A Qualitative Exploration of Women’s Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya

Abstract

Detection and treatment of human papillomavirus (HPV) and cervical precancer through screening programs is an effective way to reduce cervical cancer deaths. However, high cervical cancer mortality persists in low-and middle-income countries. As screening programs become more widely available, it is essential to understand how knowledge about cervical cancer and perceived disease risk impact screening uptake and acceptability. We evaluated women's experiences with a cervical cancer education strategy led by community health volunteers (CHVs) in Migori County, Kenya, as part of a cluster randomized controlled trial of cervical cancer screening implementation strategies. The educational modules employed simple language and images, and sought to increase understanding of the relationship between HPV and cervical cancer, the mechanisms of selfcollected HPV testing and the importance of cervical cancer screening. Modules took place in three different contexts throughout the study: (1) during community mobilization; (2) prior to screening in either community health campaigns or health facilities; and (3) prior to treatment. Between January and September 2016, we conducted in-depth interviews with 525 participants to assess their experience with various aspects of the screening program. After the context-specific educational modules, women reported increased awareness of cervical cancer screening and willingness to screen, described HPV-and cervical cancer-related stigma and emphasized the use of educational modules to reduce stigma. Some misconceptions about cervical cancer were evident. With effective and context-specific training, lay health workers, such as CHVs, can help bridge the gap between cervical cancer screening uptake and acceptability.

Community Stakeholders’ Perspectives on Introducing Human Papillomavirus Vaccination and Biobanking Evidence-Based Programs Within Medically Underserved Communities: A Community-Engaged Approach

“…20 Previous studies that trained community volunteers and public health professionals to deliver educational interventions in community settings highlight the positive effects on community members’ knowledge levels and HPV vaccination acceptance. 21–23 Findings from this study add to the literature by identifying further knowledge gaps and misconceptions within underserved communities and among program coordinators tasked with disseminating health information. Findings also support further training to address such knowledge gaps since increasing awareness and knowledge of the benefits of new medical approaches among community stakeholders can increase community buy-in and support for EBP.…”

Barriers and Facilitators to Integrating Clinical Breast Examinations With Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya

“…Providers called for the utilization of community health volunteers, who have been shown to increase patient awareness and willingness to participate in cancer screening in Kenya. 27 In addition, providers raised the need for clear referral pathways and financial support. Although Kenya is on a path to adopting universal health coverage via the National Hospital Insurance Fund, which substantially covers a portion of cost in government hospitals, there is a need for more enrollment 7 and more robust coverage of cancer screening, diagnostics, and treatment costs.…”

Comparison of the costs of HPV testing through community health campaigns versus home-based testing in rural Western Kenya: a microcosting study

“…Follow-up test was recommended in a year or 3 years for HIV-positive and HPV-negative women, respectively, to see if the infection had cleared or to check for signs of cervical cancer. 20 …”