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“When You Have Gotten Help, That Means You Were Strong”: A Qualitative Study of Experiences in a “Screen and Treat” Program for Cervical Cancer Prevention in Malawi

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Abstract

Disproportionate cervical cancer burden falls on women in low-income countries, and there are new efforts to scale up prevention worldwide, including via “screen and treat” for detection and removal of abnormal cervical lesions. This study examines Malawian women’s experiences with “screen and treat”; this is an under-explored topic in the literature, which has focused largely on knowledge about and attitudes toward screening, but not on experiences with screening. We interviewed 47 women who have been screened at least once for cervical cancer. The interview guide and analysis approach were informed by the Multi-Level Health Outcomes Framework. Women were recruited at facilities that offer “screen and treat” and asked about their experiences with screening. The average age of respondents was 40 years, and approximately half were HIV-negative. Although women were knowledgeable about the benefits of screening, they articulated many barriers including being turned away because of stock-outs of equipment, far distances to services, discomfort with male providers, and poor communication with providers. Alongside the many health education campaigns to increase awareness and demand for “screen and treat” services, the global public health community must also address implementation barriers in the resource-constrained health systems where burden is greatest. Particular attention should be paid to quality and person-centeredness of “screen and treat” services to optimize uptake and engagement in care.

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Data Availability

Data can be made available to interested parties upon reasonable request to the corresponding author.

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Acknowledgments

We are grateful for the excellent work done by Allena Makwenda and Esnart Sanudi, who conducted these interviews and the support for data collection from Partners in Hope. We thank all the women who generously shared their time and opinions for this research.

Funding

This research was supported by the NIH/National Center for Advancing Translational Sciences (grant number KL2TR001882, PI Wong, UCLA Clinical and Translational Science Institute, Institutional Development Core), and funding from the Jonsson Comprehensive Cancer Center at UCLA.

Author information

Authors and Affiliations

  1. Fielding School of Public Health, University of California, Los Angeles, CA, USA

    Corrina Moucheraud & Roshan Bastani

  2. African Institute for Development Policy, Lilongwe, Malawi

    Paul Kawale

  3. Partners in Hope Medical Center, Lilongwe, Malawi

    Savel Kafwafwa

  4. David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Risa M. Hoffman

Authors
  1. Corrina Moucheraud
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  2. Paul Kawale
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  3. Savel Kafwafwa
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  4. Roshan Bastani
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  5. Risa M. Hoffman
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Contributions

CM, RB, and RMH conceived of the overall study goals and design. CM and PK developed the study specifics. CM and RMH drafted the data collection instruments, with input from PK and SK. PK oversaw data collection with assistance from SK. CM led data analysis, with input from PK. CM drafted the manuscript, with substantial inputs from RMH and PK. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Corrina Moucheraud.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

This study was approved by the Institutional Review Board at the University of California Los Angeles and the Malawi National Health Sciences Research Committee and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

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Moucheraud, C., Kawale, P., Kafwafwa, S. et al. “When You Have Gotten Help, That Means You Were Strong”: A Qualitative Study of Experiences in a “Screen and Treat” Program for Cervical Cancer Prevention in Malawi. J Canc Educ 37, 405–413 (2022). https://doi.org/10.1007/s13187-020-01828-9

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  • DOI: https://doi.org/10.1007/s13187-020-01828-9

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