, thereby informing tailored interventions to improve early detection and reduce mortality rates.
Methods
Study Design, Population, and Sample Size
This study was a cross-sectional study conducted among men in the community in August 2023. The study population consisted of men over the age of 40 years, in selected villages under the Mphaphuli tribal authority (Thulamela) and the Niani tribal authority (Musina local municipality). Men residing in Tshikhudini, Tshiulungoma, and Dididi (Thulamela) and in Nkotswi, Bende Mutale, Masisi, and Madimbo (Niani) were recruited to participate in the study. The estimated men in both villages was N = 1963. The sample size calculation was done using Epi Info version 7 software, assuming a cross-sectional survey with a population size of 1963, a 50% knowledge score, and 5% acceptable margin of error for 95% confidence intervals. The estimated sample size was 431, which is calculated from the total population of men in the two tribal villages. Following interest in the study by the initial participants, n = 431 men took part in the study.
Data Collection Instrument
The data was collected using a questionnaire, which was developed using the framework of the African Women Awareness of Cancer (AWACAN) tool that was originally developed to measure awareness of breast and cervical cancer amongst women in sub-Saharan Africa (SSA). This tool was validated for use in South African women with a content validity index (CVI) > 78% for most items, test–retest ICC > 0.75 (good), KR-20 > 0.70 (good internal consistency), and significant construct validity (p < 0.05) [20], and has been adapted for use in this study. The AWACAN tool was modified for PCa and for use in men in the community. This version was then reviewed by a research coordinator (with a background in nursing) at Tshilidzini hospital, and further amendments were made. This tool was piloted amongst the men in the community who did not participate in the main study, after which any adjustments were made.
The questionnaire was written in English and translated into Tshivenda. The questionnaire was divided into seven sections. Section 1 [18 questions], was on information on Socio-demographic data; Sect. 2 [15 questions] an assessment of prostate cancer awareness; Sect. 3 [15 questions], knowledge of risk factors associated with prostate cancer; Sect. 4 [11 questions], an assessment of knowledge of symptoms of prostate cancer; Sect. 5 [5 questions], assessment of health seeking behavior; Sect. 6 [5 questions], assessment of confidence skills and behavior in relation to a prostate cancer sign or symptom; Sect. 7 [12 questions], assessment of barriers to seeking medical help.
Data Collection
The survey was conducted by fieldworkers who are fluent in English and Tshivenda and are knowledgeable about the area and fluent in Tshivenda, who are already a part of the SAPCS study. They were trained in conducting the surveys. Once the data had been collected, it was translated back to English. Those who agreed to participate were requested to complete a consent form. The researchers went through the consent forms with the participants and then provided clarifications where participants did not understand. The participants were asked to sign the consent form or give verbal consent before completing the questionnaires.
Data Management
This study was approved by the University of Pretoria Research Ethics Committee (Ethics Number 831/2020).
The research team ensured that all information was kept confidential. Interviewers received appropriate training to ensure uniformity during interviews. The interviewers reviewed the data with one another to ensure its completeness. Double data entry was done daily for 10% of completed questionnaires as soon as the completed questionnaires were received. The two sets of records were compared, and any discrepancies were checked against the original questionnaire and corrected. All the research data and documents referring to the above-mentioned study were stored at the following address: School of Health Systems and Public Health, University of Pretoria. Storage of the above-mentioned data and documents was maintained for a minimum of 15 years from the commencement of the study. The hard copy data and documents were stored in a locked storage area in lockable offices. The electronic data were password protected and only accessible to staff working on the project.
Data Analysis
Once the data collection was complete, the data from the questionnaires was captured using Qualtrics and exported to STATA version 16.0 for descriptive analysis and multivariate logistic regression.
Results
Characteristics of Study Population
The study included 431 men from the Vhembe district in Limpopo Province, South Africa, with a mean age of 51.16 years (standard deviation = 8.47 years). The awareness of prostate cancer was nearly evenly split, with 210 (48.7%) participants having not heard of prostate cancer and 221 (51.3%) having heard of it.
