Esther Kikelomo Afolabi

Assessment of the Quality of Cervical Cancer Prevention Services in Southwest Nigeria: A Cross-Sectional Study Using Donabedian’s Quality Framework

Introduction Cervical Cancer (CC) is the second leading cause of cancer-related deaths among women in Nigeria, after breast cancer. However, there is a significant gap in evaluating prevention services due to the absence of organized and sustained programs. Immediate action is essential to address this critical issue. Objective The study assessed the quality of CC prevention services (CCPS) in selected Southwest Nigerian states using Donabedian’s quality framework. Methods The study employed a cross-sectional descriptive research design, selecting 24 Secondary Health Facilities (SHFs) and 72 reproductive-aged women (aged 30-49) from two states to evaluate the quality of CCPS. Based on the median score and interquartile range, the Donabedian quality framework categorizes CCPS as high, moderate, or poor. A paired independent t-test was conducted to compare the quality of existing CCPS in the two states. Results The study found that 42% of selected healthcare facilities in Osun State and 34% in Lagos State offer CCPS. The facilities have basic screening materials, with Visual Inspection with Acetic Acid (VIA) being the most used. The availability of materials resources in facilities varied based on the type of CCPS. The median score ranged from 124 to 185, with 54% of facilities rated good quality, 8.3% moderate, and 37.5% poor. However, there was no significant difference in CCPS quality between the two states at t = −1.96, P = 0.062. Conclusion Quality assessment of CCPS is crucial for providing effective and equitable healthcare. Donabedian’s framework enables systematic evaluation of the services’ structural, procedural, and outcome aspects. Addressing gaps and enhancing the quality of CCPS can effectively reduce the burden of CC.

Beyond Knowledge: Trust and the Engagement of Newly Arrived Refugee Women in Cervical Cancer Prevention

Refugee women face unique challenges in accessing preventive healthcare services upon resettlement, particularly for cervical cancer screening and HPV vaccination. Despite national efforts to reduce cervical cancer incidence, uptake remains disproportionately low among newly arrived refugee populations. Emerging research suggests that trust in healthcare systems and providers plays a pivotal role in shaping engagement with these services, yet little is known about how trust is built or broken in the early resettlement period. This study explores how trust and medical mistrust shape cervical cancer prevention behaviors among newly arrived refugee women in the United States, with attention to the multilevel relational and contextual factors that influence screening and vaccination. We conducted in-depth, semi-structured interviews with 17 refugee women resettled within the past two years in a Mid-western City, recruited through a community-based organization. Interviews were conducted in participants' preferred languages and lasted approximately 60 min. Data were thematically analyzed using Braun and Clarke's six-step framework, supported by Dedoose software. A codebook was developed through double coding and refined via consensus meetings. Themes were reviewed collaboratively and verified through member checking to enhance analytical rigor. Participants (n = 17) ranged in age from 21 to 56 and represented five countries, with the majority from Rwanda and Congo. Most had less than a high school education, and nearly all reported limited or no prior knowledge of cervical cancer, Pap smears, or HPV vaccination. Some confused HPV with other illnesses, while others attributed cervical cancer to unrelated factors such as stress or diet. Four themes emerged: trust as a precondition for engagement; provider trust shaped by cultural concordance, communication, and respect; systemic mistrust shaped by health literacy, practical/access issues and social influences; and the importance of community-based relationships in rebuilding trust and supporting preventive care engagement. Refugee women's engagement with cervical cancer prevention is shaped not only by knowledge but also by cultural safety, provider concordance, and systemic trust. Interventions must prioritize community-rooted education, gender-concordant care, and culturally responsive communication to improve prevention outcomes.