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Mungo C, Adewumi K, Ellis G, Rop M, Adoyo E, Zou Y, Rahangdale L. Men's perceptions and perceived acceptability of their female partner's use of self-administered intravaginal therapies for treatment of cervical precancer in Kenya. Ecancermedicalscience 2024; 18:1719. [PMID: 39021542 PMCID: PMC11254395 DOI: 10.3332/ecancer.2024.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Indexed: 07/20/2024] Open
Abstract
Background Cervical cancer continues to be a major health issue in low- and middle-income countries (LMICs). Despite increasing access to screening, access to precancer treatment remains a significant challenge in LMICs, highlighting a need for innovative, accessible and resource-appropriate treatment approaches, including self-administered therapies. Methods A cross-sectional mixed-methods study was conducted among men aged 25-65 with a current female partner in Kisumu County, Kenya. Participants were sequentially recruited and surveyed to evaluate their understanding of human papillomavirus and cervical cancer, their views on screening and treatment and their attitudes toward self-administered therapies. Focus group discussions (FGDs) with a subset of the survey participants further explored their treatment preferences and perceptions. Results Two hundred fourteen men participated in the survey, and 39 men participated in FGDs. The median age was 39 years, and 51% had a primary school education or less. Most (96%) were in a committed relationship, and 74% earned $10 or less daily. There was strong support for self-administered topical therapies, with 98% willing to support their partners using such treatments if available. Additionally, most participants were open to supporting necessary abstinence or condom use, though 76% believed their partners might hesitate to request condom use. When given an option, most preferred their partner to self-administer such therapies at home compared to provider administration at a health facility, citing convenience, cost-effectiveness and privacy. Preferences varied between two potential therapies, 5-Fluorouracil and Artesunate, based on their administration frequency, duration and abstinence requirements. Qualitative findings largely supported the quantitative analysis. Conclusion The study demonstrates strong support for self-administered topical therapies for cervical precancer among Kenyan men. Additional research on acceptability, feasibility and efficacy in different LMICs could pave the way for these therapies to help bridge current cervical precancer treatment gaps in these settings.
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Affiliation(s)
- Chemtai Mungo
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Konyin Adewumi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Grace Ellis
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mercy Rop
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Yating Zou
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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2
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Morse RM, Brown J, Gage JC, Prieto BA, Jurczuk M, Matos A, Vásquez Vásquez J, Reátegui RR, Meza-Sanchez G, Córdova LAD, Gravitt PE, Tracy JK, Paz-Soldan VA. "Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program. BMC Public Health 2023; 23:2396. [PMID: 38042779 PMCID: PMC10693157 DOI: 10.1186/s12889-023-17324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Cervical cancer is preventable with vaccination and early detection and treatment programs. However, for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system and community of a low-resource setting prior to implementation of an HPV screen-and-treat program. METHODS This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. RESULTS We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. CONCLUSIONS Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system and community in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.
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Affiliation(s)
- Rachel M Morse
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Julia C Gage
- Center for Global Health, National Cancer Institute, Bethesda, MD, USA
| | - Bryn A Prieto
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Magdalena Jurczuk
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Andrea Matos
- Dirección de Prevención y Control de Cancer (DPCAN) of Peruvian Ministry of Health, Lima, Peru
| | | | | | | | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Kathleen Tracy
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Valerie A Paz-Soldan
- Department of Tropical Medicine and Infectious Disease, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
- Asociación Benéfica PRISMA, Lima, Peru.
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Mbulawa ZZA, Mahlangu LL, Makhabane E, Mavivane S, Nongcula S, Phafa A, Sihlobo A, Zide M, Mkiva A, Ngobe TN, Njenge L, Kwake P, Businge CB. Poor Cervical Cancer Knowledge and Awareness among Women and Men in the Eastern Cape Province Rural Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6916. [PMID: 37887654 PMCID: PMC10606360 DOI: 10.3390/ijerph20206916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
Cervical cancer knowledge and awareness is low among South Africans despite high cervical cancer prevalence. This study aimed to investigate knowledge about the symptoms, signs, risk factors, and methods of prevention of cervical cancer among women and men in the rural Eastern Cape province, South Africa. This cross-sectional analytical study was conducted in the rural community of the OR Tambo municipality in the Eastern Cape province. 252 women and men aged ≥ 25 years were randomly recruited. Data were collected using semi-structured questionnaires. A knowledge score was categorized as "good" if it was ≥65%. The majority of participants (69.8%) were women. Only a proportion of 25.6% (51/199) of the participants had good overall knowledge about cervical cancer, and the majority of these (84.3%) were women. Women previously screened for cervical cancer had a significantly higher median cervical knowledge score than those who had never been screened (p = 0.002). Only among women, good knowledge about cervical cancer was associated with a tertiary education level (OR: 3.17, 95% CI: 1.08-9.57, p = 0.044) and high household income (OR: 3.40, 95% CI: 1.24-9.75, p = 0.027). Both women and men in rural Eastern Cape had limited knowledge about the risk factors and prevention methods of cervical cancer. Public health strategies to improve knowledge and awareness of cervical cancer among both men and women are necessary.
