Barriers To Cervical Cancer Screening Research Articles

Cervical Cancer Screening Barriers and Facilitators for Sexual and Gender Minority People: A Community-Engaged Feasibility Approach

The purposes of this study were to identify barriers and facilitators to cervical cancer screening (CCS) among sexual and gender minority (SGM) people and to determine strategies to facilitate increased CCS among these populations. Between August 2021 and December 2022, 33 semistructured, in-depth qualitative interviews were conducted with SGM adults in Kentucky. Interview transcripts were analyzed using inductive content analysis to identify patterns and themes. Barriers to CCS included negative experiences with CCS, negative associations with CCS, and healthcare providers’ lack of SGM population awareness. Facilitators of CCS included positive CCS experiences related to healthcare providers and positive CCS experiences related to healthcare settings. Recommended strategies to increase CCS were SGM population-targeted CCS encouragement and cervical cancer self-screening. Healthcare provider and healthcare system barriers and facilitators have a disproportionate influence on SGM individuals’ CCS behaviors. CCS must be normalized in the SGM community and presented and promoted specifically to SGM populations. Human papillomavirus self-sampling acceptability for SGM populations should be explored. There is a critical need for piloting culturally tailored, innovative interventions supported by healthcare providers, healthcare systems, and SGM community partners, underpinned with acceptable, accessible, and evidence-based cervical cancer prevention strategies for SGM populations.

Cervical cancer screening and vaccination acceptability and attitudes among Arab American women in Southeastern Michigan: a qualitative study

Among Arab-American women in Michigan, rates of cervical cancer screening are lower than those in non-Hispanic White and Black women in the state. A deep understanding of the Arab community’s perspective on cervical cancer screening is needed to address the disparity in rates across populations in Michigan. Arab and Chaldean women across Michigan were invited to participate in Zoom-based focus groups to understand the attitudes, acceptability, and barriers of cervical cancer screening among this population. Four focus groups with a total of 19 women aged 30 to 61 were conducted. The focus groups were conducted in English, Arabic, or both languages. The guided discussion was focused on knowledge of cervical cancer and Human papillomavirus (HPV) and its transmission, attitudes towards HPV vaccination, and attitudes towards cervical cancer screening. HPV self-sampling as an alternative to traditional provider-based screening was specifically discussed as this has been proposed as a way to increase screening in hard-to-reach populations. The conversations revealed insights related to barriers at the individual and community levels for screening and vaccination, attitudes towards preventive health care including screening, a need for accessible women’s health literature, and health education. The women also discussed vaccine hesitancy related to HPV and COVID-19, suggesting a need for targeted community interventions.

Cervical Cancer Screening Barriers Among HIV Positive Women Attending ART Clinic at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia: A Qualitative Study

<i>Background</i>: Cervical cancer is the most common cause of morbidity and death among female cancer patients globally, particularly in poor nations like Ethiopia. It is a preventable, non-communicable disease of public health relevance. In Ethiopia, women's acceptance of the services for cervical cancer screening and treatment is low and poorly recorded. The goal of the current study is to investigate the obstacles that HIV-positive women face while trying to use cervical cancer screening. <i>Objective</i>: To investigate cervical cancer screening barriers among HIV positive women at Yekatit 12 Hospital Medical College, Ethiopia, 2021. <i>Methods</i>: Between April and June of 2021, a qualitative study was carried out with women who tested positive for HIV and were enrolled in the ART clinic at Yekatit 12 Hospital Medical College. At the time of the study, HIV-positive women and medical professionals were purposefully chosen from an ART clinic. In all, 14 patients and 9 healthcare professionals participated in the study. A schedule for in-depth interviews were used to gather data. Analysis was done by using atlas ti computer software. <i>Result</i>: The risk factors and symptoms of cervical cancer were not well known to the respondents. Women have identified several factors that impact their use of cervical screening: inadequate knowledge of the significance of screenings, perceptions of the seriousness of cervical cancer, the separation of the screening location from ART, having conflicting concerns, and emotional barriers like anxiety about a positive result, embarrassment, and shame anticipation. These same problems were recognized by healthcare professionals as obstacles to cervical screening. <i>Conclusion</i>: This study offers extensive data on the various complex reasons why women do not participate in cervical cancer screening programs. Consequently, it is crucial to develop interventions that can address and reduce these barriers.

Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use

BackgroundThe wide availability of routine screening with Papanicolaou (Pap) tests and vaccinations against human papillomavirus has resulted in a decline in rates of cervical cancer. As with other diseases, however, disparities in incidence and mortality persist. Cervical cancer, is found more often, at later stages, and has worse outcomes in people who live in rural areas, identify as Black or Hispanic, and in people who are incarcerated. Studies report 4–5 times higher rates of cervical cancer incidence in people detained in jails and prisons than in community-based samples. Studies to explain cervical cancer differences have been inconclusive, though there is broad consensus that issues of access play a role. In this study, we sought to learn more from people who have a history of criminal-legal system involvement and substance use about what barriers and facilitators they perceive in accessing cervical cancer preventive health and other support services in the community.ResultsWe conducted semi-structured interviews with open-ended questions by telephone with 20 self-identified women, ages 22–58, in Birmingham, Alabama. Interviews were audio recorded and transcribed and the transcripts analyzed using immersion-crystallization techniques. Our team identified two main themes, making connections: the importance of interpersonal communication, which stressed barriers and facilitators related to what makes for effective and humanistic interactions in cervical health prevention and other services, and getting it done: the logistics of access and availability, which highlighted elements of cost and payment; scheduling; transportation; and clinic policies.ConclusionsPeople with a history of criminal-legal system involvement and substance abuse meet with a variety of enabling and impeding factors at personal and interpersonal as well as systemic levels in obtaining cervical health services. To better ensure that women in this high-risk group have equitable access to cervical cancer prevention and treatment—and thus better cancer outcomes—will require multilevel efforts that include an emphasis on improving the human connection in health care encounters and improving the nuts-and-bolts logistics related to accessing that care.

Concept mapping sociocultural aspects of cervical cancer prevention among African American women.

For African American women in Houston, cervical cancer mortality is disproportionate to their racial and ethnic counterparts. Most notably, lack of human papillomavirus (HPV) screening and vaccination as well as late diagnosis increase cervical cancer mortality. However, cervical cancer is largely preventable. While previous research has identified a few social determinants that are specifically related to cervical cancer (e.g., education, income, neighborhood), there may be a host of additional social and cultural factors that contribute to a lack of preventative behavior. The present study used concept mapping to explore sociocultural determinants of cervical cancer prevention beliefs among young African American women. N = 15 African American women, ages 18-25, participated in a group concept mapping session focused on cervical cancer knowledge, beliefs about women's health, and how their social environment and culture play a role in their conceptualization of cervical cancer prevention. Five overarching concepts emerged: (1) Screening, (2) Support System, (3) Cervical Cancer 101 (knowledge), (4) Fatalism, and (5) Ease of Prevention. The present study highlights the use of concept mapping for prevention science, particularly in exploratory studies for understanding cervical cancer screening barriers, avenues for intervention, and public health messaging. We discuss the findings and implications for public health research in cervical cancer prevention tailored for African American women.

Analysis of cervical cancer screening barriers on the example of different countries of the world

Analysis of cervical cancer screening barriers on the example of different countries of the world

Cervical Cancer Screening Barriers Among Citizens of Jeddah.

The cervix, a cylindrical structure made of stroma and epithelium, is the lowest point of the uterus. A tissue-proven biopsy of the cervix with histological confirmation is necessary for aberrant cytologic results of Papanicolaou (Pap) smears to rule out cervical cancer. This study investigates barriers to cervical cancer screening among women. A cross-sectional study including 665 Saudi Arabian women residing in Jeddah between the ages of 21 and 65 years was carried out from May to November 2023. A four-part online survey was used to gather the data, which included questions about demographics, cervical cancer screening status, screening barriers, and predictors of cervical cancer screening. The most common barrierto Pap test screening was "have not been to a doctor/no regular provider"(39.7%, N = 251), followed by "lack of provider recommendation/or limited or no information in the community" (30.4%, N = 192) and "low priority/did not perceive need/being healthy" (27.7%, N = 175). The study provides valuable insights into the factors influencing cervical cancer screening in Jeddah, Saudi Arabia. The low prevalence of screening indicates a need for increased awareness and targeted interventions to improve uptake.

