Date of Award

January 2016

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Beth Jones

Second Advisor

Linda Niccolai

Abstract

Background: Located in south-eastern Africa, Malawi is a low income country with a population of 16.4 million. It is currently estimated to have the highest age-standardized rate of cervical cancer in the world at 75.9 per 100,000 population. Cervical cancer accounts for 28% of all reported female cancers in the country, and 80% of women diagnosed with the disease die from it, making cervical cancer a public health priority for the country. Despite the fact that cervical cancer screening services (by visual inspection with acetic acid (VIA)) has been offered free of charge at public health facilities in the country since 2004, the services remain underutilized across the country. The purpose of this study was to explore potential factors associated with the acceptability and utilization of cervical cancer screening services among adult women in the Neno district of Malawi, and to identify their service delivery preferences in order to guide the design of effective cervical cancer education and screening programs.

Methods: This study employed an exploratory qualitative research study design. Data was collected between July and August 2015 in the district of Neno, Malawi by conducting in-depth semi-structured interviews within a sample of 50 women between the ages of 18-55 years. Participants were recruited among women attending health facilities and community screening events within the district using a purposive sampling technique. Constructs from the Health Belief Model and Socio-Ecological Model were used to construct a conceptual framework for this study.

Results: Several themes emerged from the data, namely: misconceptions about how cervical cancer develops, low perceptions of risk of the disease, effects of interpersonal interactions on preventative behaviors, barriers limiting access to cervical cancer screening services, and service preferences for the integration of cervical cancer screening. Despite limited understanding about the transmission and development of cervical cancer, knowledge about its risk factors and signs and symptoms was relatively high among the study sample. Perceived barriers to using cervical cancer prevention services included: distance from health facilities, challenges in accessing transportation, limited availability and awareness of services, logistical factors, and a low perception of risk. Facilitators to using the services were based on: high satisfaction with healthcare, strong desires to know about one’s health status, interpersonal interactions with health professionals, husband’s approval, and faith in the curative abilities of western medicine. Women in the sample reported high acceptability and intention to obtain screening if the services were available at a nearby location. The study sample was also highly receptive of integrated approaches to receiving cervical cancer screening both at health facilities and community screening events

Conclusions: Knowledge and awareness about cervical cancer and its risk factors among the study sample was relatively high, indicating that sporadic health education and awareness raising about the disease has been taking place throughout health facilities within the Neno district. Misconceptions about the disease however highlight the importance of having a systematic method and coordinated strategy for delivering cervical cancer health education. The expansion of cervical cancer screening services across all health centers in the district is needed in order to address barriers to accessing preventative services and to increase coverage and utilization rates for VIA screening services in Neno.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/06/2018

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