A Qualitative Analysis of Factors Contributing to Cervical Cancer Screening Implementation in Health Care Facilities in Uganda

Abstract

IntroductionCervical cancer prevalence and incidence are high in sub-Saharan Africa, especially in Uganda, where screening rates are low, despite government policy recommending screening for all women aged 25-49 every three years. Most prior research focuses on client-related barriers to screening, including women's fears about the screening procedure, lack of partner support, and community-level stigma. Fewer studies elaborate on inner context factors related to health care systems, facilities, and providers. The aim of this study was to use qualitative methods to explore inner context factors that may affect cervical cancer screening in Uganda.MethodsWe recruited 20 health care facility administrators, 6 providers of cervical cancer screening, 2 district health officers, 2 division medical officers, and one government health official for key informant interviews, and 69 women (31 screened and 38 not screened for cervical cancer) for focus group discussions. Participants were recruited from four health care facilities that varied by urbanicity and funding source: one urban public facility, one urban private non-profit facility, one rural public facility, and one rural private non-profit facility.ResultsInner context themes emerged around infrastructure needs (insufficient space, equipment, and supplies) and staffing issues (inadequate staff quantity and training), which contributed to lower quality of care (e.g., long wait-times; painful, rushed exams). Women described privacy concerns as well as discomfort with male and young providers. Women with HIV were prioritized for screening based on funding streams and inability to serve all women given infrastructure and staffing issues. Despite barriers, many stakeholders were committed to providing cervical cancer screening services, and many women saw the value of screening.ConclusionThis study identified inner context barriers related to resource shortfalls, which affected quality of care. Low cost solutions are needed to improve health care readiness and increase reach of cervical cancer screening in Uganda.