Study | Population | Study type | Country (country classification*) | Tumour site | Measures | Interval† | Quality appraisal |
Abu-Helalah et al40 | 189 participants: men (n=87); women (n=91). Mean age: 57.5 years. Marital status: married (n=152); single (n=4); widow/divorced (n=22). Education: illiterate (n=30); primary school (n=48); secondary school (n=61); college (n=15); university (n=25). Employment: employed full time (n=22); employed part-time (n=8); housewife (n=62); retired (n=48); unemployed (n=40). Income (family): <JD399 (n=113); >JD400 (n=63). Area of residence: city (n=113); town (n=30); village (n=34). | Observed; cross-sectional survey of patients with colorectal cancer | Jordan (UM) | Colorectal | Authors developed survey measure | PI (>3 months: 33.9%); TI (>1 month: 32.6%) | Medium |
Agbokey et al62 | 20 women. Median age: 52.5 years (range: 29–80 years). Marital status: married (n=18); widowed (n=2). Education: no formal education (n=4); basic (n=12); secondary (n=1); tertiary (n=3). Employment: farming (n=5); teaching (n=3); trading (n=11); nursing (n=1). | Observed; in-depth qualitative interviews with patients with breast cancer | Ghana (LM) | Breast | N/A | PI (3 months; –) | High |
Ahmad et al91 | 100 women. Mean age: 41 years (range: 18–67 years). Marital status: married (n=76); not married (n=23). Education: less than grade 10 (n=17); grade 10/university/college (n=31); postgraduate education (n=52). Employment: employed (n=66); not employed (n=34). Income (annual household): below average (n=26); above average (n=74). | Hypothetical; vignette survey of a community sample recruited from community venues | Bangladesh (LM) | Breast | Vignette survey of women with a breast lump developed by authors | PI (binary; 79% would seek help with symptoms) | Medium |
Al Qadire et al48 | 241 participants: male (n=106); female (n=135). Mean age: 27.9 years (range: 18–47). Marital status: married (n=125); not married (n=116). Education: secondary or lower (n=177); diploma or more (n=31). Employment: working (n=40); not working (n=201). Income (monthly family): low (<US$845, n=210); high (>US$845, n=31). | Hypothetical; cross-sectional survey of Syrian refugees living in Jordan | Jordan (UM) | All cancers | Adapted version of the Cancer Awareness Measure | PI (2 weeks; 24.9%) | Medium |
Al Qadire49 | 2292 participants: male (n=1206); female (n=1073); missing (n=13). Mean age: 30.5 years (range: 18–81). Marital status: married (n=1108); not married (n=1169); missing (n=15). Employment: working (n=1013); not working (n=1247); missing (n=32). Income (monthly family): low (<US$845, n=1646); high (>US$845, n=320); missing (n=326). | Hypothetical; population-based cross-sectional survey | Jordan (UM) | All cancers | Adapted version of the Cancer Awareness Measure | PI (2 weeks; 34.3%) | Medium |
Asoogo and Duma63 | 30 women. Age range: 25–67 years (60% aged 40+ years). Education: illiterate/never been to school (n=2); primary education (n=7); secondary education (n=16); tertiary education (n=5). | Observed; semistructured qualitative interviews with patients with stage II and III breast cancer | Ghana (L) | Breast | N/A | PI (–) | Medium |
Aziato and Clegg-Lamptey71 | 12 women. Age range: 31–60 years. Marital status: married (n=9); separated (n=2); single (n=1). | Observed; semistructured qualitative interviews with patients with late-stage breast cancer | Ghana (LM) | Breast | N/A | TI (–) | Medium |
Basharat et al82 | 14 participants: male (n=10); female (n=4). Age range: 43–68 years. | Observed; in-depth qualitative interviews with patients with oral cancer | Pakistan (LM) | Oral | N/A | PI (1 month; 100%) | Medium |
Bonsu and Ncama64 | 11 women. Age range: 32–70+ years. Marital status: married (n=5); divorced (n=3); single (n=2); widowed (n=1). Employment: unemployed (n=3); trader (n=5); self-employed (n=2); retired teacher (n=1). Education: secondary (n=3); middle (n=7); tertiary (n=1). | Observed; in-depth qualitative interviews with patients with breast cancer and advanced stage disease | Ghana (LM) | Breast | N/A | PI (3 months; 91%) | High |
