Women’s Sociocultural Experiences of Breast Cancer in KwaZulu-Natal: A Qualitative Study

Duduzile Zwane

doi:10.25159/2708-9355/20595

Authors

Duduzile Zwane University of Limpopo https://orcid.org/0000-0001-5663-5935

DOI:

https://doi.org/10.25159/2708-9355/20595

Keywords:

psychosocial, Zulu culture, breast cancer, women

Abstract

Female breast cancer is a debilitating disease affecting many women globally. Women living in developed countries tend to have significantly better survival outcomes, whereas those in resource-constrained settings, such as KwaZulu-Natal (KZN), South Africa, are unlikely to survive beyond five years after diagnosis. This disparity is shaped by limited breast cancer awareness, financial constraints, and an overburdened healthcare system. Additionally, women in this context are largely absent from scholarly literature. In response, a qualitative phenomenological design was adopted, and 30 semi-structured interviews were conducted with purposively selected Zulu women with breast cancer at Inkosi Albert Luthuli Central Hospital, in KZN. The objective was to examine their sociocultural experiences with this condition. Through Bandura’s social cognitive theory and a thematic analysis, the findings reveal that KZN is characterised by sociocultural and spiritual norms that markedly weaken women’s coping efficacy. Crucially, the interviews highlight the urgent need to enhance the sociocultural competencies of care professionals to improve service delivery.

References

Bandura, A. 1982. “Self-Efficacy Mechanism in Human Agency.” American Psychologist 37 (2): 122–47. https://doi.org/10.1037/0003-066X.37.2.122

Bandura, A. 1994. “Self-Efficacy.” In Encyclopedia of Human Behavior. Vol 4, edited by V. S. Ramachaudran, 71–81. San Diego: Academic Press.

Bandura, A. 2006. “Guide for Constructing Self-Efficacy Scales.” In Self-Efficacy Beliefs of Adolescents, edited by F. Pajares, and T. Urdan, 307–337. Greenwich, CT: Information Age Publishing.

Bandura, A. 2012. “Social Cognitive Theory.” In Handbook of Theories of Social Psychology, edited by P. A. M. Van Lange, A. W. Kruglanski, and E. T. Higgins, 349–373. London: Sage Publications. https://doi.org/10.4135/9781446249215.n18

Braun, V., and V. Clarke. 2006. “Using Thematic Analysis in Psychology.” Qualitative Research in Psychology 3 (2): 77–101. http://dx.doi.org/10.1191/1478088706qp063oa

Brown, O., V. Goliath, D. R. van Rooyen, C. Aldous, and L. C. Marais. 2018. “Cultural Factors that Influence the Treatment of Osteosarcoma in Zulu Patients: Healthcare Professionals’ Perspectives and Strategies.” Health SA Gesondheid 23: a1095. https://doi.org/10.4102/hsag.v23i0.1095

Clarke, V., and V. Braun. 2017. “Thematic Analysis.” The Journal of Positive Psychology 12 (3): 297–298. https://doi.org/10.1080/17439760.2016.1262613

Cornell, D., and K. van Merle. 2015. “A Call for a Nuanced Constitutional Jurisprudence: South Africa, Ubuntu, Dignity and Reconciliation.” In Violence and Gender in the Globalized World, edited by S. Bahun-Radunovic, V. G. Rajan, 107–121. London, Routledge.

Creswell, J. W. 2014. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Thousand Oaks, CA: SAGE Publications.

Daniels, A. L., and D. Isaacs. 2023. “Cultural Constructions of the Mentally Ill in South Africa: A Discourse Analysis, Part One.” Culture and Psychology 29 (1): 45–66. https://doi.org/10.1177/1354067X221131998

De Gama, B. Z., D. G. Jones, T. T. Bhengu, and K. S. Satyapal. 2020. “Cultural Practices of the Zulu Ethnic Group on the Body and Their Influence on Body Donation.” Anatomical Sciences Education 13 (6): 721–731. https://doi.org/10.1002/ase.1950

Dlamini-Myeni, B., G. Mazibuko, and K. Shumba. 2024. “The Significance of Female-Specific Taboos in Zulu Culture, South Africa.” Mankind Quarterly 65 (1): 42–57. https://doi.org/10.46469/mq.2024.65.1.5

Ehlers, V. U., C. F. Kohler, E. Lutge, A. Tefera, D. L. Clarke, and I. Buccimazza. 2021. “The Surgical Burden of Breast Disease in KwaZulu-Natal Province.” South African Journal of Surgery 59 (3): 108–112. https://doi.org/10.17159/2078-5151/2021/v59n3a3364

Goldstein, S., G. Japhet, S. Usdin, and E. Scheepers. 2004. “Soul City: A Sustainable Edutainment Vehicle Facilitating Social Change.” Health Promotion Journal of Australia 15 (2): 114–120. https://doi.org/10.1071/HE04114

Karcher, K., J. McCuaig, and S. King-Hill. 2024. “(Self-) Reflection/Reflexivity in Sensitive, Qualitative Research: A Scoping Review.” International Journal of Qualitative Methods 23: 1–15. https://doi.org/10.1177/16094069241261860

KwaZulu-Natal Treasury. 2023. Socio-Economic Review and Outlook 2024–2025. https://www.kzntreasury.gov.za/Programmtwo/Final%20Socio%20Economic%20Review%20and%20Outlook%20%202024_2025_%2015%20November%202023.pdf.

