Barriers to cervical cancer screening uptake among rural women in South West Nigeria: A qualitative study

Abstract

RESEARCHBackground. Diverse barriers influence cervical cancer screening uptake among rural women. The study explored barriers related to the uptake of cervical cancer screening among rural men and women in 14 communities of Ado-Odo Ota, Ogun State, Nigeria. Objective. To inform the development of a cervical cancer screening model for use by rural women. Methods. A qualitative exploratory research design was used. Qualitative information was collected from purposively sampled 28 individuals (13 rural men and 15 rural women) using focus group discussions and in-depth interviews. Data were analysed thematically. Results. Five categorical barrier themes were identified including hospital-related, economic, geographical, educational and psychosocial barriers. Conclusion. To address the identified barriers, the involvement of spouses and religious and cultural leaders in the planning and implementation of cervical cancer screening intervention is recommended. Cervical cancer screening services should be integrated into the services of primary healthcare centres. The government should consider providing subsidised or free screening programmes for rural women.

Factors influencing cervical cancer screening practice among female health workers in Nigeria: A systematic review

“…It becomes worrisome knowing that only 8.7% of all eligible women have been reached with opportunistic screening in Nigeria 26 . Such poor screening rate has been linked to a spectrum of factors; weak health system, poor awareness, low‐risk perception, sociocultural barriers, fear of positive result, poverty, and acceptability of available screening options 27–30 . Despite the emphasis on taking advantage of women's contact with the health system to provide CCS services, evidence indicates that such opportunities have been missed 28,31 …”

Qualitative factors influencing breast and cervical cancer screening in women: A scoping review

“…It is this normative perception of privilege or exclusiveness that causes men and women to feel uncomfortable with the perceived inappropriateness about interactions involving a woman’s sexual organs that are not specifically with her husband. In addition to the fear of being seen as promiscuous due to the nature of cervical cancer, women reported that these two cancers – and female health issues in general – were generally taboo topics that should not be discussed except in private ( Thomas et al, 2011 , Azaiza and Cohen, 2008 , Khan and Woolhead, 2015 , Khazir et al, 2019 , Bayrami et al, 2015 , Malhotra et al, 2016 , Lunsford et al, 2017 , Shaw et al, 2018 , Onyenwenyi and Mchunu, 2018 ).…”

“…Gender inequality was comprised of one second-level analytical theme in that men tended to have more power and receive more priority than women in their respective societies (Theme 2.1). Husbands were noted to be a key barrier (Theme 2.1.1) as women were often unable to decide to undergo breast or cervical screening by themselves and needed the approval of their husbands, who sometimes did not believe that screening was required ( Shirzadi et al, 2020 , Binka et al, 2019 , Onyenwenyi and Mchunu, 2018 , William et al, 2013 , Keshavarz et al, 2011 ). Even if husbands permitted their wives to attend screening, women reported that it was a requirement to be accompanied by them ( Baron-Epel et al, 2004 , Khazaee-pool et al, 2014 ).…”

“…The effect of breast and cervical cancer on marital relations (Theme 2.1.2) was also evident, as participants highlighted that a sick woman would be perceived as being unable to contribute in a marital relationship ( Baron-Epel et al, 2004 , Bahmani et al, 2016 ). Women were also fearful that this would then lead to abandonment and/or divorce by their husbands ( Safizadeh et al, 2018 , Shirzadi et al, 2020 , Baron-Epel et al, 2004 , Khan and Woolhead, 2015 , McMichael et al, 2000 , Khazaee-pool et al, 2014 , Ndejjo et al, 2017 , Gu et al, 2017 , Sabih et al, 2012 , Onyenwenyi and Mchunu, 2018 , Mutyaba et al, 2007 , Pelcastre-Villafuerte et al, 2007 , Ansink et al, 2008 ). Family was often seen as a barrier (Theme 2.1.3) as women’s health needs were de-prioritised compared to that of male relatives, and women needed the approval of their family members when deciding on healthcare matters in general ( Hassani et al, 2017 , Darj et al, 2019 ).…”

“…understanding the aims and benefits of cancer screening) and general education (i.e. fewer opportunities to learn and/or acquire information) context ( Macdonald et al, 2015 , Yang et al, 2019 , Ngugi et al, 2012 , Markovic et al, 2005 , Daley et al, 2012 , Filippi et al, 2013 , Nolan et al, 2014 , Ndejjo et al, 2017 , Kahn et al, 2006 , Binka et al, 2019 , Onyenwenyi and Mchunu, 2018 , Brandt et al, 2019 , Teng et al, 2014 , Oscarsson et al, 2008 ). Women were also more likely to need financial support (Theme 3.2) and be financially dependent on spouses or their families ( Shirzadi et al, 2020 , Ngugi et al, 2012 , Filippi et al, 2013 , Tessaro et al, 1994 , Ndejjo et al, 2017 , Binka et al, 2019 , Shaw et al, 2018 , Mutyaba et al, 2007 , Pelcastre-Villafuerte et al, 2007 , Darj et al, 2019 , Urrutia et al, 2017 , Yang et al, 2019 , Trigoni et al, 2008 , Dey et al, 2016 , Savabi-Esfahani et al, 2018 , Khazaee-pool et al, 2014 , Khazir et al, 2019 , Granado et al, 2014 , Bahmani et al, 2016 , Malhotra et al, 2016 , Gu et al, 2017 , Andrasik et al, 2008 , Ersin and Bahar, 2011 , Lovell et al, 2007 , Holroyd et al, 2004 ).…”