“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

Abstract

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 was 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.

Factors Influencing the Experience of Breast and Cervical Cancer Screening Among Women in Low- and Middle-Income Countries: A Systematic Review

“… 29 In Ecuador and Malawi, there was not an outright preference for female professionals, with some women preferring male professionals because they were reported to be more sympathetic to their needs. 35 , 41 Age-related patterns were reported too, with older women in Malawi preferring to have female providers while younger women did not have a strong preference for male providers or female providers. 35 …”

“… 35 , 41 Age-related patterns were reported too, with older women in Malawi preferring to have female providers while younger women did not have a strong preference for male providers or female providers. 35 …”

“…In Malawi, there were reports of women being turned away from cervical screening appointments because of a shortage of required equipment. 35 In South Africa, participants who accessed cervical screening complained of prolonged waiting times and prejudiced health staff which negatively affected their experience, while others who had breast screening had an overall positive experience. 38 Turkish women reported positive experiences of cervical cancer screening, reporting the use of hygienic equipment and timely and fast care received.…”

“…In Malawi and South Africa, women who had positive experiences during the screening program had intentions to reengage with screening procedures in the future. 35 Women with predisposing factors for cervical cancer, such as being sexually active or having a positive HIV status, also mentioned the intention to engage with screening in the future. 35 Women with positive experiences also mentioned the likelihood that they will inform other women in their community.…”

“… 35 Women with predisposing factors for cervical cancer, such as being sexually active or having a positive HIV status, also mentioned the intention to engage with screening in the future. 35 Women with positive experiences also mentioned the likelihood that they will inform other women in their community. 30 , 39 …”