Abstract
Introduction: Cervical cancer (CC) is the most common cancer among women in Uganda, with many being diagnosed when the disease is in an advanced stage. Visual Inspection with Acetic acid (VIA) remains the most readily available CC screening method in most health facilities in Uganda, but with low screening coverage. This study aimed to understand the barriers and facilitators to CC screening in Uganda.
Methods: A qualitative study was conducted between March 2022 and March 2023 in Mukono, and Wakiso. Through Focus Group Discussions (FGDs) data was collected on perceived barriers and facilitators to CC screening among women aged 25-65 years, primary health care workers (PHC), and community representatives (local authorities and members of civil society organisations). Sixteen FGDs were conducted with 8-12 participants per group. Four FGDs with women (57 participants), four with community representatives (35participants) and four FGDs with PHC workers (32participants). Thematic analysis was performed using deductive and inductive coding guided by the social ecological model.
Results: Perceived barriers and facilitators to CC screening emerged at multiple levels. At the individual level, women identified limited knowledge about CC screening as a major barrier, alongside several forms of fears, including fear of exposing private parts, fear of positive screening results, and concerns regarding the potential costs of treatment. At the interpersonal level, inadequate support from partners, peers, and family hindered CC screening uptake. Institutional barriers included negative attitude of health worker, prolonged waiting times, and long distances to health facilities. At the community level, stigma such as being labeled adulterous for seeking CC screening services discouraged participation. Conversely, facilitators of CC screening included awareness of the benefits of screening and experience sharing at the individual level, community sensitization and decentralization of services at the community level; and availability of accessible treatment services at the institutional level.
Conclusion: Despite free, publicly available CC screening services in Uganda, women continue to encounter numerous barriers that influence both access to and utilization of these services. Enhanced community sensitization is essential to improve awareness of the importance of early CC screening. Additionally, there is a critical need to ensure that subsequent care and treatment services are more financially accessible to all women.
Clinical trial number: Not applicable.
Keywords: Barriers; Cervical cancer; Cervical cancer screening; Community; Facilitators; Women.
Conflict of interest statement
Declarations. Ethics approvals and consent to participate.: The study protocol was reviewed and approved by the Uganda Virus Research Institute Research Ethics Committee (UVRI-REC, #874) and registered with the Uganda National Council for Science and Technology (UNCST, SS #2167). Written informed consent was obtained from all participants after the moderator/interviewer explained the study’s aims, benefits, and potential risks. For illiterate participants, the informed consent process was documented with the help of an impartial witness. All study procedures, including compensation for participants’ time (each received$13.5) were performed in compliance with the principles of the World Medical Association Declaration of Helsinki, the International Conference on Harmonisation (ICH) Good Clinical Practice (GCP), and guidelines of respective regulatory bodies. Participants’ anonymity was maintained throughout the research process through the use of identification numbers. Consent for publication: Not applicable. Disclaimer: The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the different participating Institutions, neither those of the funder or donor. Competing interests: The authors declare no competing interests.