Determinants of an integrated cervical cancer screening services in primary healthcare: sharing lessons from Kisumu, Kenya
https://doi.org/10.4081/jphia.2023.1783
Submitted: 4 January 2021
Accepted: 29 August 2022
Published: 31 May 2023
Accepted: 29 August 2022
Abstract Views: 173
PDF: 137
HTML: 3
HTML: 3
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background. The successful integration of cervical cancer screening service (CCASS) into primary healthcare’s routine services depends on locality-specific and context-based service determinants.
Objective. This paper aims to identify the abovementioned determinants and discusses how health administrators can manage their influence on CCASS delivery at the primary healthcare level.
Methods. We conducted in-depth face-to-face interviews using a structured questionnaire with CCASS nurse providers and managers in four randomly selected primary health facilities. Information on the method(s) of screening utilised, the challenges faced, and the changes observed in CCASS provision were collected. Service managers were asked how they managed unplanned CCASS disruption, factors influencing CCASS replication, and aftercare support to cancer-affected women. Nurse providers were interviewed on the management of CCASS awareness and critical changes required to sustain CCASS service effectiveness. We used a constant interactive and inductive approach for data analysis.
Results. Nine thematic categories of CCASS determinants were identified: ‘cultural’, ‘socioeconomic’, ‘individual’, ‘health system’, ‘evidence-based operations’, ‘outcome-based resourcing’, ‘workflow improvement and standardisation’, ‘inclusive partner’s management’, ‘utilisation’. These determinants were grouped into three domains: ‘conceptual’, ‘outcomes’, and ‘growth’ domains, to correspond to clusters of determinants that are likely to influence the CCASS lifecycle in its formative, continuous delivery or productivity, and reproductive phases.
Conclusions. The findings show that sustaining an efficient integrated CCASS delivery at the PHC level requires phase-appropriate continuous adaptive improvements of service determinants within that locality.
References
1. Bahkali S, Househ M, Bawazir A, Khalifa M, Sheikh M. The role of primary health care in prevention, early detection, and control of cancer. InOncology: Breakthroughs in Research and Practice 2017 (pp. 660-675). IGI Global.
2. Huchko MJ, Maloba M, Nakalembe M, Cohen CR. The time has come to make cervical cancer prevention an essential part of comprehensive sexual and reproductive health services for HIV‐positive women in low‐income countries. Journal of the International AIDS Society. 2015 Dec;18:20282.
3. Moten A, Schafer D, Ferrari M. Redefining global health priorities: Improving cancer care in developing settings. Journal of global health. 2014 Jun;4(1).
4. Johnson LG, Armstrong A, Joyce CM, Teitelman AM, Buttenheim AM. Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review. Implementation Science. 2018 Dec 1;13(1):28.
5. Morema EN, Atieli HE, Onyango RO, Omondi JH, Ouma C. Determinants of cervical screening services uptake among 18–49 year old women seeking services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. BMC health services research. 2014 Dec 1;14(1):335.
6. Lott BE, Trejo MJ, Baum C, McClelland DJ, Adsul P, Madhivanan P, Carvajal S, Ernst K, Ehiri J. Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC Public Health. 2020 Dec;20:1-8.
7. Ntekim A. Cervical cancer in sub Sahara Africa. Topics on cervical cancer with an advocacy for prevention. 2012 Mar 2;4:54-9.
8. Scheirer MA. Planning evaluation through the program life cycle. American Journal of Evaluation. 2012 Jun;33(2):263-94.
9. Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC information centre on HPV and cancer (HPV information centre). Human papillomavirus and related diseases in the world. Summary report. 2019 Jan 22;22.
10. Gianino MM, Lenzi J, Bonaudo M, Fantini MP, Siliquini R, Ricciardi W, Damiani G. Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates. BMC public health. 2018 Dec 1;18(1):1236.
11. Beitin BK. Interview and sampling. The SAGE handbook of interview research: The complexity of the craft. 2012 Feb 14:243-54.
12. Lapadat JC, Lindsay AC. Transcription in research and practice: From standardization of technique to interpretive positionings. Qualitative inquiry. 1999 Mar;5(1):64-86.
13. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, Burroughs H, Jinks C. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & quantity. 2018 Jul 1;52(4):1893-907.
