Table 3 Profile of included studies showing key findings
From: Barriers to cervical cancer screening in Africa: a systematic review
Author, year, country | Title | Research method and data collection | Sampling technique Sample size | Major barriers identified |
|---|---|---|---|---|
Ndikom CM & Ofi BA., 2012, Nigeria [18] | Awareness, perception and factors affecting utilization of cervical cancer screening services in Ibadan, Nigeria: A qualitative study | Research method: Qualitative Data collection: Focus Group Discussions (FGDs) | Purposive 8 FGDs (n = 82) | Lack of awareness of cervical cancer and facilities for screening Low risk perception Illiteracy (belief that services are for rich people) Financial constraints Fear of having a positive result Attitude of indifference to their health Having many contending issues (too busy) Screening services not easily accessible Poor information dissemination by health workers |
Mookeng, M J et al., 2010, South Africa [19] | Barriers to cervical cancer screening within private medical practitioners in Soshanguve, South Africa | Research method: Qualitative Data collection: Interviews Field notes | Purposive n = 6 | Age of medical practitioner vs. age of woman Gender of medical practitioner Few opportunities for medical practitioners to conduct screening tests Failure of medical practitioners to inform patients Financial constraints for patients who pay cash |
Munthali, A C et al., 2015, Malawi [20] | Exploring barriers to the delivery of cervical cancer screening and early treatment services in Malawi: Some views from service providers | Research method: Qualitative Data collection: In-depth interviews | Not indicated n = 53 | Lack of knowledge about cervical cancer among the general population Long distances to health facilities Services not offered on a daily basis Lack of spousal involvement Misconceptions about cervical cancer Gross shortage of staff Lack of equipment and supplies Lack of supportive supervision Gender and age of service providers |
Oketch, S Y et al., 2019, Kenya [21] | Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study | Research method: Qualitative Data collection: In-depth interviews | Purposive n = 120 | Social stigma associated with cervical cancer Long distance to screening sites (travel costs and travel time) Fear of pain during screening Embarrassment if male providers provided screening Fear of disease and death |
Mwaka, A D et al., 2013, Uganda [22] | Mind the gaps: a qualitative study of perceptions of healthcare professionals on challenges and proposed remedies for cervical cancer help-seeking in post conflict northern Uganda | Research method: Qualitative Data collection: Key informant interviews (KIIs) | Purposive n = 15 | Lack of awareness and knowledge about cervical cancer and service locations Lack of knowledge about the benefits of screening Lack of accurate knowledge of cervical cancer Financial constraints (screening costs) Discomfort with exposure of women’s genitals Perceived pain during pelvic examinations Lack of spousal support (emotional & financial) Few health facilities that provide screening Long distances to screening centers Lack of transport to screening centers Gender and age of service provider |
Ndejjo, R et al., 2017, Uganda [23] | Knowledge, facilitators and barriers to cervical cancer screening among women in Uganda: a qualitative study | Research method: Qualitative Data collection: FGDs KIIs | Multistage (Random selection of sub counties and purposive selection of villages and participants) 10 FGDs (n = 119) KII (n = 11) | Lack of knowledge about cervical cancer and screening Lack of awareness about screening services availability Lack of facilities offering screening- services far away from the community Negative staff attitudes Staff shortages Lack of proper training to conduct screening Lack of screening materials Fear of discomfort during screening Gender and age of service provider Fear of a positive diagnosis Fear of finding out HIV status if provided with screening Financial constraints (transport, screening and treatment costs if found positive) |
Modibbo, FI et al., 2016, Nigeria [24] | Qualitative study of barriers to cervical cancer screening among Nigerian women | Research method: Qualitative Data collection: FGDs | Purposive 4 FGDs (n = 49) | Lack of awareness of screening programmes Modesty concerns Gender of health care provider Fear of a positive result and disclosure of the results Fear of contacting other illnesses in the hospitals Discomfort during the screening process Denial of disease condition Discrimination (Islam women from their mode of dressing) Lack of husband’s permission for screening |
Fort, VK et al., 2011, Malawi [25] | Barriers to cervical cancer screening in Mulanje, Malawi: a qualitative study | Research method: Qualitative Data collection: Interviews | Systematic n = 20 | Low knowledge about cervical cancer and screening Misconceptions about screening (pulling out uterus) Fatalistic view of cervical cancer (fear of being diagnosed and dying soon) Low perceived risk Lack of time (too busy with household chores) Difficulty in navigating health care facilities Financial constraints (transportation and time) Long waiting times Lack of understanding on benefits of screening |
