Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Open
Abstract
Objective: To define embarrassment and develop an
understanding of the role of embarrassment in relation
to cervical cancer screening and self-collected human
papillomavirus (HPV) DNA testing in Uganda.
Design: Cross-sectional, qualitative study using
semi structured one-to-one interviews and focus
groups.
Participants: 6 key-informant health workers and
16 local women, purposively sampled. Key informant
inclusion criteria: Ugandan members of the project
team. Focus group inclusion criteria: woman age
30–69 years, Luganda or Swahili speaking, living or
working in the target Ugandan community. Exclusion
criteria: unwillingness to sign informed consent.
Setting: Primary and tertiary low-resource setting in
Kampala, Uganda.
Results: In Luganda, embarrassment relating to
cervical cancer is described in two forms. ‘Community
embarrassment’ describes discomfort based on how a
person may be perceived by others. ‘Personal
embarrassment’ relates to shyness or discomfort with
her own genitalia. Community embarrassment was
described in themes relating to place of study
recruitment, amount of privacy in dwellings, personal
relationship with health workers, handling of the
vaginal swab and misunderstanding of HPV self collection as HIV testing. Themes of personal
embarrassment related to lack of knowledge, age and
novelty of the self-collection swab. Overall,
embarrassment was a barrier to screening at the outset
and diminished over time through education and
knowledge. Fatalism regarding cervical cancer
diagnosis, worry about results and stigma associated
with a cervical cancer diagnosis were other
psychosocial barriers described. Overcoming
psychosocial barriers to screening can include peer-to peer education, drama and media campaigns.
Conclusions: Embarrassment and other psychosocial
barriers may play a large role at the onset of a
screening programme, but over time as education and
knowledge increase, and the social norms around
screening evolve, its role diminishes. The role of peer to-peer education and community authorities on
healthcare cannot be overlooked and can have a major
impact in overcoming psychosocial and social barriers
to screening.
Description
Keywords
gynaecological, screening, qualitative study, ASPIRE cervical cancer, project in Uganda
Citation
Teng FF, Mitchell SM, Sekikubo M, et al. Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda. BMJ Open 2014;4:e004783. doi:10.1136/bmjopen-2014- 004783