title: Exploring factors influencing health-seeking decisions and retention in childhood cancer treatment programmes: perspectives of parents in Ghana.
abstract: BACKGROUND
  Developing countries such as Ghana have very poor childhood cancer survival rates. There is a need to determine reasons for late presentation and treatment abandonment which are major causes of poor survival. Understanding these issues could inform effective strategies for childhood cancer control in resource-constrained settings.
  
  
  OBJECTIVE
  To explore factors influencing parental decision-making for children with cancer in Ghana with regard to health seeking and retention in treatment, in order to provide information that will guide Public Health interventions for childhood cancer control.
  
  
  METHODS
  This exploratory qualitative study was conducted based on an interpretative epistemology using a social constructionist approach. Purposive sampling of parents attending the Paediatric Oncology Unit, Korle Bu Teaching Hospital in Accra, Ghana was undertaken. Twelve semi-structured moderate interviews and two small focus group discussions with a total of seven participants were undertaken. Data analysis was through thematic content analysis.
  
  
  RESULTS
  Five major themes emerged. Knowledge and perceptions revealed a total lack of appropriate knowledge prior to diagnosis. Health-seeking behaviour was determined by interplay of individual and environmental factors. Orthodox medical treatment was largely perceived favourably. The impact of cancer on parents and children included psychological, physical and socioeconomic effects. Financial, spiritual and psychosocial support helped in coping. Parents recommended public education and health financing to address the major barriers.
  
  
  CONCLUSIONS
  Broad social determinants and experiences influence parental decision making for children with cancer. This implies Health Promotion strategies with multi-sectorial involvement will be required for effective implementation of the National Strategy for Cancer Control.
  
  
  BACKGROUND
  Funded by authors.
authors.affiliation: University of Ghana School of Medicine and Dentistry, Ghana.
authors.forename: Lorna Awo
authors.initials: LA
authors.lastname: Renner
authors.affiliation: University of Liverpool, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: McGill
mesh_terms: D000328:Adult; D002648:Child; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D005869:Ghana; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research
keywords: Childhood cancer; Ghana; parent perspectives