Cancer warriors sharing personal experiences

Narrative appropriateness in promoting cancer literacy in Kenya


  • Augustus Onchari Nyakundi Chuka University



Cancer Literacy, shared decision making, Health Belief Model, narratives, palliative care


Patients sharing their illness experiences can help members of the general population to adopt measures to prevent contracting similar diseases and also improve the treatment and management outcomes of those who are sick. In this study, experiences shared by cancer patients and survivors were used to establish the appropriateness of narratives in promoting cancer literacy, as well as in describing adherence to set policies on cancer treatment and management. Anchored on the Health Belief Model, this study analysed sampled Daily Nation newspaper articles sharing the experiences of cancer patients and survivors in Kenya. The data was analysed using content analysis and compared with guidelines in national policies on cancer and the Setting Perception Invitation or Information Knowledge Empathy Summarize or Strategize (SPIKES) protocol for breaking bad news. The key findings suggest that the narratives effectively captured critical aspects on cancer literacy including detection of symptoms, diagnosis, communication of results, palliative care and treatment and management. A lack of counselling before disclosing the results of cancer diagnosis and instances of absence of shared decision making in the treatment process indicated non-adherence to national policies on cancer treatment as well as the SPIKES protocol.

Author Biography

Augustus Onchari Nyakundi, Chuka University

Augustus Nyakundi received his PhD in Mass Communication from Jomo Kenyatta University of Agriculture and Technology and is currently a senior lecturer in Journalism and Mass Communication in Chuka University, Kenya. His research interests are evaluation of communication in health interventions, translation and interpretation in healthcare settings, health literacy among vulnerable populations and palliative care communication. His most recent publication is ‘Communication strategies in the management of HIV and AIDS in Kisii County, Kenya: Successes and gaps’, which appeared in the International Journal of Communication Research. 


Akuoko, Cynthia P., Ernestina Armah, Theresa Sarpong, Dan Y. Quansah, Isaac Amankwaa and Daniel Boateng (2017) Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa. PLOS ONE 12 (2): Article e0171024.

Andersen-Hollekim, Tone, Line Melby, Kari Sand, Heidi Gilstad, Anita Das and Marit Solbjø (2021) Shared decision-making in standardized cancer patient pathways in Norway: Narratives of patient experiences. Health Expectations 24: 1780–1789.

Awdish, Rana L. A. and Leonard L. Berry (2017) Making time to really listen to your patients. Harvard Business Review, 9 October. Online:

Baile, Walter F., Robert Buckman, Renato Lenzi, Gary Glober, Estella A. Beale and Andrzej P. Kudelka (2000) SPIKES – A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist 5 (4): 302–331.

Barry, Michael J. and Susan Edgman-Levitan (2012) Shared decision making: Pinnacle of patient-centred care. New England Journal of Medicine 366 (9): 780–781.

Briggs, Gavin M., Peter A. Flynn, Mark Worthington Ian M. Rennie and Steven C. McKinstry (2008) The role of specialist neuroradiology second opinion reporting: Is there added value? Clinical Radi­ology 63 (7): 791–795.

Buckman, Robert (1992) How to Break Bad News: A Guide for Health Care Professionals. Baltimore, MD: Johns Hopkins Press.

Dobler, Claudia C., David E. Midthun and Victor M. Montori (2017) Quality shared decision making in lung cancer screening: The right process, with the right partners, at the right time and place. Mayo Clinical Proceedings 92 (11): 1612–1616.

Fallowfield, Lesley and Valerie Jenkins (2004) Communicating sad, bad, and difficult news in medicine. Lancet 363 (9405): 312–319.

Ferlay, Jacques, Isabelle Soerjomataram, Morten Ervik, Rajesh Dikshit, Sultan Eser, Colin Mathers, Marise Rebelo, Donald M. Parkin et al. (2013) GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012 v1.0: IARC Cancer Base 11. Lyon, France: International Agency for Research on Cancer.

Green, Melanie C. (2006) Narratives and cancer communication. Journal of Communication 56 (S1): S163–S183.

Hall, Daniel E., Allan V. Prochazka and Arron S. Fink (2012) Informed consent for clinical treatment. Canadian Medical Association Journal 184 (5): 533–540.

