title: Influencing women's actions on cervical cancer screening and treatment in Karawang District, Indonesia.
abstract: BACKGROUND
  The impact of cervical cancer prevention programs depends on persuading women to go for screening and, if needed, treatment. As part of an evaluation of a pilot project in Indonesia, qualitative research was conducted to explore the factors that influence women's decisions regarding screening and treatment and to generate practical recommendations to increase service coverage and reduce loss to follow up.
  
  
  METHODS
  Research was conducted at 7 of the 17 public health centers in Karawang District that implemented the pilot project. Interviews and focus group discussions were held with 20 women, 20 husbands, 10 doctors, 18 midwives, 3 district health officials, and 16 advocacy team members.
  
  
  RESULTS
  Free services and mobile outreach events encouraged women to go for screening, along with promotional efforts by community health workers, advocacy teams, and the mass media. Knowledge and perceptions were the most important barriers to screening: women were not aware of cervical cancer risks, did not know the disease was treatable, and were fatalistic. Factors facilitating treatment were social support from husbands, relatives, and friends and the encouragement and role modeling of health workers. Barriers to prompt treatment included limited access to services and the requirement for husband's consent for cryotherapy.
  
  
  CONCLUSIONS
  As cervical cancer prevention services are scaled up throughout Indonesia, the findings suggest three strategies to expand screening coverage and ensure prompt treatment: strengthening community mobilization and advocacy activities, modifying the service delivery model to encourage a single visit approach to screening and treatment, and working to gain men's support.
authors.affiliation: Jhpiego/USA, Johns Hopkins University,USA. ymkim@jhpiego.net
authors.forename: Young-Mi
authors.initials: YM
authors.lastname: Kim
authors.forename: Abigael
authors.initials: A
authors.lastname: Ati
authors.forename: Adrienne
authors.initials: A
authors.lastname: Kols
authors.forename: Fransisca Maria
authors.initials: FM
authors.lastname: Lambe
authors.forename: Djoko
authors.initials: D
authors.lastname: Soetikno
authors.forename: Megan
authors.initials: M
authors.lastname: Wysong
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Tergas
authors.forename: Presha
authors.initials: P
authors.lastname: Rajbhandari
authors.forename: Enriquito
authors.initials: E
authors.lastname: Lu
mesh_terms: D055088:Early Detection of Cancer; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007214:Indonesia; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D012944:Social Support; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D016387:Women's Health