Oliver C Ezechi

Intersectional stigma and resilience in the uptake of cervical cancer prevention services in Nigeria: a qualitative study

Background Cervical cancer is one of the leading causes of death among women in Africa, but stigma often delays cervical cancer prevention. We explore the perceptions, enablers and nurturers through the lens of intersectional stigma in the uptake of cervical cancer prevention services in Nigeria. Method Indepth interviews and focus group discussions were conducted among women aged 30–65 years and girls aged 9–26 years in Lagos, Nigeria. Data were analysed thematically. Using the relationships and expectation domain of the PEN-3 cultural model, we identified perceptions, enablers and nurturers related to the uptake of primary and secondary cervical cancer prevention services in Nigeria. We also explored how social identities may intersect with health-related stigmas and affect the uptake of these services. Result We interviewed 31 women and 31 girls. 61% of the participants were Christians and 39% were Muslims and were from the three major ethnic groups in Nigeria: Igbo (34%), Hausa (38%) and Yoruba (28%). Themes emerging from the data: (1) positive perceptions (self-efficacy): many women understood the importance of protecting themselves and their daughters from cervical cancer and strongly believed that they could educate their partners/husbands and would not let other people’s experiences with the vaccine influence them negatively. (2) Negative perceptions (anticipated stigma): some women expressed that because the human papillomavirus that causes cervical cancer is mainly sexually transmitted, they were concerned that they may be perceived as being promiscuous if they decide to commence routine cervical cancer screening. (3) Enablers (social support): nearly all women wanted the support of their spouses before receiving cervical cancer screening. (4) Nurturers (resilience): many clearly understood the complex social and economic realities faced by Nigerians that negatively affect their access to healthcare. Conclusion These findings offer intersectional insights into advancing public health and culturally anchored interventions to preventing cervical cancer-related stigma in Nigeria.

Implementation of Clinical Practice Guidelines to Prevent Cervical Cancer: Mixed Methods Study

Background Cervical cancer is a common cause of death among women globally, particularly in Africa. Each year, an average of 7093 women in Nigeria die from cervical cancer. Clinical practice guidelines developed by the Society of Obstetrics and Gynecology of Nigeria (SOGON) aim to prevent cervical cancer. However, the extent of their adoption among gynecologists remains unclear. Objective This study aimed to assess Nigerian gynecologists’ awareness, understanding, and incorporation of the SOGON clinical practice guidelines for cervical cancer prevention in their clinical practices. Methods A convergent parallel mixed methods design was used. Quantitative data were collected via a web-based and in-person survey distributed to gynecologists attending the 57th SOGON Annual General Meeting in Kano, Nigeria (November 2023). A total of 105 gynecologists completed the survey (response rate: 80%). Key informant interviews (n=12) were conducted to provide qualitative insights. Quantitative data were analyzed using descriptive and inferential statistics, including logistic regression (P<.05). Thematic analysis was applied to qualitative data. Results Among the 105 respondents (mean age 50, SD 8.3 y and mean postresidency practice 12, SD 9.4 y), 98 (93.3%) reported awareness of the SOGON guidelines, and 74 (70.5%) endorsed their importance for cervical cancer prevention. However, only 58.1% (61/105) of the respondents reported integrating the guidelines into routine clinical practice. Barriers to implementation included limited training (71/105, 67.6%), resource constraints (64/105, 60.9%), and lack of institutional support (57/105, 54.3%). Qualitative data reinforced the need for more tailored guidelines for high-risk populations and rural settings. In addition, 70.5% (74/105) of the respondents advocated for a participatory guideline review process to ensure relevance and feasibility. Conclusions While awareness of the SOGON guidelines is high, their integration into clinical practice remains suboptimal due to systemic barriers. Strengthening training programs, improving access to resources, and enhancing institutional support are critical to increasing guideline adoption and advancing cervical cancer prevention efforts in Nigeria.