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Affiliation(s)
- Zizipho Z. A. Mbulawa
- National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha 5100, South Africa
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
- UCT-SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town 7700, South Africa;
| | - Lindelo L. Mahlangu
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Esihle Makhabane
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Sisanda Mavivane
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Sindisiwe Nongcula
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Anathi Phafa
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Ayabonga Sihlobo
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Mbalentle Zide
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Athenkosi Mkiva
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Thembeka N. Ngobe
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Luxolo Njenge
- MBChB-3 2022 COBES Group, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (L.L.M.); (E.M.); (S.M.); (S.N.); (A.P.); (A.S.); (A.M.); (T.N.N.); (L.N.)
| | - Phumla Kwake
- Tabase Community Health Centre, Eastern Cape Department of Health, Mthatha 5108, South Africa;
| | - Charles B. Businge
- UCT-SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town 7700, South Africa;
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Mthatha 5100, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
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Morse RM, Brown J, Gage JC, Prieto BA, Jurczuk M, Matos A, Vásquez JV, Reátegui RR, Meza-Sanchez G, Córdova LAD, Gravitt PE, Tracy JK, Paz-Soldan VA. "Easy women get it": Pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program. RESEARCH SQUARE 2023:rs.3.rs-3256535. [PMID: 37790338 PMCID: PMC10543436 DOI: 10.21203/rs.3.rs-3256535/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Cervical cancer is preventable with vaccination and early detection and treatment programs. However, in order for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system of a low-resource setting prior to implementation of an HPV screen-and-treat program. Methods This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. Results We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. Conclusions Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.
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Affiliation(s)
- Rachel M Morse
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | | | - Julia C Gage
- Center for Global Health, National Cancer Institute
| | - Bryn A Prieto
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | - Magdalena Jurczuk
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
| | - Andrea Matos
- Dirección de Prevención y Control de Cancer (DPCAN) of Peruvian Ministry of Health
| | | | | | | | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - J Kathleen Tracy
- Department of Medicine, University of Vermont College of Medicine
| | - Valerie A Paz-Soldan
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine
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5
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Watt MH, Suneja G, Zimba C, Westmoreland KD, Bula A, Cutler L, Khatri A, Painschab MS, Kimani S. Cancer-Related Stigma in Malawi: Narratives of Cancer Survivors. JCO Glob Oncol 2023; 9:e2200307. [PMID: 36795989 PMCID: PMC10166375 DOI: 10.1200/go.22.00307] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/08/2022] [Accepted: 01/19/2023] [Indexed: 02/18/2023] Open
Abstract
PURPOSE Stigma is an impediment across the cancer care continuum, leading to delayed presentation to care, elevated morbidity and mortality, and reduced quality of life. The goal of this study was to qualitatively examine the drivers, manifestations, and impacts of cancer-related stigma among individuals who received cancer treatment in Malawi, and to identify opportunities to address stigma. METHODS Individuals who had completed treatment for lymphoma (n = 20) or breast cancer (n = 9) were recruited from observational cancer cohorts in Lilongwe, Malawi. Interviews explored the individual's cancer journey, from first symptoms through diagnosis, treatment, and recovery. Interviews were audio-recorded and translated from Chichewa to English. Data were coded for content related to stigma, and thematically analyzed to describe the drivers, manifestations, and impacts of stigma along the cancer journey. RESULTS Drivers of cancer stigma included beliefs of cancer origin (cancer as infectious; cancer as a marker of HIV; cancer due to bewitchment), perceived changes in the individual with cancer (loss of social/economic role; physical changes), and expectations about the individual's future (cancer as death sentence). Cancer stigma manifested through gossip, isolation, and courtesy stigma toward family members. The impacts of cancer stigma included mental health distress, impediments to care engagement, lack of cancer disclosure, and self-isolation. Participants suggested the following programmatic needs: community education about cancer; counseling in health facilities; and peer support from cancer survivors. CONCLUSION The results highlight multifactorial drivers, manifestations, and impacts of cancer-related stigma in Malawi, which may affect success of cancer screening and treatment programs. There is a clear need for multilevel interventions to improve community attitudes toward people with cancer, and to support individuals along the continuum of cancer care.
