Leveraging Survivor Narratives to Improve Prostate Cancer Care Engagement in Botswana: Findings From a Mixed-Methods Pilot Study

PURPOSE Prostate cancer is a leading cause of cancer-related morbidity and mortality globally, with disproportionately poor outcomes in low- and middle-income countries due to late presentation, limited awareness, and barriers to treatment. In Botswana, there is limited evidence on patient experiences and culturally appropriate interventions to support engagement. Narrative-based health communication, particularly survivor stories, has demonstrated potential to improve health behaviours but remains underexplored in African cancer-care settings. This study aimed to: (1) explore barriers and facilitators to prostate cancer presentation and treatment completion; (2) co-develop culturally relevant survivor narrative videos; and (3) assess their acceptability and utility among newly diagnosed patients. METHODS A mixed-methods pilot study was conducted among prostate cancer patients (≥18 yo) at Princess Marina Hospital. Purposive sampling was used for qualitative interviews and convenience sampling for quantitative assessments. Semi-structured interviews in local dialect explored barriers and facilitators to care, guided by the Integrated Behaviour Model. Survivor narrative videos were co-developed with survivors recounting their diagnosis-to-treatment journeys, informed by qualitative findings, and shown to newly-diagnosed patients. Acceptability and utility were assessed using a validated 13-item Likert-scale survey and open-ended feedback. Psychosocial distress was measured using the NCCN Distress Thermometer. Quantitative data were analysed descriptively, qualitative data thematically using NVivo, and findings were integrated through triangulation. RESULTS Thirty participants were interviewed, 3 contributed to video development, and 30 evaluated the videos (mean 64 years, IQR 15). Key barriers included limited awareness, stigma, masculinity norms, health system delays, and passive patient engagement. Facilitators included trust in healthcare providers, peer influence, and exposure to survivor experiences. Participants viewed 1-2 videos (6-15 minutes each). At baseline, 63% reported moderate-to-high distress, driven by socioeconomic (money, jobs) and psychosocial challenges (fears, worry, sadness). Videos were highly accepted: over 80% found them easy to understand, 86% reported increased motivation for treatment completion, over 95% found them worthwhile, and all participants would recommend them. Qualitative feedback highlighted strong endorsement and demand for wider dissemination. CONCLUSION Survivor narrative videos are a highly acceptable and potentially impactful intervention for improving prostate cancer awareness and treatment engagement in Botswana. Integrating such culturally relevant approaches into clinical care and national strategies may strengthen cancer control efforts.