{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T17:05:30Z","timestamp":1774285530962,"version":"3.50.1"},"reference-count":43,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"unspecified","delay-in-days":81,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Minor Field Studies (MFS) Swedish Development Agency SIDA","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}]},{"DOI":"10.13039\/501100004828","name":"Grand Challenges Canada","doi-asserted-by":"publisher","award":["ST-POC-2205-53442"],"award-info":[{"award-number":["ST-POC-2205-53442"]}],"id":[{"id":"10.13039\/501100004828","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,3,6]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In Rwanda, breast and cervical cancer are the most common cancers among women of reproductive age, posing significant public health challenges. These cancers do not only account for the highest mortality and morbidity, but also impact women\u2019s sexual health and well-being\u2014often overlooked in cancer care settings. Little is known about healthcare providers\u2019 capacity to counsel patients on sexual health in contexts with limited psychosocial cancer services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative cross-sectional study was conducted to explore healthcare providers\u2019 perceptions, attitudes and knowledge concerning sexual health among female patients with cervical and breast cancer and survivors in two regions of Rwanda. Between January and March 2023, semistructured in-depth interviews were conducted with 15 healthcare providers (medical doctors, nurses, midwives) experienced in treating patients with breast or cervical cancer at four facilities. Interviews were recorded, transcribed verbatim and analysed using content analysis to identify emerging themes related to providers\u2019 perspectives on sexual health counselling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two main themes emerged, with the first theme \u2018Perceived barriers to sexual healthcare for female cancer patients\u2019 highlighting social and cultural taboos related to sexuality, sexual health knowledge and awareness among both providers and patients, and socio-economic barriers. The second theme, \u2018Systemic challenges in delivering comprehensive sexual healthcare\u2019, illustrated health systems barriers such as staff shortage and unclear responsibilities, gendered barriers during counselling and ambiguous sexual health information provided. Sexual and gender-based violence as a barrier to sexual health emerged as a cross-cutting theme, with providers noting different forms of violence faced by patients during cancer therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Findings underscore the pressing need to prioritise women\u2019s sexual health and well-being within cancer care settings in a lower-middle income country context such as Rwanda. Health systems efforts are necessary to enhance the sexual health counselling proficiency of current oncology providers, as well as to train new generations of providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-002348","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T16:20:20Z","timestamp":1774282820000},"page":"e002348","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare providers\u2019 perceptions of sexual health concerns among female patients with cervical and breast cancer and survivors in Rwanda: a qualitative interview study"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9461-5521","authenticated-orcid":false,"given":"Johannes","family":"Espmark","sequence":"first","affiliation":[{"name":"Department of Global Public Health, Karolinska Institute, Stockholm, Sweden"},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"B\u00e5ge","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dieudonne","family":"Rutagumba","sequence":"additional","affiliation":[{"name":"Healthy People Rwanda, Kigali, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea Diane","family":"Ndoli","sequence":"additional","affiliation":[{"name":"Healthy People Rwanda, Kigali, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Berchmans","family":"Uwimana","sequence":"additional","affiliation":[{"name":"Healthy People Rwanda, Kigali, Rwanda"},{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nzeyimana N","family":"Innocent","sequence":"additional","affiliation":[{"name":"Healthy People Rwanda, Kigali, Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Christophe","family":"Rusatira","sequence":"additional","affiliation":[{"name":"Healthy People Rwanda, Kigali, Rwanda"},{"name":"Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5458-8319","authenticated-orcid":false,"given":"Anna","family":"K\u00e5gesten","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"2026032309201014000_4.1.e002348.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0240788","article-title":"Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa","volume":"15","author":"Moodley","year":"2020","journal-title":"PLoS One"},{"key":"2026032309201014000_4.1.e002348.2","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2021.650117","article-title":"Cancer in Africa: the untold story","volume":"11","author":"Hamdi","year":"2021","journal-title":"Front Oncol"},{"key":"2026032309201014000_4.1.e002348.3","doi-asserted-by":"crossref","DOI":"10.1016\/j.gore.2020.100605","article-title":"A scoping review: facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in sub-Saharan African health settings","volume":"33","author":"Pierz","year":"2020","journal-title":"Gynecol Oncol Rep"},{"key":"2026032309201014000_4.1.e002348.4","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.coi.2021.03.006","article-title":"Reflection: burden of cervical cancer in Sub-Saharan Africa and progress with HPV vaccination","volume":"71","author":"Ngcobo","year":"2021","journal-title":"Curr Opin Immunol"},{"key":"2026032309201014000_4.1.e002348.5","doi-asserted-by":"publisher","DOI":"10.1177\/15353702211006047"},{"key":"2026032309201014000_4.1.e002348.6","unstructured":"ICO\/IARC HPV Information Centre . 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