Abstract 13: Barriers to Diagnostic Follow-Up for Women With a Suspicious Clinical Breast Examination at the Primary Health Center in Uttar Pradesh State in India: A Qualitative Study

Abstract Purpose: The purpose of this study was to understand key barriers to diagnostic follow-up for women with a suspicious clinical breast examination (CBE) at the primary care level in Uttar Pradesh (UP) state in India. We also explored acceptability of the use of mHealth strategies to address barriers to CBE follow up for women. Methods: We conducted 28 in-depth individual interviews with key stakeholders involved in the Breast Health Initiative in Lucknow district, UP. Primary health facilities in rural and urban settings were purposively selected based on the number of CBE screening exams conducted in the last year and the number of women with a suspicious CBE identified. We interviewed six women with a suspicious CBE at the primary health facility who did not have diagnostic follow-up, six community health workers (ASHAs), six healthcare providers from primary health facilities and four district or state-level health decisionmakers. Interviews were audio-recorded and transcribed verbatim. Coding and thematic analysis will proceed once translation of the full dataset of transcripts is complete. Results: Preliminary analyses of qualitative interviews found that cancer stigma and fear are significant barriers to both breast screening and follow-up of an abnormal CBE. Male providers and long waits at the district hospital are barriers to completing confirmatory diagnostic exams. Providers maintain that, despite community education and outreach efforts by ASHAs, lack of awareness of breast cancer and the importance of follow-up for abnormal CBE remains a barrier to early detection. Conclusion: Knowledge barriers, cultural barriers, and health system barriers challenge women’s ability to follow recommendations for diagnostic follow-up of an abnormal CBE in Uttar Pradesh, India. Multi-level strategies are needed to address these barriers. Our findings will help inform the content and approach of an mHealth patient navigation strategy that could include patient education, reminders, patient tracking, and care coordination. Citation Format: Erica Liebermann, Gulnoza Usmanova, Nadeem Akhtar, Shivani Agrawal, Vaibhav Patwardhan, Parag Bhamare, Somesh Kumar. Barriers to Diagnostic Follow-Up for Women With a Suspicious Clinical Breast Examination at the Primary Health Center in Uttar Pradesh State in India: A Qualitative Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 13.