A Mixed Method Approach on the Perspectives of Cervical Cancer Screening in Makhuduthamaga

Background:Cervical cancer is said to be a burden in developing countries and commonly detected through symptoms at a later invasive stage. South Africa has therefore instituted a screening policy in the public sector for women ages between 30 and 70 but cannot meet the goals.

The aetiology, pathophysiology and progression of cervical cancer, occurs slowly over years. There   is a strong relationship between sexual exposure of HPV and dysplasia. The progression from normal cervical cells to dysplasia and then to invasive cervical cancer appears to be related to repeated injuries to the cervix (Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2007:1400). It is further indicated by Lewis et al, that ‘’ the number of deaths from cervical cancer in the United States has fallen steadily over the past 40 years due to better and earlier diagnosis through the widespread use of pap test.”

Non-invasive cervical cancer is about four times more common than invasive cervical cancer. Globally the annual incidence of cervical cancer is 471,000, with 80% of these cases occurring in underdeveloped countries. The mortality rate in these countries is 50%. The increased incidence and mortality rates are attributed to a lack of screening and treatment programmes. Approximately 10,370 women in the United States have invasive cervical cancer and 3700 women die from cervical cancer annually. The increased risk of cervical cancer is further associated with low socioeconomic status, early sexual activity (before 17 years of age), multiple sexual partners, infection with human papillomavirus (HPV), immunosuppression and smoking (Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2007:1400).The results of a study by Agurto (2004) on perceived barriers of cervical cancer screening in Latin America indicated that, services were not accessible to clients, poor quality of service and poor courtesy by providers, lack of privacy and comfort, high costs, clients’ anxiety and negligence to results were the main barriers identified by all participants to cervical cancer screening. The implication is that cervical cancer morbidity and mortality is an international concern.

 RESEARCH AIM/PURPOSE

The study is aimed at establishing knowledge/awareness of the importance of cervical cancer screening from women and professional nurses in the Makhuduthamaga sub-district in an attempt to reduce the mortality due to cervical cancer.

Objectives:The sequential explanatory research method aimed at evaluating the implementation of cervical cancer screening policy guidelines. Establishing the perceptions of women and professional nurses regarding cervical cancer screening and developing guidelines based on findings on cervical cancer screening.

Method:A mixed method approach was used by use of sequential explanatory design for both methods to complement each other. The rationale for using mixed methods for this study was to obtain a better understanding of cervical cancer screening by accommodating both women and professional nurses and by integrating numeric trends from quantitative data with specific details from qualitative data.  Qualitative method was used in focus groups, individual interviews for women and professional nurses. Quantitative method was used to gather numeric data through the use of a checklist to evaluate the implementation of the cervical cancer screening policy guideline.

The study was therefore conducted in four phases as follows:

Phase 1: The evaluation of the implementation of the guidelines in the selected clinics and the analysis of quantitative data

Phase 2: Establishing the perceptions of women through in-depth interviews and qualitative data analysis

Phase 3: Focus group discussions with professional nurses and data analysis

Phase 4: Integration of the qualitative and quantitative data and the formulation of guidelines based on the findings.

Population and sampling: The study population are the documents that are used for cervical cancer screening, the professional nurses working in Makhudthamaga, women.

Sampling was purposive.

Results:The results revealed inadequate knowledge with regard to cervical cancer screening from women and challenges with regard to implementation of cervical cancer guidelines mainly due to lack of resources and training of professional nurses and lack of knowledge from women.

Quantitative results

Results of the implementation of the cervical cancer screening policy guideline are illustrated in the following table:

 

No	Topic	Clinic1 %	Clinic2 %	Clinic3 %	Clinic4 %	Clinic5 %	Clinic6 %	Clinic7 %	Clinic8 %	Clinic9 %	Clinic10 %	Total   %
1	Target   population	100	100	100	100	100	100	100	100	100	100	100
2	Primary   prevention	100	100	20	0	60	100	0	0	20	20	42
3	Secondary   prevention	0	33	0	0	33	67	33	67	33	0	27
4	Referral   criteria	100	67	100	67	67	67	67	100	67	100	80
5	Follow   up criteria	0	50	0	100	50	0	100	50	100	50	50
6	Quality   assurance	0	50	0	100	50	0	100	50	100	50	50
7	Infection   control	100	100	100	100	100	100	100	100	100	100	100
	Average   %	57%	71%	46%	67%	66%	62%	71%	67%	74%	60%	64%

 

Qualitative results

The following themes emerged from the women interviews:

Major themes

• Perception of cervical cancer screening
• Underwent screening
• Importance of screening
• Possible consequences
• Encouragement

Sub-themes

• Lack of knowledge
• Undergone screening
• The importance of screening
• Awareness
• Assessment/diagnostic
• Early detection
• Prevention of death

      Consequences:

• Loss of the uterus
• Complications

The focus group discussions led to the following major themes:

• Uptake of cervical cancer screening
• Informed women about cervical cancer screening
• Cervical cancer importance.
• Cervical cancer screening procedure/skill
• Encouragement for follow up on cervical cancer screening and the  cervical cancer screening follow up plan
• Implementation of the National cervical cancer screening guidelines
• Cervical cancer screening inservice training

Conclusion:The results reveal a high need for training all categories of nurses, home based cares and informing all women in general about cervical cancer and screening to disseminate information to all people in the community.

Recommendations: The following recommendations were developed based on the results of the study intensified information giving to clients regarding the importants of being screened for cervical cancer, inservice training of professional nurses about the policy, review of the policy for better understanding by all stake holders and provision of human and structural (equipments)  resourses to improve the uptake of cervical cancer screening.