Skip to main content

Advertisement

SpringerLink
Log in

A Qualitative Exploration of Women’s Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Detection and treatment of human papillomavirus (HPV) and cervical precancer through screening programs is an effective way to reduce cervical cancer deaths. However, high cervical cancer mortality persists in low- and middle-income countries. As screening programs become more widely available, it is essential to understand how knowledge about cervical cancer and perceived disease risk impacts screening uptake and acceptability. We evaluated women’s experiences with a cervical cancer education strategy led by community health volunteers (CHVs) in Migori County, Kenya, as part of a cluster randomized controlled trial of cervical cancer screening implementation strategies. The educational modules employed simple language and images and sought to increase understanding of the relationship between HPV and cervical cancer, the mechanisms of self-collected HPV testing, and the importance of cervical cancer screening. Modules took place in three different contexts throughout the study: (1) during community mobilization; (2) prior to screening in either community health campaigns or health facilities; and (3) prior to treatment. Between January and September 2016, we conducted in-depth interviews with 525 participants to assess their experience with various aspects of the screening program. After the context-specific educational modules, women reported increased awareness of cervical cancer screening and willingness to screen, described HPV- and cervical cancer-related stigma and emphasized the use of educational modules to reduce stigma. Some misconceptions about cervical cancer were evident. With effective and context-specific training, lay health workers, such as CHVs, can help bridge the gap between cervical cancer screening uptake and acceptability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Finocchario-Kessler S, Wexler C, Maloba M, Mabachi N, Ndikum-Moffor F, Bukusi E (2016) Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Womens Health 16:29

    Article  Google Scholar 

  2. Louie KS, de Sanjose S, Mayaud P (2009) Epidemiology and prevention of human papillomavirus and cervical cancer in sub-Saharan Africa: a comprehensive review. Tropical Med Int Health 14(10):1287–1302

    Article  Google Scholar 

  3. White HL, Mulambia C, Sinkala M, Mwanahamuntu MH, Parham GP, Moneyham L, Grimley DM, Chamot E (2012) ‘Worse than HIV’ or ‘not as serious as other diseases’? Conceptualization of cervical cancer among newly screened women in Zambia. Soc Sci Med 74(10):1486–1493

    Article  Google Scholar 

  4. Ngugi CW, Boga H, Muigai AW, Wanzala P, Mbithi JN (2012) Factors affecting uptake of cervical cancer early detection measures among women in Thika, Kenya. Health Care Women Int 33(7):595–613

    Article  Google Scholar 

  5. Lyimo FS, Beran TN (2012) Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: three public policy implications. BMC Public Health 12:22

    Article  Google Scholar 

  6. Watson-Johnson LC, Bhagatwala J, Reyes-Garcia C, Hinojosa A, Mason M, Meade CD, Luque JS (2012) Refinement of an educational toolkit to promote cervical cancer screening among Hispanic immigrant women in rural southern Georgia. J Health Care Poor Underserved 23(4):1704–1711

    Article  Google Scholar 

  7. Drewry J, Garces-Palacio IC, Scarinci I (2010) Awareness and knowledge about human papillomavirus among Latina immigrants. Ethn Dis 20(4):327–333

    PubMed  PubMed Central  Google Scholar 

  8. Rosser JI, Njoroge B, Huchko MJ (2015) Changing knowledge, attitudes, and behaviors regarding cervical cancer screening: the effects of an educational intervention in rural Kenya. Patient Educ Couns 98(7):884–889

    Article  Google Scholar 

  9. Williams M, Kuffour G, Ekuadzi E, Yeboah M, ElDuah M, Tuffour P (2013) Assessment of psychological barriers to cervical cancer screening among women in Kumasi, Ghana using a mixed methods approach. Afr Health Sci 13(4):1054–1061

    Article  CAS  Google Scholar 

  10. Teng FF, Mitchell SM, Sekikubo M, Biryabarema C, Byamugisha JK, Steinberg M, Money DM, Ogilvie GS (2014) Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda. BMJ Open 4(4):e004783

    Article  Google Scholar 

  11. Paskett E, Tatum C, Rushing J, Michielutte R, Bell R, Long Foley K, Bittoni M, Dickinson SL, McAlearney AS, Reeves K (2006) Randomized trial of an intervention to improve mammography utilization among a triracial rural population of women. J Natl Cancer Inst 98(17):1226–1237

    Article  Google Scholar 

  12. O'Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA (2010) Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med 25(11):1186–1192

