Matthew Asare

Human Papillomavirus (HPV) Vaccination and Cervical Cancer Prevention: Ghanaian Adolescent Students’ Perspectives Through Focus Group Discussion

The Human Papillomavirus (HPV) vaccine is effective in reducing HPV-related cancers. However, little is known about Ghanaian adolescents' attitudes toward HPV vaccination. We examined the perspectives of Ghanaian adolescent students on HPV vaccination. We conducted four focus group discussions with students from School A (n=15), School B (n=20), School C (n=10), and School D (n=14) in the Ashanti Region of Ghana. Ten open-ended questions guided the discussions. Two independent coders transcribed and analyzed the data thematically using NVivo software. Fifty-nine students (mean age: 14.97 years, SD = 1.55) participated. Thematic analysis revealed: (a) low knowledge of HPV and HPV vaccines, but strong general belief in vaccine benefits; (b) barriers such as fear of side effects (e.g., pain, death), misconceptions (e.g., infertility, "destroying the womb"), and vaccine cost; (c) facilitators including perceived vaccine effectiveness, social influences (parents, doctors, friends), school-based education, and altruistic motives; and (d) lack of adolescent-parent communication, though students expressed willingness to initiate conversations when informed. These insights highlight the socio-cultural and informational gaps that may impact vaccine uptake. Findings highlight the urgent need for culturally relevant, school-based HPV education programs in Ghana. Interventions should address common misconceptions, promote adolescent-parent communication, and leverage trusted influencers such as healthcare providers and teachers to improve HPV vaccine acceptance.

Culturally adapting and evaluating an evidence-based communication intervention with HPV self-sampling to improve cervical cancer screening among women living with HIV in Ghana: a mixed-methods study

Objectives We aimed to refine and culturally adapt an evidence-based communication intervention (EBCI), which consists of the 3R message framing model (Reframe, Reprioritise, Reform) and human papillomavirus self-sampling (HPVSS) for use in a teaching hospital in Ghana, and evaluated its acceptability, feasibility, appropriateness and adoption potential among stakeholders. Design Convergent mixed-methods design. Setting The study was conducted at a teaching hospital and its surrounding communities in the Central Region of Ghana. Participants A 36-member stakeholder advisory board comprising women living with HIV (WLHIV) (n = 14), healthcare providers (HCPs) (n = 11) and community members (n = 11) participated in Nominal Group Technique sessions to adapt the intervention. The adapted EBCI was subsequently evaluated by 45 participants (WLHIV=30 and HCPs=15). Outcome measures included key characteristics of the EBCI, acceptability, feasibility, appropriateness and its potential for adoption, which were assessed using validated Likert-type scales and structured interview guides. Results Core components of the intervention (HPVSS+3R) were retained. Hospitals and community pharmacies were the preferred self-sampling venues (97%). WhatsApp audio in English and Fante/Akan was the most favoured delivery mode for 3R messages (81%). Evaluation results revealed high acceptability (mean=22.84), feasibility (mean=22.40) and adoption (mean=21.73) on a 5–25 point scale, as well as appropriateness (mean=13.3) on a 3–15 point scale. Qualitative findings highlighted convenience, privacy, empowerment and cultural relevance, which reduced fear and increased participant engagement. Conclusion The adapted EBCI demonstrated high acceptability, feasibility, appropriateness and adoption potential among key stakeholders, supporting its integration into the Ghanaian health systems to advance cervical cancer elimination goals. Trial registration number NCT06739772 .

HPV self-sampling for cervical cancer screening among women living with HIV in Ghana: protocol for a hybrid type 1 effectiveness-implementation randomized controlled trial

Women living with HIV (WLWH) face a significantly higher risk of developing cervical cancer (CC) due to immune system suppression, which impairs the body's ability to clear high-risk HPV infections. Despite this increased risk, cervical cancer screening rates remain low among WLWH in Ghana, hindered by financial, logistical, and cultural barriers. Evidence-based interventions, such as HPV self-sampling and the 3R communication model (reframe, reprioritize, and reform) offer promising strategies to improve screening uptake. The primary objective of this study was to evaluate the effectiveness of the Home-based self-sampling for cervical cancer Prevention Education (HOPE) toolkit in increasing CC screening among WLWH in Ghana. Secondary objectives include assessing the feasibility, acceptability, appropriateness and adoptability of the HOPE intervention, as well as identifying key factors that influence its implementation. The study will be conducted at the Cape Coast Teaching Hospital (CCTH) in Ghana, using a Hybrid Type 1 effectiveness-implementation randomized controlled trial (RCT) design. A total of 108 WLWH will be randomly assigned to either the HOPE intervention group, which includes HPV self-sampling and 3R messaging, or a control group receiving standard care. Data will be collected through structured surveys, key informant interviews, and focus group discussions. The study will also engage a stakeholder advisory board (SAB) comprising WLWH, healthcare providers and community members to co-develop and adapt the intervention through nominal group technique. By leveraging existing healthcare infrastructure and community engagement, this study seeks to provide a scalable, evidence-based approach to improving CC screening among WLWH in Ghana. Findings will inform national strategies for integrating HPV self-sampling and health communication interventions to enhance early detection and reduce cervical cancer-related morbidity and mortality in this high-risk population. ClinicalTrials.gov NCT06739772. Registered on 18 December 2024.