Hillen, Marij A., Nik M. Medendorp, Joost G. Daams and Ellen M. A. Smets (2017) Patient-driven second opinions in oncology: A systematic review. Oncologist 22 (10): 1197–1211.

Hinyard, Leslie J. and Matthew W. Kreuter (2007) Using narrative communication as a tool for health behaviour change: A conceptual, theoretical, and empirical overview. Health Education & Behavior 34 (5): 777–792.

Howard, George (1991) A narrative approach to thinking, cross-cultural psychology, and psych­otherapy. American Psychologist 46 (3): 187–197.

Ilinca, Stefania, Laura D. Giorgio, Paola Salari and Jane Chuma (2019) Socio-economic inequality and inequity in use of healthcare services in Kenya: Evidence from the fourth Kenya household health expenditure and utilization survey. International Journal for Equity in Health 18 (1): 1–13.

Institute of Medicine (2002) Speaking of Health: Assessing Health Communication Strategies for Diverse Populations. Washington, DC: National Academy Press.

Janz, Nancy K. and Marshall H. Becker (1984) The Health Belief Model: A decade later. Health Education Quarterly 11 (1): 1–47.

Kreuter, W. Matthew, Melanie C. Green, Joseph N. Cappella, Michael D. Slater, Meg E. Wise, Doug Storey, Eddie M. Clark, Daniel J. O’Keefe et al. (2007) Annals of Behavioral Medicine 33 (3): 221–235.

Lopez-McKee, Gloria, Jeanette A. McNeill, Julia Bader and Pat Morales (2008) Comparison of factors affecting repeat mammography screening of low-income Mexican American women. Oncology Nursing Forum 35 (6): 941–947.

McQueen, Amy, Matthew W. Kreuter, Bindu Kalesan and Kassandra I. Alcaraz (2011) Understanding narrative effects: The impact of breast cancer survivor stories on message processing, attitudes, and beliefs among African American women. Health Psychology 30 (6): 674–682.

Minichiello, Tracy A., David Ling and Debra K. Ucci (2007) Breaking bad news: A practical approach for the hospitalist. Journal of Hospital Medicine 2 (6): 415–421.

Ministry of Health, Kenya (2013) National Palliative Care Guidelines. Nairobi: Ministry of Health. Online:

Ministry of Health, Kenya (2017) National Cancer Control Strategy 2017-2022. Nairobi: Ministry of Health. Online:

Ministry of Health, Kenya (2019) Kenya National Cancer Treatment Protocols. Nairobi: Ministry of Health. Online:

Ministry of Public Health and Sanitation and Ministry of Medical Services, Kenya (2011) National Cancer Control Strategy 2011-2016. Nairobi: Ministry of Public Health and Sanitation. Online:

Ministry of Public Health and Sanitation and Min­istry of Medical Services, Kenya (2012) National Guidelines for Prevention and Manage­ment of Cervical, Breast and Prostate Cancers. Nairobi: Ministry of Health. Online:

Mohlin, Asa and Katarina Bernhardsson (2021) Narratives of survivorship: A study of breast cancer pathographies and their place in cancer rehabilitation. Current Oncology 28 (4): 2840–2851.

Mulley, Albert G., Chris Trimble and Glyn Elwyn (2012) Stop the silent misdiagnosis: Patients’ preferences matter. British Medical Journal 345: Article e6572.

Murphy, T. Sheila, Lauren B. Frank, Joyee S. Chatterjee and Lourdes Baezconde-Garbanati (2013) Narrative versus nonnarrative: The role of identification, transportation, and emotion in reducing health disparities. Journal of Com­munication 63 (1): 116–137.

Murphy, Sheila T., Lauren B. Frank, Meghan B. Moran and Paula Patnoe-Woodley (2011) Involved, transported, or emotional? Exploring the determinants of change in knowledge, attitudes, and behavior in entertainment-education. Journal of Communication 61 (3): 407–431.

Muthoni, Anne and Neville Anne Miller (2010) An exploration of rural and urban Kenyan women’s knowledge and attitudes regarding breast cancer and breast cancer early detection measures. Health Care Women International 31 (90): 801–816.

Narayanan, Vijayakumar, Bibek Bista and Cheriyan Koshy (2010) ‘BREAKS’ Protocol for breaking bad news. Indian Journal of Palliative Care 16 (2): 61–65.

