Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study
Open accessAbstract
BACKGROUND: Despite cervical cancer being preventable with effective screening programs, it is the most common cancer and the leading cause of cancer-related death among women in many countries in Africa. Screening involving pelvic examination may not be feasible or acceptable in limited-resource settings. We sought to evaluate women's perspectives on human papillomavirus (HPV) self-sampling as part of a larger trial on cervical cancer prevention implementation strategies in rural western Kenya. METHODS: We invited 120 women participating in a cluster randomized trial of cervical cancer screening implementation strategies in Migori County, Kenya for in-depth interviews. We explored reasons for testing, experience with and ability to complete HPV self-sampling, importance of clinician involvement during screening, factors and people contributing to screening decision-making, and ways to encourage other women to come for screening. We used validated theoretical frameworks to analyze the qualitative data. RESULTS: Women reported having positive experiences with the HPV self-sampling strategy. The factors facilitating uptake included knowledge and beliefs such as prior awareness of HPV, personal perception of cervical cancer risk, desire for improved health outcomes, and peer and partner encouragement. Logistical and screening facilitators included confidence in the ability to complete HPV self-sampling strategy, proximity to screening sites and feelings of privacy and comfort conducting the HPV self- sampling. The barriers to screening included fear of need for a pelvic exam, fear of disease and death associated with cervical cancer. We classified these findings as capabilities, opportunities and motivations for health behavior using the COM-B framework. CONCLUSIONS: Overall, HPV self-sampling was an acceptable cervical cancer screening strategy that seemed to meet the needs of the women in this community. These findings will further inform aspects of implementation, including outreach messaging, health education, screening sites and emphasis on availability and effectiveness of preventative treatment for women who screen positive.
AI snapshot
Written from the paper’s full text.
TL;DR
In rural western Kenya, women who participated in a community-based HPV self-sampling campaign reported positive experiences and found self-sampling acceptable, with privacy and avoidance of pelvic exam as key advantages. Using TDF/COM-B, facilitators included awareness, perceived risk, peer/partner support, confidence, and proximity, while barriers included fear of pelvic exam, stigma, and fear of disease/death.
Key findings
- Of 120 women interviewed, mean age was 36.1 years (SD 9.55); 59.4% had up to primary education; 78% were married; median children was 4 (IQR 3–5); 16% reported prior cervical cancer screening (Table 2 reports 16/80 with data, 20.0%).
- Most women reported confidence completing HPV self-sampling and positive experiences; self-sampling eliminated embarrassment and fear from pelvic exam and was valued for privacy and comfort.
- Facilitators mapped to COM-B included awareness/acceptability of HPV self-sampling, personal perception of cervical cancer risk, desire for improved health outcomes, peer and partner encouragement, confidence in self-sampling, proximity to screening sites, and privacy/comfort.
- Barriers included fear of pelvic exam, social stigma associated with cervical cancer, and fear of disease and death; some women wanted clinician involvement for information or treatment, but no women preferred clinicians to perform screening via pelvic exam.
Methods
- Qualitative sub-study within a cluster-randomized trial comparing community-based HPV testing implementation strategies in Migori County, Kenya, between January and September 2016; the parent study enrolled women aged 25–65 years.
- Purposive sample of 120 women participating in the parent trial, with 10 participants recruited from each of 12 study communities; face-to-face in-depth interviews lasted approximately 20–30 minutes after self-sampling, with the guide translated into Luo and Kiswahili and back-translated into English.
- Theoretical thematic analysis using the Theoretical Domains Framework mapped to the COM-B framework; codebook developed from five transcripts, coding in NVivo10 by five research team members with two coders per transcript.
Limitations
- Stated: the study included only women who had already self-sampled for HPV, so it lacks perspectives of women who did not participate, who may better articulate barriers to self-sampling.
- Stated: the population had high HIV prevalence and a strong response to the HIV epidemic, which may have exposed women to prior research and health interventions that influenced health beliefs and behaviors, limiting generalizability to other rural populations.
- Evident: quantitative data were missing for 3 participants, and findings rely on self-reported interview accounts without provider or male partner perspectives.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
33 of 58 cited sources checked · 18 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Only a few studies have provided self-sampling in community settings.
“Though other studies have compared HPV collection through clinician versus self-sampling [18] only a few studies have provided self-sampling in community settings [15, 19]”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [15] Crosby RA, Hagensee ME, Vanderpool R, Nelson N, Parrish A, Collins T. Community-based screening for cervical cancer: A feasibility study of rural Appalachian women. Sexually Transmitted Dis. 2015;42:607. source
- cites [19] Ogilvie GS, Mitchell S, Sekikubo M, Biryabarema C, Byamugisha J, Jeronimo J, et al. Results of a community-based cervical cancer screening pilot project using human papillomavirus self-sampling in Kampala, Uganda. Int J Gynaecol Obstet. 2013;122:118–23. https://doi.org/10.1016/j.ijgo.2013.03.019 . source
- Premisecitation
Studies have confirmed high acceptability of HPV self-sampling in different settings.
“Studies have confirmed a high acceptability to HPV self-sampling in different settings [15, 18, 19].”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [15] Crosby RA, Hagensee ME, Vanderpool R, Nelson N, Parrish A, Collins T. Community-based screening for cervical cancer: A feasibility study of rural Appalachian women. Sexually Transmitted Dis. 2015;42:607. source
- cites [18] Bansil, Pooja and Wittet, Scott and Lim, Jeanette L and Winkler, Jennifer L and Paul, Proma and Jeronimo J. Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach. BMC Public Health 2014;14:596. source
- cites [19] Ogilvie GS, Mitchell S, Sekikubo M, Biryabarema C, Byamugisha J, Jeronimo J, et al. Results of a community-based cervical cancer screening pilot project using human papillomavirus self-sampling in Kampala, Uganda. Int J Gynaecol Obstet. 2013;122:118–23. https://doi.org/10.1016/j.ijgo.2013.03.019 . source
- Premisecitation
HPV self-sampling acceptability has not been studied in rural western Kenya, a low-resource setting with limited access to health facilities and multiple barriers to pelvic exams.
“This has not been studied in rural western Kenya, a low-resource setting with limited access to health facilities and multiple barriers to pelvic exams that could be avoided in a community based self-sampling strategy [20].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [20] Rosser JI, Hamisi S, Njoroge B, Huchko MJ. Barriers to cervical cancer screening in rural Kenya: perspectives from a provider survey. J Community Health. 2015;40:756–61. source
The Introduction describes poor access to screening services in resource-limited settings, and the Results (Perception of Patient Barriers; page unavailable) report that providers in rural western Kenya identified distance from facilities and fear of pain with the speculum exam as perceived barriers. The paper does not assess HPV self-sampling acceptability or establish that community-based self-sampling would avoid those barriers; its Discussion notes that patient barriers were reported by providers, not patients. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Interpretationcitation
The finding on pelvic exam as a barrier to screening is consistent with other studies done in Africa and Asia which showed concerns around speculum use, embarrassment, and reluctance to have a male provider perform the exam.
“The findings on pelvic exam as a barrier to screening is consistent with other studies done in Africa and Asia [18, 19, 33–35] which showed concerns around speculum use, embarrassment, and reluctance to have a male provider perform the exam [37–39].”
Quote in the paperNot a substantial claim7 of 8 sources checked- cites [18] Bansil, Pooja and Wittet, Scott and Lim, Jeanette L and Winkler, Jennifer L and Paul, Proma and Jeronimo J. Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach. BMC Public Health 2014;14:596. source
- cites [19] Ogilvie GS, Mitchell S, Sekikubo M, Biryabarema C, Byamugisha J, Jeronimo J, et al. Results of a community-based cervical cancer screening pilot project using human papillomavirus self-sampling in Kampala, Uganda. Int J Gynaecol Obstet. 2013;122:118–23. https://doi.org/10.1016/j.ijgo.2013.03.019 . source
- cites [33] Gottschlich A, Rivera-Andrade A, Grajeda E, Alvarez C, Mendoza Montano C, Meza R. Acceptability of human papillomavirus self-sampling for cervical Cancer screening in an indigenous Community in Guatemala. Journal Global Oncol. 2017;3:444–54. source
The Results (Self-Collection Acceptability; page unavailable) report that most participants preferred screening at home to screening by a physician. Our copy does not say why: searches for speculum use, embarrassment, and reluctance to see a male provider found no passage addressing those concerns. The Discussion’s comparison with studies in Africa and Asia concerns acceptance of self-screening, not those specific barriers. (LLM, conf=0.72)
Experimental — accuracy not yet measured - cites [34] Senkomago V, Saraiya M. Examining acceptability of self-collection for human papillomavirus testing among women and healthcare providers with a broader lens. J Women’s Health. 2017;26. https://doi.org/10.1089/jwh.2017.6384 . source
The editorial’s main text (page unavailable) reports that HPV self-collection was acceptable in studies in India and Uganda and was preferred to routine Pap testing in a Seattle study. It does not address pelvic exams as a screening barrier or report concerns about speculum use, embarrassment, or male providers. Searches for those terms found no supporting passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [35] Oranratanaphan S, Termrungruanglert W, Khemapech N. Acceptability of self-sampling HPV testing among Thai women for cervical Cancer screening. Asian Pac J Cancer Prev. 2014;15:7437–41. https://doi.org/10.7314/APJCP.2014.15.17.7437 . source
The Introduction and Discussion describe embarrassment and fear of pain from speculum examination as reasons Thai women avoid Pap screening. They do not address reluctance to have a male provider perform the examination; the paper also does not establish the claimed pattern across both Africa and Asia. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [37] Buchanan Lunsford N, Ragan K, Lee Smith J, Saraiya M, Aketch M. Environmental and psychosocial barriers to and benefits of cervical Cancer screening in Kenya. Oncologist. 2017;22:173–81. https://doi.org/10.1634/theoncologist.2016-0213 . source
- cites [38] Arrossi S, Ramos S, Straw C, Thouyaret L, Orellana L. HPV testing: a mixed-method approach to understand why women prefer self-collection in a middle-income country. BMC Public Health. 2016;16:832. source
The Results section reports that women valued self-collection because it avoided shame and embarrassment associated with Pap tests, particularly when the gynecologist was male. The paper studies women in Argentina; the cited passages do not establish findings from Africa or Asia or report a specific concern about speculum use. No page number is available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [39] Lim JNW, Ojo AA. Barriers to utilisation of cervical cancer screening in sub Sahara Africa: a systematic review. European J Cancer Care. 2017;26:e12444. source
The Modesty section reports that embarrassment, undressing, and having a male caregiver can deter cervical screening; the Stigma and shame of disease section links embarrassment to pelvic examinations. The review does not identify concern about speculum use as a barrier, and its findings concern sub-Saharan Africa rather than Asia. (LLM, conf=0.85)
Experimental — accuracy not yet measured
- Premisecitation
HPV self-sampling has been found to improve screening uptake.
