Using Film to Disseminate Information on Cervical Cancer Prevention in Lusaka: Results from a Small Intervention Study

A systematic review of interventions to promote human papillomavirus (HPV) vaccination in Africa

OBJECTIVE

We conducted a systematic review to assess the scope and effectiveness of interventions to improve human papilloma virus (HPV) vaccination in Africa from 2006 to 2021.

STUDY DESIGN

Systematic review.

METHODS

Four databases (Medline, Embase, CINAHL and PsycINFO) were searched for articles published between 2006 and 2021. Articles were screened and included based on eligibility criteria using DistillerSR (Version 2.35). Data were extracted and reported using a narrative synthesis. A quality assessment was also conducted for each study using validated quality appraisal tools.

RESULTS

Out of 7603 articles identified by a systematic search, 18 articles met the inclusion criteria. Included studies comprised impact evaluation and cross-sectional studies published between 2012 and 2021 and conducted in eight African countries namely: Nigeria, Cameroon, South Africa, Kenya, Tanzania, Zambia, Mali, and Malawi. Study quality ranged from high to low quality. Interventions comprised fifteen educational and three multicomponent interventions. Out of thirteen impact evaluation studies (all educational interventions), twelve studies were effective in increasing HPV vaccine uptake and/or improving participants' knowledge, attitudes, and perceptions about the vaccine. Across five cross-sectional studies (two educational and three multicomponent interventions), HPV vaccine uptake rates ranged from 34% to 93.3%, with a consensus on safety and effectiveness in 67.9%-90.3% of participants post-intervention.

CONCLUSION

Educational and multicomponent interventions have been implemented to improve HPV vaccination in Africa. While educational interventions have proven effective at improving HPV vaccine uptake, a more diverse range of interventions with robust impact evaluation study designs are needed to strengthen the available evidence and improve vaccine uptake.

Does Intervening in the Level of Knowledge About Cervical Cancer Increase Screening and Vaccination in Zambia?

Cancer of the cervix can be prevented by primary and secondary prevention methods. In order for these prevention methods to be practiced it is imperative that women are made aware of cervical cancer and the existing vaccination and cervical screening services available to them. A small intervention study to inquire on the effect of showing a short video about cervical cancer and its prevention proved to be an effective means of increasing awareness and knowledge among Zambian women residing in Lusaka. This brief report follows up on the 2017 intervention study in order to determine to what extent the increased knowledge has led to increased screening and vaccination practices among Zambian women and their daughters after a 3-year period. It is concluded that awareness of prevention services increases women's likeliness to seek screening services when given enough time. Unfortunately, we found no evidence of in an increase of the number of daughters vaccinated in this study.

The effectiveness of health education interventions on cervical cancer prevention in Africa: A systematic review

Low levels of knowledge and awareness on cervical cancer play a role in limiting cervical cancer prevention uptake. This systematic review aimed to identify effective educational interventions to increase cervical cancer awareness, knowledge, and subsequently screening or vaccination uptake in African women. A literature search was conducted in Medline and EMBASE databases. We examined original, peer-reviewed English literature published between 2005 and 2020. Nineteen studies examining health education interventions' impact on awareness, knowledge, and screening or vaccination uptake in African women were included. Ten studies were controlled trials, nine performed pre- and post-measurements in one group. Most studies were published between 2015 and 2020 (86%), many were from Nigeria (47%). Studies were mostly set up in communities and schools. The most frequently used intervention was lectures, alone or combined with videos and practical demonstrations. Sixteen studies evaluated knowledge or awareness, and all showed a statistically significant improvement following the intervention. Of the ten studies that evaluated screening uptake, either as the single outcome or combined with knowledge or awareness, six found a significant rise in screening uptake after intervention. Educational interventions increased knowledge and awareness in African women, some boosted uptake of cervical cancer screening, especially when using peer health educators and culturally tailored methods. Innovative approaches such as self-collected HPV testing and mHealth also demonstrated a potential to increase uptake of screening. More research is needed to identify and analyse barriers to screening uptake, which can still be present even after a successful educational intervention.