Barriers to cervical cancer screening faced by immigrant Muslim women: a systematic scoping review

BackgroundUptake for cervical cancer screening (CCS) is extremely low among immigrant women, particularly Muslim women, because of barriers related to religious values, beliefs, and fatalism. This scoping review aimed to summarize and analyze the findings of previous studies regarding perceived barriers to CCS among Muslim immigrant women.MethodsA search of electronic databases of peer-reviewed articles, including MEDLINE, CINAHL, PubMed, and Scopus was conducted. The following criteria were used for the selection of the articles: (a) the study population consisted of immigrant Muslim women, (b) CCS barriers were the main focus of the study, (c) the articles were original research articles, (d) the research was conducted within the last 10 years, and (d) the study was reported in English language.ResultsBarriers included sociodemographic factors, economic, language, cognitive, and emotional reactions. The healthcare system was classified as a community barrier, whereas culture and religion were categorized as social barriers. Beliefs that becoming ill and dying is the will of Allah and that health problems are a punishment from God were considered to be major barriers to CCS among immigrant Muslim women.ConclusionAccess to health service centers and CCS among Muslim immigrant women is challenging. Information dissemination by health care workers is needed to increase awareness of CCS and access to CCS service points among immigrant Muslim women. Physician recommendations to attend CCS also play an important role.

Community and provider perceptions and experiences of cervical cancer screening in Rural Bolivia: a qualitative study

BackgroundDespite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas.MethodsOur qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software.ResultsFour themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members’ lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening.ConclusionsOur findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers’ ability to perform screening.

Knowledge, Practice and Barriers on Cervical Cancer Screening among Married Women.

Cervical cancer is a most common preventable public health problem. Despite availability of various screening services at Biratnagar, many barriers restrict its utilization. So, we aimed to assess the knowledge, practice and barriers of cervical cancer screening among 30-60 years married women in Biratnagar, Morang, Nepal. We conducted a community based cross sectional study in Biratnagar Morang from December 2020 to December 2021. Consecutive sampling technique was used to collect data from 280 married women of 30-60 years. Ethical approval was obtained from Nepal Health Research Council and informed consent was taken from study participants. Data was collected by face to face interview using a semi structured questionnaire. All participants had heard of cervical cancer. Most (93.9%) responded to multiple sexual partners as a risk factor and 97.9% responded to excessive vaginal bleeding as a symptom. Most (97.1%) responded that cervical cancer is preventable and 44.1% were aware of pap smear test. Eighty-four (30%) participants had ever been screened for cervical cancer. Unavailability of health insurance (85.2%), high cost of treatment (83.1%), lack of nearby service availability (70.9%), embarrassment (44.8%), presence of male doctors (43.8%), problems in time management (28.01%), no advice from health care providers (22.9%), unaware of screening (15.8%) and beliefs on traditional healers (7.1%) were barriers. In comparison to knowledge, practice of cervical cancer screening is low suggesting existence of know-do gap. Various barriers that prevent cervical cancer screening were evident.

A cross-sectional study of knowledge, attitudes, barriers and practices of cervical cancer screening among nurses in selected hospitals in the Eastern Cape Province, South Africa

BackgroundCervical cancer is a preventable but highly prevalent cancer in many low -and middle-income countries including South Africa. Cervical cancer outcomes can be improved with improved vaccination, a well-coordinated and efficient screening programme, increased community awareness and uptake, and increased knowledge and advocacy of health professionals. This study therefore aimed to ascertain the knowledge, attitudes, practices and barriers of cervical cancer screening among nurses of selected rural hospitals in South Africa.MethodsA quantitative cross-sectional study was conducted in five hospitals in the Eastern Cape Province of South Africa between October and December 2021. A self-administered questionnaire was used to assess demographic characteristics of nurses and cervical cancer knowledge, attitudes, barriers and practices. A knowledge score of 65% was deemed adequate. Data were captured in Microsoft Excel Office 2016 and exported to STATA version 17.0 for analysis. Descriptive data analyses were used to report the results.ResultsA total of 119 nurses participated in the study with just under two thirds (77/119, 64.7%) being professional nurses. Only 15.1% (18/119) of participants were assessed as having obtained a good knowledge score of ≥ 65%. The majority of these (16/18, 88.9%) were professional nurses. Of the participants with a good knowledge score, 61.1% (11/18) were from Nelson Mandela Academic Hospital, the only teaching hospital studied. Cervical cancer was deemed to be a disease of public health importance by 74.0% (88/119). However, only 27.7% (33/119) performed cervical cancer screening. Most of the participants (116/119, 97.5%) had an interest of attending more cervical cancer training.ConclusionThe majority of nurse participants did not have adequate knowledge about cervical cancer and screening, and few performed screening tests. Despite this, there is a high level of interest in being trained. Meeting these training needs is of utmost importance to implementing a comprehensive cervical cancer screening programme in South Africa.

