Joyline Chepkorir

The Role of Health Information Sources on Cervical Cancer Literacy, Knowledge, Attitudes and Screening Practices in Sub-Saharan African Women: A Systematic Review

Cervical cancer is the leading cause of cancer deaths among Sub-Saharan African women. This systematic review aimed to identify information sources and their relation to cervical cancer knowledge, literacy, screening, and attitudes. Peer-reviewed literature was searched on 2 March 2022, and updated on 24 January 2023, in four databases—CINAHL Plus, Embase, PubMed, and Web of Science. Eligible studies included those that were empirical, published after 2002, included rural women, and reported on information sources and preferences. The quality of the selected articles was assessed using the Mixed Methods Appraisal Tool. Data extraction was conducted on an Excel spreadsheet, and a narrative synthesis was used to summarize findings from 33 studies. Healthcare workers were the most cited information sources, followed by mass media, social networks, print media, churches, community leaders, the Internet, and teachers. Community leaders were preferred, while healthcare workers were the most credible sources among rural women. There was generally low cervical cancer knowledge, literacy, and screening uptake, yet high prevalence of negative attitudes toward cervical cancer and its screening; these outcomes were worse in rural areas. A content analysis revealed a positive association of health information sources with cervical cancer literacy, knowledge, screening, and positive screening attitudes. Disparities in cervical cancer prevention exist between rural and urban Sub-Saharan African women.

Web-Based Delivery of an Effective Church-Based Intervention Program to Promote Cancer Screening (Community-based Health litEracy-focused intervention for breast and cervical Cancer Control) Among Korean Immigrant Women in the United States: Randomized Controlled Trial

Abstract Background Women with limited English proficiency continue experiencing an unequal cancer burden. Non-White immigrant women present with more advanced breast and cervical cancer than non-Hispanic Whites, attributed to significant cultural barriers as well as low health literacy in attempting to navigate the United States health care system for cancer screening. Community-based Health litEracy-focused intervention for breast and cervical Cancer Control (CHECC-uP) was an in-person, community health worker-led intervention, addressing both cultural and health literacy barriers through health literacy education and follow-up counseling with navigation assistance. The in-person program was tested in a large cluster-randomized trial and yielded high efficacy in promoting mammogram and Papanicolaou test screening in Korean-speaking women. With over 90% of Americans now having online access, the in-person program was adapted to web-based delivery. Objective This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of the web version of the intervention—e-CHECC-uP. Methods A randomized pilot trial was conducted. A total of 40 women were enrolled and randomized (20 per arm). The study intervention consisted of web-based health literacy education followed by phone counseling with navigation assistance. Study assessments were done at baseline, 3 months, and 6 months. The study’s primary outcomes were cancer screening behaviors verified by medical record review. Upon completion of final study assessments, intervention participants were invited to join postintervention interviews. Results In total, 34 women (intervention: n=15; control: n=19) completed the assessment at 6 months, yielding a retention rate of 85%. The intervention participants were highly satisfied with e-CHECC-uP with a median rating of 8 on a 10-point scale. Between-group differences in screening rates were 34.6%, 47.9%, and 37.5%, respectively, for completion of the mammogram, Papanicolaou test, and both at 6 months. Conclusions We achieved a high retention rate and high participant satisfaction. Although the study was not powered for significance testing, the e-CHECC-uP intervention resulted in large group differences across all cancer screening outcomes in the pilot sample. Online technology can help address multiple logistical barriers associated with in-person intervention delivery. Our findings suggest that web-based delivery of CHECC-uP may be used to promote cancer screening among immigrant women with limited English proficiency, as a promising avenue to ultimately reduce health disparities in underserved communities.

Barriers and Opportunities for HPV Self-Sampling in Underserved Rural Communities: Insights from a Mixed Methods Study

Cervical cancer is the leading cause of cancer-related deaths among women in sub-Saharan Africa, especially in rural areas with limited access to screening. This study explored factors influencing rural Kenyan women’s willingness to self-collect samples for HPV-DNA testing. Data were drawn from a mixed methods study in two Kenyan rural counties, including surveys with 174 women and interviews with 21 participants. The mean age of the survey sample was 45.2 (SD = 13.2) years. Only 6.4% had ever been screened, yet 76.9% expressed willingness to self-collect samples for testing. Increased willingness was associated with cervical cancer awareness (OR = 3.49, 95% CI = 1.50–8.11), relying on health workers as primary sources of health information (OR = 1.88, CI = 1.23–2.86), or the news media (OR = 2.63, CI = 1.27–5.48). High cervical cancer stigma (OR = 0.71, CI = 0.57–0.88) and longer travel times of 30–120 min to a health facility (OR = 0.44, CI = 0.20–0.93) were linked to reduced willingness. Integration of the findings showed that comprehensive health promotion—through education, health worker endorsement, and mass media campaigns—may improve HPV self-sampling uptake and reduce the cervical cancer burden in rural Kenya.