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Affiliation(s)
- Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | | | - Katherine D. Westmoreland
- Department of Pediatric Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Lux Cutler
- Honors College, University of Utah, Salt Lake City, UT
| | - Abhilasha Khatri
- School of Biological Sciences and Honors College, University of Utah, Salt Lake City, UT
| | - Matthew S. Painschab
- Department of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen Kimani
- Department of Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT
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6
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de Fouw M, Stroeken Y, Niwagaba B, Musheshe M, Tusiime J, Sadayo I, Reis R, Peters AAW, Beltman JJ. Involving men in cervical cancer prevention; a qualitative enquiry into male perspectives on screening and HPV vaccination in Mid-Western Uganda. PLoS One 2023; 18:e0280052. [PMID: 36706114 PMCID: PMC9882699 DOI: 10.1371/journal.pone.0280052] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Evidence-based preventive strategies for cervical cancer in low-resource setting have been developed, but implementation is challenged, and uptake remains low. Women and girls experience social and economic barriers to attend screening and human papillomavirus (HPV) vaccination programs. Male support has been proven successful in uptake of other reproductive healthcare services. This qualitative study with focus groups aimed to understand the perspectives of males on cervical cancer screening and HPV vaccination in Western-Uganda This knowledge could be integrated into awareness activities to increase the attendance of cervical cancer screening and HPV vaccination programs. MATERIALS AND METHODS Focus group discussions were conducted with men aged 25 to 60 years, who were married and/or had daughters, in Kagadi district, Mid-Western Uganda. All interviews were transcribed verbatim and thematically analyzed using an inductive approach. RESULTS Eleven focus group discussions were conducted with 67 men. Men were willing to support their wives for screening and their daughters for HPV vaccination. Misperceptions such as family planning and poor personal hygiene leading to cervical cancer, and misperception of the preventative aspect of screening and vaccination were common. Women with cervical cancer suffer from stigmatization and family problems due to loss of fertility, less marital sexual activity, domestic violence and decreased economic productivity. CONCLUSIONS Ugandan men were willing to support cervical cancer prevention for their wives and daughters after being informed about cervical cancer. Limited knowledge among men about the risk factors and causes of cervical cancer, and about the preventative aspect of HPV vaccination and screening and their respective target groups, can limit uptake of both services. Screening and vaccination programs should actively involve men in creating awareness to increase uptake and acceptance of prevention.
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Affiliation(s)
- Marlieke de Fouw
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
| | - Yaël Stroeken
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ben Niwagaba
- Department of Technologies for Rural Transformation, African Rural University, Kagadi, Uganda
| | - Mwalimu Musheshe
- Department of Technologies for Rural Transformation, African Rural University, Kagadi, Uganda
| | - John Tusiime
- Department of Technologies for Rural Transformation, African Rural University, Kagadi, Uganda
| | - Isingoma Sadayo
- Department of Technologies for Rural Transformation, African Rural University, Kagadi, Uganda
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- Children’s Institute, University of Cape Town, Cape Town, South Africa
| | | | - Jogchum Jan Beltman
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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Mabachi NM, Wexler C, Acharya H, Maloba M, Oyowe K, Goggin K, Finocchario-Kessler S. Piloting a systems level intervention to improve cervical cancer screening, treatment and follow up in Kenya. Front Med (Lausanne) 2022; 9:930462. [PMID: 36186820 PMCID: PMC9520305 DOI: 10.3389/fmed.2022.930462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Although preventable, Cervical Cancer (CC) is the leading cause of cancer deaths among women in Sub-Saharan Africa with the highest incidence in East Africa. Kenyan guidelines recommend an immediate screen and treat approach using either Pap smear or visual screening methods. However, system (e.g., inadequate infrastructure, weak treatment, referral and tracking systems) and patient (e.g., stigma, limited accessibility, finance) barriers to comprehensive country wide screening continue to exist creating gaps in the pathways of care. These gaps result in low rates of eligible women being screened for CC and a high loss to follow up rate for treatment. The long-term goal of 70% CC screening and treatment coverage can partly be achieved by leveraging electronic health (eHealth, defined here as systems using Internet, computer, or mobile applications to support the provision of health services) to support service efficiency and client retention. To help address system level barriers to CC screening treatment and follow up, our team developed an eHealth tool—the Cancer Tracking System (CATSystem), to support CC screening, treatment, and on-site and external referrals for reproductive age women in Kenya. Preliminary data showed a higher proportion of women enrolled in the CATSystem receiving clinically adequate (patients tested positive were treated or rescreened to confirm negative within 3 months) follow up after a positive/suspicious screening, compared to women in the retrospective arm.
