Faculty of Family Medicine
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Item FAMILY FUNCTIONING, COPING STRATEGIES AND SEXUAL DYSFUNCTION AMONG CERVICAL CANCER PATIENTS IN THE KUMASI METROPOLIS, GHANA(Ghana Consllege of Physicians and Surgeons, 2023-03-15) ACQUAH-HAGAN, GERTRUDEIntroduction: Cervical cancer is arguably the most common cancer among women in Ghana, and it is associated with 16% of mortality due to cancer. In the Kumasi metropolis, it is the second most diagnosed gynecological cancer after breast cancer. This study assessed the extent of sexual dysfunction in women diagnosed with cervical cancer in the Kumasi metropolis; and explored the role of family functioning and coping strategies in dealing with the diagnosis of cervical cancer. Methods: The study was conducted from June to December 2020 among women who had a confirmed diagnosis of cervical cancer at the Komfo Anokye Teaching Hospital, Kumasi, by employing a concurrent triangulation design where both qualitative and quantitative data was collected at the same time. In all, 181 and 15 women were included in the quantitative and qualitative aspects, respectively. Data was collected using a structured questionnaire and in-depth interview guides. Sexual dysfunction, coping strategies and family functioning were measured using the Female Sexual Functional Index (FSFI), the brief-COPE and the Family APGAR scale respectively. Data was analyzed using STATA (version 16.0) statistical software package. Bivariate associations were tested using the chi-square test and fisher exact tests. The relationship between family functioning, sexual dysfunction and coping strategies was assessed using logistic and linear regression models where appropriate. Inferences were made with 95% confidence interval with 5% error margin and a p-value of <0.05. Data from the in-depth interviews were analyzed thematically using variable matrix, flow charts, and relevant quotes to highlight result. Results: The mean age of the women was 58 years (±12.85). More than two-thirds (124; 68.5%) had between 2 – 3 sexual partners and about two-thirds (119; 65.7%) had their first sexual intercourse at age 18. Participants frequently engaged in adaptive coping strategies with religious coping being the most adopted (mean =7.81, SD =0.60). Almost all (96.1%) the respondents had sexual dysfunction. Nearly two-thirds (65.7%) had highly dysfunctional families and nearly one-third (31.5%) had moderately dysfunctional families. Women with parity of 4 – 7 [OR=2.14, 95% CI: 1.12 – 4.07] and 8-13 children [OR=5.52, 95% CI: 1.50 – 20.4] had higher odds of having a functional family compared to those with 0 – 3 children. Having dysfunctional family was associated with a higher mean active coping [β=5.99; 95% CI: 4.54 – 7.46] and lower mean avoidant coping [β= -1.49; 95% CI: -2.60 – -0.38], compared with women who had functional families. There was no significant association between sexual functioning and family functioning. In the qualitative study, the women recounted difficulties with sexual intercourse due to bleeding, pain, fear and advice from doctors. Most of the women coped with their conditions by praying about it. Social support was mainly received from the husbands and children of women with cervical cancer. Almost all the women however disclosed having financial challenges because of the high cost of treatment. Conclusions: This research provides evidence of the prevalence and lived realities of sexual-related challenges and coping strategies among women diagnosed with cervical cancer. Majority of the respondents frequently engaged in adaptive coping strategies, with religious coping being the most engaged coping strategy among the women. There was high prevalence of sexual dysfunction and dysfunctional families among the women studied. Family function was positively associated with adaptive coping and negative associated with maladaptive coping strategies. Health campaigns on cervical cancer should be intensified to demystify the disease and its effects on patients, and also to harness support for women with cervical cancer.Item ASSOCIATION BETWEEN FAMILY RESOURCES AND DRUG ADHERENCE IN HYPERTENSIVE MANAGEMENT AT THE CHRONIC CARE CLINIC OF KOMFO ANOKYE TEACHING HOSPITAL(OPOKU CONSTANCE AFRA, 2021-10-25) OPOKU, CONSTANCE AFRAIntroduction Hypertension is the commonest risk factor for cardiovascular diseases which is currently the leading cause of death globally. Of the almost 1.4 billion people with hypertension worldwide, 71.4% (one billion) are found in low and middle-income countries (LMIC) with the WHO Africa region having the highest current prevalence of hypertension. One of the strongest pillars in the multifactorial approach to the management of hypertension is improving medication adherence to antihypertensives. It is imperative that innovative ways be sought to achieve this goal among health practitioners and especially Family Physicians who aim to provide comprehensive care for any pathology including hypertension. Even though there is information on social determinants of health and their influence on medication adherence and hypertension, little is known about the effect of family resources on medication adherence in hypertension and consequently blood pressure control. Aim To determine the relationship between Family Resources and Medication Adherence in patients with essential hypertension Materials and Methods This was a cross-sectional study carried out at the Chronic Care Clinic of the Family Medicine Directorate at the Komfo Anokye Teaching Hospital. Systematic sampling was used to select 110 patients with essential hypertension attending the clinic. Patients were administered a questionnaire which incorporated the Morisky 8 adherence Scale, the SCREEM questionnaire for measuring family resources and general demographic data. Medical records of the patients were also assessed to obtain current and previous blood pressure control records. The information obtained was entered into epi-info, cleaned and transferred into STATA statistical software (Version 15). Basic demographic data and frequencies were extracted following which Chi square analysis and Fisher exact tests were conducted and multivariate regression performed on specific variables to assess relevant relationships. The results of the analysed data were then presented as frequencies in tables and charts. Results A total of 110 patients with essential hypertension were enrolled in this study majority of whom were female (94, 85.5%), Christian (102, 92.7%), married (54, 49.1%) had basic education (84, 76.4%) and had uncontrolled blood pressure (65, 59.1%). Adequate family resources were reported by most respondents (85, 77.3%) with religious resources most reported as being available (89.1%) while the least available resource was economic (30.9%). The results also showed that married participants were more likely to have adequate family resources (p = 0.04) and Christians were more likely to report adequate social resources (p = 0.04). Majority of participants self-reported medium or high adherence to their antihypertensive medication (68.2%), however participant demographics had no influence on medication adherence or blood pressure control. Conclusion The most available family resource was the religious resource with the least available resource being economic. Self- reported medication adherence was found to be adequate in majority of respondents, with 68.2% of respondents reporting either medium or adequate medication adherence. No association was found between family resources and medication adherence among respondents. It is imperative that further research be conducted to establish how to harness religious resources in the improvement of medication adherence. It is also recommended that other objective adherence measuring tools be used to assess for possible relationships between family resources and medication adherence in the control of essential hypertension.