This systematic review protocol is registered with the Open Science Framework (OSF) (Registration number: osf.io/d98y2)
Search Strategy
The review will employ the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework (2020 edition) for the identification and screening of articles [16]. We will employ a comprehensive search strategy to identify various publications related to the aim of this review. The literature search will be conducted within the following electronic databases; PubMed, Web of Science, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL via EBSCOhost). The searched period for this review will be from January 2010 to 2021.
In order to develop the preliminary search strategy, the reviewers will adopt the triple stage approach to search for published evidence [17]. The first step will involve an initial limited search in PubMed and CINAHL via EBSCOhost database. Subject terms (identified from relevant study titles and abstracts of articles) and free text terms (identified from relevant study descriptions of articles) will be employed in the development of the preliminary search strategy. Step two will involve refined second search terms which are tailored to the various databases (PubMed, CINAHL via EBSCOhost, Web of Science, and EMBASE) including Google Scholar (see additional file 1 for search strategies). In step three, the citation list of the selected studies for the systematic review will be screened for additional relevant studies. The search findings will be in the English language and will be compiled by AA and SS.
Screening of studies
All the citations of the retrieved articles will be imported into Endnote X9 (version 1.19.6) reference manager for removal of duplicates, screening, and storage. After the removal of duplicates, the title and abstracts will be screened using the standard systematic review process (inclusion and exclusion criteria) by reviewers. After title and abstract screening, full-text articles will be independently assessed for eligibility based on the inclusion and exclusion criteria by two reviewers. Articles that meet the eligibility-mentioned inclusion criteria will finally be included for data synthesis. Disagreements between the two independent reviewers on the full-text inclusion will be fully discussed and if not resolved a third researcher will be involved to mediate to bring consensus. A detailed report will be written given reasons for the exclusion of those articles from the final list of articles. Details of the selection process of the included and the excluded studies at various stages will be clearly shown in the PRISMA flow chart diagram [16] (see Additional file 2).
Selection criteria
We followed the Population, Concept, and Context (PCC) framework [18] proposed by the Joanna Briggs Institute as a tool to guide literature reviews. Inclusion and exclusion criteria are summarized in line with the JBI PCC framework (see Table 1) The search focused on studies that assessed barriers and/or facilitators to breast cancer screening among women in SSA. Studies published in English language will be included. Studies published between 2010 to 2021 will be the cut-off or study date for this review. This inclusive approach allowed for the examination of current evidence on barriers and facilitators to breast cancer screening among women in SSA.
Table 1
Population, concept and context (PCC) framework
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Inclusion Criteria
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Exclusion Criteria
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Population
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The review will include research articles that involve women who have not been medically diagnosed with breast cancer as part of the study population.
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Screening for other cancers or having a history of breast cancer. Studies that do not clearly state their study population to be women without cancer. Studies that exclusively included healthcare professionals.
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Concept
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The review will include studies that assessed breast cancer screening (Clinical breast examination/breast self-examination/mammography) uptake among women focusing on barriers and facilitators.
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Articles that did not focus on breast cancer screening or services.
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Context
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Service delivery at health facilities/ Service delivery in the community within sub-Saharan Africa
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Types of studies to be included
This review will involve all originally published articles that are either quantitative qualitative or mixed methods in nature. Quantitative studies will constitute non-experimental studies including descriptive studies, descriptive cross-sectional studies, observational studies, and studies that use other quantitative methods. The qualitative studies will constitute focused group discussions (FGD), individual in-depth interviews, and other forms of interviews that meet the criteria for qualitative studies. The mixed-methods studies should comprise qualitative and quantitative designs. Studies that are published in the English language will be considered for this review. Studies published from 2010 to 2021 will be included to enable us to map up current evidence within SSA.
Data extraction
Before data extraction summary tables will be developed by reviewers to abstract key information required for the review. Four reviewers independently extract data from the included studies. The abstracted data will include the authors, country, study aim, study design, participants and sample size, type of breast cancer screening, and main findings (barriers and facilitators of BC screening) (additional file 3 on data extraction sheet). The reviewers will reconcile extracted information to make sure that extracted information will be consistent with the original studies. The reviewers will not use the summative thematic analyses developed in the original studies but will perform an independent inductive thematic analysis. The researchers will consult each other if any aspect of the included study design was unclear.
Data analysis and synthesis
For data analysis, the researchers will adopt a higher level of thematic analysis of qualitative research in systematic reviews [19]. Thematic analysis will be employed as a qualitative synthesis method because it provides a narrative and collective understanding of the data pertaining to specific phenomena or issues and not establishing definitive causal links [20]. For data synthesis, the summaries of the results will be thoroughly read and reread to make meaning. Free line-by-line coding will be performed. Codes will be reviewed and similar codes will be categorized to form descriptive themes. The descriptive themes will be assessed to generate meaning beyond the initial data leading to the development of new, interpretive analytical themes.
Assessment of methodological quality
The Mixed Methods Appraisal Tool [21] will be used for appraising and evaluating the qualitative, quantitative, and mixed methods studies. Two reviewers will independently review the articles and assign the quality rating. Discrepancies regarding the quality assessment of the articles included will be discussed among all the authors to resolve disagreements and agree upon. There exist controversies as to whether studies that are appraised as poor quality should be excluded, as exclusion may lead to the loss of potentially relevant findings and increase bias [22, 23]. Consequently, the reviewers will not exclude any study, if the study meets the inclusion criteria.