Reducing Barriers and Sustaining Utilization of a Cervical Cancer Screening Program in Rural Senegal

NCT03540069CompletedNAINTERVENTIONAL

Summary

This research project will investigate the determinants of cervical cancer screening uptake and sustained utilization in this region and develop and evaluate a context-specific peer education behavioral intervention to improve uptake. Research supports the effectiveness of peer education in increasing cancer screening rates but, currently, no cervical cancer screening peer education program specific to rural Senegal exists. To inform the participatory development of this program, the investigators will assess barriers and facilitators of screening at multiple levels: individuals (women aged 30 to 59), households (family or principle social unit of at-risk women), and the community (immediate village or neighborhood with common amenities of at-risk women). We hypothesize that a peer education program that adapts to changing contexts over time and is targeted at a multi-level audience will result in early, widespread uptake and sustained use of the VIA cervical cancer screening program. Study findings will inform programmatic planning in Kedougou and the peer education curriculum we develop can serve as a template for maximizing early impact of new cervical cancer screening services implemented in other areas of rural Senegal. Our long-term goal is to inform national-level policy to guide the implementation of cervical cancer screening programs in other rural Senegal regions.

Key Facts

Lead Sponsor

University of Illinois at Chicago

Enrollment

160

Start Date

2018-10-03

Completion Date

2021-12-15

Study Type

INTERVENTIONAL

Official Title

Reducing Barriers and Sustaining Utilization of a Cervical Cancer Screening Program in Rural Senegal

Interventions

Care Group Cervical Cancer Screening Education Curriculum

Conditions

Cervical CancerBehavior

Eligibility

Age Range

30 Years – 59 Years

Sex

ALL

Inclusion Criteria:

Women. Criteria for inclusion include:

* female Senegal citizen between the ages of 30 and 59,
* Resident in Kedougou Region,
* eligible to seek cervical cancer prevention services at a designated intervention or control health center in the Kedougou Region, Senegal,
* willing to participate in survey assessments; 5) able to give informed consent.

Men. Criteria for inclusion include:

* male Senegal citizen between the ages of 30 and 59,
* Resident in Kedougou Region,
* living in a household with at least one woman eligible to seek cervical cancer prevention services at a designated intervention or control health center in the Kedougou Region, Senegal,
* willing to participate in survey assessments;
* able to give informed consent.

Exclusion Criteria:

* No additional exclusion criteria exist.

Outcome Measures

Primary Outcomes

Change in the number of women screened for the first time, age stratified

Number of women who are screened for cervical cancer

Time frame: measured at baseline and every 6 months through 35 months.

Secondary Outcomes

Change in the number of women and men recommending the service

Number of women and men recommending that women of screening age get cervical cancer screening

Time frame: measured at baseline and every 6 months through 35 months.

Change in the knowledge of cervical cancer

Composite of Knowledge of cervical cancer score from the quantitative survey

Time frame: measured at baseline and every 6 months through 35 months.

Change in the number of women being re-screened, age stratified

Number of women being re-screened at 2 years per regional policy

Time frame: measured at baseline and every 6 months through 35 months.

Change in the number of individuals directly receiving intervention

Number of individuals communities directly receiving intervention

Time frame: measured at baseline and every 6 months through 35 months.

Change in the number of households directly receiving intervention

Number of households directly receiving intervention

Time frame: measured at baseline and every 6 months through 35 months.

Change in the number communities directly receiving intervention

Number of communities directly receiving intervention

Time frame: measured at baseline and every 6 months through 35 months.

Locations

University of Illinois at Chicago, Chicago, United States

Sénégal Ministère de la Santé et l'Action Sociale Département de Recherche, Dakar, Senegal

Université Cheikh Anta Diop, Dakar, Senegal Cancer Institute & Institute of Health and Development, Dakar, Senegal

Linked Papers

2020-04-28

Role of gender in perspectives of discrimination, stigma, and attitudes relative to cervical cancer in rural Sénégal

Cervical cancer is the leading cause of female cancer deaths in Sénégal which is ranked 17th in incidence globally, however, the screening rate there is very low. Nuanced gendered perceptions and health behaviors of both women and men play a significant role in women's health. Our study analyzed gender differences on perceptions of gender roles, discrimination, cancer attitudes, cancer stigma, and influences in healthcare decision making within our study population to inform ongoing cervical cancer prevention work in the rural region of Kédougou, Sénégal. We conducted a cross-sectional survey of 158 participants, 101 women and 57 men (ages 30-59) across nine non-probability-sampled communities from October 2018 through February 2019. Bivariate analysis was conducted to assess gender differences across all variables. We also conducted analyses to determine whether there were significant differences in beliefs and attitudes, by screening behavior and by education. We found significant gender differences regarding the perception of a woman's role (P < 0.001) and a man's role (P = 0.007) as well as in the everyday discrimination questions of "decreased respect by spouse" (P < 0.001). Regarding cancer stigma, among women, 18.00% disagreed and 10.00% strongly disagreed while among men, 3.6% disagreed and 1.8% strongly disagreed that "If I had cancer, I would want my family to know that I have it." When making decisions about one's healthcare, women are more likely than men to trust social contacts such as their spouse (46.5% vs 5.3%, p < 0.001) while men are more likely than women to trust health service personnel such as a nurse (50.9% vs 18.8%, p < 0.001). Furthermore, men and women were both more likely to state that men have the final decision regarding the healthcare decisions of women (p < 0.001). Our data reveal structural disadvantages for women within our study population as well as gender differences in the adapted everyday discrimination scale and cancer stigma scale. Higher rates of both personal and perceived cancer stigma among women has profound implications for how population and community level communication strategies for cancer prevention and control should be designed. Efforts to advance the goal of the elimination of cervical cancer should, in the short-term, seek to gain a more profound understanding of the ways that gender, language, and other social determinants impact negative social influences and other barriers addressable through interventions. Social and behavior change communication may be one approach that can focus both on education while seeking to leverage the social influences that exist in achieving immediate and long-term goals.

Linked Investigators

Elly Lou De Jesus

Jon Andrew Dykens

Reducing Barriers and Sustaining Utilization of a Cervical Cancer Screening Program in Rural Senegal