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Affiliation(s)
- Natabhona M. Mabachi
- Practice-Based Research, Innovation, and Evaluation Division, American Academy of Family Physicians, Leawood, KS, United States
- Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- *Correspondence: Natabhona M. Mabachi,
| | - Catherine Wexler
- Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Harshdeep Acharya
- Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | | | - Kathy Goggin
- Children’s Mercy Research Institute, Kansas City, MO, United States
| | - Sarah Finocchario-Kessler
- Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, KS, United States
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8
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Shrestha AD, Andersen JG, Gyawali B, Shrestha A, Shrestha S, Neupane D, Ghimire S, Campbell C, Kallestrup P. Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis. Public Health 2022; 210:16-25. [PMID: 35863158 DOI: 10.1016/j.puhe.2022.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal. STUDY DESIGN Systematic literature review and meta-analysis. METHODS PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion. RESULTS The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening. CONCLUSION Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.
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Affiliation(s)
- A D Shrestha
- Center for Global Health, Department of Public Health, Aarhus University, Denmark; COBIN, Nepal Development Society, Bharatpur, Nepal.
| | - J G Andersen
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
| | - B Gyawali
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - A Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA; Institute for Implementation Science, Kathmandu, Nepal
| | - S Shrestha
- School of Public Health, University of Alabama, Birmingham, AL, USA
| | - D Neupane
- COBIN, Nepal Development Society, Bharatpur, Nepal; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S Ghimire
- Nepal Cancer Care Foundation, Lalitpur, Nepal
| | - C Campbell
- Usher Institute, University of Edinburgh, EH8 9AG, United Kingdom
| | - P Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
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9
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Peterson CE, Silva A, Goben AH, Ongtengco NP, Hu EZ, Khanna D, Nussbaum ER, Jasenof IG, Kim SJ, Dykens JA. Stigma and cervical cancer prevention: A scoping review of the U.S. literature. Prev Med 2021; 153:106849. [PMID: 34662598 DOI: 10.1016/j.ypmed.2021.106849] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 01/08/2023]
Abstract
Cervical cancer is preventable through HPV vaccination and screening however, uptake falls below national targets. A scoping review was conducted to describe stigmas related to HPV infection and vaccination and cervical cancer and screening in the US. Results were organized into the domains proposed by Stangl and colleagues' Health Stigma and Discrimination Framework. Common drivers of stigma were fear of social judgement and rejection, self-blame, and shame. Positive facilitators included social norms that provided motivation to receive HPV vaccination and screening. Gender and social norms were notable negative facilitators of stigma. HPV infection and cervical cancer resulted in stigma marking through the belief that both result from incautious behavior-either multiple sexual partners or failing to get screening. Stereotyping and prejudice were stigma practices attributed to HPV infection and cervical cancer through these same behaviors. Stigma experiences related to HPV infection, cervical cancer, and abnormal screening results included altered self-image based on perceived/anticipated stigma, as well as discrimination. This review advances understanding of the multiple dimensions of stigma associated with these outcomes in the US population. Three areas warrant additional consideration. Future studies should 1) assess how stigma dimensions affect uptake of cervical cancer preventions efforts; 2) focus on US women most affected by cervical cancer incidence and mortality to identify potential differences in these dimensions and tailor interventions accordingly; 3) include women from geographic areas of the US with high rates of cervical cancer to adapt interventions that address potential regional variations in resources and need.
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Affiliation(s)
- Caryn E Peterson
- School of Public Health, University of Illinois at Chicago, USA.