Sociodemographic Characteristics
In terms of age, participants ranged from 30 to over 60 years old. Among them, 27 (6.3%) were aged 30–40 years, 211 (49.0%) were aged 41–50 years, 124 (28.7%) were aged 51–60 years, and 69 (16.0%) were over 60 years old. Prostate cancer awareness significantly varied with age (p < 0.001), with older participants generally more aware. For relationship status, 163 (37.8%) were married, 123 (28.5%) were living with a partner, 76 (17.6%) were single, 36 (8.4%) were separated or divorced, and 28 (6.5%) were widowed. Awareness of prostate cancer was also significantly associated with relationship status (p < 0.001), with married participants showing higher awareness. Regarding education level, 8 (1.9%) had no schooling, 78 (18.1%) had incomplete primary education, 84 (19.5%) had incomplete secondary education, 134 (31.1%) had completed secondary education, and 127 (29.5%) had education beyond secondary school. A significant association was found between education level and prostate cancer awareness (p = 0.002), with higher education levels correlating with greater awareness (Table 1).
Table 1.
Sociodemographic characteristics on prostate cancer among men in the Vhembe district in Limpopo Province, South Africa
| Heard of prostate cancer |
All participants (N= 431) |
No (n = 210) |
Yes (n = 221) |
|
|---|---|---|---|---|
| Variable | N(%) | n(%) | n(%) | p-value |
| Age | < 0.001 | |||
| 30–40 years | 27 (6.3) | 19 (9.1) | 8 (3.6) | |
| 41–50 years | 211 (49.0) | 118 (56.2) | 93 (42.1) | |
| 51–60 years | 124 (28.7) | 48 (22.8) | 76 (34.4) | |
| > 60 years | 69 (16.0) | 25 (11.9) | 44 (19.9) | |
| Relationship status | < 0.001 | |||
| Married | 163 (37.8) | 59 (28.1) | 104 (47.1) | |
| Living together with a partner | 123 (28.5) | 61 (29.1) | 62 (28.1) | |
| Single | 76 (17.6) | 53 (25.2) | 23 (10.4) | |
| Separated/divorced | 36 (8.4) | 17 (8.1) | 19 (8.6) | |
| Widowed | 28 (6.5) | 15 (7.1) | 13 (5.9) | |
| Did not answer | 5 (1.2) | 5 (2.4) | 0 (0) | |
| Level of education | 0.002 | |||
| No schooling | 8 (1.9) | 3 (1.4) | 5 (2.3) | |
| Primary incomplete | 78 (18.1) | 42 (20.0) | 36 (16.3) | |
| Secondary incomplete | 84 (19.5) | 52 (24.8) | 32 (14.5) | |
| Secondary complete | 134 (31.1) | 69 (32.9) | 65 (29.4) | |
| More than secondary | 127 | 44 (20.9) | 83 (37.5) | |
| Language | < 0.001 | |||
| Tshivenda | 355 (82.4) | 193 (91.9) | 162 (73.3) | |
| Xitsonga | 60 (13.9) | 9 (4.3) | 51 (23.1) | |
| Sepedi | 2 (0.5) | 6 (2.9) | 2 (0.9) | |
| Shona | 11 (2.6) | 0 (0) | 5 (2.3) | |
| English | 3 (0.7) | 2 (0.9) | 1 (0.4) | |
| Employed | ||||
| Did not answer | 2 (0.5) | 2 (1.0) | 0 (0) | 0.006 |
| No | 169 (39.3) | 96 (45.9) | 73 (33.0) | |
| Yes | 259 (60.2) | 111 (53.1) | 148 (67.0) | |
| Social grant | 0.051 | |||
| Did not answer | 9 (2.1) | 8 (3.8) | 1 (0.4) | |
| No | 309 (71.7) | 148 (70.5) | 161 (72.9) | |
| Yes | 113 (26.2) | 54 (25.7) | 59 (26.7) | |
| Dwelling or housing | 0.136 | |||
| Brick house/apartment | 405 (94.0) | 195 (92.9) | 210 (95.0) | |
| Informal dwelling/shack | 11 (2.6) | 9 (4.3) | 2 (0.9) | |
| Traditional dwelling/hut | 11 (2.6) | 4 (1.9) | 7 (3.2) | |
| Other | 4 (0.9) | 2 (0.9) | 2 (0.9) | |
| Electricity or solar panel | 0.029 | |||
| Did not answer | 4 (0.9) | 2 (0.9) | 2 (0.9) | |
| No | 16 (3.7) | 13 (6.2) | 3 (1.4) | |
| Yes | 411 (95.4) | 195 (92.9) | 216 (97.7) | |