Abstract B023: The impact of the promotoras program on knowledge, attitudes, and cervical cancer screening among Hispanic/Latina women: Rapid review

Abstract Cancer is one of the leading causes of death among Hispanics/Latinos adults. Within the Hispanic/Latino population, women have higher rates of infection-related cancers, such as cervical cancer, compared to other racial and ethnic minorities. Women who have a poor education, low socioeconomic status, and do not speak English have a greater incidence of cervical cancer. However, promotoras, who are health promoters, have been shown to be an effective public health intervention because they provide education, address barriers, and increase access to preventive care services. This rapid review identified and examined studies from PubMed and Scopus on the impact that promotoras had on Hispanic/Latina women regarding knowledge, attitudes, and cervical cancer screening uptake. Out of the 490 articles that met the search criteria, 14 met the inclusion criteria. Studies included various types of promotora interventions, varied in sample size, design, location, and in length of study. Several studies suggested that promotoras are effective in increasing knowledge and awareness of cervical cancer, Pap tests, and human papilloma virus (HPV). Additionally, promotoras are effective in positively changing attitudes, increasing self-efficacy, and perceived benefits of routine Pap test screening. Lastly, the promotoras demonstrate that they can change cancer screening behaviors and address financial and capacity barriers of cervical cancer screening. While most studies reported findings, a few studies showed no change in outcomes or mixed results. Overall, promotoras have a positive impact in overcoming challenges to cervical cancer screening in Hispanic/Latino communities. Citation Format: Christina E. Gareis, Paul Hunter, Amy Leader. The impact of the promotoras program on knowledge, attitudes, and cervical cancer screening among Hispanic/Latina women: Rapid review [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B023.

Perceptions of barriers to cervical cancer screening among Saudi women: A cross-sectional study.

In the Kingdom of Saudi Arabia (KSA), Cervical Cancer (CC) ranked fourth in incidence and associated mortality among all cancers, with a mean age incidence of 61 years. This study evaluates the perceived barriers to CC screening among Saudi women in Najran city, KSA. A cross-sectional study was conducted in Najran/ KSA, involving 1085 females. The data collection instrument comprised three main parts: basic data questionnaire, women's knowledge regarding CC screening, assessment of health belief model scale for CC, and Pap smear test. Data collection started through an online survey from the beginning of October 2021 till the end of January 2022. Data analyses were performed using the Statistical IBM software, version 23 (IBM Corp., Armonk, N.Y., USA). The results showed that fear of bad results (68.9%), cost of treatment (58.8%), embarrassment (59.9%), and preference for female physician (47.4%) among several others were the barriers to CC screening identified by women Over 61% of the participants had a moderate barrier to CC screening, and 24.8% had high perceived barriers. Ordinal logistic regression shows that age, higher education, high monthly income, positive family history for CC, and adequate CC screening knowledge are positive predictors of low CC screening barriers (p˂0.05). Increasing number of deliveries and parities was a negative predictor for low CC screening. CC screening barriers are still high among Saudi females. Some demographic variables may predict low CC screening barriers, and health care providers should consider these variables during CC preventive and educational programs.

Abstract 2211: Cervical cancer screening and vaccination acceptability and attitudes amongst Arab American women in southeastern Michigan

Abstract Cervical cancer screening rates among Arab-American women have been consistently shown to be lower than that of non-Hispanic White and Black women in the state of Michigan. Addressing the low cervical cancer screening rates among Arab American women in Michigan requires a deep understanding of the community’s perspective about cervical cancer screening. Thus, we conducted a series of focus groups in Southeastern Michigan to understand the attitudes, acceptability, and barriers of cervical cancer screening among this population. Four focus groups with a total of 19 women were conducted via Zoom. Participants were recruited through social media channels and community organizations. All focus groups were conducted with self-identifying Arab, Arab American, or Chaldean women aged 30 to 61. The focus groups were conducted in either English, Arabic, or a mixture of both languages. Women completed a brief anchoring survey with demographic questions and a self-assessment of their HPV knowledge (see Table 1). The guided discussion centered around knowledge of cervical cancer, broadly, knowledge of Human papillomavirus (HPV) and its transmission, attitudes towards the HPV vaccination, and attitudes towards cervical cancer screening, which included HPV self-sampling methods. The recorded sessions were transcribed and are being coded using Dedoose Version 8.0.35, a qualitative analysis software. During the focus group, the discussion centered around barriers at the individual and community levels for screening and vaccination, attitudes towards preventive health care including screening, a need for accessible women’s health literature, and health education. The women also discussed vaccine hesitancy related to HPV and COVID19. This suggests the need for targeted community interventions. General characteristics of participants (N*=19) N Mean Age (N=17) 37.9 8.7 (SD) Married (N=18) 11 61.1% Survey Language Arabic 6 31.6% English 13 68.4% How well would you say the financial needs are met in your household? Just sufficient 9 50% More than sufficiently met 3 16.7% Barely making it 3 16.7% Not met at all 3 16.7% How well informed do you think you are about cervical cancer? Not informed at all 1 5.6% Not well informed 10 55.6% Moderately informed 5 27.8% Well informed 1 5.6% Very well informed 1 5.6% Have you had vaginal sex (intercourse) before? Yes 15 83.3% No 3 16.7% Have you had oral sex before? Yes 8 47.1% No 9 52.9% Do you have any children? Yes 15 83.3% No 3 16.7% *Complete data available for 17 participants, partially complete data for 2 participants, and missing data for 1 participant Citation Format: Lilah Khoja, Heidi G. Torres, Mariam Ayyash, Madiha Tariq, Alison M. Mondul, Rafael Meza, Celeste L. Pearce. Cervical cancer screening and vaccination acceptability and attitudes amongst Arab American women in southeastern Michigan [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2211.

