Barriers and facilitators of adherence for cervical cancer prevention in low-income women in Colombia

Abstract

Abstract Introduction In Colombian women, cervical cancer screening coverage in 2017, 48.2 % of women were able to pay and 34.3% were not able to. Objective To determine the barriers and facilitators of screening adherence to preventive program for cervical cancer prevention, in women were not able to pay affiliated to a public network of primary health care in Cali, Colombia, during the years 2014-2018. Methods Sequential mixed study, quantitative initial phase and second qualitative phase. We analyzed information from 32,001 insured women and 7,691 users of the program. The quantitative design was cross-cutting, observational and analytical; we also incorporate a qualitative case study; we conduct focus groups, in-depth interviews with users, health care services and administrative staff. Results 47.5% of women were adherents to the program; women over 50 (OR = 0,82; 95% CI = 0,73-0,92), who lived further away from the health care site, (OR = 0,78; 95% CI = 0,62-0,97), had worse adherence to the program; women most often from medical consultations had increased adherence (OR = 3; 95% CI = 2,66-3,42). The qualitative case study showed similar barriers to other populations, living conditions, shame and fears of the procedure itself. We found as facilitators, agile attention, the ease of consulting services, and having some social support. Conclusions Despite the efforts of the public network of primary health care, the personnel staff consider a great barrier, the lack of updated information of women, which prevents recruitment and monitoring. Key messages In low-income women, it is necessary to generate interventions in groups of poor non-adherent women, as well as women with low adherence. Adherence depends on women’s beliefs and knowledge. Lack of interaction with a healthcare provider, increasing age and living far away from the health care site continue to be barriers.