“Also, HPV self-sampling has been found to improve screening uptake [36].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [36] Sarai Racey C, Withrow DR, Gesink D. Self-collected HPV testing improves participation in cervical Cancer screening: a systematic review and meta-analysis. Canadian J Public Health. 2013;104:e159–66. source
- Interpretationcitation
The stigma finding concurs with other studies which have also found that having pre cancer or cervical cancer has been stigmatized with women fearing being "talked" about or facing discrimination.
“it concurs with other studies which have also found that having pre cancer or cervical cancer has been stigmatized with women fearing being “talked” about or facing discrimination [37, 39].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [37] Buchanan Lunsford N, Ragan K, Lee Smith J, Saraiya M, Aketch M. Environmental and psychosocial barriers to and benefits of cervical Cancer screening in Kenya. Oncologist. 2017;22:173–81. https://doi.org/10.1634/theoncologist.2016-0213 . source
The Results (Stigma) report that participants saw being “talked about” or “discriminated against” as barriers to cervical cancer screening. The Discussion also links a positive cervical cancer result to feared stigma, but our copy does not specifically establish stigma associated with having precancer. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [39] Lim JNW, Ojo AA. Barriers to utilisation of cervical cancer screening in sub Sahara Africa: a systematic review. European J Cancer Care. 2017;26:e12444. source
The ‘Stigma and shame of disease’ section reports fear of societal rejection and ostracism after disclosure of early symptoms, supporting the claim about feared discrimination. It discusses stigma chiefly around cervical screening and symptom disclosure, however, rather than specifically establishing stigma from having precancer or cervical cancer. Page number is unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Interpretationcitation
The finding that women in rural western Kenya had positive expectations of and personal experiences with HPV self-sampling is consistent with other studies done in Africa and Asia.
“which is consistent to other studies done in Africa and Asia [18, 19, 33–35].”
Quote in the paperNot a substantial claim4 of 5 sources checked- cites [18] Bansil, Pooja and Wittet, Scott and Lim, Jeanette L and Winkler, Jennifer L and Paul, Proma and Jeronimo J. Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach. BMC Public Health 2014;14:596. source
- cites [19] Ogilvie GS, Mitchell S, Sekikubo M, Biryabarema C, Byamugisha J, Jeronimo J, et al. Results of a community-based cervical cancer screening pilot project using human papillomavirus self-sampling in Kampala, Uganda. Int J Gynaecol Obstet. 2013;122:118–23. https://doi.org/10.1016/j.ijgo.2013.03.019 . source
- cites [33] Gottschlich A, Rivera-Andrade A, Grajeda E, Alvarez C, Mendoza Montano C, Meza R. Acceptability of human papillomavirus self-sampling for cervical Cancer screening in an indigenous Community in Guatemala. Journal Global Oncol. 2017;3:444–54. source
The Discussion reports high acceptability and positive experiences with HPV self-collection, and says its results are consistent with previous studies in Asia and Africa. But this source’s own study was conducted in Guatemala, not Africa or Asia; it also does not assess women in rural western Kenya. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [34] Senkomago V, Saraiya M. Examining acceptability of self-collection for human papillomavirus testing among women and healthcare providers with a broader lens. J Women’s Health. 2017;26. https://doi.org/10.1089/jwh.2017.6384 . source
- cites [35] Oranratanaphan S, Termrungruanglert W, Khemapech N. Acceptability of self-sampling HPV testing among Thai women for cervical Cancer screening. Asian Pac J Cancer Prev. 2014;15:7437–41. https://doi.org/10.7314/APJCP.2014.15.17.7437 . source
- Findingown data
Other women mentioned the role their male spouses played, which included encouragement and support to get screened.
“Other women mentioned the role their male spouses played which included encouragement and support to get screened.”
Quote in the paperNot a substantial claim - Findingown data
A number of women recounted how their peers shared their self-sampling experience which encouraged them to get screened.
“A number of women recounted how their peers shared their self-sampling experience which encouraged them to get screened.”
Quote in the paperNot a substantial claim - Findingown data
There was an indication of stigma where some women feared being associated with having the disease.
“There was an indication of stigma where some women feared being associated with having the disease.”
Quote in the paperNot a substantial claim - Findingown data
The majority of women appreciated that HPV screening services were brought closer to them through community outreach and nearby health centers, which facilitated their ability to access HPV self-sampling.
“The majority of women appreciated the fact that the HPV screening services were brought closer to them through community outreach and in the nearby health centers which facilitated their ability to access HPV self-sampling.”
Quote in the paperSubstantial claim - Findingown data
There was a feeling of embarrassment if male providers offered screening through a pelvic exam.
“There was also the feeling of embarrassment if male providers offered screening through a pelvic exam.”
Quote in the paperSubstantial claim - Findingown data
No women preferred clinicians to provide screening via pelvic exam.
“We did not find any women who preferred clinicians to provide screening via pelvic exam.”
Quote in the paperNot a substantial claim - Findingown data
A majority of women reported that long distance travel may be a barrier due to high travel costs and travel time away from home and chores.
“A majority of women reported that long distance travel may be a barrier due to high travel costs and travel time away from home and chores.”
Quote in the paperSubstantial claim - Findingown data
When asked whether women would be able to complete the testing, there were almost uniform responses of confidence.
“When asked whether women would be able to complete the testing, we had almost uniform responses of confidence.”
Quote in the paperSubstantial claim - Findingown data
Some women felt that the privacy allowed with self-sampling afforded them agency.
“Others felt that the privacy allowed with self-sampling afforded them agency.”
Quote in the paperNot a substantial claim - Findingown data
Fear of cervical cancer screening was reflected when women mentioned they would feel pain from the pelvic exam procedure, which acted as a possible barrier to screening.
“Fear of cervical cancer screening was reflected when women mentioned that they would feel pain from the pelvic exam procedure which acted as a possible barrier to screening.”
Quote in the paperSubstantial claim - Findingown data
Women cited peer and partner encouragement as influential in their decision making process.
“Women cited peer and partner encouragement as influential in their decision making process, which shows the significance of these support systems to screening.”
Quote in the paperNot a substantial claim - Findingown data
The majority of women mentioned both their own volition and an awareness of self-sampling availability in screening decision making.
“The majority of women mentioned both their own volition and an awareness of self-sampling availability in screening decision making.”
Quote in the paperNot a substantial claim - Findingown data
Women who expressed a desire for clinicians felt their role would be to provide additional information about screening and results, and be available for treatment after a HPV positive screen test.
“The women who expressed a desire for clinicians felt their role would be to provide any additional information about screening and results, and be available for treatment after a HPV positive screen test.”
Quote in the paperNot a substantial claim - Findingown data
Health system factors such as access and proximity to care were identified as barriers to conventional screening.
“Health system factors such as access and proximity to care were also identified as barriers to conventional screening”
Quote in the paperSubstantial claim - Findingown data
Stigma around HPV and cervical cancer was not a frequent finding.
“While this was not a frequent finding”
Quote in the paperNot a substantial claim - Findingown data
HPV self-sampling compared favorably to prior experience with or beliefs about pelvic exams.
“which compared favorably to prior experience with or beliefs about pelvic exams”
Quote in the paperSubstantial claim - Findingown data
Some women in the study mentioned fear of disease and death if they do not get early screening, which encouraged them to get screened to know their HPV test results so as to seek treatment in time.
“Some women mentioned fear of disease and death if they do not get early screening, so this encouraged women to get screened to know their HPV test results so as to be able to seek treatment in time”
Quote in the paperNot a substantial claim - Findingown data
Women in the study reported that their reason for HPV self-sampling was to improve their health outcome by taking necessary steps based on the test result.
“Women reported that their reason for HPV self-sampling was to improve their health outcome by taking necessary steps based on the test result”
Quote in the paperNot a substantial claim - Findingcitation
The domain on belief about consequences also reflected the women's motivation construct that highlight barriers to HPV screening which include the fear of disease and death.
“The domain on belief about consequences also reflected the women’s motivation construct that highlight barriers to HPV screening which include the fear of disease and death”
Quote in the paperNot a substantial claim - Findingown data
Women reported having positive experiences with the HPV self-sampling strategy.
“Women reported having positive experiences with the HPV self-sampling strategy.”
Quote in the paperSubstantial claim - Findingown data
Women in the study reported that cervical cancer screening using an exam-based method elicited a number of barriers that were not part of HPV self-screening.
“Women reported that cervical cancer screening using an exam-based method elicited a number of barriers that were not part of HPV self-screening.”
Quote in the paperSubstantial claim - Findingown data
Most women in the study reported that HPV self-sampling eliminated the embarrassment and fear they had from pelvic exam by a clinician.
“Most women reiterated that self-sampling eliminated the embarrassment and fear they had from pelvic exam by a clinician”
Quote in the paperSubstantial claim - Findingown data
Some women in the study stated that education played a role in their understanding of screening in improving their health outcome.
“Some women stated the role the education played in their understanding of screening in improving their health outcome”
Quote in the paperNot a substantial claim - Findingown data
The study identified some areas of stigma around HPV and cervical cancer.
“We also identified some areas of stigma around HPV and cervical cancer.”
