Adaptation and Implementation of a Patient Navigation Program for Cervical Cancer Screening Across Contexts in Senegal

NCT05544084RecruitingNAINTERVENTIONAL

Summary

The goal of this project is to prevent unnecessary deaths due to cervical cancer in Senegal. This mixed methods research responds to identified intrapersonal- and community-level barriers to early cervical cancer screening uptake, follow-up, and treatment among women there. Investigators will apply the Dynamic Adaptation Process (DAP) as integrated into the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to study the adaptation of an evidence-based cervical cancer patient navigation program in urban and rural contexts in Senegal, measure the intervention effectiveness, and evaluate programmatic implementation outcomes. By studying the process of adaptation of a patient navigation program in a low- and middle-income country (LMIC), investigators will build new knowledge while addressing an important public health issue. The project demonstrates innovation by advancing both adaptation and implementation process knowledge of an evidence-based patient navigation intervention in various contexts within a LMIC with a particular focus on how the adaptation responds to cancer-related stigma, misinformation, and women's autonomy in healthcare decision-making. Investigators will build knowledge through local learning which will further the long-term goal to inform the national cervical cancer prevention and control programs in two areas of Senegal and other similar LMICs.

Key Facts

Lead Sponsor

University of Illinois at Chicago

Enrollment

901

Start Date

2023-08-01

Completion Date

2026-05-01

Study Type

INTERVENTIONAL

Official Title

Adaptation and Implementation of a Patient Navigation Program for Cervical Cancer Screening Across Contexts in Senegal

Interventions

Patient Navigator Approach

Conditions

Cervical CancerBehavior

Eligibility

Age Range

25 Years – 69 Years

Sex

ALL

Inclusion Criteria:

The inclusion criteria for samples a, b, \& c are as follows:

1\) Senegal citizen between the ages of 25 and 69, 2) willing to participate in survey assessments;

The additional criteria apply for both women and men for the follow samples:

Sample a: 3) an invited member of the study National Advisory Board or Regional Implementation Resource Teams as defined above; 4) able to read and write in French.

Sample b: 3) employed by the state at a study site health facility as a patient navigator, clinician (nurse, midwife) who treats and educates patients, or is a community health worker at the facility or community level (Bajenu Gox - women's health educator).

Sample c: Women: 3) a woman living with a male partner who also agrees to participate in the study, 4) eligible to seek cervical cancer prevention services at a designated health facility in Senegal. Men: 3) a man living in a household with at least one woman eligible to seek cervical cancer prevention services at a designated health facility in Senegal.

Exclusion Criteria:

* No additional exclusion criteria exist.

Outcome Measures

Primary Outcomes

Change in the number of women screened for the first time, age stratified uptake through self-report questionnaire and confirmed through record review

Change in the number of women reporting cervical cancer screening uptake, age stratified

Time frame: Baseline and then every 12 months through 36 months

Secondary Outcomes

Change in time to treatment for dysplasia, age stratified, through record review

Change in the time from diagnosis of a positive cervical cancer screen to treatment for dysplasia, age stratified

Time frame: Baseline and then every 12 months through 36 months

Change in perceived stigma of cervical cancer as the fault of the individual, through questionnaire

Change in the number of women and men stating that if a woman gets cervical cancer it is probably their own fault, age stratified

Time frame: Baseline and then every 12 months through 36 months

Change in decision to get cervical cancer screen, age stratified, through questionnaire

Change in the number of women and men stating that women are able to make their own decisions regarding getting screened for cervical cancer, age stratified

Time frame: Baseline and then every 12 months through 36 months

Change in awareness of cervical cancer, age stratified, through questionnaire

Change in the number of women and men stating awareness of cervical cancer, age stratified"

Time frame: Baseline and then every 12 months through 36 months

Change in knowledge of need for screen despite symptoms, age stratified, through questionnaire

Change in the number of women and men stating awareness of the necessity for cervical cancer screening despite having no symptoms, age stratified

Time frame: Baseline and then every 12 months through 36 months

Change in spouse communication about cervical cancer screening, through questionnaire

Perception of men and women of open communication with spouse regarding healthy approach to cervical cancer screening for women.

Time frame: Baseline and then every 12 months through 36 months

Locations

University of Cheikh Anta Diop, 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

Adaptation and Implementation of a Patient Navigation Program for Cervical Cancer Screening Across Contexts in Senegal