Feasibility of Utilizing Social Media to Promote HPV Self-Collected Sampling among Medically Underserved Women in a Rural Southern City in the United States (U.S.)

Background: Social media (Facebook, WhatsApp, Instagram, Twitter) as communication channels have great potential to deliver Human papillomavirus self-test (HPVST) intervention to medically underserved women (MUW) such as women of low income. However, little is known about MUW’s willingness to participate in HPVST intervention delivered through social media. We evaluated factors that contribute to MUW’s intention to participate in the social media-related intervention for HPVST. Methods: A 21-item survey was administered among women receiving food from a local food pantry in a U.S. southern state. Independent variables were social media usage facilitators (including confidentiality, social support, cost, and convenience), and barriers (including misinformation, time-consuming, inefficient, and privacy concerns). Dependent variables included the likelihood of participating in social-driven intervention for HPVST. Both variables were measured on a 5-point scale. We used multinomial logistic regression to analyze the data. Results: A total of 254 women (mean age 48.9 ± 10.7 years) comprising Whites (40%), Hispanics (29%), Blacks (27%), and Other (4%) participated in the study. We found that over 44% of the women were overdue for their pap smears for the past three years, 12% had never had a pap smear, and 34% were not sure if they had had a pap smear. Over 82% reported frequent social media (e.g., Facebook) usage, and 52% reported willingness to participate in social media-driven intervention for HPVST. Women who reported that social media provide privacy (Adjusted Odds Ratio (AOR) = 6.23, 95% CI: 3.56, 10.92), provide social support (AOR = 7.18, 95% CI: 4.03, 12.80), are less costly (AOR = 6.71, 95% CI: 3.80, 11.85), and are convenient (AOR = 6.17, 95% CI: 3.49, 10.92) had significantly increased odds of participating in social media intervention for HPVST. Conclusions: The findings underscore that the majority of the MUW are overdue for cervical cancer screening, regularly use social media, and are willing to participate in social media-driven intervention. Social media could be used to promote HPV self-testing among MUW.

Determinants of Low-Income Women’s Participation in Self-Collected Samples for Cervical Cancer Detection: Application of the Theory of Planned Behavior

Background Low-income women (LIW) are underrepresented in physician-provided cervical cancer screening. Providing women with an option for Human Papillomavirus (HPV) self-sampling would increase cervical cancer screening. However, little is known about LIW’s attitude towards self-sampling for cervical cancer. We determined the associations between the Theory of Planned Behavior (TPB) constructs and LIW intention for participation in the HPV self-sampling. Methods A 44-item survey was administered among women receiving food from a food pantry in central Texas. Independent variables included TPB constructs (i.e., attitudes, subjective norms, and perceived control). The outcome variables were intentions and preference for self-sampling. Both variables were measured on a 5-point scale. Hierarchical linear regression models were used to analyze the data. Results A sample of 241 participants (age 50.13 ± 9.60 years) comprising non-Hispanic White (40%), Black/African American (27%), and Hispanic (30%) participated in the study. The participants were current with a pap test (54.8%) and preferred self-sampling (42%). The participant’s attitudes and subjective norms were significantly associated with their intention for self-sampling, accounting for 38.7% of the variance ( p < .001). Women who were overdue for pap testing versus current with pap testing had increased odds of preferring self-sampling (OR = 1.72, 95% CI: 1.27, 6.04). Conclusions The key predictors for LIW’s intention for self-sampling included attitudes and subjective norms. Future research should use the TPB as a framework to examine whether intention predicts self-sampling behavior among LIW.

Rural-urban disparities and trends in cancer screening: an analysis of Behavioral Risk Factor Surveillance System data (2018-2022)

Abstract Background Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancers. This analysis aimed to examine rural-urban differences in recent trends for being up-to-date with screenings for breast, cervical, and colorectal cancers. Methods We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible adults in the United States. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year. Results Prevalence of being up-to-date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer, which dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022, with the odds of up-to-date screening being 14% to 27% lower for rural populations than for urban populations. For colorectal and cervical cancers, the odds of being up-to-date with screenings were lower for rural populations in 2018 and 2020, but no statistically significant difference was observed in 2022 (colorectal screening odds ratio = 0.96, 95% CI = 0.90 to 1.02; cervical screening odds ratio = 0.97, 95% CI = 0.93 to 1.03). Conclusion There is a concerning trend of decreasing uptake of cancer screenings that will challenge future efforts in cancer prevention and control. There is a need to better understand the factors contributing to the decline in cancer screening update.