Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies
Abstract Background Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Health Research Policy and Systems |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12961-023-01094-3 |
| _version_ | 1797272751410511872 |
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| author | Desta Debalkie Atnafu Resham Khatri Yibeltal Assefa |
| author_facet | Desta Debalkie Atnafu Resham Khatri Yibeltal Assefa |
| author_sort | Desta Debalkie Atnafu |
| collection | DOAJ |
| description | Abstract Background Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and management of cervical cancer in sub-Saharan Africa. Methods We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels). Results We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women’s relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers’ networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers’ profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social–cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure. Conclusions There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges. |
| first_indexed | 2024-03-07T14:33:50Z |
| format | Article |
| id | doaj.art-4429ac313a4249a0b5760a77801c6b19 |
| institution | Directory Open Access Journal |
| issn | 1478-4505 |
| language | English |
| last_indexed | 2024-03-07T14:33:50Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Health Research Policy and Systems |
| spelling | doaj.art-4429ac313a4249a0b5760a77801c6b192024-03-05T20:44:37ZengBMCHealth Research Policy and Systems1478-45052024-02-0122111910.1186/s12961-023-01094-3Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studiesDesta Debalkie Atnafu0Resham Khatri1Yibeltal Assefa2Department of Health Systems Management and Health Economics, School of Public Health, Bahir Dar UniversitySchool of Public Health, The University of QueenslandSchool of Public Health, The University of QueenslandAbstract Background Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and management of cervical cancer in sub-Saharan Africa. Methods We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels). Results We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women’s relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers’ networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers’ profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social–cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure. Conclusions There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges.https://doi.org/10.1186/s12961-023-01094-3Cervical cancerScreening programme implementationSecondary preventionDetractorsEnablersOpportunities |
| spellingShingle | Desta Debalkie Atnafu Resham Khatri Yibeltal Assefa Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies Health Research Policy and Systems Cervical cancer Screening programme implementation Secondary prevention Detractors Enablers Opportunities |
| title | Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies |
| title_full | Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies |
| title_fullStr | Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies |
| title_full_unstemmed | Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies |
| title_short | Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies |
| title_sort | drivers of cervical cancer prevention and management in sub saharan africa a qualitative synthesis of mixed studies |
| topic | Cervical cancer Screening programme implementation Secondary prevention Detractors Enablers Opportunities |
| url | https://doi.org/10.1186/s12961-023-01094-3 |
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