Barriers and facilitators in access to cervical cancer secondary prevention in Cochabamba, Bolivia: a qualitative study of healthcare providers' perceptions.

backgroundDespite the availability of cervical cancer (CC) screening in Bolivia, coverage remains low and uneven across municipalities. This suggests the presence of barriers to effective secondary prevention, which involves early detection through screening and treatment of precancerous lesions. There is limited research on the perceptions of healthcare providers (HCPs) regarding the challenges that women in Bolivia face when accessing CC secondary prevention. This study therefore explored HCPs' perceptions of barriers and facilitators for women's access to CC secondary prevention in Cochabamba, Bolivia.

methodsQualitative interviews were conducted with 30 HCPs working in CC secondary prevention, including gynaecologists, general practitioners, nurses, and auxiliary nurses. The interviews were analysed using reflexive thematic analysis. Levesque's access to healthcare framework informed the study design, and the socio-ecological model was used to discuss the findings across multiple levels.

resultsHCPs perceived numerous barriers and limited facilitators in access to CC secondary prevention at different levels. Barriers at the individual level included information gaps among women. Incentive-based campaigns were used to increase screening, but these did not address the actual treatment barriers or root causes. At the interpersonal-community level, barriers included family-transferred misconceptions, gender norms, and women's fear of intimate partner violence if attending screening. Facilitators included the use of the Quechua language during healthcare encounters, and material incentives to encourage attendance. Barriers at the organizational-structural level included a lack of clarity regarding which women should be screened and how often, the concentration of centralized cytology services in a single laboratory, unclear responsibilities among staff for sample collection and result delivery, and bureaucratic and administrative barriers that limited access to screening and timely results. These barriers led to long waiting times, generating mistrust and reluctance to engage with CC screening.

conclusionsHCPs perceive barriers to CC secondary prevention at the individual, community, and organizational levels, including women's lack of information, family-driven misconceptions, gender norms, unclear screening guidelines, centralized cytology services, and bureaucratic delays that erode trust. Facilitators include the use of Quechua language during care and material incentives to encourage screening attendance; however, these do not address treatment barriers or structural causes.