De Boer et al28 | 161 participants: male (n=111); female (n=50). Mean age: 34 years. Education: primary (n=83); secondary (n=58); tertiary/degree (n=20). | Observed; cross-sectional survey of patients with AIDS-associated Kaposi sarcoma (diagnosed within 6 months of the study) | Uganda (L) | Kaposi sarcoma | Authors developed and piloted survey measure | PI (3 months; 45.3%) | Medium |
Deliana et al68 | 15 participants: male (n=2); female (n=13). Age categories: 17–35 years (n=1); 36–45 years (n=5); 46–55 years (n=6); 56–65 years (n=2); 65+ years (n=1). Stage: III (n=10); IV (n=5). | Observed; in-depth qualitative interviews with patients with cancer and advanced stage disease (stages III and IV) | Indonesia (LM) | Multiple (cervical, n=5; colon, n=2; breast, n=6; ovary, n=1; skin, n=1) | N/A | TI (–) | Medium |
Dereje et al39 | 231 women. Mean age: 52.6 years (range: 23–86 years). Martial status: married (n=96); single (n=11); divorced (n=36); widowed (n=88). Education: unable to read or write (n=89); primary (n=85); secondary (n=42); diploma (n=15). Employment: housewife (n=144); government employed (n=29); privately employed (n=23); merchant (n=10); daily labourer (n=13); pensioner (n=8); other (n=4). Income (family):<3201 Ethiopian birr (approximately US$100) (n=157); >3201 Ethiopian birr (n=74). | Observed; cross-sectional survey of patients with cervical cancer (diagnosed within 68 days of the study) | Ethiopia (L) | Cervical | Questionnaire adapted from previous studies | PI (90 days; 23.4%); DI (30 days; 80.5%) | High |
Desalu et al50 | 1125 participants: male (n=578); female (n=546). Mean age: 33 years (SD: 10 years). Marital status: married (n=647); not married (n=478). Education: none/primary (n=293); secondary (n=364); tertiary (n=468). Income: low (n=883); middle-high (n=242). Smoking status: current (n=124); former (n=35); never (n=1006). | Hypothetical; population representative cross-sectional survey | Nigeria (LM) | Lung | Lung Cancer Awareness Measure | PI (2 weeks; 33.2%) | High |
Dye et al84 | 55 women. Marital status: most were married (n: –). | Observed; qualitative interview study of patients with breast cancer | Ethiopia (L) | Breast | N/A | PI (‘ignored first signs’; 69.6%) | Medium |
El-Shinawi et al92 | 45 women. Median age: 47 years. Education: illiterate (42.2%); literate (57.8%). | Observed; cross-sectional survey of patients with breast cancer (diagnosed within 6 months of the study) | Egypt (LM) | Breast | Authors developed and piloted survey measure | PI (1 month; 53%) | Medium |
Fles and Bos65 | 12 participants: male (n=8); female (n=4). Mean age: 44 years. Marital status: married (n=9); not married (n=2); widowed (n=1). Education: completed primary school or below (n=6); completed high school or above (n=6). Employment: housewife (n=3); employed (n=8); student (n=1). Stage of disease: III (n=1); IV (n=11). | Observed; in-depth semistructured qualitative interviews with patients with histologically confirmed nasopharyngeal carcinoma | Indonesia (LM) | Nasopharyngeal carcinoma | N/A | PI (median PI=5.5 months) | Medium |
Foerster et al56 | 1325 women. Mean age: 50.7 years (SD: 13.6 years). Employment: skilled (n=403); unskilled/not applicable (n=923). Socioeconomic group: low (n=600); middle (n=438); high (n=288). Area of residence: urban (n=681); rural (n=645). | Observed; cross-sectional survey of patients with breast cancer | Sub-Saharan Africa (Namibia (UM), Nigeria (LM) and Uganda (L)) | Breast | Authors developed survey measure | TI (12 months; 17%) | High |
Grosse Frie et al11 | 25 women (demographics reported by focus group). Group 1 (breast cancer survivors, n=8). Mean age: 48 years (range: 35–61 years). Marital status: married (n=8). Education: most had secondary education (n: –). Group 2 (community members, n=12). Mean age: 42 years (range: 20–65 years). Marital status: married (n=12). Education: none (n=6); primary/secondary (n=6). Group 3 (community members, n=5). Mean age: 41 years (range: 22–45 years). Marital status: married (n=4); single (n=1). Education: none (n=4); some formal education (n=1). | Observed and hypothetical; three focus groups: one with breast cancer survivors and two community members | Mali (L) | Breast | N/A | PI (–); DI (–); TI (–) | Medium |
