Dataset Information

Barriers to cervical cancer prevention in rural Cameroon: a qualitative study on healthcare providers' perspective.

ABSTRACT:

Objective

Cervical cancer in Cameroon ranks as the second most frequent cancer among women and the leading cause of cancer-related deaths, mainly due to the lack of prevention. Our principal objective was to explore potential barriers to an human papillomavirus (HPV)-based cervical cancer screening from a healthcare provider (HCP) perspective in a low-income context. Second, we aimed to explore the acceptability of a single-visit approach using HPV self-sampling.

Settings

The study took place in the District hospital of Dschang, Cameroon.

Participants

Focus groups (FGs) involved HCPs working in the area of Dschang and Mbouda.

Primary and secondary outcome measures

All FGs were audiorecorded, transcribed and coded independently by two researchers using the ATLAS.ti software. A qualitative methodology was used to capture insights related to the way people perceive their surroundings. Discussion topics focused on perceived barriers, suggestions to improve cervical cancer screening uptake, and acceptability.

Results

A total of 16 HCPs were interviewed between July and August 2019. The identified barriers were (1) lack of basic knowledge on cervical cancer among most women and men and (2) lack of awareness of the role and existence of a screening programme to prevent it. Screening for cervical cancer prevention using HPV self-sampling was considered as an acceptable approach for patients according to HCPs. Traditional chiefs were identified as key entry points to raise awareness because they were perceived as essential to reach not only women, but also their male partners.

Conclusions

Awareness campaigns about cervical cancer, its prevention and the availability of the screening programmes are crucial. Furthermore, involving male partners, as well as key community leaders or institutions was identified as a key strategy to encourage participation in the cervical cancer screening programme.

Trial registration

Ethical Cantonal Board of Geneva, Switzerland (CCER, N°2017-0110 and CER-amendment n°2) and Cameroonian National Ethics Committee for Human Health Research (N°2018/07/1083/CE/CNERSH/SP).

SUBMITTER: Roux AN

PROVIDER: S-EPMC8212185 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ObjectiveGlobally, cervical cancer (CC) incidence is higher in rural areas than in urban areas that could be explained by the influence of many factors, including inequity in accessibility of the CC prevention measures. This review aimed to identify and analyze factors associated with a lack of cervical cancer screening and HPV vaccination programs in people living in rural areas and to outline strategies to mitigate these factors.MethodsThe literature search encompassed two focal domains: cervical cancer screening and HPV vaccination among populations residing in rural areas, covering publications between January 1, 2004 to December 31, 2021 in the PubMed, Google Scholar, Scopus, and Cyberleninka databases, available in both English and Russian languages.ResultA literature review identified 22 sources on cervical cancer screening and HPV vaccination in rural and remote areas. These sources revealed similar obstacles to screening and vaccination in both high and low-income countries, such as low awareness and knowledge about CC, screening, and HPV vaccination among rural residents; limited accessibility due to remoteness and dearth of medical facilities and practitioners, associated with a decrease in recommendations from them, and financial constraints, necessitating out-of-pocket expenses. The reviewed sources analyzed strategies to mitigate the outlined challenges. Possible solutions include the introduction of tailored screening and vaccination campaigns designed for residents of rural and remote locations. New screening and vaccination sites have been proposed to overcome geographic barriers. Integrating HPV testing-based CC screening is suggested to counter the lack of healthcare personnel. HPV vaccination is essential for primary cervical cancer prevention, especially in rural and remote areas, as it requires less medical infrastructure.ConclusionCertain measures can be proposed to improve the uptake of CC screening and HPV vaccination programs among rural residents, which are needed to address the higher prevalence of CC in rural areas. Further investigation into cervical cancer prevention in rural and remote contexts is necessary to ascertain the optimal strategies that promote health equity.

Project description:BackgroundFollowing the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs-Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services.MethodsSemi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk's Domains of Healthcare Access framework.ResultsAmong 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system.ConclusionsFARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.

Project description:ObjectivesWe characterized barriers reported by women with breast cancer (BC) regarding clinical discussions of sexual health, clustered women by their endorsement of these barriers, and compared these groups.MethodsBC outpatients (N = 144; M age = 56, 67% White) in a sexual health communication intervention study provided baseline data. Exploratory factor analysis characterized sexual health communication barriers on a standardized measure. Hierarchical cluster analysis detected patient groups with similar response patterns on these factors. ANOVAs, Chi-Square and Fisher's Exact tests compared groups on socio-demographic/medical factors, sexual health communication self-efficacy and outcome expectancies, general clinical self-efficacy, sexual concerns, emotional distress, and discussion about sexual health with an oncology provider.ResultsTwo factors emerged: patients' own beliefs about or perceived inability to discuss sexual health (self-centered barriers), and patients' perceptions of providers' reactions to discussing sexual health (provider-centered barriers); self-centered barriers were endorsed more than provider-centered (P < .001). Three clusters emerged: women who endorsed (a) high self-centered and high provider-centered (n = 19; 13%), (b) high self-centered and low provider-centered (n = 95; 66%), and (c) low self-centered and low provider-centered (n = 30; 21%). Women endorsing more barriers reported lower sexual communication self-efficacy, outcome expectancies, and general clinical self-efficacy (P's ≤ .001); no differences in sexual concerns, emotional distress, or discussing sexual health were found.ConclusionsWomen more strongly endorsed self-centered barriers than provider-centered. When grouped according to these barriers, women differed in their confidence and expectations for sexual health communication, regardless of degree of sexual or emotional distress. Interventions are needed to improve both patients' and providers' skills for discussing sexual health.

Project description:Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.