| Tap water in the house | ||||
| Did not answer | 56 (12.9) | 45 (21.4) | 11 (5.0) | < 0.001 |
| No | 214 (49.7) | 118 (56.2) | 96 (43.4) | |
| Yes | 161 (37.4) | 47 (22.4) | 114 (51.6) | |
| Tap water in the yard | ||||
| No | 59 (13.7) | 41 (19.5) | 18 (8.1) | 0.001 |
| Yes | 372 (86.3) | 169 (80.5) | 203 (91.9) | |
| Tap water in the village | ||||
| Did not answer | 1 (0.2) | 0 (0) | 1 (0.5) | 0.425 |
| No | 161 (37.4) | 83 (39.5) | 78 (35.3) | |
| Yes | 269 (62.4) | 127 (60.5) | 142 (64.2) | |
| Toilet in the house or yard | < 0.001 | |||
| Did not answer | 1 (0.2) | 1 (0.5) | 0 (0) | |
| No | 32 (7.4) | 26 (12.4) | 6 (2.7) | |
| Yes | 398 (92.3) | 183 (87.1) | 215 (97.3) | |
| Toilet in the community | < 0.001 | |||
| Did not answer | 64 (14.9) | 49 (23.3) | 15 (6.8) | |
| No | 104 (24.1) | 37 (17.6) | 67 (30.3) | |
| Yes | 263 (61.0) | 124 (59.1) | 139 (62.9) | |
| Have a radio | 0.035 | |||
| Did not answer | 5 (1.2) | 3 (1.4) | 2 (0.9) | |
| No | 65 (15.0) | 41 (19.5) | 24 (10.9) | |
| Yes | 361 (83.8) | 166 (79.1) | 195 (88.2) | |
| Have a television | < 0.001 | |||
| Did not answer | 3 (0.7) | 3 (1.4) | 0 (0) | |
| No | 38 (8.8) | 32 (15.2) | 6 (2.7) | |
| Yes | 390 (90.5) | 175 (83.3) | 215 (97.3) | |
| Have a mobile phone or computer | 0.002 | |||
| Did not answer | 5 (1.2) | 5 (2.4) | 0 (0) | |
| No | 38 (8.8) | 26 (12.4) | 12 (5.4) | |
| Yes | 388 (90.0) | 179 (85.2) | 209 (94.6) | |
| Have a cell phone | < 0.001 | |||
| No | 39 (9.1) | 31 (14.8) | 8 (3.6) | |
| Yes | 392 (90.9) | 179 (85.2) | 213 (96.4) | |
| Have internet access | 0.005 | |||
| Did not answer | 12 (2.8) | 11 (5.2) | 1 (0.5) | |
| No | 98 (22.7) | 61 (29.1) | 37 (16.7) | |
| Yes | 321 (74.5) | 138 (65.7) | 183 (82.8) |
Awareness and Knowledge of Prostate Cancer
The sources of information about prostate cancer varied among participants (Tables 2 and 3). Clinics and hospitals were the most common sources, reported by 67 (15.6%) participants, followed by radio (82, 19.0%), television (30, 6.9%), newspapers (10, 2.3%), church (8, 1.9%), and other sources (25, 5.8%). However, a significant portion (209, 48.5%) did not specify where they had heard about prostate cancer. Participants’ knowledge of risk factors for prostate cancer showed that 194 (45.0%) were aware that being older than 50 years is a risk factor. Additionally, 190 (44.1%) knew that a family history of prostate cancer is a risk factor, 133 (30.8%) were aware of the risk associated with getting STIs, 124 (28.8%) with having too much sex, and 136 (31.6%) with having unprotected sex. Awareness of smoking cigarettes and drinking alcohol as risk factors was 168 (39.0%) and 156 (36.2%), respectively. Only a small number of participants believed that ancestors (32, 7.4%) or evil spirits (47, 10.9%) could cause prostate cancer.
Table 2.
Prostate cancer awareness among men in Vhembe district, Limpopo, South Africa
| Characteristics | Frequency (N = 431) |
Percentage (100%) |
|---|---|---|
| Where you heard of prostate cancer | ||
| Church | 8 | 1.9 |
| Clinic/hospital | 67 | 15.6 |
| Newspaper | 10 | 2.3 |
| TV | 30 | 6.9 |
| Radio | 82 | 19.0 |
| Other sources | 25 | 5.8 |
| Not stated | 209 | 48.5 |
| Family member or friend with prostate cancer | ||
| No | 366 | 84.9 |
| Yes | 65 | 15.1 |
| Family member or friend with prostate cancer | ||
| No | 399 | 92.6 |
| Yes | 32 | 7.4 |
Table 3.
