BACKGROUND Cervical cancer is the leading cause of cancer mortality in Rwandan women. There is a limited understanding of the barriers that women face to obtain cervical cancer screening in Rwanda. It is important to understand the barriers in order to implement effective screening programs. The goal of this study is to describe the barriers to cervical cancer screening among women in Rwanda and how they differ among women in rural and urban areas. METHODS This cross-sectional study recruited women from June 1 to 9, 2022 at Muhima and Nyamata District Hospitals in Rwanda. Women were eligible for the study if they were ≥ of 18 years and spoke Kinyarwanda or English. Women completed a 15-minute survey which included questions on the participants demographics, knowledge of cervical cancer, cervical cancer screening history, and barriers to healthcare. Women were stratified by survey location (urban vs rural). Descriptive statistics were reported. RESULTS A total of 374 women completed the survey with 169 participants from Muhima and 205 from Nyamata. Most women were in a relationship and had a primary school or less education. The most common barriers to accessing general healthcare services was long wait times at the facility, (Muhima 26%; Nyamata 30%), low quality of care, (Muhima 15%; Nyamata 12%) and transportation costs (Muhima 13%; Nyamata 9.3%). However, women from Nyamata were significantly more likely to report distance to the health center as a barrier (p-value <0.001) and women from Muhima were significantly more likely to report transportation method as a barrier (p-value =0.004). The primary reason reported for not obtaining cervical cancer screening was that women did not know how or where to get tested (Muhima 57%; Nyamata 51%). CONCLUSION The most common barriers to cervical cancer screening in Rwanda were the quality of clinical care and issues with traveling to the clinic. Implementing a cervical cancer self-collection program could help eliminate many barriers that women face to obtain health services in Rwanda. More research is needed to better understand the acceptability of cervical cancer screening in Rwanda and how it could be integrated into the healthcare system.
PURPOSE Cervical cancer is a leading cause of cancer among women in low- and middle-income countries. Women in Rwanda have high rates of cervical cancer due to limited access to effective screening methods. Research in other low-resource settings similar to Rwanda has shown that HPV-based self-collection is an effective cervical cancer screening method. This study aims to compare the preferences of Rwandan women in urban and rural settings toward self-collection and to report on factors related to self-collection amenability. METHODS A cross-sectional survey was conducted from June 1-9, 2022. Women were recruited from one urban and one rural clinic in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. The survey consisted of 51 questions investigating demographics and attitudes towards self-collection for cervical cancer screening. We reported descriptive statistics stratified by urban and rural sites. RESULTS In total, 169 urban and 205 rural women completed the survey. The majority of respondents at both sites had a primary school or lower education and were in a relationship. Both urban and rural respondents were open to self-collection; however, rates were higher in the rural site (79.9% urban and 95.6% rural; p-value<0.001). Similarly, women in rural areas were more likely to report feeling unembarrassed about self-collection (65.3% of urban, 76.8% of rural; p-value<0.001). Notably, almost all urban and rural respondents (97.6% urban and 98.5% rural) stated they would go for a cervical cancer pelvic examination to a nearby health center if their self-collected results indicated any concern (p-value=0.731). CONCLUSION Rwandan women in both urban and rural areas largely support self-collection for cervical cancer screening. Further research is needed to better understand how to implement self-collection screening services in Rwanda.
Purpose: Cervical cancer is a leading cause of cancer death among women in low- and middle-income countries. Women in Rwanda have high rates of cervical cancer due to limited access to effective screening methods. Research in low-resource settings similar to Rwanda has shown that self-collection for cervical cancer screening is an effective method. This study aimed to compare the preferences of Rwandan women in urban and rural settings toward self-collection and to report on factors related to self-collection amenability. Methods: A cross-sectional survey was conducted from June 1-9, 2022. Women were recruited from an urban and rural clinic in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. The survey consisted of 51 questions investigating demographics and attitudes towards self-collection for cervical cancer screening. All results were stratified by clinic site. We performed descriptive statistics stratified by urban and rural sites. Results: In total, 374 Rwandan women completed the survey (urban n=169 and rural n=205). The mean age was 33.09 years for urban and 32.89 years for rural respondents. The majority of respondents at both sites had a primary school or less education and were in a relationship. Both urban and rural respondents were open to self-collection; however, rates were higher in the rural site (79.9% urban and 95.6% rural; p-value<0.001). Similarly, women in rural areas were more likely to report feeling unembarrassed about self-collection (65.3% of urban, 76.8% of rural; p-value<0.001). Both urban (87.6%) and rural (90.2%) respondents were similarly unafraid of social stigma around cervical cancer. Notably, almost all urban and rural respondents (97.6% urban and 98.5% rural) stated they would go for a cervical cancer pelvic examination to a nearby health center if their self-collected results indicated any concern (p-value=0.731). Conclusion: Rwandan women in both urban and rural areas largely support the implementation and integration of self-collection for cervical cancer screening. Further research is needed to better understand how to implement self-collection screening services. Expanding self-collection for cervical cancer screening in Rwanda will contribute the global elimination of cervical cancer. Citation Format: Varun Nair, Hallie Dau, Marianne Vidler, Maryam AboMoslim, Barbra Mutamba, Zoey Nesbitt, Nadia Mithani, Laurie Smith, Stephen Rulisa, Gina Ogilvie. Understanding the Self-Collection Preferences of Women Living in Rwanda [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 90.
Background Cervical cancer is the leading cause of cancer mortality in Rwandan women. There is a limited understanding of the barriers that women face to obtain cervical cancer screening in Rwanda. It is important to understand the barriers in order to implement effective screening programs. The goal of this study is to describe the barriers to cervical cancer screening among women in Rwanda and how they differ among women in rural and urban areas. Methods This cross-sectional study recruited women from June 1 to 9, 2022, at Muhima and Nyamata District Hospitals in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. Women completed a 15-min survey which included questions on the participants’ demographics, knowledge of cervical cancer, cervical cancer screening history, and barriers to healthcare. Women were stratified by survey location (urban vs rural). Descriptive statistics were reported. Results A total of 374 women completed the survey with 169 participants from Muhima and 205 from Nyamata. Most women were in a relationship and had a primary school or less education. The most common barriers to accessing general healthcare services were long wait times at the facility (Muhima 26%; Nyamata 30%), low quality of care (Muhima 15%; Nyamata 12%), and transportation costs (Muhima 13%; Nyamata 9.3%). However, women from Nyamata were significantly more likely to report distance to the health center as a barrier (p-value < 0.001), and women from Muhima were significantly more likely to report transportation method as a barrier (p-value = 0.004). The primary reason reported for not obtaining cervical cancer screening was that women did not know how or where to get tested (Muhima 57%; Nyamata 51%). Conclusions The most common barriers to cervical cancer screening in Rwanda were the quality of clinical care and issues with traveling to the clinic. Implementing a cervical cancer self-collection program could help eliminate many barriers that women face to obtain health services in Rwanda. More research is needed to better understand the acceptability of cervical cancer screening in Rwanda and how it could be integrated into the healthcare system.
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