Nwankwo, K C et al., 2011, Nigeria [28] | Knowledge attitudes and practices of cervical cancer screening among urban and rural Nigerian women: a call for education and mass screening | Research method: Quantitative Data collection: Interviewer- administered questionnaire | Convenience n = 1000 | Lack of knowledge about cervical cancer screening No complaint Cannot afford the cost Cannot locate screening facility Screening is unnecessary Fear of a cancer diagnosis Never thought about it |
Compaore, S et al., 2016, Burkina Faso [29] | Barriers to Cervical Cancer Screening in Burkina Faso: Needs for Patient and Professional Education | Research method: Quantitative Data collection: Interviewer- administered questionnaire | Convenience n = 351 | Lack of awareness about cervical cancer and screening Low risk perception Not knowing where to go for screening Fear of being diagnosed with cervical cancer Long distance to screening site Financial constraints |
Tarwireyi, F., 2005, Zimbabwe [30] | Perceptions and barriers to cervical cancer screening in a rural district of Mutoko, Mashonaland East Province, Zimbabwe | Research method: Quantitative Data collection: Interviews –assumption is that this was an interviewer-administered questionnaire | Multi-stage random n = 1 600 | Lack of screening services at the nearest health centers Not yet ready for screening Lack of time Financial constraints – high transport costs Lack of knowledge of where to go for screening Long distance to health center Lack of proper policy to guide cervical cancer screening |
Kress, C M et al., 2015, Ethiopia [31] | Knowledge, attitudes, and practices regarding cervical cancer and screening among Ethiopian health care workers | Research method: Quantitative Data collection: Self-administered multiple choice surveys | Purposive n = 335 | Lack of necessary training to screen Lack of equipment and supplies for screening Lack of laboratory resources Screening tests too expensive to patients Difficulty to follow up with patients after screening |
Abiodun, OA et al., 2013, Nigeria [40] | The understanding and perception of service providers about the community-based cervical screening in Nigeria | Research method: Quantitative Data collection: Self- administered questionnaire | Purposive n = 100 | Low patient turnout due to a generally low level of awareness of cervical cancer and screening among the populace Lack of clear and comprehensive national cervical cancer management guidelines and policies in the region Lack of sustainability of screening service due to staff turnover Shortage of funds Inadequate consumables Shortage of skilled personnel Absence of budgetary allocation for cervical screening Lack of commitment by health personnel due to poor motivation Lack of hospital management and government support: women fail to get the service |
Okunowo, AA et al., 2018, Nigeria [33] | Women's knowledge of cervical cancer and uptake of Pap smear testing and the factors influencing it in a Nigerian tertiary hospital | Research method: Quantitative Data collection: self-administered structured questionnaire | Convenience n = 144 | Poor knowledge of cervical cancer My doctor has never advised me to do the test Poor knowledge about screening Low risk perception Lack of knowledge of where the test is done |
Perng, P et al., 2013, Tanzania [34] | Promoters of and barriers to cervical cancer screening in a rural setting in Tanzania | Research method: Quantitative Data collection: Interviewer- administered questionnaire | Convenience quota sampling n = 300 | Financial constraints (when cost barriers are removed, women who are less able to afford health care are more likely to participate) Perceived absence of ill health Age (younger and older women least likely to screen) Illiteracy |
Ebu, N I et al., 2015, Ghana [35] | Knowledge, practice, and barriers toward cervical cancer screening in Elmina, southern Ghana | Research method: Quantitative Data collection: Structured interview schedule | Multistage random n = 392 | Lack of screening sites Screening sites too far away Limited information on cervical cancer Absence of health education programmes Lack of adequate knowledge about the screening test and where it can be done Screening test is embarrassing and painful Religious values and cultural beliefs Lack of spousal support Low risk perception Fear of a cancer diagnosis and treatment Financial constraints (cost of the test unaffordable) |
Rosser, J I et al., 2015, Kenya [36] | Barriers to Cervical Cancer Screening in Rural Kenya: Perspectives from a Provider Survey | Research method: Quantitative Data collection: Self-administered survey | Purposive n = 106 | Staff shortages Lack of trained staff Insufficient space Insufficient supplies Inadequate knowledge of cervical cancer Long waiting times Gender of service provider Fear of pain with the speculum exam |