    Article  Google Scholar 

  13. Perry HB, Zulliger R, Rogers MM (2014) Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 35:399–421

    Article  Google Scholar 

  14. Nuno T, Martinez ME, Harris R, García F (2011) A Promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: a randomized controlled trial. Cancer Causes Control 22(3):367–374

    Article  Google Scholar 

  15. Taylor VM, Jackson JC, Yasui Y, Nguyen TT, Woodall E, Acorda E, Li L, Ramsey S (2010) Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women. Am J Public Health 100(10):1924–1929

    Article  Google Scholar 

  16. Mock J, McPhee SJ, Nguyen T, Wong C, Doan H, Lai KQ, Nguyen KH, Nguyen TT, Bui-Tong N (2007) Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women. Am J Public Health 97(9):1693–1700

    Article  Google Scholar 

  17. Huchko MJ, Kahn JG, Smith JS, Hiatt RA, Cohen CR, Bukusi E (2017) Study protocol for a cluster-randomized trial to compare human papillomavirus based cervical cancer screening in community-health campaigns versus health facilities in western Kenya. BMC Cancer 17(1):826

    Article  Google Scholar 

  18. O'Brien MJ, Squires AP, Bixby RA, Larson SC (2009) Role development of community health workers: an examination of selection and training processes in the intervention literature. Am J Prev Med 37(6 Suppl 1):S262–S269

    Article  Google Scholar 

  19. Ragan KR, Buchanan Lunsford N, Lee Smith J, Saraiya M, Aketch M (2018) Perspectives of screening-eligible women and male partners on benefits of and barriers to treatment for precancerous lesions and cervical cancer in Kenya. Oncologist 23(1):35–43

    Article  Google Scholar 

  20. Tang TS, Funnell M, Sinco B, Piatt G, Palmisano G, Spencer MS, Kieffer EC, Heisler M (2014) Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. Diabetes Care 37(6):1525–1534

    Article  Google Scholar 

  21. Allen JD, Stoddard AM, Mays J, Sorensen G (2001) Promoting breast and cervical cancer screening at the workplace: results from the Woman to Woman Study. Am J Public Health 91(4):584–590

    Article  CAS  Google Scholar 

  22. Menna T, Ali A, Worku A (2015) Effects of peer education intervention on HIV/AIDS related sexual behaviors of secondary school students in Addis Ababa, Ethiopia: a quasi-experimental study. Reprod Health 12:84

    Article  Google Scholar 

  23. Rose MA (1992) Evaluation of a peer-education program on heart disease prevention with older adults. Public Health Nurs 9(4):242–247

    Article  CAS  Google Scholar 

  24. Posavac EJ, Kattapong KR, Dew DR Jr (1999) Peer-based interventions to influence health-related behaviors and attitudes: a meta-analysis. Psychol Rep 85(3 Pt 2):1179–1194

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the participants as well as the health care providers and research assistants for their support of and contributions to this project. We would also like to acknowledge for Katelyn Bryant-Comstock for assistance with editing of this manuscript.

Funding

This study was funded by the National Cancer Institute, R01 CA188428.

Author information

Authors and Affiliations

  1. Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC, 27708, USA

    Yujung Choi, Konyin Adewumi & Megan J. Huchko

  2. Center for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya

    Sandra Y. Oketch & Elizabeth Bukusi

  3. Department of Obstetrics and Gynecology, University of Washington, P.O. Box 356460, Seattle, WA, 98195, USA

    Elizabeth Bukusi

  4. Department of Obstetrics and Gynecology, Duke University, 201 Trent Dr., 203 Baker House, Durham, NC, 27710, USA

    Megan J. Huchko

Authors
  1. Yujung Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandra Y. Oketch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Konyin Adewumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Bukusi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Megan J. Huchko
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors were involved in the preparation, review, and editing of the final manuscript. MJH conceptualized the study and led the data collection. SO and EB led study activities on the ground and assisted in conceptualization of the analysis. YC wrote the manuscript with contributions from the authorship team (SO, KA, EB, and MJH).

Corresponding author

Correspondence to Yujung Choi.

Ethics declarations

Written informed consent was obtained from each participant in her preferred language and ethical approval was obtained from the Kenya Medical Research Institute Ethical Review Committee, Duke University and the University of California, San Francisco’s Committee on Human Research.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, Y., Oketch, S.Y., Adewumi, K. et al. A Qualitative Exploration of Women’s Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya. J Canc Educ 35, 36–43 (2020). https://doi.org/10.1007/s13187-018-1437-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-018-1437-2

Keywords

Search

Navigation