Health Comes First: A Qualitative Study of Empowerment in Women Facing Breast Cancer in Ghana and Ethiopia.

Purpose: Breast cancer is the second leading cause of cancer-related mortality among women in sub-Saharan Africa (SSA) and an accelerating global health priority. Little is known of the empowerment process as it relates to cancer outcomes in Africa. Our study sought to explore how women in Ghana and Ethiopia experience power throughout their fight against breast cancer.

Methods: Women with breast cancer (stage 0 to III) were recruited from breast cancer clinics at St Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, and Komfo Anokye Teaching Hospital in Kumasi, Ghana. We conducted semistructured interviews in English, Amharic, and Twi using the assistance of native interpreters. Narratives were inductively analyzed in a team-based approach.

Results: Forty-six total women (21 from Ethiopia and 25 from Ghana) participated in our study. Our findings highlighted empowerment was central to women's overall goal of survival and to resume their family and societal roles. Women encountered factors that decreased empowerment, such as spousal influence on choice, social isolation, and physical weakness; and women identified empowering factors, such as selecting who to divulge their cancer diagnosis to, adopting a mindset of self-reliance, and drawing on hope for the future.

Conclusion: We identified several factors that facilitate or obstruct the empowerment of women facing breast cancer in Ghana and Ethiopia. It is critical we recognize this unique aspect of the patient experience to frame how we think about designing potential solutions, such as the introduction of breast reconstruction, to improve care and quality of life among survivors.