Grosse Frie et al52 | 64 women. Marital status: married (n=45); not married (n=19). Employment: housewife (n=34); working (n=30). Size of tumour: T0/T1/T2 (n=15); T3/T4 (n=49). | Observed; cross-sectional survey of women diagnosed with breast cancer | Mali (L) | Breast | Survey measure developed from previous study and pilot tested by authors | PI (mean=11.6 months; median=4.8 months); DI (mean=6.4 months; median=0.9 months); TI (mean=2.5 months; median=1.3 months) | Medium |
Freij et al51 | 896 women. Mean age: 41 years (range: 18–85 years). Marital status: single (n=181); married (n=618); divorced/widowed (n=89); not given (n=8). Education: secondary school and below (n=399); diploma and above (n=497). Employment: full time (n=705); not working or retired (n=191). Income (family): <JD1000 (n=751); >JD1000 (n=145). | Hypothetical; cross-sectional survey of women with no previous diagnosis of ovarian cancer | Jordan (UM) | Ovarian | Ovarian Cancer Awareness Measure | PI (2 weeks; 20.8%) | High |
Gadgil et al29 | 389 women. Mean age: 48 years (range: 30–69 years). Income: high (n=147); middle (n=140); low (n=82). | Hypothetical; cross-sectional postal survey of middle-class urban women living in Mumbai | India (LM) | Breast | Questionnaire developed and validated International Agency for Research on cancer and translated into Hindu | PI (binary; 5% would not seek medical help) | Medium |
Gakunga et al76 | 6–11 women in each group. Age range: 30–60 years. Socioeconomic status: group 1 (breast cancer diagnosis; high SES); group 2 (breast cancer diagnosis; low SES); group 3 (no breast cancer diagnosis; high SES); group 4 (no breast cancer diagnosis; low SES). | Hypothetical and observed; four focus group discussions: two groups with women diagnosed with breast cancer and two groups with women in the community without a diagnosis of breast cancer | Kenya (LM) | Breast | N/A | PI (–); TI (–) | Medium |
Gebremariam et al41 | 441 women. Mean age: 44.4 years (SD: 12.2 years). Marital status: married (n=255); widowed (n=73); single (n=67); divorced (n=46). Education: not attended school (n=87); primary school (n=112); secondary school (n=142); diploma and above (n=100). Employment: housewife (n=217); employed outside the home (n=198); retired (n=13); not employed (n=13). Income (family monthly):<US$194 (n=325); >US$194 (n=106); no income (n=3); missing (n=7). | Observed; cross-sectional survey of newly diagnosed patients with breast cancer | Ethiopia (L) | Breast | Questionnaire adapted from previous study | PI (90 days; 34%); DI (30 days; 69%) | Medium |
Getachew et al66 | 12 women. Age range: 26–65 years. Marital status: married (n=9); widowed (n=3). Education: illiterate (n=5); primary (n=3); secondary (n=1); diploma and above (n=3). Employment: housewife (n=2); farmer (n=6); merchant (n=1); government employee (n=3). Area of residence: urban (n=4); rural (n=8). | Observed; in-depth qualitative interviews with patients with breast cancer | Ethiopia (L) | Breast | N/A | PI (–) | Medium |
Grunfeld and Kohli30 | 685 women. Mean age: 49 years (range: 16–84). Marital status: married (n=530); not married (n=155). Education: no education (n=253); primary/middle education (n=130); high school (n=50); graduate (n=252). Area of residence: urban (n=367); rural (n=318). | Hypothetical; cross-sectional survey study to explore anticipated breast cancer symptom presentation in urban and rural women with no previous diagnosis of breast cancer | India (LM) | Breast | Survey adapted from a survey developed in the UK | PI (1 month; 44%) | High |
