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

Abstract

ObjectiveCervical 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.SettingsThe study took place in the District hospital of Dschang, Cameroon.ParticipantsFocus groups (FGs) involved HCPs working in the area of Dschang and Mbouda.Primary and secondary outcome measuresAll 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.ResultsA 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.ConclusionsAwareness 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 registrationEthical 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).

Perception on cervical cancer and enhancing strategies to screening uptake among women in Bamenda, Cameroon: A qualitative method

“…Moreover, under the private initiative of civil society organizations (CSO), some sensitization campaigns are conducted within the community or professional and academic settings. These efforts do not cover the national territory and a large majority of Cameroonians are not yet informed and are continually exposed to risks factors of cancers (NSPCaPC, 2020;Roux et al 2021). This therefore makes it pertinent to determine the uptake of this preventive measures among women and determine the strategies that these women may prefer so as to increase uptake.…”

“Cervical cancer screening: awareness is not enough”. Understanding barriers to screening among women in West Cameroon—a qualitative study using focus groups.

“…Barriers were classified using the conceptual framework of Thaddeus' and Maine's three-delay model [15]. This framework was utilized in a previous study exploring the barriers to CC screening in Dschang district from the perspective of healthcare providers, enabling us to compare findings from both studies [16]. According to this model, the decision to seek healthcare can be classified into three delays.…”

“…In addition, in a study conducted by Roux et al to examine the CC screening program in Dschang, HCPs reported that women's misconceptions about CC symptoms and prevention strategies explained why women did not access CC screening. According to Roux et al, improving health literacy also encompasses addressing fatalistic perceptions and stigma [16]. Because CC is perceived to be fatal, and sometimes viewed as a punishment, screening can stimulate emotions such as fear and shame.…”

“…Previous studies have reported that the disparity between rural and local areas is exacerbated by poverty. [4,16,25] Participants identified mobile screening facilities as a practical way to improve physical and economic access to CC screening. A female participant explained: "If we come to find you there, we sacrifice ourselves; we close our shops, we know that we are sacrificing ourselves (…).…”

“My motivation was to save”: a qualitative study exploring factors influencing motivation of community healthcare workers in a cervical cancer screening program in Dschang, Cameroon

“…Technology and techniques for cervical cancer screening are improving. However, the uptake of programs is affected by factors including socio-economic issues, structural issues (such as distance to facilities and availability of transport) and sociocultural factors (such as psychological such as “fear of the results” or knowledge related barriers) [ 15 , 16 ]. Community healthcare workers (CHWs) can play an important role in overcoming these obstacles.…”