Quote in the paperSubstantial claim - Findingown data
Most women in the study were aware that early HPV screening would prevent disease progression.
“and that early HPV screening would prevent disease progression.”
Quote in the paperNot a substantial claim - Findingown data
Women in the study reported having a positive experience conducting HPV self-sampling compared to previous testing with a pelvic exam.
“reported having a positive experience conducting the self-sampling compared to previous testing with a pelvic exam.”
Quote in the paperSubstantial claim - Findingown data
Most women in the study were aware that they were susceptible to cervical cancer.
“Most of the women were aware of the fact that they were susceptible to cervical cancer”
Quote in the paperNot a substantial claim - Study design and conductcitation
A sample size of 10 interviews per community would provide enough information and variation in data within the target population.
“We determined that a sample size of 10 interviews per community would provide enough information and variation in data within the target population [27].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [27] Boddy CR. Sample size for qualitative research. Qualitative Market Res. 2016;19(4):426–32. source
- Interpretationown data
The inadequacy of resources and proximity to screening services intensifies the lack of screening and under screening.
“The inadequacy of the resources and proximity to screening services intensifies the lack of screening and under screening.”
Quote in the paperSubstantial claim - Premisecitation
Trained human resources, functional referral and laboratory facilities, and lack of transport and tracking systems make cytology-based screening strategies unfeasible in most LMICs.
“trained human resources, functional referral and laboratory facilities, and lack of transport and tracking systems make cytology-based screening strategies unfeasible in most LMICs [2].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] Denny L, Kuhn L, De Souza M, Pollack AE, Dupree W, Wright TC. Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. J Am Med Assoc. 2005;294(17):2173–81. source
- Interpretationcitation
The motivation construct illustrated the women's behavior to screening under the beliefs about capabilities domain whereby the perception of one's susceptibility to cervical cancer does affect screening behavior.
“The motivation construct illustrated the women’s behavior to screening under the beliefs about capabilities domain whereby the perception of one’s susceptibility to cervical cancer does affect screening behavior”
Quote in the paperSubstantial claim - Study design and conductnone given
The study is limited by the inclusion of data only from women who had already self-sampled for HPV.
“This study is limited by the inclusion of data only from women who had already self-sampled for HPV.”
Quote in the paperSubstantial claim - Interpretationreasoning
Acceptability of HPV self-sampling suggests an opportunity to increase attendance and screening through community based programs in LMICs.
“Acceptability of this method suggests an opportunity to increase attendance and screening through community based programs in LMICs.”
Quote in the paperSubstantial claim - Interpretationreasoning
HPV self-sampling may bridge the gap for women in underserved areas by increasing screening availability in more remote areas.
“HPV self-sampling may bridge the gap for women in underserved areas as it has the potential to increase screening availability in more remote areas, by using a less invasive procedure.”
Quote in the paperSubstantial claim- Rests on an assumption: HPV self-sampling is less invasive than pelvic exam.
- Interpretationreasoning
Cervical cancer screening access in terms of distance and convenience provide opportunities to increase screening uptake.
“Cervical cancer screening access in terms of distance and convenience provide opportunities to increase screening uptake.”
Quote in the paperSubstantial claim - Study design and conductreasoning
The sampled population may have been exposed to prior research studies and health interventions that may have influenced their health beliefs and behaviors.
“which may consequently have been exposed to prior research studies and health interventions that may have influenced their health beliefs and behaviors.”
Quote in the paperSubstantial claim
- May combine two claims. 30
- Classified as probably not a substantial claim. 28
May combine two claims.
PremisecitationTo increase screening coverage, HPV testing has been offered to women via self-collection, removing the need for a pelvic exam, clinic setting and a trained provider.
“To increase screening coverage, HPV testing has been offered to women via self-collection, removing the need for a pelvic exam, clinic setting and a trained provider [12–17].”
Quote in the paperSubstantial claim3 of 6 sources checked- cites [12] Agurto I, Arrossi S, White S, Coffey P, Dzuba I, Bingham A, et al. Involving the community in cervical cancer prevention programs. Int J Gynecol Obstet. 2005;89:S38–45. source
- cites [13] Arrossi S, Thouyaret L, Herrero R, Campanera A, Magdaleno A, Cuberli M, et al. Eff ect of self-collection of HPV DNA offered by community health workers at home visits on uptake of screening for cervical cancer (the EMA study): a population-based cluster-randomised trial. Lancet Glob Health. 2015;3:e85–94. source
- cites [14] Sewali B, Okuyemi KS, Askhir A, Belinson J, Vogel RI, Joseph A, et al. Cervical cancer screening with clinic-based pap test versus home HPV test among Somali immigrant women in Minnesota: a pilot randomized controlled trial. Cancer Med. 2015;4:620–31. source
- cites [15] Crosby RA, Hagensee ME, Vanderpool R, Nelson N, Parrish A, Collins T. Community-based screening for cervical cancer: A feasibility study of rural Appalachian women. Sexually Transmitted Dis. 2015;42:607. source
- cites [16] Barbee L, Kobetz E, Menard J, Cook N, Blanco J, Barton B, et al. Assessing the acceptability of self-sampling for HPV among haitian immigrant women: CBPR in action. Cancer Causes Control. 2010;21:421–31. source
- cites [17] De Alba I, Anton-Culver H, Hubbell FA, Ziogas A, Hess JR, Bracho A, et al. Self-sampling for human papillomavirus in a community setting: feasibility in Hispanic women. Cancer Epidemiol Prevent Biomark. 2008;17:2163–8. source
Classified as probably not a substantial claim. May combine two claims.
PremisecitationThe TDF has been validated for use in the COM-B, behavior change wheel and the two frameworks are used together to inform intervention and describe behavior change in implementation and behavior change research.
“The TDF has been validated for use in the COM-B, behavior change wheel and the two frameworks are used together to inform intervention and describe behavior change in implementation and behavior change research [21, 22].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [21] Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37. source
The Discussion says the refined TDF maps onto COM-B and fits with the Behaviour Change Wheel for informing intervention design. The Background and Conclusions describe validation of the TDF’s domain structure and content, not validation specifically for use in COM-B. That distinction makes the claim partly, but not fully, supported. Page numbers were not supplied. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [22] Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. source
The Background says the framework of 12 theoretical domains has proved useful for assessing and intervening in implementation problems. The Methods and Results describe COM-B as the basis of the behaviour change wheel and its use in designing and characterising interventions. Our copy does not say that the TDF was validated for use with COM-B or that the TDF and behaviour change wheel were used together. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationWomen who expressed personal susceptibility to cervical cancer believed it was necessary to have HPV self-test done and vice versa to those who expressed lack of personal susceptibility.
“and for women who expressed personal susceptibility to cervical cancer believed it was necessary to have HPV self- test done and vice versa to those who expressed lack of personal susceptibility [44–46].”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [44] Hill D, Gardner G, Rassaby J. Factors predisposing women to take precautions against breast and cervix Cancer. J Appl Soc Psychol. 1985;15:59–79. source
- cites [45] Mutyaba T, Mmiro FA, Weiderpass E. Knowledge, attitudes and practices on cervical cancer screening among the medical workers of Mulago hospital, Uganda. BMC Med Educ. 2006;6:13. source
The Attitudes section says female medical workers cited not feeling at risk as a reason for not having been screened, and the Discussion links low perceived vulnerability to low screening uptake. The paper discusses cervical screening, particularly Pap smears, but does not establish that women who felt susceptible believed HPV self-testing was necessary, or that those who did not feel susceptible believed the opposite. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [46] 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 Serv Res. 2014;14:335. source
The Results table on perceived susceptibility and the Conclusions report that women who did not perceive themselves as susceptible were less likely to have been screened for cervical cancer (page not provided). The paper measures self-reported cervical screening uptake, not whether women believed an HPV self-test was necessary; that specific belief and test are not supported. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe qualitative data were analyzed using validated theoretical frameworks.
“We used validated theoretical frameworks to analyze the qualitative data.”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [21] Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37. source
- cites [22] Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFear of disease and death has been identified in other studies.
“which has been identified in other studies [18, 52].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [18] Bansil, Pooja and Wittet, Scott and Lim, Jeanette L and Winkler, Jennifer L and Paul, Proma and Jeronimo J. Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach. BMC Public Health 2014;14:596. source
The Results (Reasons for not self-sampling; page unavailable) identify fear of finding cancer or pre-cancer, and the Discussion likewise describes fear of learning one has cancer. Neither passage identifies fear of death as a reported concern, so the source supports only the disease-related part of the claim. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [52] Li M, Nyabigambo A, Navvuga P, Nuwamanya E, Nuwasiima A, Kaganda P, et al. Acceptability of cervical cancer screening using visual inspection among women attending a childhood immunization clinic in Uganda. Papillomavirus Res. 2017;4:17–21. source
The Discussion reports that women who refused screening feared learning they had cervical cancer, supporting the fear-of-disease part of the claim. It does not identify fear of death. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationHealth system factors such as access and proximity to care have also acted for other prevention programs as has been found in other studies.
“as they have also acted for other prevention programs as has been found in other studies [37, 38, 40–43].”
Quote in the paperNot a substantial claim3 of 6 sources checked- cites [37] Buchanan Lunsford N, Ragan K, Lee Smith J, Saraiya M, Aketch M. Environmental and psychosocial barriers to and benefits of cervical Cancer screening in Kenya. Oncologist. 2017;22:173–81. https://doi.org/10.1634/theoncologist.2016-0213 . source
- cites [38] Arrossi S, Ramos S, Straw C, Thouyaret L, Orellana L. HPV testing: a mixed-method approach to understand why women prefer self-collection in a middle-income country. BMC Public Health. 2016;16:832. source
- cites [40] Zachary O, Turan J, Bukusi EA, Cohen CR, Gray GEMK. “You know you are sick, why do you carry a pregnancy again?” applying the socio-ecological model to understand barriers to PMTCT service utilization in Western Kenya. J AIDS Clin Res. 2015;6.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [41] Tung W-C, Nguyen DHT, Tran D. Applying the transtheoretical model to cervical cancer screening in Vietnamese-American women. Int Nurs Rev. 2008;55:73–80. source
- cites [42] Daley E, Alio A, Anstey EH, Chandler R, Dyer K, Helmy H. Examining barriers to cervical cancer screening and treatment in Florida through a socio-ecological lens. J Community Health. 2011;36:121–31. source
- cites [43] Kivuti-Bitok LW, Pokhariyal GP, Abdul R, McDonnell G. An exploration of opportunities and challenges facing cervical cancer managers in Kenya. BMC Research Notes. 2013;6:136. source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationKnowledge and perception play a key role in influencing screening behavior.