Iskandarsyah et al77 | 50 women. Age range: 34–65 years. Marital status: married (n=44); widowed (n=6). Education: none (n=3); elementary school (n=23); junior high school (n=13); senior high school (n=11). Employment: housewife/unemployed (n=42); labourer/irregular job (n=7); private employee (n=1). Stage of disease: I (n=0); II (n=18); III (n=29); IV (n=3). | Observed; 50 semistructured qualitative interviews with patients with breast cancer | Indonesia (LM) | Breast | N/A | PI (3 months; 70%); TI (3 months; 42%) | Medium |
Iskandarsyah et al31 | 70 women. Mean age: 45.6 years (range: 28–66). Marital status: married (n=57); widowed (n=11); single (n=2). Education: none (n=7); elementary school (n=36); junior high school (n=11); senior high school (n=10); college or university (n=6). Employment: housewife/unemployed (n=46); labourer/regular job (n=18); private employee (n=1); government officer (n=5). Income (family): <$200 (n=53); $200–$300 (n=13); >$300 (n=4). Health insurance: yes (n=14); no (n=56). Stage of disease: I (n=3); II (n=37); III (n=16); IV (n=14). | Observed; cross-sectional survey of patients undergoing cancer treatment | Indonesia (LM) | Breast | Five questionnaires: Breast Cancer Knowledge Test, Brief Illness Perception Questionnaire, Multidimensional Health Locus of Control Scales, Satisfaction with Cancer Information, Distress Thermometer | PI (–); TI (3 months; 24%) | High |
Kaninjing et al75 | 25 men. Mean age: 59.3 years. Marital status: married (n=20); single (n=5). Education: less than high school (n=15); high school (n=4); university (n=6). Employment: employed (n=12); retried (n=10); unemployed (n=3). Income: low (n=15); middle (n=6); high (n=2); missing (n=2). | Hypothetical; focus groups with a community sample of men with no previous diagnosis of prostate cancer | Cameroon (LM) | Prostate | N/A | PI (–) | Medium |
Khan et al54 | 315 women. Age: <40 years (n=54); >40 years (n=111). Marital status: married (n=294); not married (n=21). Education: under 8 years (n=234); over 8 years (n=81). Socioeconomic status: poor/low (n=269); medium/high (n=46). | Observed; cross-sectional survey of patients with breast cancer | Pakistan (LM) | Breast | Authors developed survey measure | PI (3 months; 39%) | Medium |
Hameed Khaliq et al61 | 200 women. Marital status: married (n=169); not married (n=31). Median age: 45 years (range: 22–70). Education: median 2 years (range 0–16 years). Employment: self-employed (n=19); employed (n=35); housewife (n=146). Income (monthly; PKR): median 15 250 (range: 0–150 000). Area of residence: urban (n=95); rural (n=105). Stage: II (n=36); III (n=108); IV (n=56). | Observed; cross-sectional survey of patients with breast cancer | Pakistan (LM) | Breast | Survey measure developed from previous study and pilot tested by authors | PI (median through primary care=89 days) | Medium |
Kishore et al60 | 95 participants: equal number of males and females (actual number: –). Mean age: 52 years. Employment: semiskilled (54.7%); skilled (20%); other (%: –). | Observed; cross-sectional survey of patients recently diagnosed with cancer (within 1 month) | India (L) | All cancer | Pretested 42-item questionnaire | PI (mean=24 months) | Medium |
Kohler et al70 | 20 women. Median age: 47 years. Age group: 25–40 (n=9); 41–55 (n=4); 56+ (n=7). Marital status: married (n=15); single/divorced (n=2); widowed (n=3). Education: no formal schooling (n=5); some primary schooling (n=8); some secondary schooling (n=7). | Observed; in-depth qualitative interviews with patients with breast cancer | Malawi (L) | Breast | N/A | PI; DI; TI (total time range: few weeks to few years) | Medium |
Kumar et al67 | Quantitative component: 269 women. Age group: 25–44 (n=90); 45–64 (n=162); 65+ (n=17). Marital status: married (n=235); unmarried (n=16); widowed (n=18). Education: no formal education (n=70); primary (n=34); middle (n=43); secondary (n=58); higher secondary (n=36); graduate and above (n=26%); missing (n=1). Employment: home maker (n=230); daily wage (n=5); farmer (n=1); salaried (n=16); business (n=5); other (n=9); missing (n=3). Area of residence: urban (n=73); rural (n=195); missing (n=1). Socioeconomic status: lower class (n=74); middle class (n=67); upper class (n=128). Qualitative component: 15 women. Age range: 35–65 years. | Observed; mixed-methods study with (A) cross-sectional survey of patients with breast cancer; and (B) in-depth qualitative interviews with patients with breast cancer with a patient interval of 3 months or longer | India (LM) | Breast | Authors developed survey measure | PI; TI (total interval 3 months; 53.1%) | Medium |
Maghous et al45 | 137 women. Mean age: 48.3 years. Marital status: married (n=77); single (n=26); widowed/divorced (n=34). Education: illiterate (n=115); primary (n=14); secondary/higher (n=8). Employment: no employment (n=23); housewife (n=102); full time employed (n=10); part-time employed (n=2). Area of residence: rural (n=48); urban (n=89). | Observed; cross-sectional survey of patients with advanced stage breast cancer with a PI of 3 months or longer | Morocco (LM) | Breast | Authors developed survey measure | PI (median=6 months); DI (median=1 month) | High |
Leng et al57 | 186 participants: male (n=58); female (n=127). Median age: 50 years (range: 19–79 years). Marital status: married (n=162); divorced/separated (n=2); widowed (n=12); never married (n=10). Education: none (n=20); primary (n=46); secondary (n=52); vocational/technical (n=18); polytechnic/OND/some college (n=15); bachelor’s degree (n=24); postgraduate degree (n=9). Employment: none (n=37); trader (n=68); farmer (n=9); artisan (n=23); professional (n=38); other (n=11). | Observed; cross-sectional survey of patients with cancer attending radiotherapy clinics | Nigeria (LM) | Multiple | Questionnaire adapted from two questionnaires from previous studies | TI (–) | Medium |
Malik and Gopalan32 | 138 women. Mean age: 46 years. Marital status: married (n=132); single (n=4); divorced/widowed (n=2). Education: illiterate (n=43); high school (n=61); college or above (n=33). Employment: home maker (n=125); teacher (n=8); other (n=5). Stage: I–II (n=90); III–IV (n=48). | Observed; cross-sectional survey of recently diagnosed (<3 months) patients with breast cancer presenting with a lump | Pakistan (L) | Breast | Authors developed survey measure | PI (1 month; 52.9%) | Medium |
Manir et al46 | 212 women. Median age: 24 years (range 21–54 years). Education: postgraduate (n=129); undergraduate (n=83). | Hypothetical; cross-sectional survey of urban highly educated women | India (LM) | Breast | Adapted version of the Cancer Awareness Measure | PI (1 month; 48.6%) | Medium |
Martei72 | 31 women. Mean age: 47 years (range: 25–85). | Observed; semistructured qualitative interviews with women undergoing breast cancer treatment | Ghana (L) | Breast | N/A | PI (–) | Medium |
McEwan et al83 | 15 women (additional demographics: –). | Observed; structured qualitative interviews with patients with breast cancer | Egypt (LM) | Breast | N/A | PI (3 months; 60%); DI (3 months; 53%); TI (3 months; 33%) | Medium |
Meacham et al78 | 20 women. Age range: 35–67 years. Age group: 30–39 (n=1); 40–49 (n=8); 50–59 (n=6); 60–69 (n=5). Marital status: married (n=11); separated/divorced (n=2); widowed (n=4); single (n=3). Education: primary (n=1); secondary (n=4); university (n=15). Stage: I (n=7); II (n=11); III (n=4). | Observed; semistructured qualitative interviews with breast cancer survivors (defined as being in remission for 1+ years) | Uganda (L) | Breast | N/A | TI (–) | Medium |
Mhaidat et al93 | 801 participants: male (n=568); female (n=233). Marital status: married (n=29); single (n=772). Mean age: 20.36 years (range: 18–37 years). Age group: <20 years (n=295); >20 years (n=506). Education: medical-related degree (n=146); non-medical-related degree (n=655). | Hypothetical; cross-sectional survey of undergraduate university students from five universities | Jordan (UM) | Colorectal | Adapted version of the Cancer Awareness Measure | PI (2 weeks; 27.4%) | Medium |
