Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya
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Background: Cervical cancer is the second most commonly diagnosed cancer in females and is a leading cause of cancer-related mortality in Kenya; limited cervical cancer screening services may be a factor. Few studies have examined men’s and women’s perceptions on environmental and psychosocial barriers and benefits related to screening. Materials and Methods: In 2014, 60 women aged 25–49 years and 40 male partners participated in 10 focus groups (6 female and 4 male), in both rural and urban settings (Nairobi and Nyanza, Kenya), to explore perceptions about barriers to and benefits of cervical cancer screening. Focus groups were segmented by sex, language, geographic location, and screening status. Data were transcribed, translated into English, and analyzed by using qualitative software. Results: Participants identified screening as beneficial for initiating provider discussions about cancer but did not report it as a beneficial method for detecting precancers. Perceived screening barriers included access (transportation, cost), spousal approval, stigma, embarrassment during screening, concerns about speculum use causing infertility, fear of residual effects of test results, lack of knowledge, and religious or cultural beliefs. All participants reported concerns with having a male doctor perform screening tests; however, men uniquely reported the young age of a doctor as a barrier. Conclusion: Identifying perceived barriers and benefits among people in low- and middle-income countries is important to successfully implementing emerging screening programs. The novel findings on barriers and benefits from this study can inform the development of targeted community outreach activities, communication strategies, and educational messages for patients, families, and providers.
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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].”
From Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study (2019) · cites this paper as [37]
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 measuredIn this population, adherence to treatment and screening coverage may be reduced by fear of infertility.
“In this population, adherence to treatment and screening coverage may be reduced by fear of infertility [8, 9].”
From Fertility and Miscarriage Incidence After Cervical Intraepithelial Neoplasia Treatment by Thermal Ablation: A Cohort Study (2025) · cites this paper as [9]
The Results (page unavailable) report that some women feared speculum use during screening could cause infertility, supporting fear of infertility as a potential screening barrier. The paper does not link that fear to treatment adherence or measure its effect on screening coverage. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe 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].”
Health 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].”
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Oketch, S. Y., Kwena, Z., Choi, Y., Adewumi, K., Moghadassi, M., Bukusi, E. A., & Huchko, M. J. (2019) · BMC Women's Health · doi:10.1186/s12905-019-0778-2 · Cited by 77 · see citing works
Wisniak, A., Yakam, V., Bolo, S. E., Moukam, A., Sormani, J., Vassilakos, P., Kenfack, B., & Petignat, P. (2025) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.17954 · Cited by 4 · see citing works
- Authors
- Buchanan Lunsford, N., Ragan, K., Lee Smith, J., Saraiya, M., & Aketch, M.
- Affiliations
- Division of Cancer Prevention and Control Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Centers for Disease Control and Prevention (US)
- Kenya Medical Research Institute (KE)
- Venue
- The Oncologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-02-01
- Volume
- 22
- Issue
- 2
- Pages
- 173-181
- ISSN
- 1083-7159 (ISSN-L)
- 1549-490X
- PMC
- PMC5330703
- OpenAlex
- W2586507372
- Cited by
- 74
- References
- 1
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 8 · 2023: 11 · 2022: 13 · 2021: 3 · 2020: 15 · 2019: 1 · 2018: 3 · 2017: 2
- FWCI
- 5.39
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Oncologist (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Energy
- Centers for Disease Control and Prevention (U01GH000048)
- Oak Ridge Institute for Science and Education
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, psychosocial barriers, environmental barriers, screening acceptance, stigma, spousal approval, gender and health, cultural beliefs, access to screening, low- and middle-income countries, Kenya, cervical cancer prevention
- MeSH terms
- Adult, Uterine Cervical Neoplasms, Female, Humans, Kenya, Mass Screening, Middle Aged, Early Detection of Cancer
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