Strategies to enhance the approach to prostate cancer screening of South African black men in the Free State: a Delphi study

Submitted: 4 October 2022
Accepted: 19 December 2022
Published: 24 May 2023
Abstract Views: 349
PDF: 223
HTML: 28
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Background. The incidence and mortality rates of prostate cancer (PCa) are disproportionately on the increase among South African black men. Recent studies show a greater net benefit of prostate-specific antigen screening of black men compared with the general population. There are, however, knowledge, attitude, and practice (KAP) gaps among primary healthcare providers (HCPs) and users (black men) on PCa screening. Likewise, there is a scarcity of research on strategies to address these gaps. Objective. This study sought to determine complementing strategies to enhance the approach to PCa screening of African men in the Free State, South Africa, from the perspectives of primary HCPs and users. Methods. This study utilized a three-round modified Delphi survey to achieve its aim. Consensus was determined by an a priori threshold of ≥70% of agreement. Results. The survey involved a multidisciplinary panel of 19 experts. The consensus was reached on 34 items (strategies) to enhance the approach to PCa screening in the study setting. Community health education strategies were proffered, relating to relevant topics, methods, venues of delivery, and persons to deliver the education. Continuing education topics and methods of instruction were suggested for primary HCPs. Conclusions. In view of the existing KAP gaps in PCa screening among primary HCPs and users (black men), an expert consensus was determined, on complementing strategies to enhance the approach to PCa screening of South African black men in the study setting.

Adeloye D, David RA, Aderemi AV, et al. An estimate of the incidence of prostate cancer in Africa: A systematic review and meta-analysis. PLoS One 2016;11(4):e0153496.

Bahnassy AA, Abdellateif MS, Zekri AN. Cancer in Africa: Is it a genetic or environmental health problem? Front Oncol 2020;10:604214.

Le Roux HA, Urry RJ, Sartorius B, Aldous C. Prostate cancer at a regional hospital in South Africa: we are only seeing the tip of the iceberg. S Afr J Surg 2015;53(3 and 4):57–62.

Cassim N, Ahmad A, Wadee R, Rebbeck TR, Glencross DK, George JA. Prostate cancer age-standardised incidence increase between 2006 and 2016 in Gauteng Province, South Africa: A laboratory data-based analysis. S Afr Med J 2020;111(1):26–32.

Dewar M, Kaestner L, Zikhali Q, Jehle K, Sinha S, Lazarus J. Investigating racial differences in clinical and pathological features of prostate cancer in South African men. S Afr J Surg 2018;56(2):54–8.

Nkoana S, Sodi T, Makgahlela M, Mokwena J. Cancer survivorship: religion in meaning making and coping among a group of Black prostate cancer patients in South Africa. J Relig Health 2022;61(2):1390–400.

US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for prostate cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2018;319(18):1901–13.

Cuzick J, Thorat MA, Andriole G, et al. Prevention and early detection of prostate cancer. Lancet Oncol 2014;15(11):e484–e92.

Mutua K, Pertet AM, Otieno C. Cultural factors associated with the intent to be screened for prostate cancer among adult men in a rural Kenyan community. BMC Public Health 2017;17(1):894.

Basourakos SP, Gulati R, Vince RA Jr, et al. Harm-to-benefit of three decades of prostate cancer screening in Black men. NEJM Evid 2022;1(6):10.1056/evidoa2200031.

Eales OO, Smith S. Do socio-economically disadvantaged patients prefer shared decision-making? S Afr Fam Pract 2021;63(1):e1–e6.

Dullie L, Meland E, Hetlevik Ø, Mildestvedt T, Gjesdal S. Development and validation of a Malawian version of the primary care assessment tool. BMC Fam Pract 2018;19(1):63.

Mash B, Ray S, Essuman A, Burgueño E. Community-orientated primary care: A scoping review of different models, and their effectiveness and feasibility in sub-Saharan Africa. BMJ Glob Health 2019;4(Suppl 8):e001489.

Free State Department of Health. Annual Performance Plan, Free State Department of Health 2020/21. Bloemfontein, South Africa: Free State Department of Health; 2021.

Uebel K, Guise A, Georgeu D, Colvin C, Lewin S. Integrating HIV care into nurse-led primary health care services in South Africa: A synthesis of three linked qualitative studies. BMC Health Serv Res 2013;13:171.

Husaini DL, Harris-Thurton L, Brown NT, et al. Prostate cancer awareness, knowledge, and perception of screening among men aged 40–70 in the Belize district. J Public Health 2021;2021.

Mofolo N, Betshu O, Kenna O, et al. Knowledge of prostate cancer among males attending a urology clinic, a South African study. Springerplus 2015;4:67.

Kappen S, Jürgens V, Freitag MH, Winter A. Early detection of prostate cancer using prostate-specific antigen testing: An empirical evaluation among general practitioners and urologists. Cancer Manag Res 2019;11:3079–97.

Leyva B, Persoskie A, Ottenbacher A, et al. Do men receive information required for shared decision making about PSA testing? Results from a national survey. J Cancer Educ 2016;31(4):693–701.