Knowledge of risk factors and symptoms for prostate cancer among men in the Vhembe district, Limpopo, South Africa
| Characteristics | Frequency (N = 431) |
Percentage (100%) |
|
|---|---|---|---|
| Knowledge on the risk factors for prostate cancer | |||
| Being older than 50 years | |||
| Don’t know | 220 | 51.0 | |
| No | 17 | 3.9 | |
| Yes | 194 | 45.0 | |
| Having males with prostate cancer history in the family | |||
| Don’t know | 218 | 50.6 | |
| No | 23 | 5.3 | |
| Yes | 190 | 44.1 | |
| Getting STI’s | |||
| Don’t know | 233 | 54.1 | |
| No | 65 | 15.1 | |
| Yes | 133 | 30.8 | |
| Having too much sex | |||
| Don’t know | 238 | 55.2 | |
| No | 69 | 16.0 | |
| Yes | 124 | 28.8 | |
| Having unprotected sex | |||
| Don’t know | 229 | 53.1 | |
| No | 66 | 15.3 | |
| Yes | 136 | 31.6 | |
| Smoking cigarette | |||
| Don’t know | 219 | 50.8 | |
| No | 44 | 10.2 | |
| Yes | 168 | 39.0 | |
| Drinking alcohol | |||
| Don’t know | 224 | 52.0 | |
| No | 51 | 11.8 | |
| Yes | 156 | 36.2 | |
| Ancestors | |||
| Don’t know | 29 | 6.7 | |
| No | 370 | 85.9 | |
| Yes | 32 | 7.4 | |
| Evil spirits cause prostate cancer | |||
| Don’t know | 30 | 7.0 | |
| No | 354 | 82.1 | |
| Yes | 47 | 10.9 | |
| Bladder does not empty fully | |||
| Don’t know | 149 | 34.6 | |
| No | 41 | 9.5 | |
| Yes | 241 | 55.9 | |
| Frequent urination within 2 h | |||
| Don’t know | 142 | 32.9 | |
| No | 71 | 16.5 | |
| Yes | 218 | 50.6 | |
| Can’t hold urine | |||
| Don’t know | 147 | 34.1 | |
| No | 73 | 16.9 | |
| Yes | 211 | 49.0 | |
| Urine stops and starts during urination | |||
| Don’t know | 146 | 33.9 | |
| No | 59 | 13.7 | |
| Yes | 226 | 52.4 | |
| Strain when urinating | |||
| Don’t know | 142 | 33.0 | |
| No | 58 | 13.4 | |
| Yes | 231 | 53.6 | |
| Passing urine many times at night | |||
| Don’t know | 163 | 37.8 | |
| No | 97 | 22.5 | |
| Yes | 171 | 39.7 | |
| Persistent lower abdominal/back pain | |||
| Don’t know | 158 | 36.7 | |
| No | 75 | 17.4 | |
| Yes | 198 | 45.9 | |
| Blood in urine/semen | |||
| Don’t know | 142 | 33.0 | |
| No | 52 | 12.1 | |
| Yes | 237 | 54.9 | |
| Painful ejaculation | |||
| Don’t know | 149 | 34.6 | |
| No | 68 | 15.8 | |
| Yes | 214 | 49.6 | |
| Erectile dysfunction | |||
| Don’t know | 150 | 34.8 | |
| No | 59 | 13.7 | |
| Yes | 222 | 51.5 | |
| Swelling in the legs or pelvic area | |||
| Don’t know | 153 | 35.5 | |
| No | 90 | 20.9 | |
| Yes | 188 | 43.6 | |
| Numbness or pain in the hips or legs | |||
| Don’t know | 166 | 38.5 | |
| No | 84 | 19.5 | |
| Yes | 181 | 42.0 | |
| Painful bones | |||
| Don’t know | 163 | 37.8 | |
| No | 97 | 22.5 | |
| Yes | 171 | 39.7 | |
Health-Seeking Behavior
When asked about health-seeking behavior, only 7 (1.6%) participants indicated they would ignore symptoms of prostate cancer, while 385 (89.3%) would not, and 39 (9.1%) were unsure. Consulting health professionals showed variability: 103 (24.0%) would visit a traditional healer, 166 (38.5%) would consult a nurse at a clinic or hospital, 89 (20.7%) would see a doctor at a clinic or hospital, and 57 (13.2%) would go to a private GP or doctor (Table 4).