Cervical cancer screening utilization and associated factors among women of 30–65 years in Girar Jarsoo district North shoa, Ethiopia, 2021

BackgroundCervical cancer screening is the method of early detection of cervical cancer before occurrence to decrease mortality and morbidity of the women. When women screened at least once in their lifetime for cervical cancer, their risk of cancer could be decreased by 25–36%. Despite this advantage the coverage of cervical cancer screening remains below 2% across country level. Therefore, this study aimed to assess cervical cancer screening utilization and associated factors among women 30–65 years in north shoa Ethiopia. MethodCommunity-based cross-sectional study was conducted using stratified cluster sampling technique among 855 women in March 2021. Data were collected using pretested and semi-structured interviewer administered questionnaire. Adjusted odds ratio with a 95% confidence interval was used to report the association between predictors and the outcome variable. ResultCervical cancer screening utilization was found to be 21.2% (95% CI = 18.5–23.9).Being HIV positive [AOR = 16.49 (95% CI: 9.20–29.54)], knowing someone who had ever been screened for cervical cancer [AOR = 5.46 (95% CI: 2.53–11.79)], having good knowledge about cervical cancer screening [AOR = 3.8 (95% CI: 2.21–6.56)], women found in fourth quintile wealth index [AOR = 3.31 (95% CI: 1.13–9.70)] and having low perceived barriers for cervical cancer screening [AOR = 2.58 (95% CI: 1.43–4.64] were found to be significantly associated with cervical cancer screening utilization. ConclusionThe study revealed the utilization of cervical cancer screening among women 30–65 years is low. Health education program and other multi-disciplinary approaches should be done to increase cervical cancer screening utilization.

Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women

Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women

Knowledge, utilization and barriers of cervical cancer screening among women attending selected district hospitals in Kigali - Rwanda.

Cervical cancer is the third most common cancer attacking women globally, and the second in Eastern Africa where Rwanda is located. Regular screening is an effective prevention approach for cervical cancer. Despite that, the screening rate for cervical cancer in Africa is estimated between 10% and 70%, with a number of barriers. This is especially the case in sub-Saharan Africa. In Rwanda, there is limited literature on the rate of use of screening services or the barriers to cervical screening. To assess knowledge, utilization, and barriers of cervical cancer screening among women attending selected district hospitals in Kigali, Rwanda. A descriptive cross-sectional study with a structured questionnaire was used to collect data. Nominal 'yes' or 'no' questions were used to gather data on knowledge and utilisation of cervical cancer and its screening. Likert-type scale questions were used to identify different barriers to screening services. Data were analysed using descriptive and inferential statistics. Respondents were selected by systematic random sampling from the database of women attending gynaecology services at three district hospitals in Kigali, Rwanda. Three hundred and twenty-nine women responded to the survey. Half of the respondents (n = 165) had high knowledge level scores on cervical cancer screening. The cervical cancer screening rate was 28.3%. Utilization of screening was associated with knowledge (P = 0.000, r = -0.392) and selected demographic factors (P = 0.000). Individual barriers included poor knowledge on availability of screening services, community barriers included living in a rural area, and health provider and systems barriers included lack of awareness campaigns, negative attitudes of healthcare providers toward clients, and long waiting times; all barriers limit the access to screening services. A low rate of cervical cancer screening was identified for women attending selected district hospitals in Kigali-Rwanda due to various barriers. On-going education on cervical cancer and its screening is highly recommended. It is important that trained health providers encourage their clients to have cervical cancer screening and work to reduce related barriers.

