title: Mind the gaps: a qualitative study of perceptions of healthcare professionals on challenges and proposed remedies for cervical cancer help-seeking in post conflict northern Uganda.
abstract: BACKGROUND
  There are limited data on perceptions of health professionals on challenges faced by cervical cancer patients seeking healthcare in the developing countries. We explored the views of operational level health professionals on perceived barriers to cervical screening and early help-seeking for symptomatic cervical cancer and the proposed remedies to the challenges.
  
  
  METHODS
  Fifteen key informant interviews were held with health professionals including medical directors, gynecologists, medical officers, nurses and midwives in the gynecology and obstetrics departments of two hospitals in northern Uganda during August 2012 to April 2013. We used content analysis techniques to analyze the data.
  
  
  RESULTS
  Health professionals' perceived barriers to cervical cancer care included: (i) patients and community related barriers e.g. lack of awareness on cervical cancer and available services, discomfort with exposure of women's genitals and perceived pain during pelvic examinations, and men's lack of emotional support to women (ii) individual healthcare professional's challenges e.g. inadequate knowledge and skills about cervical cancer management; (iii) health facility related barriers e.g. long distances and lack of transport to cervical cancer screening and care centers, few gynecologists and lack of pathologists, delayed histology results, lack of established palliative care services and inadequate pain control; and (iv) health policy challenges e.g. lack of specialized cancer treatment services, and lack of vaccination for human papilloma virus. Other challenges included increased number of cervical cancer patients and late stage of cervical cancer at presentations.
  
  
  CONCLUSIONS
  Operational level healthcare professionals in northern Uganda reported several practical challenges facing cervical cancer care that influence their decisions, management goals and practices. The challenges and proposed remedies can inform targeted interventions for early detection, management, and control of cervical cancer in Uganda.
authors.affiliation: Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P,O Box 7072, Kampala, Uganda. mwakaad@yahoo.com.
authors.forename: Amos D
authors.initials: AD
authors.lastname: Mwaka
authors.forename: Henry R
authors.initials: HR
authors.lastname: Wabinga
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003906:Developing Countries; D055088:Early Detection of Cancer; D005260:Female; D005843:Geography; D006176:Gynecology; D006268:Health Facilities / Q000706:statistics & numerical data / Q000600:supply & distribution*; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D008880:Midwifery; D009726:Nurses; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D057240:Patient Preference; D036301:Qualitative Research; D012944:Social Support; D014186:Transportation; D014454:Uganda; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy