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Original Article

Motivations and experiences of women who accessed “see and treat” cervical cancer prevention services in Zambia

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Pages 91-98 | Received 21 Oct 2011, Accepted 06 Jan 2012, Published online: 28 Feb 2012
 

Abstract

Background: In Zambia, a country with a generalized HIV epidemic, age-adjusted cervical cancer incidence is among the highest worldwide. In 2006, the University of Alabama at Birmingham-Center for Infectious Disease Research in Zambia and the Zambian Ministry of Health launched a visual inspection with acetic acid (VIA) -based “see and treat” cervical cancer prevention program in Lusaka. All services were integrated within existing government-operated primary health care facilities. Objective: Study aims were to (i) identify women’s motivations for cervical screening, (ii) document women’s experiences with screening and (iii) describe the potentially reciprocal influences between women undergoing cervical screening and their social networks. Design and methods: Focus group discussions (FGD) and in-depth interviews (IDI) were conducted with women who accepted screening and with care providers. Low-level content analysis was performed to identify themes evoked by participants. Between September 2009 and July 2010, 60 women and 21 care providers participated in 8 FGD and 10 IDI. Results: Women presented for screening with varying needs and expectations. A majority discussed their screening decisions and experiences with members of their social networks. Key reinforcing factors and obstacles to VIA screening were identified. Conclusions: Interventions are needed to gain support for the screening process from influential family members and peers.

Acknowledgements

The authors thank Chibesa Wumulume, Mubiana Macwang’i, Phillimon Ndubani, and Diane M. Grimley for helpful comments and suggestions. The authors also wish to thank their team of research assistants and data managers at the Institute for Economic and Social Research at the University of Zambia, and the Centre for Infectious Diseases in Zambia for their support on behalf of this study. Finally, they are grateful to the Lusaka District Health Management Team, under the direction of the Zambian Ministry of Health, for their support of this study.

Declaration of interest: The project described was supported by Award Number R21CA124336 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. None of the authors report any conflict of interest.

Current knowledge on this subject

  • Once-in-a-lifetime “screen and treat” protocols based on low-technology visualization techniques, or human papillomavirus DNA testing, can effectively reduce global rates of invasive cervical cancer among women in resource-limited countries.

  • Special challenges are encountered in regions with generalized HIV epidemic such as sub-Saharan Africa, because post-treatment follow-up visits and repeated screening are needed to effectively prevent cervical cancer in HIV-infected women.

  • In resource-rich countries, cervical cancer screening causes embarrassment, fear, discomfort and inconvenience that act as deterrent in many women.

What this study adds

  • Women who attended a cervical cancer prevention program in Lusaka, Zambia, cited trust in screening personnel as the most important determinant of a positive screening experience.

  • In the context of screening by visualization of the cervix, being offered the possibility to see a digital picture of one’s cervix, along with receiving brief explanations from the screening nurse, was a strong motivator for many women.

  • Most Zambian women discuss their screening decisions with members of their social networks before attending screening. After screening, women who had mainly positive screening experiences tend to promote screening in their networks, whereas women who had mixed experiences are more likely to exert a negative influence on their peers.

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