“As has been previously documented, knowledge and perception play a key role in influencing screening behavior [47–51].”
Quote in the paperNot a substantial claim1 of 5 sources checked- cites [47] McMullin JM, De Alba I, Chávez LR, Hubbell FA. Influence of beliefs about cervical cancer etiology on pap smear use among Latina immigrants. Ethn Health. 2005;10:3–18. source
- cites [48] Breitkopf CR, Pearson HC, Breitkopf DM. Poor knowledge regarding the pap test among low-income women undergoing routine screening. Perspectives on sexual and reproductive health, vol. 37; 2005. p. 78–84. source
- cites [49] Jirojwong S, Thassri J, Skolnik M. Perception of illness and the use of health care givers among cervical cancer patients at Songkla Nagarind hospital. A study in southern Thailand. Cancer Nurs. 1994;17:395–402 http://www.ncbi.nlm.nih.gov/pubmed/7954387 . source
- cites [50] Maaita M, Barakat M. Jordanian women’s attitudes towards cervical screening and cervical cancer. J Obstet Gynaecol. 2002;22:421–2. source
- cites [51] Rosser JI, Njoroge B, Huchko MJ. Changing knowledge, attitudes, and behaviors regarding cervical cancer screening: the effects of an educational intervention in rural Kenya. Patient Educ Couns. 2015;98:884–9. source
May combine two claims.
Findingown dataMany communities are located considerable distances (average 24 km) from health facilities and most of these facilities lack the screening and treatment resources needed.
“Many of the communities are located considerable distances (average 24 km) from the health facilities and most of these facilities lack the screening and treatment resources needed.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAwareness and acceptability of HPV self-sampling and confidence in ability to complete HPV self-sampling influenced women's decision to be screened.
“Themes related to capability nested within the TDF domains of knowledge and skills and included awareness and acceptability of HPV self-sampling and participant’s confidence in their ability to complete HPV self-sampling strategy. There were all seen to influence their decision to be screened.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataSome women had anxiety about the HPV self-sampling procedure, including fear of a scratch and fear of using the care brush.
“Some women had anxiety about the procedure, seen in the following quotes: “Those who haven’t gone for the test feel that the procedure can lead into a scratch …: ” and that “… .some women told me that they are scared of having to use the care brush”.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataA general belief that cervical cancer is a life threatening disease was a major hindrance to testing.
“There were also feelings that general belief that cervical cancer is a life threatening disease was a major hindrances to testing.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataMost women thought that self-sampling would be widely accepted by the community because women are afraid of the metal insertion procedure.
“Most women thought that the self-sampling would be widely accepted by the community “because they are afraid of the metal insertion procedure. They will go for this”.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe identified barriers to screening were social stigma associated with cervical cancer, fear of pelvic exam, and fear of disease and death.
“The identified barriers to screening were: social stigma associated with cervical cancer, a number of fears were reflected which included fear of pelvic exam and fear of disease and death.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataDespite women's confidence in and preference for self-collection without a pelvic exam, there were diverse opinions on the need for clinician presence.
“Despite women’s confidence in and preference for a self-collection without a pelvic exam, there were diverse opinions on the need for clinician presence.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFacilitators to screening completion included that the procedure does not take time, is private and self-performed, and the new type of testing was easy to undertake with no difficulties.
“Some of the facilitators to screening completion included “… ..the procedure does not take time”, “because it is private and one performs the test by herself” and “… the new type of testing was easy to undertake with no difficulties”.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataPeer and partner encouragement, mapped to the social influences domain, were common and an important motivator for screening.
“We found that peer and partner encouragement, mapped to the social influences domain, were common and an important motivator for screening.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataSome HIV-positive women in the study wanted to employ necessary prevention mechanisms in recognition of their increased susceptibility to complications.
“For some HIV-positive women, they wanted to employ any necessary prevention mechanisms in recognition of their increased susceptibility to complications.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingreasoningFactors from women's previous screening experiences made them hesitant to go for screening again, making the HPV self-sampling approach an attractive opportunity.
“All of these factors from the women’s previous screening experiences made them hesitant to go for screening again, and therefore making the HPV self-sampling approach an attractive opportunity.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataUsing the TDF to map drivers of behavior change (COM-B), environmental context and resources were the most widely cited, followed by social influences, both under the opportunity construct.
“Using the TDF to map drivers of behavior change (COM-B), we found that environmental context and resources were the most widely cited, followed by social influences, both under the opportunity construct.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataOne woman in the study expressed a desire to test for HPV to avoid complications that would interfere with childbearing.
“One woman expressed a desire to test for HPV to avoid complications that would interfere with childbearing.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataLate detection and failure to seek treatment was associated with death.
“as late detection and failure to seek treatment was associated with death.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataWomen in rural western Kenya had positive expectations of and personal experiences with HPV self-sampling.
“We found that women in rural western Kenya had positive expectations of and personal experiences with HPV self-sampling”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Findingown dataWomen in the study reported that those who screen positive for HPV are able to seek early treatment as a preventive measure.
“where those who screen positive for HPV are able to seek early treatment as a preventive measure.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Findingnone givenA combination of the TDF and COM-B allowed for identification of the women's facilitators and barriers to screening which in turn described potential drivers of behavior change in the relation to screening with self-collected HPV.
“A combination of the TDF and COM-B allowed for identification of the women’s facilitators and barriers to screening which in turn described potential drivers of behavior change in the relation to screening with self-collected HPV.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataFive members of the research team coded transcripts independently, with each transcript coded by two members producing coding reports for joint review.
“Using NVivo10 [29], a group of five members of the research team coded the transcripts independently, with each transcript coded by two members producing coding reports for joint review.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationTesting for HPV is a simple, low-cost technology that reduces cervical cancer incidence and related mortality when directly coupled with outpatient cryotherapy treatment for women testing HPV positive.
“Testing for HPV is a simple, low-cost technology that has been shown to reduce the cervical cancer incidence and related mortality when directly coupled with outpatient cryotherapy treatment for women testing HPV positive [2, 9, 10].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [2] Denny L, Kuhn L, De Souza M, Pollack AE, Dupree W, Wright TC. Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. J Am Med Assoc. 2005;294(17):2173–81. source
- cites [9] lin QY, Sellors JW, Eder PS, ping BY, Lim JM, hui ZF, et al. A new HPV-DNA test for cervical-cancer screening in developing regions: a cross-sectional study of clinical accuracy in rural China. Lancet Oncol. 2008;9:929–36. source
- cites [10] Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical Cancer in rural India. N Engl J Med. 2009. source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAll translations were read again along with the audio by a member of the study team to confirm accuracy.
“All translations were read again along with the audio by a member of the study team to confirm accuracy.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationHigh-risk human papillomavirus (HPV) is the primary cause of almost all cervical cancer.
“High-risk human papillomavirus (HPV) is the primary cause of almost all cervical cancer [7].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] Ministry of Public Health and Ministry of Medical Services. Government of Kenya. National Guidelines for prevention and Management of Cervical, breast and prostate Cancers. 2012.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe World Health Organization recommends a simplified HPV screen & treat as a strategy for cervical cancer control in LMICs.
“The World Health Organization (WHO) recommends a simplified HPV screen & treat as a strategy for cervical cancer control in LMICs [11].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] World Health Organization. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention: WHO Press; 2013.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe interview guide was developed in English, translated to Luo and Kiswahili, and back-translated into English to ensure accuracy.
“The guide was developed in English, translated to the local languages (Luo and Kiswahili), and then back-translated into English to ensure accuracy.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationCervical cancer is preventable with effective screening and treatment of pre-invasive lesions.
“This is despite the fact that cervical cancer is preventable with effective screening and treatment of pre-invasive lesions [2].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] Denny L, Kuhn L, De Souza M, Pollack AE, Dupree W, Wright TC. Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. J Am Med Assoc. 2005;294(17):2173–81. source
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationHigh quality, accessible and acceptable screening programs are necessary to prevent cervical cancer.
“While high quality, accessible and acceptable screening programs are necessary to prevent cervical cancer [8]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] Sankaranarayanan R. Cancer survival in Africa, Asia, the Caribbean and Central America. Introduction IARC Scientific Publications. 2011:1–5.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Interpretationown dataOverall, HPV self-sampling was an acceptable cervical cancer screening strategy that seemed to meet the needs of the women in this community.
“Overall, HPV self-sampling was an acceptable cervical cancer screening strategy that seemed to meet the needs of the women in this community.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe social support systems of peer and partner support is important in successful implementation of health prevention programs.
“The social support systems of peer and partner support is important in successful implementation of health prevention programs [40]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [40] Zachary O, Turan J, Bukusi EA, Cohen CR, Gray GEMK. “You know you are sick, why do you carry a pregnancy again?” applying the socio-ecological model to understand barriers to PMTCT service utilization in Western Kenya. J AIDS Clin Res. 2015;6.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningImportant facets of environmental context and resources include the need to increase community outreach, provide access to screening and treatment services in central locations and ensure privacy for women undergoing counseling and testing.
“Important facets of environmental context and resources include the need to increase community outreach, provide access to screening and treatment services in central locations and ensure privacy for women undergoing counseling and testing.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningTo address the issue of fear of potentially learning that one has cancer, a rigorous screening awareness campaign is needed to empower the women and address the fears of screening and an understanding to personal perception of cervical cancer risk.
