ArticleWomen's health (London, England)
Navigating realities: Client and provider perspectives on cervical cancer screening services in rural Uganda: A convergent mixed-methods study.
Article in Women's health (London, England). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BackgroundCervical cancer is the leading cause of cancer-related mortality among women in Uganda, with national screening coverage critically low at 20.6%. The disease is largely preventable through early detection, yet client-level and health-system failures conspire to suppress uptake.ObjectivesTo integrate client and provider perspectives to construct a comprehensive explanatory model of barriers to cervical cancer screening uptake in Hoima district, rural Uganda.DesignA convergent mixed-methods design, with quantitative and qualitative data collected concurrently across 20 health facilities and integrated through systematic triangulation.MethodsThe quantitative component recruited 400 women aged 20-60 years through systematic random sampling, analysed using binary logistic regression. The qualitative component recruited 30 health workers for key informant interviews, analysed using Braun and Clarke's thematic analysis framework. Reporting conforms to STROBE and COREQ guidelines.ResultsOnly 3.0% of women (n = 12/400) reported ever undergoing screening. Three significant determinants of uptake were identified: awareness of screening importance (AOR = 7.34, 95% CI: 2.41-22.37, p = 0.021); unmarried marital status (AOR = 8.69, 95% CI: 1.85-40.82, p = 0.006); and student occupation (AOR = 6.92, 95% CI: 1.51-31.81, p < 0.05). Wide confidence intervals reflect the small number of screened women. Qualitative analysis identified five supply-side themes: extreme centralisation of services; near-universal lack of trained personnel (96.7% untrained); absence of essential equipment; variable health worker knowledge; and workload-related resistance to expansion. Triangulation revealed strong convergence: the supply-side training deficit directly explains the demand-side knowledge gap. Apparent dissonance around cost was resolved by recognising that indirect access costs represent the true financial barrier for rural women.ConclusionLow screening uptake reflects a self-reinforcing cycle of structural weakness and uninformed community demand. Effective intervention requires simultaneously strengthening health system capacity and stimulating demand through targeted health education via preferred channels, notably radio and churches.
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