| | - Abigail Silva
- Department of Public Health Sciences, Loyola University Chicago, Parkinson School of Health Sciences and Public Health, USA
| | | | | | - Elise Z Hu
- University of Illinois College of Medicine, USA
| | | | | | - Ian G Jasenof
- University of Illinois Health, Mile Square Health Center, USA
| | - Sage J Kim
- School of Public Health, University of Illinois at Chicago, USA
| | - J Andrew Dykens
- University of Illinois College of Medicine, USA; Department of Family Medicine, College of Medicine, Center for Global Health, USA
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10
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Lee F, Bula A, Chapola J, Mapanje C, Phiri B, Kamtuwange N, Tsidya M, Tang J, Chinula L. Women's experiences in a community-based screen-and-treat cervical cancer prevention program in rural Malawi: a qualitative study. BMC Cancer 2021; 21:428. [PMID: 33882885 PMCID: PMC8061221 DOI: 10.1186/s12885-021-08109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malawi has the world's highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country's cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. Through a qualitative study, we explore the experiences of women who underwent this community-based pilot screening program. METHODS We implemented our pilot program in rural Malawi and conducted an exploratory qualitative sub-study. We conducted in-depth interviews with women who were treated with thermocoagulation during the program. We used semi-structured interviews to explore screen-and-treat experience, acceptability of the program and attitudes towards self-sampling for HPV testing as an alternative screening method. Content analysis was conducted using NVIVO v12. RESULTS Between July - August 2017, 408 participants eligible for screening underwent VIA screening. Thirty participants had VIA positive results, of whom 28 underwent same day thermocoagulation. We interviewed 17 of the 28 women who received thermocoagulation. Thematic saturation was reached at 17 interviews. All participants reported an overall positive experience with the community-based screen-and-treat program. Common themes were appreciation for bringing screening directly to their villages, surprise at the lack of discomfort, and the benefits of access to same day treatment immediately following abnormal screening. Negative experiences were rare and included discomfort during speculum exam, long duration of screening and challenges with complying with postprocedural abstinence. Most participants felt that utilizing self-collected HPV testing could be acceptable for screening in their community. CONCLUSIONS Our exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with VIA and thermocoagulation was widely accepted. Participants valued the accessible, timely, and painless thermocoagulation treatment and reported minimal side effects. Future considerations for reaching rural women can include community-based follow-up, cervical cancer education for male partners and self-sampling for HPV testing.
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Affiliation(s)
- Fan Lee
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA.
| | | | | | | | | | | | | | - Jennifer Tang
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA
- UNC-Project Malawi, Lilongwe, Malawi
| | - Lameck Chinula
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA
- UNC-Project Malawi, Lilongwe, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
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11
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Taghizadeh Asl R, Van Osch L, De Vries N, Zendehdel K, Shams M, Zarei F, De Vries H. The role of knowledge, risk perceptions, and cues to action among Iranian women concerning cervical cancer and screening: a qualitative exploration. BMC Public Health 2020; 20:1688. [PMID: 33176743 PMCID: PMC7656771 DOI: 10.1186/s12889-020-09701-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/14/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Iran has a low incidence but higher rate of death from cervical cancer (CC). The country is in the process of implementing an organized screening program including HPV testing and cytology. Studies show high dropout in continued testing among eligible women. This qualitative study aimed to explore women's awareness regarding CC and CC testing and the role of knowledge, perceived risk, and cues to action in this process. METHOD Through a qualitative study based on the Framework Method, we recruited 81 women aged 25-65 who participated in 15 focus group discussions (FGDs) and two in-depth interviews in Tehran. The interviewees were selected purposefully during January to May 2015 from households belonging to different socioeconomic classes until data saturation. The data were acquired through 11 open-ended questions and 32 related probe questions. All interviews were transcribed and independently analyzed by two researchers (Kappa and agreement testing respectively: 0.77, 97.11%). RESULTS The coded texts were categorized under three themes and 13 subthemes. The three thematic areas referred to knowledge, cues to action, and perceived risks regarding CC and screening. The results showed that women had limited and unspecified knowledge about CC and screening, compounded by misconceptions regarding infection and cancer prevention measures. Social and cultural barriers hindered proper communication between health system/providers and clients and within communities on subjects related to CC and screening. The perceived risk of getting CC was low because of overestimating the role of hereditary factors for CC, difficulty in differentiating between cancer and sexually transmitted infections (STI), and the absence of visible symptoms. CONCLUSION The results indicate a strong need to invest more efforts to improve health education and communication in the current national health program to promote awareness of the need to screen for CC through, for example, establishing correct knowledge and risk perceptions among women. In addition, this intervention should address women's social environment in order to prevent misconceptions being communicated to women.
