Loss to follow-up after initial screening for cervical cancer: A qualitative exploration of barriers in Southern India

Abstract

Background: In India, opportunistic screening is routinely conducted for cervical cancer, but systematic, community-based screening is relatively new. Hence, the uptake and follow-up for community-based screening remain poor. Objectives: In this study, we aimed to explore the barriers to community-based screening and suggest possible solutions for mitigating the loss to follow-up among screen-positive women from the perspectives of both, the community women (CWs) and service providers (SPs). Materials and Methods: This descriptive, qualitative study conducted at a non-governmental organization in Tirunelveli district of Tamil Nadu between December 2017 and January 2018 included 11 CWs who completed various stages of screening and five SPs involved in community-based screening. The participants were purposively identified and interviewed face to face using a semi-structured questionnaire. Interviews were conducted in Tamil, following which the transcripts were validated by the participants, translated to English, and analyzed. The reporting was based on the Consolidated Criteria for Reporting Qualitative Research guidelines. Results: Unawareness and poor understanding of the screening process, fear associated with the procedures and the disease, no financial and family support, and sociocultural beliefs were identified as the barriers to follow-up. Persistent follow-up through phone calls and home visits along with increasing the awareness about the screening process and its benefits, establishing a rapport with the community, and using local community-based organizations to track the CWs are suggested as possible measures to mitigate the loss to follow-up. Conclusion: Sociocultural, economic, and psychological factors are the main barriers to follow-up after initial screening in cervical cancer screening programs. Conducting population-based systematic screening and awareness programs and keeping the local public healthcare professionals on the frontline along with incentivizing the healthcare professionals and screen-positive women are recommended to improve the adherence to follow-up.