Perceived barriers and facilitators to conventional cervical screening: a qualitative study among women, primary health workers and community representatives in Uganda.

introductionCervical cancer (CC) is the most common cancer among women in Uganda, with many being diagnosed when the disease is in an advanced stage. Visual Inspection with Acetic acid (VIA) remains the most readily available CC screening method in most health facilities in Uganda, but with low screening coverage. This study aimed to understand the barriers and facilitators to CC screening in Uganda.

methodsA qualitative study was conducted between March 2022 and March 2023 in Mukono, and Wakiso. Through Focus Group Discussions (FGDs) data was collected on perceived barriers and facilitators to CC screening among women aged 25-65 years, primary health care workers (PHC), and community representatives (local authorities and members of civil society organisations). Sixteen FGDs were conducted with 8-12 participants per group. Four FGDs with women (57 participants), four with community representatives (35participants) and four FGDs with PHC workers (32participants). Thematic analysis was performed using deductive and inductive coding guided by the social ecological model.

resultsPerceived barriers and facilitators to CC screening emerged at multiple levels. At the individual level, women identified limited knowledge about CC screening as a major barrier, alongside several forms of fears, including fear of exposing private parts, fear of positive screening results, and concerns regarding the potential costs of treatment. At the interpersonal level, inadequate support from partners, peers, and family hindered CC screening uptake. Institutional barriers included negative attitude of health worker, prolonged waiting times, and long distances to health facilities. At the community level, stigma such as being labeled adulterous for seeking CC screening services discouraged participation. Conversely, facilitators of CC screening included awareness of the benefits of screening and experience sharing at the individual level, community sensitization and decentralization of services at the community level; and availability of accessible treatment services at the institutional level.

conclusionDespite free, publicly available CC screening services in Uganda, women continue to encounter numerous barriers that influence both access to and utilization of these services. Enhanced community sensitization is essential to improve awareness of the importance of early CC screening. Additionally, there is a critical need to ensure that subsequent care and treatment services are more financially accessible to all women. CLINICAL TRIAL NUMBER: Not applicable.