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Affiliation(s)
- Rahim Taghizadeh Asl
- Cancer Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran
| | - Liesbeth Van Osch
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Nanne De Vries
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Kazem Zendehdel
- Cancer Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran
| | - Mohsen Shams
- School of Health, Yasuj University of Medical Sciences, Pasdaran 15 Blvd., Yasuj, Iran
| | - Fatemeh Zarei
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University(TMU), P.O. Box: 14115-331, Tehran, Iran
| | - Hein De Vries
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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12
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Lewis S, Moucheraud C, Schechinger D, Mphande M, Banda BA, Sigauke H, Kawale P, Dovel K, Hoffman RM. "A loving man has a very huge responsibility": A mixed methods study of Malawian men's knowledge and beliefs about cervical cancer. BMC Public Health 2020; 20:1494. [PMID: 33008344 PMCID: PMC7532091 DOI: 10.1186/s12889-020-09552-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In Malawi, numerous barriers may prevent women from accessing cervical cancer screening services - including social factors such as male partner involvement. We conducted surveys that included open- and closed-ended questions with married Malawian men to evaluate their knowledge and beliefs about cervical cancer. METHODS HIV-positive adult (≥18 years) men (married or in a stable relationship) were recruited from an antiretroviral therapy clinic in Lilongwe, Malawi. Men were asked a series of survey questions to assess their knowledge about cervical cancer, experience with cervical cancer, their female partner's screening history, and their beliefs about gender norms and household decision-making. Following the survey, participants responded to a set of open-ended interview questions about cervical cancer screening, and men's role in prevention. RESULTS One hundred-twenty men were enrolled with average age 44 years and 55% having completed secondary school or higher education. Despite only moderate knowledge about cervical cancer and screening (average assessment score of 62% correct), all men expressed support of cervical cancer screening, and most (86%) believed they should be involved in their female partner's decision to be screened. Over half (61%) of men said their female partner had previously been screened for cervical cancer, and this was positively correlated with the male respondent having more progressive gender norms around sexual practices. Some men expressed concerns about the screening process, namely the propriety of vaginal exams when performed by male clinicians, and whether the procedure was painful. CONCLUSIONS Male partners in Malawi want to be involved in decisions about cervical cancer screening, but have limited knowledge about screening, and hold rigid beliefs about gender norms that may affect their support for screening. Messaging campaigns addressing men's concerns may be instrumental in improving women's adoption of cervical cancer screening services in Malawi and similar settings.
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Affiliation(s)
- Samuel Lewis
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Corrina Moucheraud
- University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Devon Schechinger
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs, Los Angeles, CA, USA
| | | | | | | | - Paul Kawale
- African Institute for Development Policy, Lilongwe, Malawi
| | - Kathryn Dovel
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Risa M Hoffman
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
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13
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Pierz AJ, Randall TC, Castle PE, Adedimeji A, Ingabire C, Kubwimana G, Uwinkindi F, Hagenimana M, Businge L, Musabyimana F, Munyaneza A, Murenzi G. A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings. Gynecol Oncol Rep 2020; 33:100605. [PMID: 32637528 PMCID: PMC7327246 DOI: 10.1016/j.gore.2020.100605] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 01/11/2023] Open
Abstract
To address gaps in access to cervical cancer screening and early diagnosis of breast cancer services in Sub-Saharan African (SSA), this scoping review was conducted to explore facilitators and barriers that exist on the patient-, provider-, and system-level. An extensive literature search was conducted in accordance with scoping review methodology and the Cochrane guidelines. Our search criteria were limited to original research studies conducted in community or clinical settings in SSA within the last 10 years (2010-2020). Themes found from this review included patient knowledge and provider education, access to screening services, trust, health-related behaviors, attitudes, values, and practices, community and social values, health infrastructure, resource allocation, and political will. Identified barriers included lack of knowledge about cervical and breast cancer among patients, gaps in education and training among providers, and lack of resources and health infrastructure at the facility level and within the overall health system. Facilitators included perceived risk of cancer, support and encouragement of the provider, and utilization of novel approaches in low-resource settings by health systems. To better address individual-, provider-, and health system and facility-based facilitators and barriers to care, there is a need for political and financial investment and further research on the health service delivery in specific national health systems, especially in the context of the global campaign to eliminate cervical cancer as a public health problem.
