Boamah Mensah Adwoa Bemah, Konney Thomas Okpoti, Adankwah Ernest, Amuasi John, Nones Madalyn, Okyere Joshua, Boadu Kwame Ofori, Eduah Felicia Maame Efua, Xiong Serena, Moon Jeong Robin, Virnig Beth, Kulasingam Shalini
Department of Nursing, School of Nursing and Midwifery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Obstetrics and Gynecology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
PLOS Glob Public Health. 2025 Apr 30;5(4):e0003011. doi: 10.1371/journal.pgph.0003011. eCollection 2025.
Cervical cancer screening has reduced cervical cancer-related mortality by over 70% in countries that have achieved high coverage. However, there are significant geographic disparities in access to screening. In Ghana, although cervical cancer is the second most common cancer in women, there is no national-level cervical cancer screening program, and only 2-4% of eligible Ghanaian women have ever been screened for cervical cancer. This study used an exploratory, sequential mixed-methods approach to examine barriers and facilitators to cervical cancer screening from women's and healthcare workers' perspectives. These were further informed by the Dynamic Sustainability Framework (DSF), in particular, two domains, namely the practice setting and ecological system. Two convenience samples of 215 women and 17 healthcare personnel were recruited for this study. All participants were from one of three selected clinics (Ejisu Government Hospital, Kumasi South Hospital, and the Suntreso Government Hospital) in the Ashanti region of Ghana. Descriptive analyses were used to group the data by practice setting. Statistical differences in means and proportions were used to evaluate women's barriers to cervical cancer screening. Quantitative findings from the women's survey informed qualitative, in-depth interviews with the healthcare workers and were analyzed using an inductive thematic analysis. The median age of women and healthcare workers was 37.0 years and 38.0 years, respectively. Most women (n = 194, 90.2%) reported never having been screened. Women who had not been screened were more likely to have no college or university education. Practice setting factors included long clinic wait times and distance to the clinic. Ecological system factors identified were population characteristics such as lack of knowledge about available services, shyness when undergoing a clinician-performed pelvic exam, and requiring a spouse's permission before scheduling. These findings highlight the need for non-clinician-based, culturally sensitive cervical cancer screening options such as self-collected HPV tests to increase screening participation in Ghana.
在筛查覆盖率高的国家,宫颈癌筛查已使宫颈癌相关死亡率降低了70%以上。然而,在筛查服务的可及性方面存在显著的地域差异。在加纳,尽管宫颈癌是女性中第二常见的癌症,但该国没有国家级的宫颈癌筛查项目,只有2%至4%符合条件的加纳女性曾接受过宫颈癌筛查。本研究采用探索性、序贯混合方法,从女性和医护人员的角度审视宫颈癌筛查的障碍和促进因素。动态可持续性框架(DSF),特别是其中的两个领域,即实践环境和生态系统,为这些研究提供了进一步的参考。本研究招募了两个便利样本,分别为215名女性和17名医护人员。所有参与者均来自加纳阿散蒂地区选定的三家诊所之一(埃久苏政府医院、库马西南医院和孙特雷索政府医院)。描述性分析用于按实践环境对数据进行分组。均值和比例的统计差异用于评估女性进行宫颈癌筛查的障碍。对女性调查的定量结果为对医护人员的定性深入访谈提供了依据,并采用归纳主题分析法进行分析。女性和医护人员的年龄中位数分别为37.0岁和38.0岁。大多数女性(n = 194,90.2%)报告从未接受过筛查。未接受筛查的女性更有可能没有大学学历。实践环境因素包括诊所候诊时间长和距离诊所远。确定的生态系统因素包括人口特征,如对现有服务缺乏了解、接受临床医生进行盆腔检查时害羞以及在安排筛查前需要配偶的许可。这些发现凸显了在加纳需要有基于非临床医生的、对文化敏感的宫颈癌筛查选项,如自我采集的人乳头瘤病毒检测,以提高筛查参与率。