School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Women's Health Research Institute, Vancouver, BC, Canada.
Int J Gynaecol Obstet. 2021 Jan;152(1):103-111. doi: 10.1002/ijgo.13454.
To understand the knowledge, preferences, and barriers for self-collected cervical cancer screening (SC-CCS) and follow-up care at the individual and health system level to inform the implementation of community-based SC-CCS.
Surveys and focus group discussions (FGDs) with women and FGDs with healthcare providers were conducted in Uganda. Survey data were analyzed using frequencies and FGD data were analyzed using thematic content analysis. Data were triangulated between methods.
Sixty-four women were surveyed and 58 participated in FGDs. Facilitators to screening access included decentralization, convenience, privacy, confidentiality, knowledge, and education. Barriers to accessing screening included lack of transportation and knowledge, long wait times, difficulty accessing health care, and lack of trust in the health system. Additional implementation challenges included insufficiently trained human resources and lack of infrastructure.
Integrating SC-CCS within rural health systems in low-resource settings has been under-evaluated. Community-based SC-CSS could prevent high cervical cancer-related mortalities while working within the human and financial resource limitations of rural health systems. SC-CCS is acceptable to women and healthcare providers. By addressing rural women's preferences and barriers to care, decision-makers can build health systems that provide community-centered care close to women's homes across the care continuum.
了解个人和卫生系统层面上自我采集宫颈癌筛查（SC-CCS）及后续护理的知识、偏好和障碍，为实施基于社区的 SC-CCS 提供信息。
在乌干达，对妇女进行了调查和焦点小组讨论（FGD），并对卫生保健提供者进行了 FGD。使用频率分析调查数据，使用主题内容分析对 FGD 数据进行分析。方法之间进行了数据三角剖分。
对 64 名妇女进行了调查，有 58 名妇女参加了 FGD。促进筛查的因素包括权力下放、便利、隐私、保密、知识和教育。获得筛查的障碍包括缺乏交通和知识、等待时间长、难以获得医疗保健以及对卫生系统缺乏信任。额外的实施挑战包括人力资源不足和基础设施缺乏。
在资源匮乏的低资源环境下，将 SC-CCS 纳入农村卫生系统的情况尚未得到充分评估。基于社区的 SC-CSS 可以在农村卫生系统的人力和财力资源限制范围内，预防高宫颈癌相关死亡率。SC-CCS 被妇女和卫生保健提供者所接受。通过解决农村妇女对护理的偏好和障碍，决策者可以建立卫生系统，在整个护理连续体中为妇女提供以社区为中心、靠近其家庭的护理。