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Affiliation(s)
- Amanda J. Pierz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Thomas C. Randall
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charles Ingabire
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
| | | | | | - Marc Hagenimana
- Cancer Diseases Unit, Rwanda Biomedical Center, Kigali, Rwanda
| | - Lydia Businge
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
| | - Francoise Musabyimana
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
| | - Athanase Munyaneza
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
| | - Gad Murenzi
- Division of Clinical Education and Research, Rwanda Military Hospital, Kigali, Rwanda
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14
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Greibe Andersen J, Shrestha AD, Gyawali B, Neupane D, Kallestrup P. Barriers and facilitators to cervical cancer screening uptake among women in Nepal - a qualitative study. Women Health 2020; 60:963-974. [PMID: 32643576 DOI: 10.1080/03630242.2020.1781742] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annually. Almost 90% of cervical cancer deaths occur in low and middle income countries. Screening is the most effective tool in prevention, early diagnosis, and treatment of cervical cancer. Nepal has no national cervical cancer screening programme, and data from 2003 showed that only 2.8% of Nepalese women had ever been screened. We conducted a qualitative study to obtain better insight into barriers and facilitators to cervical cancer screening among women in Nepal to generate data to inform interventions. In February 2019, four focus group discussions with previously screened and non-screened women, and Female Community Health Volunteers and four in-depth interviews with health workers were conducted in Pokhara Metropolitan City. Semi-structured interview guides were used, interviews were audio-recorded, transcribed verbatim, and analyzed using grounded theory approach with open coding. This resulted in five main themes: 1) lack of husband's support for screening, 2) prevalent stigma and discrimination, 3) lack of awareness about screening options, 4) getting screened, and 5) health care providers. We encourage policymakers and stakeholders apply these findings to improve awareness, access to information, and better screening services in Nepal.
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Affiliation(s)
| | | | - Bishal Gyawali
- Department of Public Health, Global Health Section, University of Copenhagen, Denmark
| | - Dinesh Neupane
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Moucheraud C, Kawale P, Kafwafwa S, Bastani R, Hoffman RM. "It is big because it's ruining the lives of many people in Malawi": Women's attitudes and beliefs about cervical cancer. Prev Med Rep 2020; 18:101093. [PMID: 32322461 PMCID: PMC7168763 DOI: 10.1016/j.pmedr.2020.101093] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/28/2020] [Accepted: 04/04/2020] [Indexed: 12/29/2022] Open
Abstract
Adoption of routine cervical cancer screening in Malawi is very low, even though it has the highest cervical cancer burden in the world. We performed a multi-level assessment of Malawian women's knowledge and perceptions of cervical cancer risk and screening. Using the Multi-Level Health Outcomes Framework, we conducted interviews with 60 adult Malawian women aged 18-62 at facilities with cervical cancer screening. Eligible participants were recruited regardless of HIV status or history of screening, and asked about their experiences with cervical cancer disease and screening. Interviews were audio recorded and a theory-informed codebook was developed. Analysis focused on thematic differences across groups by age, HIV status, and screening history. Half of the sample (n = 30) had either never been screened for cervical cancer or were at the facility for their first-ever screen. Most women said that cervical cancer is dangerous, and many knew someone affected. Many women spoke about the importance of screening for prevention of cancer. Risk factors were generally well-understood, including increased risk with HIV, although this was misunderstood by some HIV-negative women to mean they were not at risk. Social networks were identified as a key determinant of screening, and gender issues were likewise highly salient. Despite high knowledge levels about cervical cancer, there remain significant challenges to improving screening, including interpersonal and system-level barriers. Future work should strengthen service delivery, target social networks and intimate partners, and develop targeted communication strategies for HIV-positive and -negative groups, especially in high-burden settings.
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Affiliation(s)
- Corrina Moucheraud
- University of California, Fielding School of Public Health, Department of Health Policy and Management, Los Angeles CA USA
| | - Paul Kawale
- African Institute for Development Policy, Lilongwe Malawi
| | | | - Roshan Bastani
- University of California, Fielding School of Public Health, Department of Health Policy and Management, Los Angeles CA USA
| | - Risa M Hoffman
- University of California, David Geffen School of Medicine, Division of Infectious Diseases, Los Angeles CA USA
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16
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Area-specific economic status should be regarded as a vital factor affecting the occurrence, development and outcome of cervical cancer. Sci Rep 2020; 10:4759. [PMID: 32179827 PMCID: PMC7075972 DOI: 10.1038/s41598-020-61660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/28/2020] [Indexed: 11/09/2022] Open
Abstract
For patients with cervical cancer, despite the incidence and mortality rates have been declining in recent years, due to its huge population base, cervical cancer has always been a serious public health problem. Our research placed emphasis on the indices greatly associated with overall area-specific social economic status, making up for the defects of traditional research which only pay attention to the situation of some specific disease or patients’ individual social status. A total of 39160 women identified cervical cancer were concluded in our study from the Surveillance, Epidemiology, and End Results (SEER) 18 Program data between 1980 and 2014. With improving the area-specific social economic factors in recent years, the occurrence and prognosis of cervical cancer showed different variation patterns respectively. Some states like California and Georgia for their better economic status and more healthcare investment by local medical institution, population there showed a lower prevalence, incidence, more timely diagnosis, effective treatment, and better prognosis. According to our study, we aimed to give a scientific interpretation on how the area-specific social economic factors affect the disease situation at the macro level and help local medical institution make advisable decisions for controlling cervical cancer.