Muthoni and Miller73 | 6–7 participants in each of eight focus groups (exact number: –). Age range: 20–60 years. | Hypothetical; eight focus groups (two in a middle-income urban area; two in a low-income urban area; two in rural area and ethnically Kikuyu Kiambu districts; and two in rural area and ethnically Kamba Machakos districts) | Kenya (L) | Breast | N/A | PI (–) | Medium |
Mwaka et al12 | 149 women. Mean age: 48 years. Age group: 18–29 (n=7); 30–44 (n=52); 45–59 (n=63); 60+ (n=25); missing (n=2). Education: no formal education (n=67); primary (n=72); secondary (n=7); tertiary (n=2); missing (n=1). Employment: housewife/peasant (n=132); petty trader (n=10); formally employed (n=4); missing (n=3). Stage: I (n=17); II (n=29); III (n=67); IV (n=31); missing (n=5). | Observed; cross-sectional survey of patients with cervical cancer | Uganda (L) | Cervical | Authors developed survey measure guided by the Model of Pathways to Treatment | PI (3 months; 55%) | Medium |
Mwaka et al79 | Total number of participants: –. Age range: 18–59. | Hypothetical. Twenty-four focus groups with members of the community living in rural (12 focus groups) or urban areas (12 focus groups) | Uganda (L) | Cervical | N/A | TI (–) | High |
Mwaka et al13 | 18 women. Mean age: 42 years (range: 35–56). Employment: subsistence farmers (n=15); small-scale business workers (n=2); formally employed as an office worker (n=1). | Observed; in-depth qualitative interviews with patients with cervical cancer | Uganda (L) | Cervical | N/A | PI+DI (median PI+DI: 20 months; range 2–140 months) | High |
Ntirenganya et al33 | 136 women. Country: Sierra Leone (n=57); Rwanda (n=79). Median age: Sierra Leone (31 years); Rwanda (43 years). Education: none (n=71); primary school (n=47); secondary school (n=16); tertiary school (n=2). Employment: none (n=19); home maker (n=7); domestic helper (n=2); farmer (n=96); self-employed/small business (n=12). | Observed; cross-sectional survey to assess self-reported current breast masses in women and help-seeking/barriers to help-seeking in those reporting a lump symptom | Sierra Leone (L) and Rwanda (L) | Breast | Surgeons Overseas Assessment of Surgical Need (SOSAS) survey | PI (binary; 6.2% did not seek medical help) | Medium |
Odongo et al34 | 162 women. Mean age: 45 years. Marital status: married (n=87); single (n=20); widowed (n=25); divorced (n=28). Education: none (n=15); primary (n=54); secondary (n=57); tertiary (n=36). Employment: unskilled worker (n=36); subsistence farmer (n=53); formal employment (n=29); unemployed (n=44). Income (monthly): <93 750 shillings (US$36; n=70); >93 750 shillings (US$36; n=91). Area of residence: rural (n=142); urban (n=20). Stage: II (n=6); III (n=17); IV (n=139). | Observed; cross-sectional survey of female patients with breast cancer | Uganda (L) | Breast | Previously validated questionnaire | PI (3 months; 89%) | Medium |
Okobia et al59 | 1000 women. Mean age: 29 years (range 15–91). Marital status: married (n=484); single (n=451); divorced/separated (n=21); widowed (n=23); missing (n=21). Education: primary (n=222); secondary (n=442); NCE/polytechnic (n=113); university (n=108); other (n=23); missing (n=92). | Hypothetical; cross-sectional survey of women living in an urban community | Nigeria (LM) | Breast | Authors developed survey measure | TI (binary; 54.7% would not accept treatment) | Medium |
Olarewaju et al42 | 275 women. Age group: 25–35 (n=30); 36–46 (n=102); 47–57 (n=66); 58–68 (n=49); 69–79 (n=28). Marital status: single (n=12); married (n=193); divorced/separated (n=19); widowed (n=51). Education: primary (n=46); secondary (n=87); tertiary (n=142). Employment: unemployed (n=124); employed (n=151). Income: <18 000 (below national minimum wage; n=99); >18 000 (above national minimum wage; n=176). | Observed; cross-sectional survey of patients with breast cancer attending surgical and oncology clinics | Nigeria (LM) | Breast | Authors developed survey measure | PI (3 months; 35.3%); DI (8 weeks; 30.5%) | Medium |
