Exploring Primary Care Providers’ and Patients’ Perspectives on Barriers and Enablers to Cervical Precancerous Lesion Detection in Primary Care Clinic Settings in Soweto

Abstract

Background Cervical cancer remains a major public health concern, ranking as the fourth most common cause of cancer incidence and mortality in women worldwide. Sub-Saharan Africa has the highest cervical cancer incidence and mortality rates globally, and it remains the leading cause of mortality among women in the region, mainly due to delayed diagnosis. This study explored primary care providers’ and patients’ perspectives on barriers and enablers to early detection of cervical cancer at primary healthcare clinics in Soweto. Methods Using a qualitative approach, semi-structured in-depth interviews were conducted with 22 healthcare providers (nurses, doctors, and facility managers) from 8 healthcare facilities in Orange Farm and Soweto and 15 women patients (9 screened and 6 not screened for cervical cancer). The in-depth interviews were audio-recorded and transcribed verbatim. The data were then input into NVivo for framework analysis. Healthcare provider and patient findings were analysed separately, focusing on barriers and enablers for early detection and treatment of cervical cancer. The results were framed using the Socio-Ecological Model for providers and a combination of the Socio-Ecological Model and Health Belief Model for patients. Results Healthcare providers reported that the South African National Department of Health provides inadequate cancer training and support, and that staff rotations led to gaps in cancer and screening knowledge. Healthcare providers perceived that patients had limited awareness of cancer and of screening services, consequently reducing demand. Providers highlighted resource shortages – staff, facilities, supplies, and access to lab results – limiting screening provision. They perceived that many women preferred self-medication, accessed traditional health practitioners’ services, and often sought primary healthcare services when in critical condition. Interviews with women showed that they were generally aware of cervical cancer and screening procedures. Their perceived barriers to access included fear of diagnosis, perceived discomfort and pain with the procedure, and limited provider and equipment vii resources. Patients cited long waiting times, delays in obtaining screening results, and missing results as additional barriers to screening access. Conclusion The findings reveal discordance between provider and patient perceptions of women’s knowledge and awareness of cervical cancer and screening services. However, both groups identified substantial barriers to effective cervical cancer screening service provision and uptake that are amenable to interventions.