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17
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Choi Y, Oketch SY, Adewumi K, Bukusi E, Huchko MJ. A Qualitative Exploration of Women's Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:36-43. [PMID: 30368651 PMCID: PMC6920575 DOI: 10.1007/s13187-018-1437-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Detection and treatment of human papillomavirus (HPV) and cervical precancer through screening programs is an effective way to reduce cervical cancer deaths. However, high cervical cancer mortality persists in low- and middle-income countries. As screening programs become more widely available, it is essential to understand how knowledge about cervical cancer and perceived disease risk impacts screening uptake and acceptability. We evaluated women's experiences with a cervical cancer education strategy led by community health volunteers (CHVs) in Migori County, Kenya, as part of a cluster randomized controlled trial of cervical cancer screening implementation strategies. The educational modules employed simple language and images and sought to increase understanding of the relationship between HPV and cervical cancer, the mechanisms of self-collected HPV testing, and the importance of cervical cancer screening. Modules took place in three different contexts throughout the study: (1) during community mobilization; (2) prior to screening in either community health campaigns or health facilities; and (3) prior to treatment. Between January and September 2016, we conducted in-depth interviews with 525 participants to assess their experience with various aspects of the screening program. After the context-specific educational modules, women reported increased awareness of cervical cancer screening and willingness to screen, described HPV- and cervical cancer-related stigma and emphasized the use of educational modules to reduce stigma. Some misconceptions about cervical cancer were evident. With effective and context-specific training, lay health workers, such as CHVs, can help bridge the gap between cervical cancer screening uptake and acceptability.
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Affiliation(s)
- Yujung Choi
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC, 27708, USA.
| | - Sandra Y Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Konyin Adewumi
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC, 27708, USA
| | - Elizabeth Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, P.O. Box 356460, Seattle, WA, 98195, USA
| | - Megan J Huchko
- Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC, 27708, USA
- Department of Obstetrics and Gynecology, Duke University, 201 Trent Dr., 203 Baker House, Durham, NC, 27710, USA
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Kim HW, Kim DH, Kim Y. Men's awareness of cervical cancer: a qualitative study. BMC Womens Health 2018; 18:155. [PMID: 30249228 PMCID: PMC6154413 DOI: 10.1186/s12905-018-0650-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS As HPV is a sexually transmitted virus, men are crucial in the prevention of cervical cancer, but research about men's awareness on cervical cancer is limited. Therefore, in this study, we investigated men's awareness toward women's cervical cancer, to thoroughly understand the viewpoints of men, and to emphasize the centrality of the role of men in the prevention of cervical cancer. METHODS A qualitative descriptive design was chosen to explore men's awareness of women's cervical cancer. Twelve men aged 20-58 were interviewed. Snowball sampling was conducted to recruit participants. RESULTS Most participants stated that they were not interested in women's health, and that they did not have much knowledge about cause and prevention of cervical cancer. They acknowledged that cervical cancer was different from other cancers, based on cause and prognosis of disease. The recognition of cervical cancer in participants varied widely depending on their relationship with women. Respondents' recognition of cervical cancer was classified into four types based on a Situational Awareness (SA) model including individual factors (knowledge about cervical cancer, interest in women's health) and system/task factors (relationship with women, men's responsibility). CONCLUSION This study is one of the few studies describing men's awareness on cervical cancer. Korean men's awareness level was low, and their concern and knowledge were not good. Some participants thought that cervical cancer can be treated, can be prevented, and is recognized as a disease of a female with men intervening. Our participants perceived that the role of men is necessary for the prevention of cervical cancer. Therefore, a strategy is needed to develop the awareness and knowledge of men on cervical cancer prevention. When planning cervical cancer education for men, phase and type-specific approaches are required, depending on perception level.
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Affiliation(s)
- Hae Won Kim
- College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Duck Hee Kim
- Department of Nursing, Woosuk University, 443, Samnye-ro, Samnye-eup, Wanju-gun, Jeollabuk-do 55338 Republic of Korea
| | - Youngji Kim
- College of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, 21936 Republic of Korea
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