Implementation and Evaluation of Educational Videos to Improve Cancer Knowledge and Patient Empowerment

PURPOSE

Low health literacy is a leading cause of treatment abandonment among patients receiving cancer care at Kamuzu Central Hospital (KCH) in Malawi.

METHODS

We developed cancer educational videos featuring Malawian providers and played them in the KCH oncology clinic. The videos addressed cancer-related topics, including disease biology, common myths, diagnostic procedures, treatment, side effects, and survivorship. After 6 months of implementation, we compared results from 50 pre- and postintervention surveys to assess change in cancer knowledge and care experience.

RESULTS

Both pre- and postintervention cancer knowledge were good: a median of nine questions were answered correctly of 11 in both assessments. Despite the intervention, most continued to incorrectly identify cancer as an infection (pre: n = 26, 52%; post: n = 25, 50%; P = 1.0), although improvements were observed in patients' knowledge of correct actions for fever at home (pre: n = 38, 76%; post: n = 43, 86%; P = .31). Care experiences were overall good. Postintervention results indicate that more patients felt always listened to by their providers (pre: n = 18, 36%; post: n = 29, 58%; P < .01). However, we also noted a higher rate of patient dissatisfaction of care as more patients felt that they could not understand chemotherapy counseling (pre: n = 11, 22%; post: n = 22, 44%; P < .01). Assessments of video satisfaction indicate that patients found the videos very helpful in terms of understanding their disease (n = 47, 96%) and side effects (n = 48, 98%) and felt empowered to speak up with their providers (n = 46, 96%).

CONCLUSION

Standardized education materials for patients that can be feasibly implemented throughout sub-Saharan Africa are urgently needed. Cancer educational videos are a low-cost way to educate and empower patients with cancer in resource-constrained settings although in-person discussions remain a crucial part of care.

Implementation of human papillomavirus video education for women participating in mass cervical cancer screening in Tanzania

BACKGROUND

Because the global disease burden of cervical cancer is greatest in Africa, the World Health Organization has endorsed visual inspection with acetic acid screening with cryotherapy triage for the screen-and-treat approach. With the lowest doctor-to-patient ratio worldwide (1:50,000), Tanzania has nearly 10,000 new cases of cervical cancer and 7000 deaths annually.

OBJECTIVE

We report on the feasibility of visual inspection with acetic acid in the severely resource-limited Mwanza district and on the impact of intervening education on baseline human papillomavirus and cervical cancer knowledge.

STUDY DESIGN

Two 5-day free visual inspection with acetic acid (VIA) clinics in urban Buzuruga and rural Sangabuye on the shores of Lake Victoria were approved by our university institutional review board and local Tanzanian health authorities. Participants completed a demographic survey and a 6-question (1 point per question) multiple choice test written in Kiswahili to assess baseline knowledge. A 15-minute educational video in Kiswahili (MedicalAidFilms: Understanding screening, treatment, and prevention of cervical cancer) was followed by repeated assessment using the same test, visual inspection with acetic acid screening, and optional HIV testing. Pre- and postvideo scores and change of score were analyzed via t test, analysis of variance, and multivariate regression. Significance was considered at P<.05.

RESULTS

From July 2, 2018 to July 6, 2018, 825 women were screened, and 207 women (25.1%) were VIA positive (VIA+). One hundred forty-seven VIA+ nonpregnant women received same-day cryotherapy. Seven hundred sixty women participated in an educational intervention-61.6% of whom were from an urban site and 38.2% from a rural site. The mean age was 36.4 (standard deviation, 11.1). Primary languages were Kiswahili (62.2%) and Kisukuma (30.6%). Literacy was approximately 73%, and average education level was equivalent to the seventh grade (United States). Less than 20% of urban and rural women reported access to healthcare providers. Mean score of the participants before watching the video was 2.22 (standard deviation, 1.76) and was not different between VIA+ and VIA negative groups. Mean score of the participants after watching the video was 3.86 (standard deviation, 1.78). Postvideo scores significantly improved regardless of age group, clinic site, primary language, education level, literacy, or access to healthcare provider (P<.0001). Change of score after watching the video was significantly greater in participants from urban areas (1.99±2.07) than in those from rural areas (1.07±1.95) (P<.0001). Multivariate analysis identified urban site as an independent factor in change of score (P=.0211).

