Objectives: To explore healthcare workers (HCW) experiences, barriers and facilitators in managing patients with symptoms of possible breast, cervical or colorectal cancer. Design: A qualitative in-depth interview study with HCWs managing patients with breast, cervical and colorectal cancer symptoms. We also conducted workshops with a group of HCWs to check the credibility of the interview findings. Setting: The study was conducted with staff working in primary, secondary and tertiary health facilities in the Eastern and Western Cape in South Africa (SA) and Harare and Bulawayo and their referral provinces in Zimbabwe. Participants: HCWs with experience in managing patients with symptoms of possible breast, cervical or colorectal cancer were recruited for the study. Participants were purposively sampled, according to region, healthcare level, and job role. A total of 56 participants (26 in SA and 30 in Zimbabwe) participated in the in-depth interviews. Twenty-six (12 in SA and 14 in Zimbabwe) participated in four clinical advisory group workshops across both countries. Results: Drawing on the Model of Pathways to Treatment, HCW perceptions of patient-level factors influencing the diagnostic interval included financial limitations, and patients' absence and delays in attendance. Healthcare provider and system factors included: challenges with referral and feedback systems; training needs; low awareness of protocols and guidelines; inappropriate and suboptimal clinical assessments; and broader socio-economic factors and resource limitations. Conclusion: Improving the timely diagnosis of breast, cervical, and colorectal cancer in Southern Africa necessitates targeted strategies that address both patient-related, provider and health-system delays.

The authors have declared no competing interest.

This research was funded by the NIHR (NIHR133231) using UK international development funding from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study protocol received ethical approval from (i) The University of Cape Town, Faculty of Health Sciences Human Research Ethics Committee (HREC Ref: 664/2021 and HREC 892/2023), (ii) The Joint Research Ethics Committee (JREC) at The University of Zimbabwe (JREC Ref: 363/2021) and (iii) the Medical Research Council Zimbabwe (HREC Ref: MRCZ/A/2831).

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