Table 4.
Confidence, skills, and health-seeking behavior in relation to prostate cancer signs and symptoms among men in the Vhembe District, Limpopo, South Africa
| Characteristics | Frequency (N = 431) |
Percentage (100%) |
|---|---|---|
| Health seeking behavior for prostate cancer | ||
| Would you ignore symptoms of prostate cancer | ||
| Don’t know | 39 | 9.1 |
| No | 385 | 89.3 |
| Yes | 7 | 1.6 |
| Self-medicate if there are symptoms | ||
| Don’t know | 43 | 10.0 |
| No | 348 | 80.7 |
| Yes | 40 | 9.3 |
| Tell someone if there are symptoms | ||
| Don’t know | 38 | 8.8 |
| No | 97 | 22.5 |
| Yes | 296 | 68.7 |
| Who would you tell first | ||
| Family | 125 | 29.0 |
| Friend | 31 | 7.2 |
| Partner | 127 | 29.5 |
| Other | 148 | 34.3 |
| Who would you consult with first | ||
| Traditional healer | 69 | 16.0 |
| Nurse at clinic/hospital | 166 | 38.5 |
| Doctor at clinic/hospital | 89 | 20.7 |
| Private GP/doctor | 57 | 13.2 |
| Prophet/faith healer | 11 | 2.6 |
| Other | 39 | 9.0 |
| Visit a traditional healer if there are symptoms | ||
| Don’t know | 35 | 8.1 |
| No | 292 | 67.9 |
| Yes | 103 | 24.0 |
| If you had symptoms, how soon would you visit a traditional healer | ||
| < 1 week | 65 | 63.7 |
| 1 week to < 1 month | 22 | 21.6 |
| 1 month to < 3 months | 10 | 9.8 |
| 3 months | 5 | 4.9 |
| If you had symptoms, how soon would you visit a health center | ||
| Never | 73 | 17.1 |
| < 1 week | 236 | 55.1 |
| 1 week < 1 month | 87 | 20.3 |
| 1 month < 3 months | 13 | 3.0 |
| 3 months | 19 | 4.4 |
| Confident in symptoms of prostate cancer | ||
| Don’t know | 52 | 12.1 |
| No | 163 | 37.8 |
| Yes | 216 | 50.1 |
| Visited healthcare workers for symptoms | ||
| Don’t know | 110 | 25.5 |
| No | 287 | 66.6 |
| Yes | 34 | 7.9 |
| Visited traditional healers for symptoms | ||
| Don’t know | 111 | 25.8 |
| No | 291 | 67.5 |
| Yes | 29 | 6.7 |
| Reasons do not visit healthcare workers | ||
| Fear of the results | ||
| Don’t know | 40 | 9.3 |
| No | 321 | 74.5 |
| Yes | 70 | 16.2 |
| Fear of the procedure | ||
| Don’t know | 40 | 9.4 |
| No | 311 | 72.7 |
| Yes | 77 | 17.9 |
| Busy to go to healthcare centers | ||
| Don’t know | 40 | 9.3 |
| No | 337 | 78.2 |
| Yes | 54 | 12.5 |
| Long time spent at healthcare centers | ||
| Don’t know | 39 | 9.1 |
| No | 284 | 65.9 |
| Yes | 108 | 25.1 |
| No money for transport | ||
| Don’t know | 39 | 9.1 |
| No | 318 | 74.1 |
| Yes | 72 | 16.8 |
| No confidence in disclosing the problem | ||
| Don’t know | 37 | 8.6 |
| No | 318 | 73.8 |
| Yes | 76 | 17.6 |
| Past bad health experience | ||
| Don’t know | 42 | 9.7 |
| No | 295 | 68.5 |
| Yes | 94 | 21.8 |
| Feeling embarrassed | ||
| Don’t know | 37 | 8.6 |
| No | 334 | 77.5 |
| Yes | 60 | 13.9 |
| Cultural barrier with healthcare workers | ||
| Don’t know | 40 | 9.3 |
| No | 354 | 82.1 |
| Yes | 37 | 8.6 |
| No use going to healthcare center | ||
| Don’t know | 42 | 9.7 |
| No | 334 | 77.5 |
| Yes | 55 | 12.8 |
| Things that are not discussed in my culture | ||
| Don’t know | 39 | 9.1 |
| No | 319 | 74.0 |
| Yes | 73 | 16.9 |
Factors Associated with Knowledge of Prostate Cancer
Multivariate analysis revealed several significant factors associated with knowledge of prostate cancer (Table 5). Older age groups showed higher awareness, with adjusted odds ratios (aOR) of 2.71 (95% CI [1.04–7.02], p = 0.040) for ages 51–60 years, and 3.70 (95% CI [1.30–10.53], p = 0.014) for those over 60 years. Language also played a crucial role, with Xitsonga speakers having an aOR of 6.83 (95% CI [3.18–14.67], p < 0.001). Having tap water in the house was strongly associated with higher awareness (aOR = 8.65, 95% CI [3.81–19.7], p < 0.001), as was owning a cell phone (aOR = 4.47, 95% CI [1.73–11.57], p = 0.002).