Nielsen-Bohlman, Lynn, Allison M. Panzer and David A. Kindig (eds) (2004) Health Literacy: A Prescription to End Confusion. Washington, DC: National Academic Press.

Nyarigoti, Naom, Quin E. Awuor and Eunice Nyamasyo (2017) The role of culture in managing the cancer crisis in Kenya. International Journal of Innovative Research and Development 6 (6): 39–44.

Olver, Ian, Mariko Carey, Jamie Bryant, Allison Boyes, Tiffany Evans and Rob Sanson-Fisher (2020) Second opinions in medical oncology. BMC Palliative Care 19 (1): 112.

Powe, Barbara D. and Ramona Finnie (2003) Cancer fatalism: The state of the science. Cancer Nursing 26 (6): 454–465.

Power, Emily, Cornelia H. M. Van Jaarsveld, Kirsten McCaffery, Anne Miles, Wendy Atkin and Jane Wardle (2008) Understanding intentions and action in colorectal cancer screening. Annals of Behavioral Medicine 35 (3): 285–294.

Rees, Charlotte E. and Peter A. Bath (2000) The inf­ormation needs and source preferences of women with breast cancer and their family members: A review of the literature published between 1988 and 1998. Journal of Advanced Nursing 31 (4): 833–841.

Roberts, Cleora S., Charles E. Cox, Douglas S. Reintgen, Walter F. Baile and Michael Gibertini (1994) Influence of physician communication on newly diagnosed breast cancer patients’ psychologic adjustment and decision-making. Cancer 74 (Suppl. 1): 336–341.

Rosser, Joelle I., Jennifer M. Zakaras, Sabina Hamisi and Megan J. Huchko (2014) Men’s knowledge and attitudes about cervical cancer screening in Kenya. BMC Women’s Health 14: Article 138.

Seifart, Carola, Mareike Hofmann, Tobias Bär, Jorge Riera Knorrenschild, Ulf Seifart and Winfried Rief (2014) Breaking bad news – What patients want and what they get: Evaluating the SPIKES protocol in Germany. Annals of Oncology 25 (3): 707–711.

Shmueli, Liora, Nadav Davidovitch, Joseph S. Pliskin, Ran D. Balicer, Igal Hekselman and Geva Greenfield (2017) Seeking a second medical opinion: Composition, reasons and perceived outcomes in Israel. Israel Journal of Health Policy Research 6 (67): 1–11.

Singh, Madhav, M. and Rajiv K. Agarwal (2017) Breaking bad news in clinical setting: A systematic review. Indian Journal of Applied Research 7 (12): 29–32.

Tam, Kar-Fai, Danny Ka-Leung Cheng, Tong Yow Ng and Hextan Y. S. Ngan (2005) The behaviours of seeking a second opinion from other health-care professionals and the utilization of comple­mentary and alternative medicine in gynaecologic cancer patients. Journal of Multinational Assoc­iation for Supportive Care in Cancer 13 (9): 679–684.

Unger, Jennifer B., Leopoldo J. Cabassa, Gregory B. Molina, Sandra Contreras and Melvin Baron (2013) Evaluation of a fotonovela to increase depression knowledge and reduce stigma among Hispanic adults. Journal of Immigrant and Minority Health 15 (2): 398–406.

Union for International Cancer Control. 2020. GLOBOCAN 2020: New global cancer data. Online:

Wachira, Beth W., Lucy W. Meng’anyi and Ruth G. Mbugua (2018) Knowledge, perception and uptake of prostate cancer screening: A cross-sectional study at a level III hospital in Kenya. Public Health Research 8 (4): 81–87. https://doi.10.5923/j.phr.20180804.01

World Health Organization (2018) Integrating Palliative Care and Symptom Relief into Primary Health Care: A WHO Guide to Planners, Imple­menters and Managers. Geneva: World Health Organization. Online:

World Health Organization and Institut Català d’Oncologia Information Centre on HPV and Cervical Cancer (2010) Human Papillomavirus and Related Cancers in Kenya: Summary Report. Previously online:

World Health Organization Global Cancer Observ­atory (2021). Kenya. Online:



How to Cite

Nyakundi, A. O. (2022). Cancer warriors sharing personal experiences: Narrative appropriateness in promoting cancer literacy in Kenya. Communication and Medicine, 17(3), 257–269.