Barriers and Recommendations for a Cervical Cancer Screening Program among Women in Low-resource Settings in Lagos Nigeria: A Qualitative Study

Background: Cervical cancer is the fourth most common cancer in women globally despite being a largely treatable and preventable malignancy. Developing countries account for over 80% of all new cases of cervical cancer. Women residing in low-resource settings such as those residing in slums have a higher risk of cervical cancer, and lower uptake of cervical cancer screening. Diverse barriers influence the uptake of cervical cancer screening among women in low-resource settings. Objectives: This qualitative study was carried out prior to a cervical cancer screening program and explored women’s knowledge about cervical cancer, and their perceived barriers and recommendations for the program.Method: Four focus group discussions (FGD) were conducted among 35 women between the ages of 21 – 65 years residing in two urban slums in Lagos, Nigeria. Each FGD was limited to 8-10 participants of women of similar ages. Voice recordings were transcribed verbatim and analysis was done using thematic analysis.Results: Most of the women were not aware of cervical cancer and none knew the symptoms or risk factors of cervical cancer. The participants felt that the cervical cancer screening program would be well accepted in the community, however, they expressed concerns about the cost of the screening test and the sex of the person performing the test. The recommendations proffered for a successful cervical cancer screening program include; reducing the cost of the test or providing the test free of charge, having people that speak the local language as part of the team, using female health care providers, using a private location within the community or nearby PHC, and publicizing the program with the use of SMS, phone calls, town crier, and health talks. It was recommended that organizing health education sessions would help improve women’s poorly perceived susceptibility to cervical cancer.Conclusion: Interventions to increase uptake of cervical cancer screening among women in low resource settings need to improve knowledge and understanding of cervical cancer and address the barriers to cervical cancer screening such as cost, distance, and as much as possible, sex of the healthcare provider should be considered.