Moucheraud Corrina, Chibaka Symon, Golub Ginger, Kalande Pericles, Makwaya Amos, Ochieng Eric, Ogutu Vitalis, Phiri Khumbo, Phiri Sam, Hoffman Risa M
School of Global Public Health, New York University, New York, USA.
Children in the Wilderness, Lilongwe, Malawi.
BMC Public Health. 2025 May 27;25(1):1956. doi: 10.1186/s12889-025-23143-y.
Cervical cancer screening is an essential public health intervention, and critical to meeting the Global Strategy for Cervical Cancer Elimination goals - yet most women in low- and middle-income countries are never screened. There is a need to understand context-specific factors that facilitate or prevent women from engaging in screening.
This analysis leverages data collected in 2022-2023 from a national mobile phone-based survey in Kenya and from a household survey conducted in three districts of Malawi. Informed by the Health Belief Model, we assess whether women's reported cervical cancer screening history (ever or never screened) was associated with their perceived susceptibility (awareness of cervical cancer risk factors), perceived severity (knowing someone who was affected by cervical cancer), perceived barriers (access to services), perceived benefits (trust in information about cervical cancer prevention), self-efficacy (engagement in other preventive health behaviors), and cues to action (speaking with others about cervical cancer prevention).
Ever-screening for cervical cancer was reported by 49.7% of the 736 Kenyan respondents and 42.5% of the 261 Malawian respondents. There were few associations between women's demographic or socioeconomic characteristics and screening history. The strongest associations were seen for cues to action (women who had spoken about cervical cancer with health workers had 1.88 the adjusted risk ratio for screening in Kenya [95% CI 1.59, 2.24] and 1.89 the adjusted risk in Malawi [95% CI 1.41, 2.54] compared to women who never had these conversations); and for knowing someone who had, or who had died due to, cervical cancer (aRR 1.34 and 1.30 respectively in Kenya, and aRR 2.03 and 1.46 respectively in Malawi). In both countries, self-efficacy was also associated with screening, as was perceived severity in both countries (i.e., knowing someone who had, or who had died due to cervical cancer, which was reported by many Kenyan and Malawian respondents). In Kenya, knowledge of cervical cancer risk factors was also associated with women's screening history, as was access to other preventive health services in Malawi.
These results suggest promising areas for interventions aiming to increase cervical cancer screening in these contexts: encouraging health workers to discuss screening with eligible women, leveraging women's peers who have been affected by cervical cancer, and promoting screening during other preventive health services.
宫颈癌筛查是一项重要的公共卫生干预措施，对于实现消除宫颈癌全球战略目标至关重要——然而，低收入和中等收入国家的大多数女性从未接受过筛查。有必要了解促进或阻碍女性参与筛查的特定背景因素。
本分析利用了2022 - 2023年从肯尼亚一项基于手机的全国性调查以及在马拉维三个地区进行的一项家庭调查中收集的数据。依据健康信念模型，我们评估女性报告的宫颈癌筛查史（曾接受筛查或从未接受筛查）是否与她们感知到的易感性（对宫颈癌危险因素的知晓）、感知到的严重性（认识受宫颈癌影响的人）、感知到的障碍（获得服务的机会）、感知到的益处（对宫颈癌预防信息的信任）、自我效能感（参与其他预防性健康行为）以及行动提示（与他人谈论宫颈癌预防）相关。
736名肯尼亚受访者中有49.7%报告曾接受宫颈癌筛查，261名马拉维受访者中有42.5%报告曾接受筛查。女性的人口统计学或社会经济特征与筛查史之间几乎没有关联。最强的关联出现在行动提示方面（与从未进行过此类对话的女性相比，与医护人员谈论过宫颈癌的女性在肯尼亚的调整风险比为1.88 [95%置信区间1.59, 2.24]，在马拉维的调整风险为1.89 [95%置信区间1.41, 2.54]）；以及认识患有宫颈癌或因宫颈癌去世的人（在肯尼亚的调整风险比分别为1.34和1.30，在马拉维分别为2.03和1.46）。在这两个国家，自我效能感也与筛查相关，两国的感知严重性也与筛查相关（即认识患有宫颈癌或因宫颈癌去世的人，许多肯尼亚和马拉维受访者都报告了这一点）。在肯尼亚，对宫颈癌危险因素的了解也与女性的筛查史相关，在马拉维，获得其他预防性健康服务的机会也与筛查史相关。
这些结果表明，在这些背景下，旨在增加宫颈癌筛查的干预措施有一些有前景的领域：鼓励医护人员与符合条件的女性讨论筛查，利用受宫颈癌影响的女性同伴，并在其他预防性健康服务期间推广筛查。
