Understanding the Barriers and Facilitators to Cervical Cancer Screening Among Women in Gonaives, Haiti: An Explanatory Sequential Mixed-Methods Study

Abstract

Cervical cancer is the most common cancer, and the second leading cause of cancer deaths in Haitian women. Aim: Identify the factors that either facilitate or prevent women in Gonaives to uptake cervical cancer screening. Methods: This study was an explanatory sequential mixed-method design in a stratified random sample of 200 women, aged 25 years and older, in Gonaives, Haiti. Surveys estimated the proportion of women who had received cervical cancer screening. Fisher’s exact tests were used to compare women who had been screened to women who had not been screened. Logistic regression models were used to examine the association between screening status and possible factors that may affect women’s decision to seek screening. Thirteen women who had not been screened and seven healthcare providers/administrators were interviewed about perceived barriers to screening. Analysis of the qualitative data used an inductive, thematic content analytic approach. providers and administrators were interviewed about perceived barriers to screening. Results: Women who had been screened were more likely to have higher level of education (80% versus 62%, p=0.02) and less likely to say feedback from peers would impact their decision to go for screening (16% versus 37%, p=0.06) compared to women who had not been screened. Although not statistically significant, an association was found between past screening status and fear (8% versus 23%, p=0.11). The major themes that emerged from the interviews were grouped according to three main themes: 1) proximal barriers to screening; 2) distal barriers to screening; 3) facilitators to screening. By merging the results in a comparative joint display, level of education was reflected in a gap between level of information and awareness; peer’s feedback was reflected in fear. Although not statistically significant, partners’ approval (16% screened versus 37% not screened), “not being given the screening results” (58% screened versus 36% not screened) and access to treatment (92% screened versus 97% not screened) emerged as barriers to cervical cancer screening in interviews. Conclusion/Implications: This study revealed that cervical cancer prevention efforts in Gonaives should focus on improving the quality and the specificity of the information provided during awareness campaigns, as well as improving the screening services for women to receive their test results and to have access to care if ever they are tested positive.