“To address the issue of fear of potentially learning that one has cancer, a rigorous screening awareness campaign is needed to empower the women and address the fears of screening and an understanding to personal perception of cervical cancer risk.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningThe results support the need for improved community education and stigma reduction to ensure high uptake of screening and support for women who screen positive.
“Our results support the need for improved community education and stigma reduction to ensure high uptake of screening and support for women who screen positive.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningThe study does not have the perspectives of those who did not participate, a population who may be the most difficult to reach and may better articulate the barriers to self-sampling.
“As such, we do not have the perspectives of those who did not participate, a population who may be the most difficult to reach and may better articulate the barriers to self-sampling.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataCoding reports were discussed in meetings to refine the codebook and guide the analysis, and themes were considered in relation to the TDF domains and mapped onto the COM-B framework.
“Coding reports were discussed in a series of meetings to refine the codebook and guide the analysis and the themes considered in relation to the domains in the TDF and then mapped onto the segments of COM-B framework.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataEducation and awareness of cervical cancer prevention initiated and influenced women's personal decision to screen.
“indicating that education and awareness of the cervical cancer prevention initiated and influenced their personal decision to screen.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningEmploying the self-sampling approach provides the opportunity to eliminate some of these barriers and improve on screening uptake.
“Consequently, employing the self-sampling approach provides the opportunity to eliminate some of these barriers and improve on screening uptake.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataIncreased community awareness and emphasis that screening would not involve a pelvic exam, can be done in privacy, and would still involve provider counseling and may encourage even broader participation in organized screening campaigns.
“Increased community awareness and emphasis that screening would not involve a pelvic exam, can be done in privacy, and would still involve provider counseling and may encourage even broader participation in organized screening campaigns.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThese may impact their response towards the HPV self-sampling uptake and thus may also not be generalizable to other rural populations without such a robust response to HIV.
“These may impact their response towards the HPV self-sampling uptake and thus may also not be generalizable to other rural populations without such a robust response to HIV.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningAcceptability of self-sampling in the community setting is encouraging as these can ensure focus on treatment efforts for those who screen positive.
“Thus, acceptability of self-sampling in the community setting is encouraging as these can ensure focus on treatment efforts for those who screen positive.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Study design and conductreasoningDue to the study's cluster randomized design, it provides a representative sample.
“Also, due to the study’s cluster randomized design, it provides a representative sample”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
InterpretationreasoningPrevention of cervical cancer remains an unmet priority in low income regions.
“therefore prevention of cervical cancer remains an unmet priority.”
Quote in the paperSubstantial claim- Rests on an assumption: Health systems in low income regions have limited financial and human resources.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe participants were potentially comfortable due to the fact that the interviews were conducted in their native languages.
“and the participants were potentially comfortable due to the fact that the interviews were conducted in their native languages.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe study sampled a population with a high HIV prevalence and a strong response to the epidemic.
“We also sampled a population with a high HIV prevalence and a strong response to the epidemic”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The ultimate success of HPV self-sampling as a strategy depends on its acceptability among women in the target population.
“Although the strategy of HPV self- sampling would address many logistical barriers, the ultimate success of this strategy depends upon its acceptability among women in the target population.”
The paper relies on this without support.
HPV self-sampling is less invasive than pelvic exam.
“by using a less invasive procedure”
The paper relies on this without support.
Health systems in low income regions have limited financial and human resources.
“The health systems in low income regions have limited financial and human resources”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Prior-screening percentage confuses count with percentage
MinorTable 2 reports 16 previously screened women among 80 with data for that question, or 20.0%. The prose instead reports 16%.
Reported 16 · recomputed 20
“and 16% of women had undergone prior screening (Table 2).”
Table note cites the wrong reference for Cane et al.
MinorThe note attributes the descriptions to Cane et al. [23], but reference 23 is by Huchko et al.; Cane et al. is reference 21.
“Note: Note: Description data from Cane et al. [23]”
“23. Huchko MJ, Kahn JG, Smith JS, Hiatt RA, Cohen CR, Bukusi E. Study protocol for a cluster-randomized trial to compare human papillomavirus based cervical cancer screening in community-health campaigns versus health facilities in western Kenya.”
Prose understates the proportion with at most primary education
MinorThe table lists 77 women with primary education out of 117, already 65.8% before including the four women with no education. This contradicts the stated 59.4% with up to a primary education.
“Over half (59.4%) the women interviewed had up to a primary school education.”
“Table: Table 2 Socio-demographic characteristics and reproductive history of participants (n = 117) | Socio-demographic Characteristics | n (%) | Reproductive History Characteristics | n (%) | | --- | --- | --- | --- | | Age Mean (SD) | 36.08 (9.55) | Number of children (IQR) | 4 (3,5) | | Education Level | | Family planning use (n = 80) | | | Primary | 77 (55.8) | Yes | 36 (45.0) |”
Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008
Ferlay, J., Shin, H., Bray, F., Forman, D., Mathers, C. D., & Parkin, D. M. (2010) · International Journal of Cancer · doi:10.1002/ijc.25516 · Cited by 21,271 · see citing works
Michie, S., van Stralen, M. M., & West, R. (2011) · Implementation Science · doi:10.1186/1748-5908-6-42 · Cited by 13,697 · see citing works
Cane, J., O’Connor, D., & Michie, S. (2012) · Implementation Science · doi:10.1186/1748-5908-7-37 · Cited by 4,888 · see citing works
Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., Foy, R., Duncan, E. M., Colquhoun, H., Grimshaw, J. M., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0605-9 · Cited by 3,819 · see citing works
Making psychological theory useful for implementing evidence based practice: a consensus approach
Michie, S. (2005) · Quality and Safety in Health Care · doi:10.1136/qshc.2004.011155 · Cited by 3,440 · see citing works
Sample size for qualitative research
Boddy, C. R. (2016) · Qualitative Market Research: An International Journal · doi:10.1108/qmr-06-2016-0053 · Cited by 1,669 · see citing works
HPV Screening for Cervical Cancer in Rural India
Sankaranarayanan, R., Nene, B. M., Shastri, S. S., Jayant, K., Muwonge, R., Budukh, A. M., Hingmire, S., Malvi, S. G., Thorat, R., Kothari, A., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0808516 · Cited by 1,278 · cited 1× · see citing works
“Testing for HPV is a simple, lowcost technology that has been shown to reduce the cervical cancer incidence and related mortality when directly coupled with outpatient cryotherapy treatment for women testing HPV positive [2, 9, 10].”
BackgroundQiao, Y.-L., Sellors, J. W., Eder, P. S., Bao, Y.-P., Lim, J. M., Zhao, F.-H., Weigl, B., Zhang, W.-H., Peck, R. B., Li, L., et al. (2008) · The Lancet Oncology · doi:10.1016/s1470-2045(08)70210-9 · Cited by 471 · see citing works
Denny, L., Kuhn, L., De Souza, M., Pollack, A. E., Dupree, W., & Wright, T. C. (2005) · JAMA · doi:10.1001/jama.294.17.2173 · Cited by 364 · see citing works
Mutyaba, T., Mmiro, F. A., & Weiderpass, E. (2006) · BMC Medical Education · doi:10.1186/1472-6920-6-13 · Cited by 242 · see citing works
Racey, C. S., Withrow, D. R., & Gesink, D. (2013) · Canadian Journal of Public Health · doi:10.1007/bf03405681 · Cited by 232 · see citing works
Wilkinson, S. A., Thomas, S., Phillips, C. J., Marshall, A. P., Chaves, N. J., Jankelowitz, S. K., Lin, I. B., Loy, C. T., Rees, G., Sakzewski, L., et al. (2015) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s78458 · Cited by 224 · see citing works
Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review
Lim, J. N. W., & Ojo, A. A. (2017) · European Journal of Cancer Care · doi:10.1111/ecc.12444 · Cited by 220 · see citing works
Arrossi, S., Thouyaret, L., Herrero, R., Campanera, A., Magdaleno, A., Cuberli, M., Barletta, P., Laudi, R., & Orellana, L. (2015) · The Lancet Global Health · doi:10.1016/s2214-109x(14)70354-7 · Cited by 217 · see citing works
de Sanjosé, S., Serrano, B., Castellsagué, X., Brotons, M., Muñoz, J., Bruni, L., & Bosch, F. X. (2012) · Vaccine · doi:10.1016/s0264-410x(12)01435-1 · Cited by 192 · cited 1× · see citing works
“Background Cervical cancer deaths worldwide were estimated at 275, 000 annually and over 530,000 new cases diagnosed [1].”
BackgroundBansil, P., Wittet, S., Lim, J. L., Winkler, J. L., Paul, P., & Jeronimo, J. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-596 · Cited by 184 · cited 3× · see citing works
“The domain on belief about consequences also reflected the women’s motivation construct that highlight barriers to HPV screening which include the fear of disease and death which has been identified in other studies [18, 52].”