Understanding Cervical Cancer Screening Barriers among Migrant Women: A Qualitative Study with Healthcare and Community Workers in Portugal.

Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation of migrant women living in Portugal. A qualitative study with online focus groups was conducted. Healthcare workers experienced in CCS and community workers working with migrant communities were purposively sampled. A semi-structured guide was used covering the participation of migrant women in CCS, barriers, and strategies to overcome them. Data were analyzed using content analysis. Participants considered that migrant women have low participation in CCS related to insufficient knowledge, low risk perception, and lack of interest on preventive care. Other barriers such as difficulties in accessing the healthcare services, relationship with healthcare workers, language, and cultural differences were highlighted. Promoting continuity of care, disseminating culturally tailored information, and use of self-sampling methods were suggested to improve participation in CCS. Inequalities in access to CCS among migrant women are mostly caused by information gaps and healthcare system-related barriers. Building a migrant-friendly healthcare system that creates opportunities for healthcare workers to establish relationships with their patients and delivering culturally and linguistically adapted information may contribute to overcoming those barriers and increasing the participation of migrant women in screening.

Prevention of cervical cancer through two HPV-based screen-and-treat implementation models in Malawi: protocol for a cluster randomized feasibility trial

BackgroundCervical cancer is the leading cause of cancer incidence and mortality among Malawian women, despite being a largely preventable disease. Implementing a cervical cancer screening and preventive treatment (CCSPT) program that utilizes rapid human papillomavirus (HPV) testing on self-collected cervicovaginal samples for screening and thermal ablation for treatment may achieve greater coverage than current programs that use visual inspection with acetic acid (VIA) for screening and cryotherapy for treatment. Furthermore, self-sampling creates the opportunity for community-based screening to increase uptake in populations with low screening rates. Malawi’s public health system utilizes regularly scheduled outreach and village-based clinics to provide routine health services like family planning. Cancer screening is not yet included in these community services. Incorporating self-sampled HPV testing into national policy could address cervical cancer screening barriers in Malawi, though at present the effectiveness, acceptability, appropriateness, feasibility, and cost-effectiveness still need to be demonstrated.MethodsWe designed a cluster randomized feasibility trial to determine the effectiveness, acceptability, appropriateness, feasibility, and budget impact of two models for integrating a HPV-based CCSPT program into family planning (FP) services in Malawi: model 1 involves only clinic-based self-sampled HPV testing, whereas model 2 includes both clinic-based and community-based self-sampled HPV testing. Our algorithm involves self-collection of samples for HPV GeneXpert® testing, visual inspection with acetic acid for HPV-positive women to determine ablative treatment eligibility, and same-day thermal ablation for treatment-eligible women. Interventions will be implemented at 14 selected facilities. Our primary outcome will be the uptake of cervical cancer screening and family planning services during the 18 months of implementation, which will be measured through an Endline Household Survey. We will also conduct mixed methods assessments to understand the acceptability, appropriateness, and feasibility of the interventions, and a cost analysis to assess budget impact.DiscussionOur trial will provide in-depth information on the implementation of clinic-only and clinic-and-community models for integrating self-sampled HPV testing CCSPT with FP services in Malawi. Findings will provide valuable insight for policymakers and implementers in Malawi and other resource-limited settings with high cervical cancer burden.Trial registrationClinicalTrials.gov identifier: NCT04286243. Registered on February 26, 2020.

Registered nurses' perspectives on barriers of cervical cancer screening in Swaziland: a qualitative study.

Introductioncervical cancer is highly preventable and curable if diagnosed and treated early, however, it is still the leading cause of death among women. Despite efforts to increase cervical cancer screening, its uptake is still low. The purpose of the study was to investigate the perspectives of registered nurses on barriers of cervical cancer screening in Swaziland.Methodsan exploratory qualitative design was used for the study. Face to face in depth interviews were conducted with 15 registered nurses using an interview guide. The study was conducted in four clinics from both the private and public sectors, which were purposively sampled. Interviews were captured using an audio recording device, they were transcribed verbatim and then analysed using thematic analysis.Resultsfour themes emerged which were deterrents to cervical cancer screening. These were perceived client barriers, health care system related barriers, nurse related barriers and the nature of the procedure.Conclusionthese barriers to service provision need to be addressed by extensive health education to women as well as the cervical cancer screening programme to provide all resources required to increase the uptake of screening.