Barriers to follow-up after an abnormal cervical cancer screening result and the role of male partners: a qualitative study
Open Access
- 14 September 2021
- Vol. 11 (9), e049901
- https://doi.org/10.1136/bmjopen-2021-049901
Abstract
Introduction Cervical cancer is the leading cause of cancer deaths among women in Malawi, but preventable through screening. Malawi primarily uses visual inspection with acetic acid (VIA) for screening, however, a follow-up for positive screening results remains a major barrier, in rural areas. We interviewed women who underwent a community-based screen-and-treat campaign that offered same-day treatment with thermocoagulation, a heat-based ablative procedure for VIA-positive lesions, to understand the barriers in accessing post-treatment follow-up and the role of male partners in contributing to, or overcoming these barriers. Methods We conducted in-depths interviews with 17 women recruited in a pilot study that evaluated the safety and acceptability of community-based screen-and-treat programme using VIA and thermocoagulation for cervical cancer prevention in rural Lilongwe, Malawi. Ten of the women interviewed presented for post-treatment follow-up at the healthcare facility and seven did not. The interviews were analysed for thematic content surrounding barriers for attending for follow-up and role of male partners in screening. Results Transportation was identified as a major barrier to post-thermocoagulation follow-up appointment, given long distances to the healthcare facility. Male partners were perceived as both a barrier for some, that is, not supportive of 6-week post-thermocoagulation abstinence recommendation, and as an important source of support for others, that is, encouraging follow-up attendance, providing emotional support to maintaining post-treatment abstinence and as a resource in overcoming transportation barriers. Regardless, the majority of women desired more male partner involvement in cervical cancer screening. Conclusion Despite access to same-day treatment, long travel distances to health facilities for post-treatment follow-up visits remained a major barrier for women in rural Lilongwe. Male partners were identified both as a barrier to, and an important source of support for accessing and completing the screen-and-treat programme. To successfully eliminate cervical cancer in Malawi, it is imperative to understand the day-to-day barriers women face in accessing preventative care.Keywords
Funding Information
- National Institute of Health (R25TW009340, U54CA190152)
This publication has 18 references indexed in Scilit:
- Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga province, South AfricaGlobal Health Action, 2017
- Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural MalawiInternational Journal of Cancer, 2016
- An Insight Into Cervical Cancer Screening and Treatment Capacity in Sub Saharan AfricaJournal of Lower Genital Tract Disease, 2016
- Immunodeficiency and the risk of cervical intraepithelial neoplasia 2/3 and cervical cancer: A nested case‐control study in the Swiss HIV cohort studyInternational Journal of Cancer, 2015
- Exploring barriers to the delivery of cervical cancer screening and early treatment services in Malawi: some views from service providersPatient Preference and Adherence, 2015
- Geospatial analysis of condom availability and accessibility in urban MalawiInternational Journal of STD & AIDS, 2015
- Factors Shaping Initial Decision-Making to Self-test Amongst Cohabiting Couples in Urban Blantyre, MalawiAIDS and Behavior, 2014
- Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in UgandaBMJ Open, 2014
- Meta‐analysis of the efficacy of cold coagulation as a treatment method for cervical intraepithelial neoplasia: a systematic reviewBJOG: An International Journal of Obstetrics and Gynaecology, 2014
- Meta‐analysis of the effectiveness of cryotherapy in the treatment of cervical intraepithelial neoplasiaInternational Journal of Gynecology & Obstetrics, 2012