Piloting a Digital App Based on the Friendship Bench for Depression and Anxiety in Palestine: Mixed Methods Study.

Breast cancer (BC) is a significant global public health concern, with an increasing incidence and disproportionate mortality in low- and middle-income countries (LMICs), including Ghana []. While the incidence rates are comparatively lower in LMICs than in high-income countries, mortality rates are markedly higher due to a combination of factors, including delayed diagnosis, limited access to specialized care, and the reliance on non-biomedical health systems [,]. In Ghana, BC is the most common cancer among women and a leading cause of cancer-related deaths []. A majority of cases (80%) are diagnosed at advanced stages, often after a prolonged time from symptom onset to formal diagnosis [,]. The delays are partly attributed to the absence of a national screening program coupled with structural weaknesses in the formal healthcare system, but they are also profoundly influenced by sociocultural norms and health-seeking behaviors that prioritize traditional medicine as a first-line response [,]. Several studies have reported that traditional medicine, covering herbal remedies and faith or spiritual healing, deeply rooted in Ghanaian society, plays a vital role in the health journeys of women with breast-related symptoms. Boamah Mensah et al. [] reported that women often turn to traditional medicine practitioners (TMPs) driven by considerations of cost-effectiveness, fear of invasive procedures, spiritual explanations of illness, and delays in the orthodox healthcare system. Mburu et al. [] demonstrated that women follow nonlinear pathways to care, beginning with self-detection and then consulting TMPs before seeking hospital care. Bonsu et al. [] documented that women frequently misjudge early symptoms (such as painless lumps or bloody nipple discharge) and delay care until symptoms worsen, often influenced by social networks and TMPs who either downplay the severity or reframe the symptoms in spiritual or benign terms.