Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya

Abstract

Background. Cervical cancer is the second most commonly diagnosed cancer in females and is a leading cause of cancerrelated mortality in Kenya; limited cervical cancer screening services may be a factor. Few studies have examined men's and women's perceptions on environmental and psychosocial barriers and benefits related to screening. Materials and Methods. In 2014, 60 women aged 25-49 years and 40 male partners participated in 10 focus groups (6 female and 4 male), in both rural and urban settings (Nairobi and Nyanza, Kenya), to explore perceptions about barriers to and benefits of cervical cancer screening. Focus groups were segmented by sex, language, geographic location, and screening status. Data were transcribed, translated into English, and analyzed by using qualitative software. Results. Participants identified screening as beneficial for initiating provider discussions about cancer but did not report it as a

Perspectives of Screening-Eligible Women and Male Partners on Benefits of and Barriers to Treatment for Precancerous Lesions and Cervical Cancer in Kenya

“…Previous studies have reported concerns of marital discord occurring after a woman informs her husband that she has cervical cancer [9,11]. We uniquely found that male and female participants' concerns about the need to abstain from sexual intercourse while a woman is undergoing treatment, doctors not discussing the treatment process with husbands, and women's fear of marital discord can negatively impact their decision to seek treatment.…”

“…Several treatment barriers identified in this study are similar to barriers associated with cervical cancer screening, such as knowledge gaps, religious or cultural beliefs, spousal approval, stigma, and access to services [9]. Although the NCCPP Strategic Plan promotes see-and-treat approaches for precancerous lesions and treatment of diagnosed cervical cancer, the majority of screening clinics lack treatment services [4].…”

Lessons for Patient Engagement in Research in Low- and Middle-Income Countries

“…It is well known that several barriers exist to accessing healthcare services in LMICs, such as distance to nearest health facility, lack of resources, and complex bureaucratic referral systems [22]. These barriers are linked to poor health outcomes [22][23][24]. Therefore, if access to healthcare services for basic treatment is limited, and health outcomes remain poor as a result, the common notion is that it is unlikely and even unwise to focus efforts towards less ''urgent'' initiatives, like patient involvement in research.…”

“…In many settings, the diagnosis of an illness can lead to unpleasant effects on community life, such as social isolation and stigmatization [24,25,32]. Patients with cancer report experiencing social stigma, with consequences such as termination of employment, familial shame, and social rejection [23,31,33].…”

“…A multidisciplinary and multisectoral team, which cultivates cross talk on a leveled platform, could work to establish a collaborative space between patients and non-patients and help clarify roles. In designing a study on cervical cancer in Kenya, researchers obtained community support and trust by holding stakeholder meetings that served as an open forum to discuss study objectives and overall implementation of screening [24]. Overall, establishing well-defined roles for patient participation and providing a space for collaboration is critical to facilitating patient engagement in research.…”