Von Pressentin KB. Evaluating the impact of family physicians within the district health system of South Africa [Thesis (D.Phil)]. Faculty of Medicine and Health Sciences. Stellenbosch, South Africa: Stellenbosch University, 2017:27.

Lynn B, Hatry A, Burnett C, Kan L, Olatunbosun T, Bluman B. Identifying primary care physicians continuing education needs by examining clinical practices, attitudes, and barriers to screening across multiple cancers. J Cancer Educ 2018;33(6):1255–62.

Mash R, Blitz J. Overcoming challenges in primary care education in South Africa. Educ Prim Care 2015;26(4):274–8.

Lightfoot M, Palazuelos D. Evaluating the teaching methods of a community health worker training curriculum in Rural Guatemala. J Fam Med Community Health 2016;3(6):1096.

Azad A, Min JG, Syed S, Anderson S. Continued nursing education in low-income and middle-income countries: A narrative synthesis. BMJ Glob Health 2020;5(2):e001981.

Rural Health Information Hub. Health education [homepage on the Internet]. n.d. [cited 13 Jun 2022]. Available from:

Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: how to decide its appropriateness. World J Methodol 2021;11(4):116–29.

Broomfield D, Humphris GM. Using the Delphi technique to identify the cancer education requirements of general practitioners. Med Educ 2001;35(10):928–37.

Hou X, Hu W, Russell L, Kuang M, Konge L, Nayahangan LJ. Educational needs in the COVID-19 pandemic: A Delphi study among doctors and nurses in Wuhan, China. BMJ Open. 2021;11(4):e045940.

Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med 2017;31(8):684–706.

Keeney E, Thom H, Turner E, Martin RM, Sanghera S. Using a modified Delphi approach to gain consensus on relevant comparators in a cost-effectiveness model: application to prostate cancer screening. Pharmacoeconomics 2021;39(5):589–600.

Department of Health. Provincial guidelines for the implementation of three streams of PHC re-engineering. Pretoria, South Africa: Department of Health; 2011.

Grad R, Légaré F, Bell NR, et al. Shared decision making in preventive health care: what it is; what it is not. Can Fam Physician 2017;63(9):682–4.

Barber L, Gerke T, Markt SC, et al. Family history of breast or prostate cancer and prostate cancer risk. Clin Cancer Res 2018;24(23):5910–17.

Ren ZJ, Cao DH, Zhang Q, et al. First-degree family history of breast cancer is associated with prostate cancer risk: A systematic review and meta-analysis. BMC Cancer 2019;19(1):871.

Sandiford L, D’Errico EM. Facilitating shared decision making about prostate cancer screening among African American men. Oncol Nurs Forum 2016;43(1):86–92.

Howard A, Morgan P, Fogel J, et al. A community/faith-based education program to increase knowledge and shared decision making behavior for prostate cancer screening among Black men. ABNF Journal 2018;29(3):61–8.

Capanna C, Chujutalli R, Murray S, Lwin K, Aung M, Jolly P. Prostate cancer educational intervention among men in western Jamaica. Prev Med Rep 2015;2:788–93.

Mbugua RG, Karanja S, Oluchina S. Barriers and facilitators to uptake of prostate cancer screening in a Kenyan rural community. Ann Afr Surg 2021;18(3):130–6.

Serrell EC, Hansen M, Mills G, et al. Prostate cancer navigation: Initial experience and association with time to care. World J Urol 2019;37(6):1095–101.

Ezenwankwo EF, Nnate DA, Oladoyinbo CA, et al. Strengthening capacity for prostate cancer early diagnosis in West Africa amidst the COVID-19 pandemic: A realist approach to rethinking and operationalizing the World Health Organization 2017 Guide to Cancer Early Diagnosis. Ann Glob Health 2022;88(1):29.

Family Physicians SAAO. The contribution of family physicians to district health services in South Africa: A national position paper by the South African Academy of Family Physicians. S Afr Fam Pract 2022;64(1):e1–e7.

Matthew Olukayode Abiodun Benedict, Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein

Senior lecturer / medical specialist, Department of Family Medicine, Faculty of Health Sciences, Bloemfontein

Wilhelm Johannes Steinberg, Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein

Associate Professor, Principal Family Practitioner, Department of Family Medicine, Faculty of Health Sciences, Bloemfontein

Frederik M. Claassen, Department of Urology, Faculty of Health Sciences, University of the Free State, Bloemfontein

Adjunct Professor, Department of Urology, Faculty of Health Sciences, Univeristy of the Free State, Bloemfontein

Nathaniel Mofolo, School of Clinical Medicine, University of the Free State, Bloemfontein

Head of Department (at time of study), School of Clinical Medicine, Facuty of Health Sciences, University of the Free State, Bloemfontein

Benedict, M. O. A., Steinberg, W. J., Claassen, F. M., & Mofolo, N. (2023). Strategies to enhance the approach to prostate cancer screening of South African black men in the Free State: a Delphi study. Journal of Public Health in Africa, 14(7).


Download data is not yet available.