Chigbu, C O & Aniebue, U., 2011, Nigeria [37] | Why southeastern Nigerian women who are aware of cervical cancer screening do not go for cervical cancer screening | Research method: Quantitative Data collection: Interviewer- administered questionnaire | Systematic sampling n = 3 712 | Lack of adequate information Absence of symptoms Fear of violation of privacy Fear of outcome of results No family history of cervical cancer Distance to screening centers |
Titiloye, M A et al., 2017, Nigeria [38] | Barriers to utilization of cervical cancer screening services among women of reproductive age in Ondo, Southwest Nigeria | Research method: Quantitative Data collection: Interviewer- administered questionnaire | Multi-stage n = 244 | Fear of result Negative attitudes of health workers Husband’s influence on decision Screening procedure is painful Financial constraints (too expensive) Screening test not readily available Lack of knowledge on what age it is appropriate to go for screening Long distance to health facility Lack of time to get screened because it takes much time Health facility screening operational times not convenient Misconceptions about screening |
Abiodun, OA., et al. 2013, Nigeria [32] | An assessment of women’s awareness and knowledge about cervical cancer and screening in Ogun State, Nigeria | Research method: Quantitative Data collection: Interviewer- administered questionnaire | Multi-stage random n = 2 000 | Lack of awareness and knowledge on cervical cancer Lack of awareness and knowledge on cervical cancer screening Lack of interest Lack of access to screening |
Ibekwe, CM et al., 2011, Botswana [39] | Perceived barriers of cervical cancer screening among women attending Mahalapye hospital, Botswana | Research method: Quantitative Data collection: Self-administered questionnaire for those who could read and write Interviewer-administered questionnaire for those who could neither read nor write | Convenience n = 300 | Lack of information about the benefits of screening Low risk perception for cervical cancer |
Mangoma, J F et al., 2006, Zimbabwe [26] | An assessment of rural women's knowledge, constraints and perceptions on cervical cancer screening: the case of two districts in Zimbabwe | Research method: Mixed—Quantitative and Qualitative Data collection: Quantitative Interviewer administered questionnaire Qualitative Semi-structured questionnaires to nurses & nurse aides In-depth interviews with health personnel FGDs with women Document analysis Narratives from 2 women suffering from cervical cancer & 1 who had hysterectomy | Quantitative Cluster random n = 356 Qualitative Purposive n = 29 n = 16 20 FGDs Hospital and clinical records n = 3 | Lack of knowledge about the need for and importance of screening Lack of awareness about the local screening programme Gender of service provider Discomfort during screening procedure (lying on one’s back with legs open) Low level of knowledge and understanding about cervical cancer Absence of signs and symptoms Lack of money Men not understanding the importance of screening Absence of a screening programme Long distances to nearest screening sites Lack of trained nurses Lack of follow up (women referred for screening do not go because of lack of money, time and not understanding the consequences of the disease) Competing priorities (bread and butter issues) Misconceptions about cervical cancer (caused by witchcraft) |
Ngugi, C W et al., 2012, Kenya [27] | Factors affecting uptake of cervical cancer early detection measures among women in Thika, Kenya | Research method: Mixed—Quantitative and Qualitative Data collection: Quantitative Interviewer- administered questionnaire Qualitative In-depth interviews | Not explained Quantitative n = 498 Qualitative n = 50 | Lack of knowledge and awareness of cervical cancer and the benefits of screening Screening sites too far away Financial constraints (screening, treatment and transport costs) Fear of pain during the procedure Responsibility in the home (too busy with other household work and time spent at hospital is too long) Lack of spousal support Health workers not supportive of the programme (too busy even if women ask to be screened, no explanation of procedure before the test, rude to patients) Gender of service provider |
Getachew, S et al., 2019, Ethiopia [41] | Cervical cancer screening knowledge and barriers among women in Addis Ababa, Ethiopia | Research method: Mixed—Quantitative and Qualitative Data collection: Quantitative Interviewer- administered questionnaire Qualitative FGDs | Quantitative Multi-stage n = 520 Qualitative Purposive 4 FGDs (n = 37) | Lack of symptoms Lack of knowledge regarding cervical cancer Lack of adequate information about the existence of screening, who is eligible for screening, where and when they should be screened Lack of screening services at the nearest health centers Health professionals do not promote screening |