Improving cervical cancer screening utilisation in Keetmanshoop Urban Namibia: an intervention study
This was a three phased study using a sequential multi-method design. Phase 1 was a scoping review which concluded that the interventions employed in Africa to improve cervical cancer screening for the period 2008-2018 were health education, HPV testing, integrating services and multi-faceted health promotion activities. Phase 2 consisted of in-depth interviews with 19 nurses, 18 women and 16 men. Barriers to screening utilisation were inadequate knowledge about cervical cancer, inadequate knowledge about the screening test, shortage of resources, influence of fear and woman’s demographic characteristics. Suggestions to improve screening utilisation were; health education, nurse training on cervical cancer and screening and modifications in the health care delivery system. The third and final phase was the intervention study that saw the structuring of a community based educational intervention program. Twenty-one (n=21) lay community-based workers called Health extension workers (HEWs) were trained to assist in recruiting women for the community based educational program. Knowledge of HEWs was improved through training and education. The community based educational program was launched with the support of political and local organizational leadership. A total of 105 women (n=105) participated in the community based educational program of which all four outcomes namely, screening uptake, women’s knowledge, attitude, and the clinic readiness to offer cervical cancer screening. Statistical analysis using Chi square showed that the odds ratio (OR) of woman getting screened after the educational session was 2.4 times. All three phases of the current study provided evidence that lack of knowledge is a barrier to screening uptake and educational interventions have been employed with varying outcomes. In this study, education coupled with closing other operational gaps in the healthcare delivery system, improved screening utilisation. However, education alone without addressing structural barriers such as resource shortages and lack of training will be insufficient to improve screening.
A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2020