Table 5.
Factors associated with knowledge of prostate cancer among men in the Vhembe district, Limpopo, South Africa
| Univariate | Multivariate | |||
|---|---|---|---|---|
| Variable | OR (95% CI) | p value | aOR (95% CI) | p value |
| Age | ||||
| 30–40 years | Ref | - | - | - |
| 41–50 years | 1.87 (0.78–4.47) | 0.158 | 1.64 (0.67–4.01) | 0.281 |
| 51–60 years | 3.76 (1.53–9.26) | 0.004 | 2.71 (1.04–7.02) | 0.040 |
| > 60 years | 4.18 (1.60–10.93) | 0.004 | 3.70 (1.30–10.53) | 0.014 |
| Relationship status | ||||
| Married | Ref | |||
| Living together with a partner | 0.58 (0.36–0.93) | 0.024 | 0.63 (0.39–1.02) | 0.062 |
| Single | 0.25 (0.14–0.44) | < 0.001 | 0.34 (0.18–0.64) | 0.001 |
| Separated/divorced | 0.63 (0.31–1.31) | 0.220 | 0.63 (0.30–1.32) | 0.219 |
| Widowed | 0.49 (0.22–1.10) | 0.085 | 0.34 (0.14–0.83) | 0.017 |
| Did not answer | 1 | - | - | - |
| Language | ||||
| Tshivenda | Ref | - | - | - |
| Xitsonga | 6.75 (3.23–14.13) | < 0.001 | 6.83 (3.18–14.67) | < 0.001 |
| Sepedi | 1 | - | - | |
| Shona | 0.99 (0.29–3.31) | 0.991 | 1.05 (0.29–3.69) | 0.945 |
| English | 0.59 (0.05–6.62) | 0.673 | 0.73 (0.06–8.47) | 0.804 |
| Tap water in the house | ||||
| Did not answer | Ref | - | - | - |
| No | 3.33 (1.63–6.78) | 0.001 | 3.37 (1.53–7.39) | 0.002 |
| Yes | 9.92 (4.73–20.83) | < 0.001 | 8.65 (3.81–19.7) | < 0.001 |
| Tap water in the yard | ||||
| No | Ref | - | ||
| Yes | 2.74 (1.51–4.94) | 0.001 | 1.98 (1.02–3.84) | 0.044 |
| Have a cell phone | ||||
| No | Ref | - | ||
| Yes | 4.61 (2.07–10.29) | < 0.001 | 4.47 (1.73–11.57) | 0.002 |
Logistic regression analysis
• The outcome variable was either the participants heard about prostate cancer or not
• We used manual forward selection to determine factors associated with knowledge of prostate cancer
• Univariate: we used a cut off p-value of 0.25
• Multivariate: we used a cut off p-value of 0.05 to identify factors associated with knowledge of prostate cancer
• Collinearity and goodness of fit was done.
Discussion
This study provides a comprehensive analysis of the awareness and knowledge of prostate cancer among men in the Vhembe district of Limpopo Province, South Africa. The results underscore the crucial role of sociodemographic factors in shaping health awareness and behaviors, particularly in relation to prostate cancer.
