Influence of Spirituality and Modesty on Acceptance of Self-Sampling for Cervical Cancer Screening

Abstract

IntroductionWhereas systematic screening programs have reduced the incidence of cervical cancer in developed countries, the incidence remains high in developing countries. Among several barriers to uptake of cervical cancer screening, the roles of religious and cultural factors such as modesty have been poorly studied. Knowledge about these factors is important because of the potential to overcome them using strategies such as self-collection of cervico-vaginal samples. In this study we evaluate the influence of spirituality and modesty on the acceptance of self-sampling for cervical cancer screening.MethodologyWe enrolled 600 participants in Nigeria between August and October 2014 and collected information on spirituality and modesty using two scales. We used principal component analysis to extract scores for spirituality and modesty and logistic regression models to evaluate the association between spirituality, modesty and preference for self-sampling. All analyses were performed using STATA 12 (Stata Corporation, College Station, Texas, USA).ResultsSome 581 (97%) women had complete data for analysis. Most (69%) were married, 50% were Christian and 44% were from the south western part of Nigeria. Overall, 19% (110/581) of the women preferred self-sampling to being sampled by a health care provider. Adjusting for age and socioeconomic status, spirituality, religious affiliation and geographic location were significantly associated with preference for self-sampling, while modesty was not significantly associated. The multivariable OR (95% CI, p-value) for association with self-sampling were 0.88 (0.78–0.99, 0.03) for spirituality, 1.69 (1.09–2.64, 0.02) for religious affiliation and 0.96 (0.86–1.08, 0.51) for modesty.ConclusionOur results show the importance of taking cultural and religious beliefs and practices into consideration in planning health interventions like cervical cancer screening. To succeed, public health interventions and the education to promote it must be related to the target population and its preferences.

The acceptability of self-sampled screening for HPV DNA: a systematic review and meta-analysis

“…However, self-sampling has the potential to further reduce screening costs, as it eliminates the need for an initial clinical encounter in the screening process 30. Self-sampling may also increase access to screening for women who currently do not access cervical cancer prevention services 31 32. For example, approximately 25% of women in the USA have not had a Pap test within the last three years 33.…”

HPV self‐sampling acceptability and preferences among women living with HIV in Botswana

“…Self‐swab preference was correlated with higher education just as it was in our sample; however, knowledge of cervical cancer and awareness of HPV did not affect preferences in our sample like it did in Cameroon. Conversely, in Nigeria, where 19% preferred self‐sampling, higher socioeconomic status and increased spirituality were associated with lower odds of self‐sampling preference, though women were asked about screening hypothetically . In a study of Ghanaian women who experienced both screening approaches, more than half (58%) preferred self‐sampling over provider screening and 62% felt it would increase the likelihood of them screening at all …”

“…Conversely, in Nigeria, where 19% preferred self-sampling, higher socioeconomic status and increased spirituality were associated with lower odds of self-sampling preference, though women were asked about screening hypothetically. 15 In a study of Ghanaian women who experienced both screening approaches, more than half (58%) preferred self-sampling over provider screening and 62% felt it would increase the likelihood of them screening at all. 16 Similar to our findings, important themes of embarrassment, lack of privacy at home, handling the swab, and novelty of the self-swab have been linked to unwillingness to self-sample.…”

Rural community’s perspectives on cervical cancer screening: Report of a consensus-planning workshop

“…Cervical screening, including self-sampling, is feasible and acceptable, but a wider acceptability depends on educational efforts related to the target population, while taking cultural and religious beliefs and practices into consideration [17] . We need to develop appropriate health education methods to motivate women in order to increase screening coverage [18] .…”