Pace et al35 | 144 women. Median age: 49 years. Marital status: married (n=71); single/widowed/divorced (n=73). Education: none/primary (n=108); secondary/university (n=36). Stage: I or II (n=35); III (n=75); IV (n=34). | Observed; cross-sectional survey of patients with breast cancer | Rwanda (L) | Breast | Adapted questionnaire used in another study | PI (6 months; 45%) | Medium |
Price et al36 | 79 participants: male (n=20); female (n=59). Mean age: 46 years (range: 29–75 years). | Observed; cross-sectional survey of patients with cancer | Cameroon (LM) | Breast (n=50), lymphoma (n=19), Kaposi sarcoma (n=10) | Authors developed and pilot tested survey measure | PI (3 months; 40%); TI (1 week; 16%) | Medium |
Pruitt et al74 | 31 women. Mean age: 51 years (range: 28 to 80+). Education: no formal education (n=7); university or polytechnic degree (n=9); intermediate education (n=15). | Observed; semistructured qualitative interviews with patients with breast cancer | Nigeria (LM) | Breast | N/A | PI (–); TI (–) | Medium |
Salih et al43 | 63 women. Mean age: 46.89 (range: 22–91). Marital status: married (n=7); single (n=56). Education: illiterate (n=22); literate (n=41). Employment: unemployed (n=53); employed (n=10). Income (annual): <GDP per capita (n=53); >GDP per capita (n=10). Area of residence: rural (n=19); urban (n=44). | Observed; cross-sectional survey of patients with breast cancer | Sudan (L) | Breast | Authors developed survey measure guided by Anderson Model of Total Patient Delay | PI (3 months; 75%) | Medium |
Sanuade et al69 | 20 women. Age group:<40 years (n=2); 40–49 years (n=8); 50–59 years (n=6); 60+ years (n=4). Marital status: married (n=16); widowed (n=2); separated (n=2). Education: none (n=2); primary (n=2); middle (n=4); secondary (n=4); tertiary (n=4); missing (n=4). Employment: unemployed (n=2); trader (n=11); other (n=7). Stage: I and II (n=13); III and IV (n=7). | Observed; four focus groups with patients with breast cancer | Ghana (LM) | Breast | N/A | TI (1 month; 78.9%) | Medium |
Sayed et al37 | 697 survey participants. Female participants (n=442). Median age: 22 years (range: 19–25 years). Marital status: married (n=307); single (n=70); widowed (n=40); divorced (n=17). Education: none (n=212); primary (n=182); secondary (n=30); tertiary (n=8); adult education (n=5). Employment: farmer (n=−136); trader (n=47); housewife (n=77); other (n=76); none (n=102). Male participants (n=237). Median age: 31 years (range: 24–43 years). Marital status: married (n=173); single (n=49); widowed (n=8); divorced (n=5). Education: none (n=48); primary (n=133); secondary (n=44); tertiary (n=9); adult education (n=2). Employment: farmer (n=90); trader (n=36); other (n=80); none (n=30). | Hypothetical; mixed-methods study involving a cross-sectional survey of men and women recruited from the community and six focus groups with a community sample | Kenya (LM) | Breast | Authors developed survey measure | PI (1 week; 9.3%) | Medium |
Sharma et al44 | 90 women. Mean age: short PI group (45 years); long PI group (49 years). Marital status: married (n=36); not married (n=35); missing (n=19). Education: none (n=16); primary (n=32); secondary (n=22); university (n=6); missing (n=14). Employment: unemployed (n=58); employed (n=29); missing (n=3). | Observed; cross-sectional survey of female patients with breast cancer | Haiti (L) | Breast | Authors developed survey measure | PI (3 months; 42%) | Medium |
Sharp et al47 | 341 women. Age group: 25–39 (n=182); 40–49 (n=89); 50–74 (n=70). Marital status: married/living with significant partner (n=207); single (n=129). Education: primary (n=236); above primary (n=104). Employment: full time employed/student (n=235); not in full-time employment/not full-time student (n=99); missing (n=7). Income: <500 000 shillings (n=125); >500 001 shillings (n=127). Area of residence: urban (n=83); rural (n=258). | Hypothetical; cross-sectional survey of community sample of women without breast cancer | Uganda (L) | Breast | Attitudes on Breast Cancer Surveillance and Knowledge survey | PI (binary; 15.5% had a recent breast examination) | Medium |