CONCLUSION

Visual inspection with acetic acid screening for cervical cancer is feasible and accepted in northern Tanzania. Short video-based educational intervention improved baseline knowledge on the consequences of human papillomavirus infection in the studied populations. The impact was greater in the urban setting than in the rural setting.

Exploring the Gender-Specific Impact of Educational Film on Maternal and Child Health Knowledge and Behavior: A Qualitative Study in Serenje District, Zambia

Background

Educational film is a communication tool that helps to present complex information simply and clearly, keeping audiences interested for longer and helping to reinforce important learning. Medical Aid Films produces educational films targeted at communities and health workers, with a focus on maternal and child health (MCH) content. Pilot work suggests that film screenings have attracted male as well as female viewers and have started to increase male involvement in MCH care. We explored stakeholder perspectives and gender-specific responses to educational films screened in a rural district of Serenje, Zambia.

Methods

A qualitative study using focus group discussions and in-depth interviews with men and women who had viewed the films at least once, and key informant interviews with health workers who helped deliver the film screenings. Thematic framework analysis was used to derive themes and subthemes, and illustrative quotes are used to substantiate interpretation of the findings.

Results

Men’s and women’s perspectives are clustered around the influence of the films on knowledge and behavior in relation to MCH topics and male involvement and overall community responses to the films. The three themes summarizing key informant perspectives relate to their impressions of the influence of the films on male involvement in MCH and their views on using film to deliver heath information.

Conclusion

Educational films have the potential to improve women’s and men’s knowledge and awareness of MCH topics, including healthy nutrition and welfare of women during pregnancy, the need to seek skilled care during pregnancy and for childbirth, and the importance of male involvement in supporting the care of women and children. Before widespread implementation, decisions must be made about whether and how to integrate the films with community health education programs, the needs, values, and preferences of men and women and how to present and deliver the film content in a way that maximizes participation of men and women in MCH but does not undermine women’s rights, autonomy, or safety.

Knowledge, attitudes and practices of cervical cancer prevention among Zambian women and men

BACKGROUND

In Zambia, cervical cancer screening was started in 2006 and the human papillomavirus vaccine was piloted in 2013. Nevertheless, cervical cancer remains the leading cancer. It is assumed that knowledge, social interaction, health behaviors and religion are factors that can influence screening and vaccination practices. This study addresses the question, what is the relationship between knowledge about cervical cancer, attitudes, self-reported behavior, and immediate support system, towards screening and vaccination of cervical cancer of Zambian women and men. The results of this study serve as a basis for future research, an input for improvement and adjustment of the existing prevention program and build on documented health behavior frameworks.

METHODS

A cross-sectional mixed methods study was conducted from February to May 2016. Two separate questionnaires were used to collect data from women (N = 300) and men (N = 300) residing in Chilenje and Kanyama (two townships in the capital city Lusaka). Respondent's knowledge of cervical cancer was operationalized by grading their ability to correctly identify causes and protective factors if they were aware of cervical cancer. Besides providing descriptive statistics of all study variables, we tested four research hypotheses concerning the link between knowledge, attitudes and practices suggested by the literature, by applying appropriate statistical tests (chi square test, analysis of variance, logistic regression).

RESULTS

Less than half of the respondents (36.8%) had heard of cervical cancer, 20.7% of women had attended screening and 6.7% of the total sample had vaccinated their daughter. Knowledge of causes and prevention was very low. There was a strong association between having awareness of cervical cancer and practicing screening (odds ratio = 20.5, 95% confidence interval = [9.214, 45.516]) and vaccination (odds ratio = 5.1, 95% confidence interval = [2.473, 10.423]). Social interactions were also found to greatly influence screening and vaccination behaviors.

CONCLUSIONS

The low level of knowledge of causes and prevention of cervical cancer suggests a need to increase knowledge and awareness among both women and men. Interpersonal interactions have great impact on practicing prevention behaviors, for instance, vaccination of daughters.