Open Access“When You Have Gotten Help, That Means You Were Strong”: A Qualitative Study of Experiences in a “Screen and Treat” Program for Cervical Cancer Prevention in Malawi
Author(s) -
Corrina Moucheraud,
Paul Kawale,
Savel Kafwafwa,
Roshan Bastani,
Risa M. Hoffman
Publication year - 2020
Publication title -
journal of cancer education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.579
H-Index - 43
eISSN - 1543-0154
pISSN - 0885-8195
DOI - 10.1007/s13187-020-01828-9
Subject(s) - medicine , cervical cancer , family medicine , cervical screening , cervical cancer screening , nursing , qualitative research , public health , cancer screening , health care , cancer , economic growth , social science , sociology , economics
Disproportionate cervical cancer burden falls on women in low-income countries, and there are new efforts to scale up prevention worldwide, including via "screen and treat" for detection and removal of abnormal cervical lesions. This study examines Malawian women's experiences with "screen and treat"; this is an under-explored topic in the literature, which has focused largely on knowledge about and attitudes toward screening, but not on experiences with screening. We interviewed 47 women who have been screened at least once for cervical cancer. The interview guide and analysis approach were informed by the Multi-Level Health Outcomes Framework. Women were recruited at facilities that offer "screen and treat" and asked about their experiences with screening. The average age of respondents was 40 years, and approximately half were HIV-negative. Although women were knowledgeable about the benefits of screening, they articulated many barriers including being turned away because of stock-outs of equipment, far distances to services, discomfort with male providers, and poor communication with providers. Alongside the many health education campaigns to increase awareness and demand for "screen and treat" services, the global public health community must also address implementation barriers in the resource-constrained health systems where burden is greatest. Particular attention should be paid to quality and person-centeredness of "screen and treat" services to optimize uptake and engagement in care.