Choi Hanul, Dion Haley, Huang Michelle, Sathyan Laya, Herfel Emily, Makhulo Breandan, Ambaka Jeniffer, Huchko Megan J
Center for Global Reproductive Health, Duke University Global Health Institute, Durham, North Carolina, USA
Center for Global Reproductive Health, Duke University Global Health Institute, Durham, North Carolina, USA.
BMJ Glob Health. 2025 May 6;10(5):e017616. doi: 10.1136/bmjgh-2024-017616.
Human papillomavirus (HPV) is the leading source of cervical cancer in Kenya. HPV, like other sexually transmitted infections, is stigmatised, which hinders efforts to address the disease. Education and empowerment are crucial in combating HPV stigma and increasing screening uptake. We conducted qualitative analyses of a video-assisted HPV educational intervention in Kisumu, Kenya to determine its impact on women's knowledge, motivation and behaviour for HPV and cervical cancer prevention. The stigma-responsive video featured a group discussion with an individual describing her experience with HPV, self-testing and preventive treatment.
Three focus group discussions (FGDs) were conducted with 10 women, respectively, ages 30-64, from three intervention clinics, to explore their experience with the video-assisted education, perspectives on HPV and self-sampling, and the feasibility of peer-led education to increase screening and follow-up. The initial codebook was developed prior to the FGDs using an Information-Motivation-Behavioral (IMB) Skills model framework, followed by a rapid analysis to identify missing themes. We conducted qualitative coding using NVivo V.12. The IMB Skills model was used to analyse the codes and findings from the FGDs to assess the impact of the education.
Women in FGDs identified the lack of community-level knowledge on HPV and the stigma and fear of physical pain from pelvic examination as barriers to HPV screening. Many participants mentioned that the knowledge gained through the video reduced their stigma and fear, and it motivated them to screen. Participants demonstrated behavioural change through self-sampling uptake, community empowerment and referral to watch the video.
From the FGDs, we found the direct mechanism linking information, motivation and screening behaviour in our video-assisted HPV educational intervention. The intervention improved women's self-reported HPV-related knowledge and increased their motivation for self-sampling and engagement in preventive behaviours. We recommend scaling up the intervention by bringing the video-assisted education to more clinics in Kisumu.
人乳头瘤病毒（HPV）是肯尼亚宫颈癌的主要病因。与其他性传播感染一样，HPV也受到污名化，这阻碍了应对该疾病的努力。教育和赋权对于消除HPV污名化和提高筛查接受率至关重要。我们对肯尼亚基苏木的一项视频辅助HPV教育干预措施进行了定性分析，以确定其对女性预防HPV和宫颈癌的知识、动机及行为的影响。这部应对污名化的视频展示了一场小组讨论，其中一名个体讲述了她感染HPV的经历、自我检测及预防性治疗情况。
分别与来自三个干预诊所的10名年龄在30至64岁之间的女性进行了三场焦点小组讨论（FGD），以探讨她们对视频辅助教育的体验、对HPV和自我采样的看法，以及同伴主导教育在增加筛查和后续跟进方面的可行性。初始编码手册是在焦点小组讨论之前使用信息-动机-行为（IMB）技能模型框架编制的，随后进行快速分析以识别缺失的主题。我们使用NVivo V.12进行定性编码。IMB技能模型用于分析焦点小组讨论的编码和结果，以评估教育的影响。
焦点小组讨论中的女性指出，社区层面缺乏对HPV的了解以及污名化和对盆腔检查身体疼痛的恐惧是HPV筛查的障碍。许多参与者提到，通过视频获得的知识减轻了她们的污名化和恐惧，并促使她们进行筛查。参与者通过自我采样、社区赋权和推荐观看视频表现出行为改变。
通过焦点小组讨论，我们在视频辅助HPV教育干预措施中发现了将信息、动机和筛查行为联系起来的直接机制。该干预措施提高了女性自我报告的与HPV相关的知识，并增加了她们自我采样和参与预防行为的动机。我们建议扩大干预规模，将视频辅助教育推广到基苏木更多的诊所。
