Abstract
The impact of cervical cancer prevention programs depends on persuading women to go for screening and, if needed, treatment. As part of an evaluation of a pilot project in Indonesia, qualitative research was conducted to explore the factors that influence women's decisions regarding screening and treatment and to generate practical recommendations to increase service coverage and reduce loss to follow up. Research was conducted at 7 of the 17 public health centers in Karawang District that implemented the pilot project. Interviews and focus group discussions were held with 20 women, 20 husbands, 10 doctors, 18 midwives, 3 district health officials, and 16 advocacy team members. Free services and mobile outreach events encouraged women to go for screening, along with promotional efforts by community health workers, advocacy teams, and the mass media. Knowledge and perceptions were the most important barriers to screening: women were not aware of cervical cancer risks, did not know the disease was treatable, and were fatalistic. Factors facilitating treatment were social support from husbands, relatives, and friends and the encouragement and role modeling of health workers. Barriers to prompt treatment included limited access to services and the requirement for husband's consent for cryotherapy. As cervical cancer prevention services are scaled up throughout Indonesia, the findings suggest three strategies to expand screening coverage and ensure prompt treatment: strengthening community mobilization and advocacy activities, modifying the service delivery model to encourage a single visit approach to screening and treatment, and working to gain men's support.
Highlights
The impact of cervical cancer prevention programs depends on persuading women to go for screening and, if needed, treatment
As cervical cancer prevention services are scaled up throughout Indonesia, the findings suggest three strategies to expand screening coverage and ensure prompt treatment: strengthening community mobilization and advocacy activities, modifying the service delivery model to encourage a single visit approach to screening and treatment, and working to gain men’s support
Instead of Pap smears, which are too costly for the average woman in Indonesia and available on a very limited basis, the Cervical and Breast Cancer Prevention (CECAP) Project relied on visual inspection with dilute acetic acid (VIA) to screen women
Summary
The impact of cervical cancer prevention programs depends on persuading women to go for screening and, if needed, treatment. Conclusion: As cervical cancer prevention services are scaled up throughout Indonesia, the findings suggest three strategies to expand screening coverage and ensure prompt treatment: strengthening community mobilization and advocacy activities, modifying the service delivery model to encourage a single visit approach to screening and treatment, and working to gain men’s support. Helping Indonesian women access cervical cancer screening, coupled with more efficient treatment services, could reduce deaths from this disease, which is preventable when detected and treated during precancerous stages. To this end, the Cervical and Breast Cancer Prevention (CECAP) Project developed and tested a national service delivery model for cervical cancer screening and treatment in Indonesia. A series of studies has demonstrated its effectiveness (Megevand et al, 1996; Belinson et al, 1999; University of Zimbabwe and Jhpiego, 1999; Mandelblatt et al, 2002; Goldie et al, 2005; Sankaranarayanan et al, 2005: 2007; Almonte et al, 2007), and over 40 low-income countries have introduced VIA on either a national or pilot-study basis (CCA, 2012)
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