'I'm here to save my life': a qualitative study of experiences navigating a cryotherapy referral system for human papillomavirus-positive women in western Kenya

Megan Huchko, Konyin Adewumi, Sandra Oketch, Ibrahim Saduma, Elizabeth Bukusi, Megan Huchko, Konyin Adewumi, Sandra Oketch, Ibrahim Saduma, Elizabeth Bukusi

Abstract

Background: We sought to understand the beliefs, social norms and logistical factors that affect human papillomavirus (HPV)-positive women's uptake of cryotherapy treatment as part of a two-part cervical cancer screening strategy in rural Kenya.

Methods: In-depth interviews within a parent cluster-randomised trial.

Setting: Government-run county hospital in western Kenya.

Participants: 273 of 372 (73.4%) HPV-positive women who underwent cryotherapy RESULTS: Many women feared that an HPV infection meant they would develop cancer. Almost all women reported initial fear of the treatment procedure, followed by a more positive experience than anticipated. Lacking funds for transportation to the treatment site was the most common barrier. Women felt that decentralised treatment would be the most important facilitator of greater access. Spousal encouragement and financial support were key facilitators of treatment access, however many women felt that other husbands in the community would not be supportive. Women described successfully acquiring treatment as empowering, and almost all would recommend seeking cryotherapy to other women who test HPV-positive. Most felt eager to share their own experiences with others to encourage treatment.

Conclusions: The main facilitators of treatment access were understanding of the health risks and sense of empowerment. A decentralised treatment model or transportation support may facilitate access, along with improved health messaging about HPV infection, cancer and the treatment process. Focusing on women's personal feelings of empowerment may further improve uptake and satisfaction. These data will be used to design a strategy to improve linkage to treatment.

Trial registration: NCT02124252.

Keywords: cervical cancer; community gynaecology; organisational development; qualitative research.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Bray F, Ferlay J, Soerjomataram I, et al. . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394–424. 10.3322/caac.21492
    1. Kenya national Bureau of statistics (KNBS) and ICF macro: Kenya demographic and health survey 2008-09. Calverton, Maryland: KNBS and ICF Macro; 2010.
    1. Paul P, Winkler JL, Bartolini RM, et al. . Screen-and-treat approach to cervical cancer prevention using visual inspection with acetic acid and cryotherapy: experiences, perceptions, and beliefs from demonstration projects in Peru, Uganda, and Vietnam. Oncologist 2013;18 Suppl:6–12. 10.1634/theoncologist.18-S2-6
    1. Msyamboza KP, Phiri T, Sichali W, et al. . Cervical cancer screening uptake and challenges in Malawi from 2011 to 2015: retrospective cohort study. BMC Public Health 2016;16:806 10.1186/s12889-016-3530-y
    1. Sankaranarayanan R, Nene BM, Shastri SS, et al. . HPV screening for cervical cancer in rural India. N Engl J Med 2009;360:1385–94. 10.1056/NEJMoa0808516
    1. Denny L, Kuhn L, Hu C-C, et al. . Human papillomavirus-based cervical cancer prevention: long-term results of a randomized screening trial. J Natl Cancer Inst 2010;102:1557–67. 10.1093/jnci/djq342
    1. World Health Organization Comprehensive cervical cancer prevention and control: a healthier future for girls and women. Geneva: WHO Guidance Note; 2013.
    1. Rosser JI, Hamisi S, Njoroge B, et al. . Barriers to cervical cancer screening in rural Kenya: perspectives from a provider survey. J Community Health 2015;40:756–61. 10.1007/s10900-015-9996-1
    1. Rosser JI, Njoroge B, Huchko MJ. Changing knowledge, attitudes, and behaviors regarding cervical cancer screening: the effects of an educational intervention in rural Kenya. Patient Educ Couns 2015;98:884–9. 10.1016/j.pec.2015.03.017
    1. Were E, Nyaberi Z, Buziba N. Integrating cervical cancer and genital tract infection screening into mother, child health and family planning clinics in Eldoret, Kenya. Afr Health Sci 2010;10:58–65.
    1. Huchko MJ, Bukusi EA, Cohen CR. Building capacity for cervical cancer screening in outpatient HIV clinics in the Nyanza Province of Western Kenya. Int J Gynaecol Obstet 2011;114:106–10. 10.1016/j.ijgo.2011.02.009
    1. Huchko MJ, Ibrahim S, Blat C, et al. . Cervical cancer screening through human papillomavirus testing in community health campaigns versus health facilities in rural Western Kenya. Int J Gynaecol Obstet 2018;141:63–9. 10.1002/ijgo.12415
    1. Damschroder LJ, Aron DC, Keith RE, et al. . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4 10.1186/1748-5908-4-50
    1. Huchko MJ, Kahn JG, Smith JS, et al. . Study protocol for a cluster-randomized trial to compare human papillomavirus based cervical cancer screening in community-health campaigns versus health facilities in Western Kenya. BMC Cancer 2017;17:826 10.1186/s12885-017-3818-z
    1. Oketch SY, Kwena Z, Choi Y, et al. . Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural Western Kenya: a qualitative study. BMC Womens Health 2019;19:75 10.1186/s12905-019-0778-2
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101. 10.1191/1478088706qp063oa
    1. Holme F, Kapambwe S, Nessa A, et al. . Scaling up proven innovative cervical cancer screening strategies: challenges and opportunities in implementation at the population level in low- and lower-middle-income countries. Int J Gynecol Obstet 2017;138(Suppl 1):63–8. 10.1002/ijgo.12185
    1. Campos NG, Sharma M, Clark A, et al. . The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries. Int J Gynecol Obstet 2017;138(Suppl 1):47–56. 10.1002/ijgo.12184
    1. Johnson LG, Armstrong A, Joyce CM, et al. . Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review. Implementation Sci 2018;13 10.1186/s13012-018-0718-9
    1. Mbachu C, Dim C, Ezeoke U. Effects of peer health education on perception and practice of screening for cervical cancer among urban residential women in south-east Nigeria: a before and after study. BMC Womens Health 2017;17:41 10.1186/s12905-017-0399-6
    1. Shakya S, Karmacharya BM, Afset JE, et al. . Community-Based health education has positive influence on the attitude to cervical cancer screening among women in rural Nepal. J Canc Educ 2016;31:547–53. 10.1007/s13187-015-0863-7

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