Effectiveness of family-centred sexual health education and HPV self-sampling in promoting cervical cancer screening among hard-to-reach indian women in rural and tribal areas: a community-based pilot study

Abstract

Background While cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman–centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India. Methods Our community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30–69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants’ uptake of cervical cancer screening was assessed after attendance in SHE. Findings Results revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS. Conclusions The implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs.

Surviving the Storm: The Impact of COVID-19 on Cervical Cancer Screening in Low- and Middle-Income Countries

“…For instance, our study observed advancements in participants' knowledge and attitudes about cervical cancer and screening, coupled with a reduction in STI stigma following their engagement in SHE sessions (overall mean difference in knowledge: z = 6.1 ± 2.4, p < 0.001; attitudes towards the Pap test: z = 2.2 ± 8.4, p < 0.001; STI stigma: z = 2.8 ± 12.4, p < 0.001). Among the 120 women enrolled in our study, 115 chose HPV-SS as the primary screening test, while 2 opted for Pap and 1 chose VIA testing, demonstrating an increase in screening participation [7].…”

“…While cervical cancer is highly preventable through early detection and treatment, LMICs struggle to adopt preventive measures due to limited healthcare infrastructure, sociocultural factors (modesty, male dominance in making decisions about family matters, etc. ), social stigma surrounding sexually transmitted infections, limited knowledge about cervical cancer and screening, and a lack of female healthcare providers [4][5][6][7]. As a result, screening coverage in LMICs is only 19%, compared to 63% in high-income countries [8].…”

Co-creation of human papillomavirus self-sampling delivery strategies for cervical cancer screening in rural Zimbabwe: nominal group technique

“…Therefore the role of education in overcoming many of the barriers at the individual level cannot be ignored. Delivery of education through peer educators has also been shown to increase the acceptability and uptake of cervical cancer screening ( 40 , 41 ). According to findings from a systematic review by Makadzange et al the use of peer educators and culturally sensitive and tailored material significantly impacted the delivery of educational messages for cervical cancer prevention to the target population in Africa ( 40 ).…”

“…According to findings from a systematic review by Makadzange et al the use of peer educators and culturally sensitive and tailored material significantly impacted the delivery of educational messages for cervical cancer prevention to the target population in Africa ( 40 ). Similarly, a study conducted in India also supports using culturally appropriate educational material and interventions to reach communities and promote the uptake of cervical cancer screening especially among rural communities where the lack of education is the major hurdle to increased screening uptake among women ( 41 ).…”