Changing knowledge, attitudes, and behaviors regarding cervical cancer screening: The effects of an educational intervention in rural Kenya

Abstract

Objective Cervical cancer screening uptake may be influenced by inadequate knowledge in resource-limited settings. This randomized trial evaluated a health talk’s impact on cervical cancer knowledge, attitudes, and screening rates in rural Kenya. Methods 419 women attending government clinics were randomized to an intervention (n=207) or control (n=212) group. The intervention was a brief health talk on cervical cancer. Participants completed surveys at enrollment (all), immediately after the talk (intervention arm), and at three-months follow-up (all). The primary outcomes were the change in knowledge scores and the final screening rates at three-months follow-up. Secondary outcomes were changes in awareness about cervical cancer screening, perception of personal cervical cancer risk, cervical cancer and HIV stigma, and screening acceptability. Results Knowledge Scores increased by 26.4% (8.7 to 11.0 points) in the intervention arm compared to only 17.6% (8.5 to 10.0 points) in the control arm (p<0.01). Screening uptake was moderate in both the intervention (58.9%; N=122) and control (60.9%; N=129) arms, with no difference between the groups (p=0.60). Conclusion A brief health talk increased cervical cancer knowledge, although it did not increase screening over simply informing women about free screening. Practice Implications Screening programs can increase patient understanding with just a brief educational intervention.

Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model

“…The systematic search returned 3704 unique entries, after duplicates were removed. Screening and application of eligibility criteria produced 19 studies for inclusion in the review [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Figure 2 shows the results of the study selection process.…”

“…Pap smear or cytology-based cervical screening was assessed most often (n = 6, 31.6%) [16,17,21,26,31,33]. A quarter of studies (n = 5, 26.3%) did not specify which screening test was being performed [20,22,24,29,32]. Multiple screening methods were used in some studies, such as those that compared uptake of HPV self-sampling to facility-based visual inspection screening methods [19,25,27,28].…”

“…One study created a screening score that accounted for presence of screening behavior, as well as when screening was last received and whether or not a woman was upto-date with screening recommendations [19]. Some studies used vague language to describe uptake of cervical screening, which made it impossible to clearly deduce the measure of screening [16,22,28,29,32]. At baseline, screening coverage ranged from 0 to 53.6%, with most studies reporting coverage of less than 10% (n = 12, 63.2%).…”

“…Following intervention, coverage ranged from 1.7 to 99.2%, with six studies reporting a significant improvement in screening that achieved ≥60% coverage (31.6%). More than a third of the studies reported non-significant increases in screening uptake associated with their intervention (n = 7, 36.8%); all of them were educational interventions [16,17,21,29,[31][32][33].…”

Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study

“…Despite simplified screening strategies, educational programs may increase duration of time spent at clinics when receiving services [19]. Research is needed on clinical care processes that minimize total time spent at the clinic for cervical cancer screening.…”