Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya.
Cervical cancer is the second most commonly diagnosed cancer in females and is a leading cause of cancer-related mortality in Kenya; limited cervical cancer screening services may be a factor. Few studies have examined men's and women's perceptions on environmental and psychosocial barriers and benefits related to screening.



In 2014, 60 women aged 25-49 years and 40 male partners participated in 10 focus groups (6 female and 4 male), in both rural and urban settings (Nairobi and Nyanza, Kenya), to explore perceptions about barriers to and benefits of cervical cancer screening. Focus groups were segmented by sex, language, geographic location, and screening status. Data were transcribed, translated into English, and analyzed by using qualitative software.



Participants identified screening as beneficial for initiating provider discussions about cancer but did not report it as a beneficial method for detecting precancers. Perceived screening barriers included access (transportation, cost), spousal approval, stigma, embarrassment during screening, concerns about speculum use causing infertility, fear of residual effects of test results, lack of knowledge, and religious or cultural beliefs. All participants reported concerns with having a male doctor perform screening tests; however, men uniquely reported the young age of a doctor as a barrier.



Identifying perceived barriers and benefits among people in low- and middle-income countries is important to successfully implementing emerging screening programs. The novel findings on barriers and benefits from this study can inform the development of targeted community outreach activities, communication strategies, and educational messages for patients, families, and providers.The Oncologist2017;22: 173-181Implications for Practice:This article provides important information for stakeholders in clinical practice and research when assessing knowledge, beliefs, and acceptability of cervical cancer screening and treatment services in low- and middle-resourced countries. Formative research findings provide information that could be used in the development of health interventions, community education messages, and materials. Additionally, this study illuminates the importance of understanding psychosocial barriers and facilitators to cervical cancer screening, community education, and reduction of stigma as important methods of improving prevention programs and increasing rates of screening among women.
Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA nbuchanan@cdc.gov.
Natasha
N
Buchanan Lunsford
Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Kathleen
K
Ragan
Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Judith
J
Lee Smith
Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Mona
M
Saraiya
Kenya Medical Research Institute, Kisumu, Kenya.
Millicent
M
Aketch
D000328:Adult; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D006801:Humans; D007630:Kenya; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology
Cervical cancer; Focus groups; Kenya; Perceptions; Screening