14. Piña IL, Cohen PD, Larson DB, Marion LN, Sills MR, Solberg LI, Zerzan J. A framework for describing health care delivery organizations and systems. American journal of public health. 2015 Apr;105(4):670-9.
15. Levano W, Miller JW, Leonard B, Bellick L, Crane BE, Kennedy SK, Haslage NM, Hammond W, Tharpe FS. Public education and targeted outreach to underserved women through the national breast and cervical cancer early detection program. Cancer. 2014 Aug 15;120(S16):2591-6.
16. Makkonen P, Heinävaara S, Sarkeala T, Anttila A. Impact of organized and opportunistic Pap testing on the risk of cervical cancer in young women–A case-control study from Finland. Gynecologic Oncology. 2017 Dec 1;147(3):601-6.
17. Adab P, McGhee SM, Yanova J, Wong CM, Hedley AJ. Effectiveness and efficiency of opportunistic cervical cancer screening: comparison with organized screening. Medical care. 2004 Jun 1:600-9.
18. Cadet TJ, Burke SL, Stewart K, Howard T, Schonberg M. Cultural and emotional determinants of cervical cancer screening among older Hispanic women. Health care for women international. 2017 Dec 2;38(12):1289-312.
19. Nene B, Jayant K, Arrossi S, Shastri S, Budukh A, Hingmire S, Muwonge R, Malvi S, Dinshaw K, Sankaranarayanan R. Determinants of women’s participation in cervical cancer screening trial, Maharashtra, India. Bulletin of the World Health Organization. 2007;85:264-72.
20. Hildesheim A, Hadjimichael O, Schwartz PE, Wheeler CM, Barnes W, Lowell DM, Willett J, Schiffman M. Risk factors for rapid-onset cervical cancer. American journal of obstetrics and gynecology. 1999 Mar 1;180(3):571-7.
21. Liebrich C, Brummer O, Von Wasielewski R, Wegener G, Meijer CJ, Iftner T, Petry KU. Primary cervical cancer truly negative for high-risk human papillomavirus is a rare but distinct entity that can affect virgins and young adolescents. European journal of gynaecological oncology. 2009;30(1):45.
22. Dyer, O. WHO links long term pill use to cervical cancer. 2002
23. Howell D, Pelton B. Advancing the quality of oncology nursing care: Interlink Community Cancer Nurses’ model for reflective practice. Canadian Oncology Nursing Journal/Revue canadienne de soins infirmiers en oncologie. 2001;11(4):182-6.
24. Ansmann L, Pfaff H. Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution: Comment on"(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare". International journal of health policy and management. 2018 Apr;7(4):349.
25. Buckley GJ, Lange JE, Peterson EA. The United States' Strategic Imperative to Invest in Health Systems. InInvesting in Global Health Systems: Sustaining Gains, Transforming Lives 2014 Sep 25. National Academies Press (US).
26. Pfeiffer J, Johnson W, Fort M, Shakow A, Hagopian A, Gloyd S, Gimbel-Sherr K. Strengthening health systems in poor countries: a code of conduct for nongovernmental organizations. American journal of public health. 2008 Dec;98(12):2134-40.
27. Regan DG, Donovan B. Balancing the cost–benefit equation for cervical cancer prevention: a moving target. The Lancet Public Health. 2016 Dec 1;1(2):e42-3.
28. Dror DM, Preker AS, editors. Social reinsurance: a new approach to sustainable community health financing. The World Bank; 2002 Sep 27.
29. Mwanahamuntu MH, Sahasrabuddhe VV, Blevins M, Kapambwe S, Shepherd BE, Chibwesha C, Pfaendler KS, Mkumba G, Vwalika B, Hicks ML, Vermund SH. Utilization of cervical cancer screening services and trends in screening positivity rates in a ‘screen-and-treat’program integrated with HIV/AIDS care in Zambia. PloS one. 2013 Sep 18;8(9):e74607.
30. Chankova S, Muchiri S, Kombe G. Health workforce attrition in the public sector in Kenya: a look at the reasons. Human resources for health. 2009 Dec 1;7(1):58.
