Implementation of clinical breast examination screening programme as part of primary care in Vietnam: An analysis of contextual factors

Clinical breast examination (CBE) screening for breast cancer in Vietnam was proved to be cost-effective and acceptable to women. However, the outcomes of the implementation of such proposed programme are unknown. To inform the design and implementation planning of the proposed screening programme, this study investigated and analysed the contextual factors of implementing a CBE programme as part of primary care in Vietnam. Regarding methods, the Breast Health Global Initiative Framework and its seven contextual domains for breast cancer health care (including i. epidemiological, ii. policy/legal, iii. geographical/environmental, iv. service and organisational, v. financial, vi. social and economic, vii. cultural and psychosocial) guided the programme implementation analysis. Literature review, documentary analysis of polices, and key informant interviews (with representatives of health authorities at all four levels of Vietnam health system) were used to gather data for each domain. The results show that Vietnam's policy context pointed to the focus on cancer early detection through screening. According to key informants, district level was the most appropriate level for organising and delivering a CBE programme, and only doctors should perform a CBE. Knowledge about breast cancer and perceived susceptibility to receiving a breast cancer diagnosis was positively associated with CBE uptake. In conclusions, the current policy framework supports the implementation of a CBE screening programme in Vietnam. CBE should be performed by doctors, at the district level, and alongside health promotion.