The study revealed significant associations between age, relationship status, and language with prostate cancer awareness. Older participants demonstrated greater awareness, likely due to increased health concerns and interactions with healthcare services as they age [21]. Married individuals also showed higher awareness, which may be attributed to spousal influence and support in health matters [22]. Language played a crucial role, with Xitsonga speakers exhibiting significantly higher awareness compared to speakers of other languages. These findings suggest that tailored health communication strategies that consider linguistic and cultural contexts are essential for effective public health interventions [23].
Education emerged as a significant factor influencing awareness and knowledge of prostate cancer. Participants with higher levels of education were more likely to be aware of prostate cancer and its risk factors. This finding aligns with existing literature, which highlights education as a critical determinant of health literacy [24, 25]. Higher educational attainment typically equips individuals with better access to health information [26] and the capacity to understand and utilize such information effectively [27]. Therefore, educational interventions aimed at increasing prostate cancer awareness should be prioritized, particularly targeting groups with lower educational levels[28].
The study also explored health-seeking behaviors and found that a significant number of participants would consult traditional healers or delay seeking medical advice for prostate cancer symptoms. This preference for traditional healers highlights the need for culturally sensitive health education that integrates traditional beliefs with modern medical practices [29]. Collaborating with traditional healers and community leaders could bridge the gap between traditional and Western health systems [30], encouraging earlier and more appropriate health-seeking behavior [31].
Despite the relatively high awareness of prostate cancer among the study population, knowledge of specific risk factors and symptoms varied. While a significant portion of participants recognized the importance of age and family history as risk factors, many were unaware of other critical risk factors, such as STIs and lifestyle behaviors, similar to a recent study in South Africa [32]. Additionally, knowledge of prostate cancer symptoms was limited, with many participants unable to identify key symptoms such as frequent urination, blood in urine or semen, and erectile dysfunction. This gap in specific knowledge is concerning as it may impede early detection and timely medical intervention [13].
Early detection of prostate cancer significantly improves treatment outcomes and survival rates [5]. Therefore, public health campaigns should not only aim to increase general awareness but also enhance specific knowledge of risk factors and symptoms [14]. Educational programs should incorporate detailed information about the importance of regular screening and the symptoms that warrant medical consultation.
The findings of this study have important implications for public health interventions in the Vhembe district and similar settings. Interventions should focus on the following to improve prostate cancer outcomes: Educational Campaigns: Targeting men with lower educational attainment and providing information in local languages to improve health literacy and awareness. Community Engagement: Involving community leaders and traditional healers in health education efforts to address cultural barriers and promote early detection. Screening Programs: Implementing and promoting accessible prostate cancer screening programs, especially for older men and those with a family history of prostate cancer. Comprehensive Health Education: Providing detailed information about prostate cancer risk factors, symptoms, and the importance of early detection through various communication channels.
Limitations
This study has some limitations. Its cross-sectional design limits causal inference, and self-reported data may be affected by recall or social desirability bias. Cultural beliefs and symptom knowledge were not deeply explored, and health system accessibility was not assessed, which may influence awareness and behavior.
Conclusion
In conclusion, this study highlights the critical role of education, sociodemographic factors, and culturally sensitive health communication in enhancing prostate cancer awareness and early detection. By addressing these factors through targeted public health interventions, we can improve prostate cancer outcomes and reduce the burden of this disease in the Vhembe district and beyond. Future research should continue to explore the interplay between education, cultural beliefs, and health behaviors to develop more effective strategies for cancer prevention and control.
Author Contribution
All authors contributed to the study conception and design. Data analysis was performed by Zazi Zikalala, and the first draft of the manuscript was written by Sean Patrick. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Funding
Open access funding provided by University of Pretoria. This study was funded by the Cancer Association of South Africa (CANSA). This work was supported by the U.S. Congressionally Directed Medical Research Program (CDMRP or DoD) Prostate Cancer Research Program (PCRP) Ideas Award to Hayes (TARGET Africa Project; PC200390); Health Equity Research and Outcomes Improvement Consortium (HEROIC) Award to Hayes and Bornman (HEROIC PCaPH Africa1K Consortium; PC210168 and PC23067).
Data Availability
The data that support the findings of this study are available on request from the corresponding author.
Declarations
Ethics Approval
This study was approved by the University of Pretoria Research Ethics Committee (Ethics Number 831/2020).
Competing Interests
The authors declare no competing interests.’
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author.