31. Assefa T, Mariam DH, Mekonnen W, Derbew M, Enbiale W. Physician distribution and attrition in the public health sector of Ethiopia. Risk management and healthcare policy. 2016;9:285.
32. Odhiambo J, Rwabukwisi FC, Rusangwa C, Rusanganwa V, Hirschhorn LR, Nahimana E, Ngamije P, Hedt-Gauthier BL. Health worker attrition at a rural district hospital in Rwanda: a need for improved placement and retention strategies. Pan African Medical Journal. 2017;27(1).
33. Sherigar B, Dalal A, Durdi G, Pujar Y, Dhumale H. Cervical cancer screening by visual inspection with acetic acid-interobserver variability between nurse and physician. Asian Pac J Cancer Prev. 2010 Jan 1;11(3):619-22.
1. Bahkali S, Househ M, Bawazir A, Khalifa M, Sheikh M. The role of primary health care in prevention, early detection, and control of cancer. InOncology: Breakthroughs in Research and Practice 2017 (pp. 660-675). IGI Global.
2. Huchko MJ, Maloba M, Nakalembe M, Cohen CR. The time has come to make cervical cancer prevention an essential part of comprehensive sexual and reproductive health services for HIV‐positive women in low‐income countries. Journal of the International AIDS Society. 2015 Dec;18:20282.
3. Moten A, Schafer D, Ferrari M. Redefining global health priorities: Improving cancer care in developing settings. Journal of global health. 2014 Jun;4(1).
4. Johnson LG, Armstrong A, Joyce CM, Teitelman AM, Buttenheim AM. Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review. Implementation Science. 2018 Dec 1;13(1):28.
5. Morema EN, Atieli HE, Onyango RO, Omondi JH, Ouma C. Determinants of cervical screening services uptake among 18–49 year old women seeking services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. BMC health services research. 2014 Dec 1;14(1):335.
6. Lott BE, Trejo MJ, Baum C, McClelland DJ, Adsul P, Madhivanan P, Carvajal S, Ernst K, Ehiri J. Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC Public Health. 2020 Dec;20:1-8.
7. Ntekim A. Cervical cancer in sub Sahara Africa. Topics on cervical cancer with an advocacy for prevention. 2012 Mar 2;4:54-9.
8. Scheirer MA. Planning evaluation through the program life cycle. American Journal of Evaluation. 2012 Jun;33(2):263-94.
9. Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC information centre on HPV and cancer (HPV information centre). Human papillomavirus and related diseases in the world. Summary report. 2019 Jan 22;22.
10. Gianino MM, Lenzi J, Bonaudo M, Fantini MP, Siliquini R, Ricciardi W, Damiani G. Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates. BMC public health. 2018 Dec 1;18(1):1236.
11. Beitin BK. Interview and sampling. The SAGE handbook of interview research: The complexity of the craft. 2012 Feb 14:243-54.
12. Lapadat JC, Lindsay AC. Transcription in research and practice: From standardization of technique to interpretive positionings. Qualitative inquiry. 1999 Mar;5(1):64-86.
13. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, Burroughs H, Jinks C. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & quantity. 2018 Jul 1;52(4):1893-907.
14. Piña IL, Cohen PD, Larson DB, Marion LN, Sills MR, Solberg LI, Zerzan J. A framework for describing health care delivery organizations and systems. American journal of public health. 2015 Apr;105(4):670-9.
15. Levano W, Miller JW, Leonard B, Bellick L, Crane BE, Kennedy SK, Haslage NM, Hammond W, Tharpe FS. Public education and targeted outreach to underserved women through the national breast and cervical cancer early detection program. Cancer. 2014 Aug 15;120(S16):2591-6.
16. Makkonen P, Heinävaara S, Sarkeala T, Anttila A. Impact of organized and opportunistic Pap testing on the risk of cervical cancer in young women–A case-control study from Finland. Gynecologic Oncology. 2017 Dec 1;147(3):601-6.
17. Adab P, McGhee SM, Yanova J, Wong CM, Hedley AJ. Effectiveness and efficiency of opportunistic cervical cancer screening: comparison with organized screening. Medical care. 2004 Jun 1:600-9.