Lambert, M., E. Mendenhall, A. W. Kim, H. Cubasch, M. Joffe, and S. A. Norris. 2020. “Health System Experiences of Breast Cancer Survivors in Urban South Africa.” Women’s Health 16: 1–10. https://doi.org/10.1177/1745506520949419

Makhetha, M., N. Chabilal, and C. Aldous. 2023. “Recent Trends in Hereditary Breast Cancer Incidence by Race and Age in KwaZulu‐Natal, South Africa: An 11‐Year Single‐Centre Retrospective Study (2011–2021).” International Journal of Cancer 154 (1): 65–70. https://doi.org/10.1002/ijc.34687

McPherson, G., and S. Thorne. 2006. “Exploiting Exceptions to Enhance Interpretive Qualitative Health Research: Insights from a Study of Cancer Communication.” International Journal of Qualitative Methods 5 (2): 73–86. https://doi.org/10.1177/160940690600500210

Mdondolo, N., L. de Villiers, and V. J. Ehlers. 2003. “Cultural Factors Associated with the Management of Breast Lumps Amongst Xhosa Women.” Health SA Gesondheid 8 (3): 86–97. https://doi.org/10.4102/hsag.v8i3.138

Monteiro-Ferreira, A. M. 2005. “Reevaluating Zulu Religion: An Afrocentric Analysis. Journal of Black Studies 35 (3): 347–363. https://doi.org/10.1177/0021934704263127

Naidu, M. 2009. “‘Topless’ Tradition for Tourists: Young Zulu Girls in Tourism.” Agenda 23 (79): 38–48.

Nicolaides, A. 2023. “Considering the Philosophy of Ubuntu in South African Healthcare Ethical Practices.” The Journal of Medical Laboratory Science and Technology of South Africa 5 (1): 71–76. https://doi.org/10.36303/JMLSTSA.133

Phakathi, B., S. Nietz, H. Cubasch, C. Dickens, T. Dix-Peek, M. Joffe, A. I. Neugut, J. Jacobson, R. Duarte, and P. Ruff. 2021. “Survival of South African Women with Breast Cancer Receiving Anti-Retroviral Therapy for HIV.” The Breast 59: 27–36. https://doi.org/10.1016/j.breast.2021.05.014

Reddy, P., S. Ebrahim, B. Singh, S. Ramklass, and I. Buccimazza. 2017. “Breast Cancer and HIV: A South African Perspective and a Critical Review of the Literature.” South African Journal of Surgery 55 (1): 10–15. https://hdl.handle.net/10520/EJC-6e2662fc9

Rudwick, S., and M. Shange. 2009. “Hlonipha and the Rural Zulu Woman.” Agenda 23 (82): 66–75.

Statistics South Africa. 2022. Census Statistical Release. https://census.statssa.gov.za/assets/documents/2022/P03014_Census_2022_Statistical_Release.pdf.

Taquette, S. R., and L. M. Borges da Matta Souza. 2022. “Ethical Dilemmas in Qualitative Research: A Critical Literature Review.” International Journal of Qualitative Methods 21: 1–15. https://doi.org/10.1177/16094069221078731

Van Oers, H., and L. Schlebusch. 2020. “Indicators of Psychological Distress and Body Image Disorders in Female Patients with Breast Cancer.” Journal of Mind and Medical Sciences 7 (2): 179–187. https://doi.org/10.22543/7674.72.P179187

Velanovich, V., F. R. Lewis Jr, S. D. Nathanson, V. F. Strand, G. B. Talpos, S. Bhandarkar, R. Elkus, W. Szymanski, and J. J. Ferrara. 1999. “Comparison of Mammographically Guided Breast Biopsy Techniques.” Annals of Surgery 229 (5): 625–633. https://doi.org/10.1097/00000658-199905000-00004

Walker, L., and S. Sivell. 2022. “Breaking Bad News in a Cross-Language Context: A Qualitative Study to Develop a Set of Culturally and Linguistically Appropriate Phrases and Techniques with Zulu Speaking Cancer Patients.” Patient Education and Counseling 105 (7): 2081–2088. https://doi.org/10.1016/j.pec.2022.01.007

Washington, K. 2010. Zulu Traditional Healing, Afrikan Worldview and the Practice of Ubuntu: Deep Thought for Afrikan/Black Psychology. The Journal of Pan African Studies 3 (8): 1–16. https://www.semanticscholar.org/paper/Zulu-Traditional-Healing%2C-Afrikan-Worldview-and-the-Washington/5cef4d8d687e8e89139c7e1c34e88eaf7c4fa192.