BackgroundResultInfluentialInfluence of beliefs about cervical cancer etiology on pap smear use among Latina immigrants
Mcmullin, J. M., Alba, I. D., Chávez, L. R., & Hubbell, F. A. (2005) · Ethnicity & Health · doi:10.1080/1355785052000323001 · Cited by 123 · see citing works
Cervical cancer in the developing world
Sherris, J. D. (2001) · Western Journal of Medicine · doi:10.1136/ewjm.175.4.231 · Cited by 120 · see citing works
Rosser, J. I., Njoroge, B., & Huchko, M. J. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.03.017 · Cited by 111 · see citing works
Self-citationAssessing the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action
Barbee, L., Kobetz, E., Menard, J., Cook, N., Blanco, J., Barton, B., Auguste, P., & McKenzie, N. (2010) · Cancer Causes & Control · doi:10.1007/s10552-009-9474-0 · Cited by 105 · see citing works
Factors Predisposing Women to Take Precautions Against Breast and Cervix Cancer
Hill, D., Gardner, G., & Rassaby, J. (1985) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.1985.tb00894.x · Cited by 103 · see citing works
Morema, E. N., Atieli, H. E., Onyango, R. O., Omondi, J. H., & Ouma, C. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-335 · Cited by 103 · see citing works
Daley, E., Alio, A., Anstey, E. H., Chandler, R., Dyer, K., & Helmy, H. (2011) · Journal of Community Health · doi:10.1007/s10900-010-9289-7 · Cited by 89 · see citing works
Barriers to Cervical Cancer Screening in Rural Kenya: Perspectives from a Provider Survey
Rosser, J. I., Hamisi, S., Njoroge, B., & Huchko, M. J. (2015) · Journal of Community Health · doi:10.1007/s10900-015-9996-1 · Cited by 79 · see citing works
Self-citationSewali, B., Okuyemi, K. S., Askhir, A., Belinson, J., Vogel, R. I., Joseph, A., & Ghebre, R. G. (2015) · Cancer Medicine · doi:10.1002/cam4.429 · Cited by 75 · see citing works
Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya
Buchanan Lunsford, N., Ragan, K., Lee Smith, J., Saraiya, M., & Aketch, M. (2017) · The Oncologist · doi:10.1634/theoncologist.2016-0213 · Cited by 74 · see citing works
Gottschlich, A., Rivera-Andrade, A., Grajeda, E., Alvarez, C., Mendoza Montano, C., & Meza, R. (2017) · Journal of Global Oncology · doi:10.1200/jgo.2016.005629 · Cited by 72 · see citing works
Poor knowledge regarding the Pap test among low-income women undergoing routine screening.
(2005) · PubMed · doi:10.1363/psrh.37.078.05 · Cited by 69 · see citing works
Huchko, M. J., Ibrahim, S., Blat, C., Cohen, C. R., Smith, J. S., Hiatt, R. A., & Bukusi, E. A. (2017) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.12415 · Cited by 65 · see citing works
Self-citationInvolving the community in cervical cancer prevention programs
Agurto, I., Arrossi, S., White, S., Coffey, P., Dzuba, I., Bingham, A., Bradley, J., & Lewis, R. (2005) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2005.01.015 · Cited by 60 · see citing works
Ogilvie, G. S., Mitchell, S., Sekikubo, M., Biryabarema, C., Byamugisha, J., Jeronimo, J., Miller, D., Steinberg, M., & Money, D. M. (2013) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2013.03.019 · Cited by 59 · see citing works
Self-Sampling for Human Papillomavirus in a Community Setting: Feasibility in Hispanic Women
De Alba, I., Anton-Culver, H., Hubbell, F. A., Ziogas, A., Hess, J. R., Bracho, A., Arias, C., & Manetta, A. (2008) · Cancer Epidemiology, Biomarkers & Prevention · doi:10.1158/1055-9965.epi-07-2935 · Cited by 54 · see citing works
Arrossi, S., Ramos, S., Straw, C., Thouyaret, L., & Orellana, L. (2016) · BMC Public Health · doi:10.1186/s12889-016-3474-2 · Cited by 51 · see citing works
Applying the transtheoretical model to cervical cancer screening in Vietnamese‐American women
Tung, W. ‐., Nguyen, D. H. T., & Tran, D. N. (2008) · International Nursing Review · doi:10.1111/j.1466-7657.2007.00602.x · Cited by 50 · see citing works
Kenya AIDS Indicator Surveys 2007 and 2012
Maina, W. K., Kim, A. A., Rutherford, G. W., Harper, M., K’Oyugi, B. O., Sharif, S. K., Kichamu, G., Muraguri, N., Akhwale, W. S., & Cock, K. M. D. (2014) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000123 · Cited by 49 · see citing works
Jordanian women's attitudes towards cervical screening and cervical cancer
(2002) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443610220141416 · Cited by 48 · see citing works
An exploration of opportunities and challenges facing cervical cancer managers in Kenya
Kivuti-Bitok, L. W., Pokhariyal, G. P., Abdul, R., & McDonnell, G. (2013) · BMC Research Notes · doi:10.1186/1756-0500-6-136 · Cited by 48 · see citing works
Onono, M. A. (2015) · Journal of AIDS & Clinical Research · doi:10.4172/2155-6113.1000467 · Cited by 46 · see citing works
Acceptability of Self-Sampling HPV Testing Among Thai Women for Cervical Cancer Screening
Oranratanaphan, S., Termrungruanglert, W., & Khemapech, N. (2014) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2014.15.17.7437 · Cited by 37 · see citing works
Cancer survival in Africa, Asia, the Caribbean and Central America. Introduction.
Sankaranarayanan, R. (2011) · PubMed · Cited by 33 · see citing works
Community-Based Screening for Cervical Cancer: A Feasibility Study of Rural Appalachian Women
Crosby, R. A., Hagensee, M. E., Vanderpool, R., Nelson, N., Parrish, A., Collins, T., & Jones, N. (2015) · Sexually Transmitted Diseases · doi:10.1097/olq.0000000000000365 · Cited by 31 · see citing works
Li, M., Nyabigambo, A., Navvuga, P., Nuwamanya, E., Nuwasiima, A., Kaganda, P., Asiimwe, F. T., Vodicka, E., Mugisha, N. M., Mukose, A., et al. (2017) · Papillomavirus Research · doi:10.1016/j.pvr.2017.06.004 · Cited by 22 · see citing works
Jirojwong, S., Thassri, J., & Skolnik, M. (1994) · Cancer Nursing · doi:10.1097/00002820-199410000-00004 · Cited by 21 · see citing works
Huchko, M. J., Kahn, J. G., Smith, J. S., Hiatt, R. A., Cohen, C. R., & Bukusi, E. (2017) · BMC Cancer · doi:10.1186/s12885-017-3818-z · Cited by 18 · cited 1× · see citing works
“The parent study enrolled women aged 25 to 65 years living within selected communities within Migori County, and offered HPV-based selfscreening in health facilities or through community health campaigns between January to September 2016 [23].”
BackgroundSelf-citationSenkomago, V., & Saraiya, M. (2017) · Journal of Women's Health · doi:10.1089/jwh.2017.6384 · Cited by 8 · see citing works
Poor Knowledge Regarding the Pap Test Among Low-Income Women Undergoing Routine Screening
Breitkopf, C. R., Pearson, H. C., & Breitkopf, D. M. (2005) · Perspectives on Sexual and Reproductive Health · doi:10.1363/3707805
Flagged first, then by citations
Research works printed but not linked: 4
- de Sanjosé S, Serrano B, Castellsagué X, Brotons M, Muñoz J, Bruni L, Bosch FX. Human papillomavirus (HPV) and related cancers in the global Alliance for vaccines and immunization (GAVI) countries: a WHO/ICO HPV information Centre report. Vaccine. 2012;30(Suppl 4):D1–83.
- World Health Organization. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention: WHO Press; 2013.
- National AIDS and STI Control Programme (NASCOP) K. Kenya AIDS Indicator Survey 2012: Final Report. 2014.
- QSR International. NVivo qualitative data analysis software | QSR international Pty ltd. version 10. 2012. https://www.qsrinternational.com/nvivo/home .
Cited by
Sorted by citations
The Lancet Commission on diagnostics: transforming access to diagnostics
Fleming, K. A., Horton, S., Wilson, M. L., Atun, R. A., DeStigter, K. K., Flanigan, J. S., Sayed, S., Adam, P., Aguilar, B., Andronikou, S., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00673-5 · Cited by 481 · see citing works
Petersen, Z., Jaca, A., Ginindza, T. G., Maseko, G., Takatshana, S., Ndlovu, P., Zondi, N., Zungu, N., Varghese, C. V., Hunting, G., et al. (2022) · BMC Women s Health · doi:10.1186/s12905-022-02043-y · Cited by 292 · see citing works
“Women often must travel to facilities far from where they live for screening services, indicating limited access in many geographic areas which is worsened by transport and other additional costs [15, 18, 22, 23].”
BackgroundMolecular Detection Methods in HPV-Related Cancers
Williams, J., Kostiuk, M. A., & Biron, V. L. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.864820 · Cited by 115 · see citing works
Barriers to cervical cancer screening in Africa: a systematic review
Mantula, F., Toefy, Y., & Sewram, V. (2024) · BMC Public Health · doi:10.1186/s12889-024-17842-1 · Cited by 119 · see citing works
“Social stigma associated with cervical cancer and screen‑ ing One study revealed that women decline cervical cancer screening because of the stigma associated with having cervical cancer [21].”
BackgroundInfluentialSelf-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis
Camara, H., Zhang, Y., Lafferty, L., Vallely, A. J., Guy, R., & Kelly‐Hanku, A. (2021) · BMC Public Health · doi:10.1186/s12889-021-11554-6 · Cited by 102 · see citing works
“In addition, women could ask questions to others who had previously undergone the procedure: being told about the absence of pain and the easiness of the selfcollection by their peers increased women’s self-efficacy [45, 54].”
BackgroundHuman Papilloma Virus self-sampling performance in low- and middle-income countries
Mulki, A. K., & Withers, M. H. (2021) · BMC Women s Health · doi:10.1186/s12905-020-01158-4 · Cited by 87 · see citing works
A systematic review of self‐sampling for HPV testing in Africa
Nodjikouambaye, Z. A., Adawaye, C., Bouassa, R. M., Sadjoli, D., & Bélec, L. (2020) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13112 · Cited by 39 · see citing works
Akoto, E. J., & Allsop, M. J. (2023) · JCO Global Oncology · doi:10.1200/go.22.00359 · Cited by 30 · see citing works
“Women with positive experiences also mentioned the likelihood that they will inform other women in their community.(30,39)”
BackgroundDemissie, B. W., Azeze, G. A., Asseffa, N. A., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0262142 · Cited by 26 · see citing works
Stanczuk, G. A., Currie, H. D., Forson, W., Baxter, G. J., LAWRENCE, J. R., Wilson, A., Palmer, T. J., Arbyn, M., & Cuschieri, K. S. (2021) · International Journal of Cancer · doi:10.1002/ijc.33888 · Cited by 24 · see citing works
“The literature would suggest that the former offers higher uptake5 but comes at additional financial and environmental costs through unused kits.21,22 Also, preference for self-sampling over clinician-taken sampling cannot always be taken for granted as recently illustrated by De Pauw et al who, like others, have obse…”
Goldstein, A. T., Goldstein, L. S., Lipson, R., Bedell, S., Wang, J., Stamper, S. A., Brenner, G., Goldstein, G. R., O’Keefe, K., O’Keefe, S., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035153 · Cited by 23 · see citing works
Lemmo, D., Martino, M. L., Vallone, F., Donizzetti, A. R., Freda, M. F., Palumbo, F., Lorenzo, E. M., D’Argenzio, A., & Caso, D. (2022) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2022.100354 · Cited by 23 · see citing works
Exploring the barriers to Pap smear test in Iranian women: a qualitative study
Marashi, T., Irandoost, S. F., Lebni, J. Y., & Soofizad, G. (2021) · BMC Women s Health · doi:10.1186/s12905-021-01428-9 · Cited by 24 · see citing works
“Other studies have also confirmed such beliefs as barriers to screening [9, 49, 69, 70].”
