To be screened or not to be screened: a community-based exploration of cervical cancer screening barriers, facilitators, and preferences in Ethiopia

Abstract Background Cervical cancer is a common cancer among women worldwide. While preventable and treatable, its incidence is high in Ethiopia, where only 1 out of every 7 age-eligible women have been screened in their lifetime. Systemic barriers to healthcare and inequities in social determinants of health must be addressed to achieve screening coverage. Understanding the specific factors affecting women’s access and decision to be screened can inform healthcare service delivery that is responsive to the local context and population needs to increase reach, feasibility, and appropriateness of cervical cancer screening. Purpose This study aims to identify, rank, and qualitatively describe self-reported factors that influence Ethiopian women’s cervical cancer decision-making and care-seeking behaviors. Participants and methods Focus group discussions were conducted with women living with and without HIV ( n  = 25 each) in Adama, Ethiopia. Embedded within the discussions, an item ranking activity generated dialogue about how various factors influenced screening behavior and participant-driven suggestions for overcoming barriers. Composite salience values (csv) were calculated (range 0 to 1) to determine top-rank factors from most (csv = 1) to least important (csv = 0) across discussions. Qualitative analysis used these factors to perform deductive coding of the interview transcripts and to contextualize the findings with narrative synthesis and direct participant quotes. Results Participants were 18 to 60 years old (mean age: 34 years) with varied lived experiences in terms of education, religion, marital status, and health status. Participants listed 14–19 different factors related to cervical cancer screening decision and behavior in each of four focus groups (mean: 16.25). Nine determinants emerged as the most salient between groups: socioeconomic status (csv = 0.825); awareness (csv = 0.75); commitment/motivation (csv = 0.55); distance to screening (csv = 0.475); age (csv = 0.475); fear of results/cancer (csv = 0.475); addiction (csv = 0.425); service availability (csv = 0.40); and fear of the screening procedure (csv = 0.325). Conclusion This study described what women perceived as influential barriers and facilitators to receipt of preventive cervical cancer screening. Addressing low cervical cancer awareness through community-centered education, with a focus on fears, misconceptions, stigma, and self-efficacy to screen while simultaneously addressing structural barriers like transportation, cost, and clinic hours are concurrently needed to increase uptake of preventive screening.