Factors, including patient education, that impact cancer treatment adherence in low- and middle-income African countries: a scoping review

PURPOSE: Cancer-related morbidity and mortality are disproportionately higher in low- and middle-income countries. One factor that is crucial to improving outcomes is adherence to cancer treatments, which is lower in low- and middle-income countries, especially in Africa, due to patient, provider and system factors. This scoping review aims to map and summarise the characteristics of patient education strategies designed to improve cancer treatment adherence in low- and middle-income African countries. METHODS: This scoping review used the methods of the Joanna Briggs Institute framework. The review included English-language primary studies published in peer-reviewed journals. It focused on adults with cancer receiving an educational intervention aimed at improving treatment adherence in low- and middle-income African countries using narrative synthesis. RESULTS: Eleven included articles generated three overarching themes on treatment adherence: challenges of social structures; safe, meaningful patient education; and the power of interpersonal interactions between patients, healthcare professionals and families. Technology-assisted education, direct lectures, role playing and demonstration-based methods delivered through group and one-on-one sessions were effective strategies for improving treatment adherence. However, low-income and literacy, treatment complexity and lack of social support were frequently reported as barriers to improving cancer treatment adherence. Challenges of social structure in treatment adherence included low-literacy (and low-health literacy), cultural and religious beliefs, financial burdens, limited access to cancer care and inadequate health system infrastructure. CONCLUSIONS: The mapped evidence highlights that there are several patient education strategies that have been published in low- and middle-income African countries. However, empirical evidence is limited, heterogeneous in findings and not evaluated with validated methods.