ResultAsare, M., Abah, E., Obiri‐Yeboah, D., Lowenstein, L. M., & Lanning, B. A. (2022) · Healthcare · doi:10.3390/healthcare10071270 · Cited by 23 · see citing works
Awareness about Gynecologic Cancers and Related Factors among Healthy Women: A Cross-Sectional Study
Öztürk, R., Bakır, S., Kazankaya, F., et al. (2021) · Social Work in Public Health · doi:10.1080/19371918.2021.1965936 · Cited by 21 · see citing works
“In addition, some studies have demonstrated that other factors affecting women’s routine examination and follow-up can be STIs as well as having a family history and fear of cancer (Kim et al., 2019; Oketch et al., 2019).”
BackgroundBula, A. K., Lee, F., Chapola, J. C., Mapanje, C., Tsidya, M., Thom, A., Tang, J. H., & Chinula, L. (2022) · PLoS ONE · doi:10.1371/journal.pone.0262590 · Cited by 21 · see citing works
Ahishakiye, E., & Kanobe, F. (2024) · Discover Artificial Intelligence · doi:10.1007/s44163-024-00185-6 · Cited by 20 · see citing works
“It is estimated that new cases and mortality will increase by 75% by 2025 if appropriate attention and early detection methods are not applied for early treatment [4].”
Islam, J. Y., Mutua, M., Kabare, E., Manguro, G., Hudgens, M. G., Poole, C., Olshan, A. F., Wheeler, S. B., McClelland, R. S., & Smith, J. S. (2020) · Sexually Transmitted Diseases · doi:10.1097/olq.0000000000001167 · Cited by 19 · see citing works
“Indeed, factors facilitating uptake of HPV self-collection among women in Kenya include confidence in the ability to complete HPV self-sampling, proximity to screening sites, and feelings of privacy and comfort conducting the HPV self-sampling.(29) However, it is important to note that it is unknown whether a woman's…”
BackgroundDzobo, M., Dzinamarira, T., Jaya, Z. N., Kgarosi, K., & Mashamba-Thompson, T. P. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e32926 · Cited by 20 · see citing works
“Privacy was a key driver to women performing self-sampling, particularly among women reluctant to have a specimen collected by a male health worker [62] and women who did not want to meet up with healthcare practitioners who had examined them.”
BackgroundResultInfluentialLee, F., Bula, A. K., Chapola, J. C., Mapanje, C., Phiri, B., Kamtuwange, N., Tsidya, M., Tang, J. H., & Chinula, L. (2021) · BMC Cancer · doi:10.1186/s12885-021-08109-8 · Cited by 17 · see citing works
“Mitchell SM, Pedersen HN, Stime EE, Sekikubo M, Moses E, Mwesigwa D, et al. Self-collection based HPV testing for cervical cancer screening among women living with HIV in Uganda: a descriptive analysis of knowledge, intentions to screen and factors associated with HPV positivity.”
BackgroundInfluentialNwaozuru, U., Obiezu‐Umeh, C., Obi‐Jeff, C., Shato, T., Gbaja-Biamila, T. A., Oladele, D. A., Idigbe, I. E., Tucker, J. D., Ezechi, O., & Iwelunmor, J. (2021) · Implementation Science Communications · doi:10.1186/s43058-021-00243-5 · Cited by 13 · see citing works
Theoretical Domains Framework: A Bibliometric and Visualization Analysis from 2005-2023
Zhou, Y., Huang, Y., Wang, Y., Xu, X., Yu, Z., & Gu, Y. (2024) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s470223 · Cited by 13 · see citing works
“27 Beyond cancer, there is a wealth of TDF research in stroke rehabilitation.”
BackgroundDzobo, M., Dzinamarira, T., Maluleke, K., Jaya, Z. N., Kgarosi, K., & Mashamba-Thompson, T. P. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-062090 · Cited by 14 · see citing works
Huchko, M. J., Adewumi, K., Oketch, S. Y., Ibrahim, S., & Bukusi, E. A. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028669 · Cited by 13 · see citing works
“In both the CHC and health facility arms, education and outreach was led by community health volunteers, and women who tested HPV-positive were notified of their results and referred to the Migori County Hospital for treatment with cryotherapy.(15) After treatment, women were invited to participant in an in-depth inte…”
MethodSelf-citationChinn, J. O., & Tewari, K. S. (2019) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000597 · Cited by 13 · see citing works
“The researchers also examined barriers to traditional pelvic exam, which included concerns around speculum use, embarrassment, and reluctance to have a male provider perform the examination [17].”
BackgroundKangethe, J. M., Monroe‐Wise, A., Muiruri, P. N., Komu, J. G., Mutai, K. K., Nzivo, M. M., & Pintye, J. C. (2022) · Southern African Journal of HIV Medicine · doi:10.4102/sajhivmed.v23i1.1353 · Cited by 12 · see citing works
Cervical cancer prevention: Human papillomavirus testing as primary screening
Desai, S., Zhu, M. J., & Lapidos‐Salaiz, I. (2021) · Cancer · doi:10.1002/cncr.34006 · Cited by 11 · see citing works
“HPV selfsampling was cited by women as a private and safe method of screening because they have less worry about having a male provider conduct a pelvic examination.(42) There is opportunity for LMICs to strengthen demand creation strategies, engage community health workers and peers to educate and sensitize women, an…”
BackgroundMethodOtieno, J. A., Were, L. M., Nyanchoka, M., Olwanda, E. E., Mulaku, M., Sem, X., Kohli, M., Markby, J. L., Muriuki, A., & Ochodo, E. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1439164 · Cited by 15 · see citing works
Experiences of human papillomavirus self‐sampling by women >60 years old: A qualitative study
Blomberg, K., & Nyman, M. H. (2023) · Health Expectations · doi:10.1111/hex.13707 · Cited by 10 · see citing works
Nigussie, T., Mamo, Y., Qanche, Q., et al. (2021) · BioMed Research International · doi:10.1155/2021/4797590 · Cited by 10 · see citing works
Knowledge of cervical cancer and barriers to screening among women in a city in Northern Nigeria
Hauwa, I., Oluwasanu, M. M., John-Akinola, Y. O., & Oyewole, O. E. (2021) · Journal of Public Health · doi:10.1007/s10389-021-01593-z · Cited by 10 · see citing works
Rangolo, N., Tshitangano, T. G., & Olaniyi, F. C. (2021) · Nursing Reports · doi:10.3390/nursrep11040069 · Cited by 9 · see citing works
Shrestha, S., Thapa, S., Sims, P., Ardelean, A., Basu, A., Caws, M., Gurung, S. C., & Holdsworth, G. (2021) · Sexual and Reproductive Health Matters · doi:10.1080/26410397.2021.2005283 · Cited by 9 · see citing works
“Lack of privacy during screening, embarrassment among women, stigma and low priority given to women’s health issues have been identified as factors contributing to the reluctance of women to access cervical cancer screening services in lowincome countries.(12) A self-sampling pathway has the potential to overcome many…”
BackgroundHassine, A., Antoni, G., Fender, M., Slama, K., Léandri, F.-X., Fanon, J., Auvray, C., Jaffar‐Bandjee, M., Traversier, N., Fagour, L., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-065952 · Cited by 6 · see citing works
Okyere, J. (2025) · BMC Cancer · doi:10.1186/s12885-025-13704-0 · Cited by 7 · see citing works
“Consequently, a plethora of empirical studies have examined the factors that influence the women’s uptake of CCS [12–15].”
Ezenwankwo, E. F., Ogbodo, V. E., Alom, G. O., Nwadilibe, I. B., Ofodum, C. M., Nwankwo, C. A., Okigbo, C. C., Omeje, C., Onyebuchi, S. J., Oladoyimbo, C. A., et al. (2021) · European Journal of Cancer Care · doi:10.1111/ecc.13545 · Cited by 4 · see citing works
Andrew-Bassey, U. I., Oke, D. O., Okunlola, M. A., & Morhason-Bello, I. O. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-085408 · Cited by 3 · see citing works
Moucheraud, C., Chibaka, S., Golub, G. M., Kalande, P., Makwaya, A., Ochieng, E., Ogutu, V., Phiri, K., Phiri, S., & Hoffman, R. M. (2025) · BMC Public Health · doi:10.1186/s12889-025-23143-y · Cited by 6 · see citing works
“This perceived risk was also strongly associated with women’s own cervical cancer screening behavior, as has been identified in previous studies from these countries [34, 58, 60].”
Dzobo, M., Dzinamarira, T., Murewanhema, G., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1275311 · Cited by 3 · see citing works
Evaluation of video-assisted HPV education in government-supported clinics in Western Kenya
Dion, H., Choi, H., Huang, M. W., et al. (2023) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002539 · Cited by 3 · see citing works
Self-citationHarsch, S., Weber, L. S., Kassaman, D., Kailemia, P. N., & Oria, V. O. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1527400 · Cited by 6 · see citing works
Comparative Performance of Machine Leaning Algorithms in Prediction of Cervical Cancer
Ahishakiye, E., Mwangi, W. R., Muriithi, P., et al. (2021) · Cited by 3 · see citing works
Nthambi, L., Temmerman, M., Macharia, W., Nyagol, J. A., Mogere, S., Neary, J., Nyabs, E., Itindi, J., Langat, A., Wangari, E., et al. (2025) · BMC Women s Health · doi:10.1186/s12905-025-04048-9 · Cited by 2 · see citing works
“Most women who attend maternal and child health (MCH) clinics are of reproductive age and a key target group for cervical cancer screening [11, 14–16].”
