Barriers and facilitators to colposcopy attendance following an abnormal pap smear: patient and provider perspectives

Cervical cancer is a public health problem particularly in developing countries where incidence of cervical cancer remains high, either due to a lack of screening or poorly organised screening programmes. Cytology based cervical screening is only beneficial if women with abnormal Papanicolaou (Pap) smears are appropriately investigated. Colposcopy attendance following an abnormal Pap smear is a major problem in South Africa. The aim of this study was to explore barriers and facilitators to colposcopy attendance following an abnormal Pap smear result. A qualitative study was conducted at a public sector tertiary hospital colposcopy service and two primary health care clinics in Cape Town, South Africa. Data collection included 32 semi-structured interviews: 12 face-to-face interviews with colposcopy clinic attendees, 12 telephonic interviews with colposcopy clinic non- attendees and 8 face-to-face interviews with health care providers. Client interviews explored barriers and facilitators to colposcopy attendance; knowledge and experiences of Pap smears, cervical cancer and the colposcopy procedure; scheduling of colposcopy appointments; provider communication; reasons for non-attendance; and community support and beliefs. Provider interviews explored barriers and facilitators to colposcopy attendance from a provider’s perspective, the colposcopy referral process, and provider challenges in the provision of Pap smear or colposcopy services. Results from this study highlighted that the main barriers to colposcopy attendance were: poor levels of knowledge of the importance of a Pap smear and the colposcopy procedure; a lack of awareness of cervical cancer as a disease; a fear of cancer; the asymptomatic nature of the disease; and transport costs. Health system factors that impacted negatively on colposcopy clinic attendance included: the inadequate feedback of Pap smear results – clients were not informed of Pap smear results or colposcopy appointments and therefore did not attend; a disjointed system of colposcopy scheduling; and staff shortages which resulted in less time for client tracking. Factors which promoted colposcopy attendance included experiencing symptoms; a family history of cancer due to the experience with death; colposcopy services situated closer to clients; and social support receive d from family members. Addressing these barriers requires promoting client knowledge with educational materials and improving provider communication with clients. In addition, establishing colposcopy services closer to clients and standardising the system of colposcopy scheduling can improve colposcopy adherence.

Grantor dc:publisher.institution

Department of Public Health and Family Medicine

Year dc:date.issued

2014

Author dc:creator

• Dawood, Shanaaz

Advisors dc:contributor.advisor

• Moodley, Jennifer
• Harries, Jane

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/11427/13135

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/13135