Stapleton et al55 | 343 women. Mean age: 49 (range: 22–81). Stage: I and II (n=185); III and IV (n=158). Education: no formal schooling (n=201); completed primary school (n=63); completed secondary school (n=78). Employment: unemployed (n=207); employed (n=35). | Observed; cross-sectional survey of female patients with breast cancer | Egypt (LM) | Breast | Authors developed survey measure | PI (3 months; 11.7%) | Medium |
Steiness et al81 | 43 women. Mean age: 34.7 years (range: 18–60). Marital status: married (n=34); separated (n=4); divorced (n=1); widowed (n=3); never married (n=1). Education: none (n=10); primary (n=8); secondary (n=19); college+ (n=6). Perceived wealth in comparison to neighbours: ‘better than neighbours’ (n=8); ‘same as neighbours’ (n=12); ‘worse than neighbours’ (n=23). | Observed; qualitative interviews with women with breast cancer symptoms (but no formal diagnosis of cancer) | Bangladesh (L) | Breast | N/A | PI | Medium |
Strobele et al94 | 996 women. Mean age: 33.4 years (range: 18–86). Marital status: married (n=795); not married (n=201). Education: none (n=557); elementary (n=192); secondary (n=134); tertiary (n=57, 5.7%); university (n=55); missing (n=7). Employment: housewife (n=167); farmer (n=369); business (n=323); public service (n=25); student (n=47); other (n=38). | Observed; population representative cross-sectional survey to assess current or former breast symptoms in women, help-seeking in those reporting symptoms and barriers to help-seeking | Burkina Faso (L) | Breast | SOSAS survey | PI (binary; 30% sought medical advice) | Medium |
Tessler et al58 | 1942 participants (18+; age and gender of sample: –). Of the 38 who had experienced rectal bleeding: male (n=21); female (n=17). | Observed; population representative cross-sectional survey to assess current or former rectal bleeding in the population, help-seeking in those reporting symptoms and barriers to help-seeking | Nepal (L) | Colorectal | SOSAS survey | PI (binary; 60% sought medical advice) | Medium |
Uddin et al80 | 48 women. Marital status: married (n=43); not married (n=5). Mean age: 37.5 years (range: 20–69). Education: illiterate (n=9); less than high school (n=7); high school (n=17); bachelor’s degree (n=14); graduate degree (n=1). Employment: unemployed (n=39); employed (n=9). | Hypothetical; six qualitative focus groups conducted in urban (n=2) and rural (n=4) communities | Egypt (LM) | Breast | N/A | PI | Medium |
Ukwenya et al38 | 111 women. Median age (split by group): ‘short interval’ (50 years); ‘long interval’ (43 years). Marital status: married (n=97); not married (n=14). Education: illiterate/primary (n=59); secondary/tertiary (n=52). Stage: I (n=10); II (n=18); III (n=37); IV (n=46). | Observed; cross-sectional survey of women undergoing treatment for breast cancer | Nigeria (LM) | Breast | Authors developed survey measure | PI+DI+TI (1 month; 89.2%) | Medium |
Zahid et al53 | 190 participants: men (n=119); women (n=71). Mean age: 48.3 years. Marital status: married (n=136); not married (n=54). Education:<grade 5 (n=161); grades 5–10 (n=19); >grade 10 (n=10). Income (monthly): <PKR10 000 (n=156); PKR10 001–PKR20 000 (n=31); >PKR20 000 (n=3). | Observed; cross-sectional survey of patients with oral cancer | Pakistan (LM) | Oral | Authors developed survey measure | TI (mean=6.3 days) | Medium |
The symbol (–) refers to not applicable or data not available.
*Country classification in final year of data collection as defined by the World Bank (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups).
†The number of days/weeks in brackets denotes the cut-off for a long interval versus short interval and the % of participants with a long interval. Mean/median/binary interval times are given in some studies.
DI, diagnostic interval; GDP, gross domestic product; JD, Jordanian dinar; L, low-income economy; LM, low/middle-income economy; N/A, not applicable; NCE, Nigeria Certificate of Education; ; OND, Ordinary National Diploma; PI, patient interval; PKR, Pakistani rupee; SES, socioeconomic status; TI, pretreatment interval; UM, upper/middle-income economy.