Whitley, S., Hawkins, R. L., Davies, J. C., Cao, J., Malcomson, L., Crosbie, E. J., & McWilliams, L. (2025) · Health Expectations · doi:10.1111/hex.70338 · Cited by 3 · see citing works
“Women fa-voured comfort and privacy associated with self ‐ sampling [51].”
Wycliff, K., Cordova-Pozo, K. L., Peter, H., et al. (2022) · PAMJ Clinical Medicine · doi:10.11604/pamj-cm.2022.9.45.32219 · Cited by 1 · see citing works
Health Education with Media Leaflet Against Women's Knowledge of Cervical Cancer Screening
Sumiaty, S., & Hasnawati, H. (2022) · Napande Jurnal Bidan · doi:10.33860/njb.v1i1.1081 · Cited by 1 · see citing works
Lumia, C., Fumagalli, S., Martinelli, M., et al. (2026) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s601358 · Cited by 1 · see citing works
Fertility Age Couples Motivation On Cervical Cancer Early Detection
Khotimah, S. N., & Ernawati, D. (2021) · International Journal of Health Science and Technology · doi:10.31101/ijhst.v3i2.1977 · Cited by 1 · see citing works
“(Darj et al., 2019a), (Oketch et al., 2019) b. HIV In the article by (Darlin et al., 2013b), totally, 25.5% of those tested were HSV-2 positive, and 5.6% were HIV positive.”
BackgroundInfluentialBonnah, J., Awuah, B., & Williams, M. S. (2026) · BMC Cancer · doi:10.1186/s12885-026-15785-x · Cited by 1 · see citing works
Akubue, J. B. E., Nwankwo, C. U., Ogbe, A. C., Anieche, J. E., & Afonne, A. J. (2021) · International Journal of Medical Science and Health Research · doi:10.51505/ijmshr.2021.5214 · Cited by 1 · see citing works
Khalednejad, M., Salehi, L., Pashang, S., Moghimbeigi, A., & Nameghi, A. N. M. (2022) · Current Women s Health Reviews · doi:10.2174/1573404818666220304104128 · Cited by 1 · see citing works
Mbuthia, F. W., Kiplangat, D. C., Muiruri, N., et al. (2025) · doi:10.12688/verixiv.699.1 · Cited by 1 · see citing works
Xiong, S., Abdi, H. I., Ghebre, R. G., Kulasingam, S., Lazovich, D., Mason, S. M., & Pratt, R. J. (2021) · Research Square · doi:10.21203/rs.3.rs-798142/v1
Wycliff, K., Cordova-Pozo, K. L., Peter, H., Daniel, E. O., & Kalam, M. A. (2021) · doi:10.31730/osf.io/y4mvt
Chidinma, A. U. (2022) · Texila international journal of public health · doi:10.21522/tijph.2013.10.04.art013
Cervical Cancer Prevention Paradox: Unveiling Screening Barriers and Solutions
Obeagu, E. I. (2023) · Cancer Research and Cellular Therapeutics · doi:10.31579/2640-1053/182
Chepkorir, J., Perrin, N., Kivuti-Bitok, L., et al. (2024) · medRxiv · doi:10.1101/2024.09.21.24313929
Assessing how women access healthcare to inform cervical cancer and HIV screening in rural UgandaPreprint
Sheehan, M., Dau, H., AboMoslim, M., Naguti, P., Mwandacha, N., Booth, A., Ruck, C. E., Smith, L., Orem, J., Ogilvie, G. S., et al. (2024) · medRxiv · doi:10.1101/2024.10.22.24315934
“Exacerbating the disproportionate burden of cervical cancer in LMICs, women are often diagnosed at advanced stages and are unable to receive effective treatment due to limited-46 service accessibility and availability (5).”
MethodInfluentialChepkorir, J., Perrin, N., Kivuti-Bitok, L., Gallo, J. J., Gross, D. A., Anderson, J., Reynolds, N. R., Wyche, S. P., Kibet, H., Kipkuri, V., et al. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22050783
“Prior research has established that cervical cancer (CC) stigma is a significant barrier to symptom disclosure, seeking screening services, and accessing treatment in many sub-Saharan African communities [13,35–37].”
InfluentialAndrew-Bassey, U. I., Oke, D. O., Okunlola, M. A., et al. (2025) · PLOS Global Public Health · doi:10.1371/journal.pgph.0004641
“Perception, attitude, perspective, and acceptability were used interchangeably in many studies [8,16,18,19,22–24].”
Twabi, H. H., Sibande, W., Mhango, O., Msosa, T. C., Chipandwe, C., Mukoka, M., Kumwenda, M., Sivalingam, V. N., Solomon, D., Msefula, C. L., et al. (2025) · PLOS Global Public Health · doi:10.1371/journal.pgph.0004763 · Cited by 1 · see citing works
Guliam, A., Sadana, A., Opiyo, E., et al. (2025) · medRxiv · doi:10.1101/2025.10.24.25338728
Camara, H., Zhang, Y., Lafferty, L., Vallely, A. J., Guy, R., & Kelly-Hanku, A. (2021) · Figshare · doi:10.6084/m9.figshare.15110200
Camara, H., Zhang, Y., Lafferty, L., Vallely, A. J., Guy, R., & Kelly-Hanku, A. (2021) · Figshare · doi:10.6084/m9.figshare.15110209
Camara, H., Zhang, Y., Lafferty, L., Vallely, A. J., Guy, R., & Kelly-Hanku, A. (2021) · Figshare · doi:10.6084/m9.figshare.15110206
Additional file 1 of Barriers to cervical cancer screening in Africa: a systematic review
Mantula, F., Toefy, Y., & Sewram, V. (2024) · Figshare · doi:10.6084/m9.figshare.25255797
Camara, H., Zhang, Y., Lafferty, L., Vallely, A. J., Guy, R., & Kelly-Hanku, A. (2021) · Figshare · doi:10.6084/m9.figshare.15110203
Adankwah, E., Mensah, A. B. B., Konney, T., Nones, M., Ekekpi, R. Z., Okyere, J., Basing, L. A., Boadu, K. O., Eduah, F. M. E., Virnig, B. A., et al. (2026) · Journal of Cancer Policy · doi:10.1016/j.jcpo.2026.100710
Vaginal vitamin D for Genitourinary syndrome of menopause: a cohort study and literature review
Massaad, C., Razzak, R. A., & Ghazal, K. (2026) · Future Science OA · doi:10.1080/20565623.2026.2621650
“…since chronic inflammation can take place and build up over time from different circumstances such as hormonal change and repeated infections [23]. among other conditions relating to older women, an atrophic cervix is relatively common and is related to a low level of estrogen, which is the…”
Afaya, A., Awunyo, W., Udeoha, M. A., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0344086
Menigistu, Y. H., & Gessese, N. B. (2026) · Social Sciences & Humanities Open · doi:10.1016/j.ssaho.2026.102746
Andrew-Bassey, U. I., Bello, Y. O., Okunlola, M. A., & Morhason-Bello, I. O. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-110692
“24 32 42–44 It is plausible that the contrasting perception of women in this due might be due to lack of experience or because they never watched the procedure before.”
Nanyonjo, G., Paepe, E. D., Wambuzi, M., et al. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-14624-w
“Additionally, offering screening through female providers or promoting acceptable alternatives such as HPV self-sampling, increasingly endorsed in LMICs, may help overcome privacy and embarrassment concerns [37–39].”
Pourette, D., Cripps, A., Hassine, A., Opigez, E., Bardou, M., & Dumont, A. (2026) · BMC Public Health · doi:10.1186/s12889-026-28369-y
“Other studies have highlighted the influence of peers [24] and husbands [26–28], particularly in cultural contexts of close family proximity.”
Somba, M., Dumbaugh, M., Mhalu, G., et al. (2026) · medRxiv · doi:10.64898/2026.08.26.26361100
Mwanzia, L. N., Biederman, E. B., Draucker, C. B., & Champion, V. L. (2026) · BMC Women s Health · doi:10.1186/s12905-026-04833-0
Beyond Preference: Understanding Acceptability of Urine-Based HPV Screening in Rural EswatiniPreprint
Squillace, F., Mutti, V. A., Angelone, P., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-10688393/v1
- Authors
- Oketch, S. Y., Kwena, Z., Choi, Y., Adewumi, K., Moghadassi, M., Bukusi, E. A., & Huchko, M. J.
- Affiliations
- Kenya Medical Research Institute (KE)
- Duke University (US)
- University of California, San Francisco (US)
- University of Nairobi (KE)
- Corresponding author
- Oketch, Sandra Y.
- Venue
- BMC Women's Health
- Published
- 2019-06-13
- Volume
- 19
- Issue
- 1
- Pages
- 75-75
- ISSN
- 1472-6874 (ISSN-L)
- PMC
- PMC6567898
- OpenAlex
- W2951788009
- Cited by
- 77
- References
- 46
- Citations by year
- 2026: 12 · 2025: 10 · 2024: 9 · 2023: 6 · 2022: 12 · 2021: 23 · 2020: 3 · 2019: 2
- FWCI
- 6.61
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Women s Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Greater South Information System
- Funders
- National Cancer Institute of the National Institutes of Health (R01-CA188428)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, HPV self-sampling, women's perspectives, screening uptake, barriers to screening, screening decision-making, pelvic examination, rural women, COM-B model, cervical cancer prevention
- MeSH terms
- Adult, Uterine Cervical Neoplasms, Female, Humans, Kenya, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Rural Population, Health Behavior, Self Efficacy, Papillomaviridae, Papillomavirus Infections, Qualitative Research, Early Detection of Cancer
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