18. Cadet TJ, Burke SL, Stewart K, Howard T, Schonberg M. Cultural and emotional determinants of cervical cancer screening among older Hispanic women. Health care for women international. 2017 Dec 2;38(12):1289-312.
19. Nene B, Jayant K, Arrossi S, Shastri S, Budukh A, Hingmire S, Muwonge R, Malvi S, Dinshaw K, Sankaranarayanan R. Determinants of women’s participation in cervical cancer screening trial, Maharashtra, India. Bulletin of the World Health Organization. 2007;85:264-72.
20. Hildesheim A, Hadjimichael O, Schwartz PE, Wheeler CM, Barnes W, Lowell DM, Willett J, Schiffman M. Risk factors for rapid-onset cervical cancer. American journal of obstetrics and gynecology. 1999 Mar 1;180(3):571-7.
21. Liebrich C, Brummer O, Von Wasielewski R, Wegener G, Meijer CJ, Iftner T, Petry KU. Primary cervical cancer truly negative for high-risk human papillomavirus is a rare but distinct entity that can affect virgins and young adolescents. European journal of gynaecological oncology. 2009;30(1):45.
22. Dyer, O. WHO links long term pill use to cervical cancer. 2002
23. Howell D, Pelton B. Advancing the quality of oncology nursing care: Interlink Community Cancer Nurses’ model for reflective practice. Canadian Oncology Nursing Journal/Revue canadienne de soins infirmiers en oncologie. 2001;11(4):182-6.
24. Ansmann L, Pfaff H. Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution: Comment on"(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare". International journal of health policy and management. 2018 Apr;7(4):349.
25. Buckley GJ, Lange JE, Peterson EA. The United States' Strategic Imperative to Invest in Health Systems. InInvesting in Global Health Systems: Sustaining Gains, Transforming Lives 2014 Sep 25. National Academies Press (US).
26. Pfeiffer J, Johnson W, Fort M, Shakow A, Hagopian A, Gloyd S, Gimbel-Sherr K. Strengthening health systems in poor countries: a code of conduct for nongovernmental organizations. American journal of public health. 2008 Dec;98(12):2134-40.
27. Regan DG, Donovan B. Balancing the cost–benefit equation for cervical cancer prevention: a moving target. The Lancet Public Health. 2016 Dec 1;1(2):e42-3.
28. Dror DM, Preker AS, editors. Social reinsurance: a new approach to sustainable community health financing. The World Bank; 2002 Sep 27.
29. Mwanahamuntu MH, Sahasrabuddhe VV, Blevins M, Kapambwe S, Shepherd BE, Chibwesha C, Pfaendler KS, Mkumba G, Vwalika B, Hicks ML, Vermund SH. Utilization of cervical cancer screening services and trends in screening positivity rates in a ‘screen-and-treat’program integrated with HIV/AIDS care in Zambia. PloS one. 2013 Sep 18;8(9):e74607.
30. Chankova S, Muchiri S, Kombe G. Health workforce attrition in the public sector in Kenya: a look at the reasons. Human resources for health. 2009 Dec 1;7(1):58.
31. Assefa T, Mariam DH, Mekonnen W, Derbew M, Enbiale W. Physician distribution and attrition in the public health sector of Ethiopia. Risk management and healthcare policy. 2016;9:285.
32. Odhiambo J, Rwabukwisi FC, Rusangwa C, Rusanganwa V, Hirschhorn LR, Nahimana E, Ngamije P, Hedt-Gauthier BL. Health worker attrition at a rural district hospital in Rwanda: a need for improved placement and retention strategies. Pan African Medical Journal. 2017;27(1).
33. Sherigar B, Dalal A, Durdi G, Pujar Y, Dhumale H. Cervical cancer screening by visual inspection with acetic acid-interobserver variability between nurse and physician. Asian Pac J Cancer Prev. 2010 Jan 1;11(3):619-22.
Akpan, E., Abinya, N., Odhiambo, E., & Ekpo, E. U. (2023). Determinants of an integrated cervical cancer screening services in primary healthcare: sharing lessons from Kisumu, Kenya. Journal of Public Health in Africa, 14(4). https://doi.org/10.4081/jphia.2023.1783
Copyright (c) 2023 the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Downloads
Download data is not yet available.
Citations
