Title

Perceived barriers among pregnant women towards cervical cancer screening

Date of Award

2014

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

Department

Family Medicine (East Africa)

Abstract

Background: Cervical cancer remains the most common cancer in women in Eastern Africa in general and Tanzania in particular. However, to a large extent cervical cancer is preventable by effective screening programmes as has been demonstrated in many developed countries. Developing countries lack formal national screening programmes. Screening is usually mainly done opportunistically.

Objective: To assess the perceived barriers to uptake of cervical cancer screening among pregnant women attending antenatal clinics in two hospitals in Dar es Salaam.

Methodology: This was a qualitative study, conducted at two hospitals in Dar es salaam, a government facility (Amana District Hospital) and a private facility (Aga Khan Hospital Dar-es-Salaam).14 Face-to-face in-depth interviews were conducted among 12 pregnant women aged 21 years and above attending antenatal clinics (ANC) at the two hospitals. Participants were selected through a combination of purposeful and convenient sampling. A brief screening questionnaire to identify participants with some knowledge of cervical cancer was used to select subjects for the in-depth interviews. The theoretical frame of reference was the Health Belief Model (HBM). The questionnaires were formed on the basis of the HBM. This provided a frame for the questions and will to some extent have guided the analysis and interpretation of the responses to the questionnaires and the interview data. The interview data were however categorised as described in the phenomenological method of analysis, giving themes that were not directed by the HBM. The analysis was therefore mainly data driven. The study examined the various community, institutional, and individual factors that are perceived to impede cervical cancer screening among an at-risk population in Dar-Es-salaam.

Results: The thematic analysis of the interviews gave insight into the women's understanding of cervix cancer and screening for this cancer in relation to their health, their private lives and in the encounters with the health care system. This was described in five themes that emerged: Women’s poor knowledge about cervical cancer and its screening, Difficulty discusing matters of reproductive health, Perception of low personal Risk, Negative Perception Around The disease -death Sentence, Deficiencies of the Healthcare Providers/System.

Conclusion: Low level of awareness and misconceptions about cervical cancer and its screening are important perceived barriers coupled with structural barriers like crowding and unreliable services in the hospitals. These could be addressed by increasing awareness and improving knowledge by incorprating this education in ANC classes. Increasing number of healthcare workers, improving patient flow systems in the hospitals and having special designate clinics for screening can help overcome the structural barriers.

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