Improving the Care Seeking Behaviour Toward Cervical Cancer Screening Participation Among Gwafan Community Women, North- Central, Nigeria

Improving the Care Seeking Behaviour Toward Cervical Cancer Screening Participation Among Gwafan Community Women, North- Central, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving the Care Seeking Behaviour Toward Cervical Cancer Screening Participation Among Gwafan Community Women, North- Central, Nigeria Eunice Samuel Ari, Regidor III Poblete Dioso, John Obafemi Sotunsa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2463486/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Jul, 2023 Read the published version in BMC Women's Health → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: Cervical cancer is the fourth most common cancer in women globally and the second in low-Middle income countries, its screening rate is yet to reach 70% WHO target. Most interventions that proved effective in improving screening participation in some communities did not achieve the desired behavioural outcome in some settings. Aim: This study aimed at evaluating the care seeking behaviour interventions on cervical cancer screening participation. Method: A Pragmatic Multiphase Mixed Methods Design was adopted for this study and three phases of Human Centered Design process was used for data collection. Thematic analysis was used for qualitative data while SPSS for the quantitative data analysis. Results: Findings indicate that most (57.4%) participants were within 30–65 years, most (81.0%) were extremely poor with annual income < 284,700.00 Naira. Before intervention, most (77.4%) were afraid of exposing their private parts, 75.9% were afraid of being diagnosed with cervical cancer; 52.1% felt the procedure was embarrassing, 53.2% felt the procedure was painful; 11.2% had ever screened; majority (88.8%) said involving husband, (86.5%) welcoming attitude of care provider are among facilitators for screening. Screening participation improved from 11.2% preintervention to 29.7% postintervention (average mean screening score from 1.89 ± 0.316 to 1.7000 ± 0.458), all participants who screened postintervention said the procedure was not embarrassing, painful, and were not afraid of procedure and screening room. In conclusion, screening habit in the community was low preintervention as this may result from social norms, affect, utility, influence of sociodemographic variables and lack of facilitating conditions. Care-seeking behaviour interventions has significantly increased screening participation. Care-seeking behaviour Cervical cancer Human Centre Design Screening participation Introduction Cervical cancer (CC) is caused by a sexually acquired infection with Human papillomavirus (HPV). Globally, this is the fourth most common cancer in women with an estimated 570,000 new cases and 311,000 deaths in 2018 (Arbyn, Weiderpass, Bruni, Sanjose, Saraiya, Ferlay et al., 2020). At the regional level, Cervical cancer is most common in Africa, with rates seven to ten times higher than in Australia, Western Asia, North America, and New Zealand (Bray, Ferlay, Soerjomataram, Siegel, Torre, Jemal, 2018 ). In low- and middle-income countries, CC is the second most common cancer and the major cause of death among women in low and middle-income countries, accounting for 88% of deaths (Bray et al., 2018 ). Nigerian women aged 15 and above who are at risk of developing cervical cancer are 50.33 million, 14943 women are diagnosed and 10403 died yearly (Bruni, Albero, Serrano, Mena, G´omez, Mu˜noz, Bosch, de Sanjos´e, 2019). The worrisome rise in adolescent and young adult patients with malignant epithelial malignancies of the cervix is alarming among patients aged 0–30 years old, especially 21–30 years age group (Abudu & Akinbami, 2016 ). Cervical cancer is preventable worldwide through screening, detection, and treatment of precancerous abnormalities (Islam, Billah, Hossain & Oldroyd, 2017 ). Cervical cancer screening guidelines recommend that women between the ages of 21 and 29 should get a Pap test every three years; women between the ages of 30 and 65 should get an HPV test every five years or a Pap test every three years after consulting with their doctor; and those over the age of 66 should ask their doctors if they need continued screening testing every five year (US Preventive Services Task Force, 2018 ). According to projections, the burden of the disease will rise to nearly 460,000 deaths by 2040 if preventive services are not scaled up quickly (Bray et al., 2018 ). Cervical cancer screening rates have declined in Western countries (Mayo Clinic, 2019), and among women between ages 45 and 65 in the United State ((Donatus, Nina, Sama, Nkfusai, Bede, Shirinde & Cumber, 2019). Screening uptake is declining in low-resource countries (Achampong, et al, 2018). In Nigeria, there is paucity of information on screening rate, but some studies conducted in parts of the country found that cervical cancer screening coverage by conventional cytology is less than 9% in the populace (Musa, Silas, Mehta., Murphy, & Hou 2019), 10.2% among Federal Civil Servants in North Central Nigeria (Hyacinth, Adekeye, Ibeh, and Osoba 2012 ), and 32.6% among health workers at JUTH and its environs (Eka, 2016 ). It was found that most cervical cancer cases (72.3%) are diagnosed at advanced stages(Musa, Nankat, Achenbach, Shambe, Taiwo, & Mandong, 2016). Women use cervical cancer screening services at a relatively late age, with a median age of 37 (Musa et al., 2019 ), 40–49 years (Egbodo, Edugbe, Akunaeziri, Ayuba, Oga, Shambe et al., 2018 ). Low uptake may result from fear, embarrassment (Hahm, Choi, Lee, Suh, Lee, Shin et al., 2017; (Frerichs, Rhode, Bell, Hunt, Lowery, Brooks, et al., 2018; Alexis & Worsley, 2018 ; Nyambe, Kampen, Baboo, & Hal, 2018 ; Ifemelumma et al., 2019 ; Momberg, Botha, Van Der Merwe, & Moodley, 2017 ; Lor, Backonja & Lauver, 2017 ; Joffe, Ayeni, Norris, Mccormack, Ruff, Das, et al., 2018); Vhuromu. Goon, Maputle, Lebese, & Okafor, 2018), low socioeconomic status (US Preventive Services Task Force, 2018 ), unsatisfied previous screening experience (Al-Amoudi, Cañas, Hohl, Distelhorst, & Thompson, 2015 ; Al Dasoqi, Zeilani, Abdalrahim, & Evans., 2013), while experiencing gynaecological symptoms (Ndejjo et al., 2017; Momberg et al., 2017 ; Nyambe et al., 2018 ) may encourage participation. Facilitating conditions for screening which were effective in some settings did not achieve their desired aim in other settings as found in these studies: free screening did not increase screening rate (Donatus et al., 2019 ), Availability of screening centres nears women homes (5km away from their homes) did translate to screening (Vhuromu et al., 2018 ), Educational interventions were not very effective overall (Mbachu Cyril, & Uche, 2017; (Lott, Trejo, Baum, McClelland, Adsul, Madhivanan et al., 2020 , Economic incentivization interventions were moderately effective, increased uptake but still achieving less than 20% coverage ((Mehrotra, An, Patel and Sturm, 2014 ), very high willingness to screen, even pre-intervention, but that intent was not always well-translated to the uptake of cervical cancer screening ((Ndikom, Ofi, Omokhodion, Adedokun & Ndikom, 2017), increase from 75.8 to 91.0% in willingness to screen yet no change in actual screening (Lott et al., 2020 ), significant improvement in uptake without any community health educators (Chigbu, Onyebuchi, Onyeka, Odugu and Dim, 2017 ), pre-invitation leaflet nor online booking did not increase uptake by three months (18.8% pre-invitation leaflet vs. 19.2% control and 17.8% online booking vs. 17.2% control. The offer of a nurse navigator, a self-sample kit on request, and choice between timed appointments and nurse navigator were ineffective (Kitchener, Gittins, Cruickshank, Moseley, Fletcher, Albrow et al., 2018 ). Health talk did not affect practice (Yunitasari, Rosyda, & Santoso, 2020 ). In the absence of facilitating conditions, barriers to screening ensued. To reduce the burden of cervical cancer, women must take up cervical screening services which will detect the presence of HPV to prevent precancerous cells from transforming to the cancerous cell especially in a country where human papilloma vaccine is not readily available and accessible. Effective CC screening interventions based on women's needs are a critical component of the prevention that will eventually reduce the global burden of in cervical. Method A Pragmatic Multiphase Mixed Methods Design was adopted for this study and three phases of Human Centered Design process was used for data collection. Thematic analysis was used for qualitative data while SPSS for the quantitative data analysis. 340 women purposively recruited after meeting inclusion criteria: women aged 21–65 years, sexually active, no diagnosis of cervical cancer, intact cervix, residing in Gwafan Community and willing to participate. Baseline and endline data on affect and habit regarding care seeking behaviour for cervical cancer screening was assessed. Result Phase One (Inspirational phase): This phase used quantitative approach to collect data on socioeconomic variables, affect and habit regarding care seeking behaviour for cervical cancer screening participation. Table 1 Demographic Characteristics Item Frequency (f) Percent (%) Age in years 21–29 145 42.6 30–65 195 57.4 Total 340 100.0 Annual Income in Naira 479500 8 9.5 Total 84 100.0 Table 1 shows out of the 84 women who responded to annul income earned 479,500 Naira, respectively. Table 2 Pre-intervention Affect. Item Frequency (f) Percent (%) The procedure is embarrassing Yes 177 52.1 No 163 47.9 Total 340 100.0 Procedure is painful Yes 181 53.2 No 159 46.8 Total 340 100.0 Fear of exposing my private part Yes 263 77.4 No 77 22.6 Total 340 100.0 Fear of the procedure and screening environment Yes 220 64.7 No 120 35.3 Total 340 100.0 Fear of being diagnosed with the disease Yes 258 75.9 No 82 24.1 Total 340 100.0 Table 2 . shows that majority (52.1%) felt the procedure for cervical cancer screening is embarrassing, 53.2% felt the procedure is painful, 77.4% said fear of exposing my private part, 64.7% said they are afraid of cervical cancer screening procedure and environment, 75.9% said they are afraid of being diagnosed with cervical cancer. Table 3 Pre-intervention Habit Item Frequency (f) Percent (%) I have ever screened for cervical cancer Yes 38 11.2 No 302 88.8 Total 340 100.0 Year Screened < 2018 13 34.2 2018–2021 25 65.8 Total 38 100.0 Experience during previous Screening Bad procedural experience 5 13.2 Good experience 33 86.8 Total 38 100.0 Table 3 . shows that majority (88.8%) of the women had never screened for cervical cancer while only 11.2% have screened for cervical cancer. Out of the 38 women who had screened, 86.8% had a good experience during screening while 5 (13.2%) had bad experiences. Phase two (Ideation phase): Phase two- focused on data collected through Focus Group discussion with 4 community women on the development of care seeking behaviour intervention. The opinions of an academic expert, researcher’s supervisor, and Midwives responsible for sample collection was also sought at this phase. First meeting We discussed and brainstormed at some interventions that may improve screening from previous studies and these interventions include offering transport (Brouwers. De Vito, Bahirathan, Carol, Carroll, Cotterchio,et al., 2011), having health insurance (Khalil, Hatch, Price, Palakurty, Simoneit, Radisic,et al., 2019), free screening services (Vhuromu et al., 2018 ; Egbodo et al., 2018 ; Musa et al., 2019 ), alternative clinic sites, female family Doctors (Hulme, Moravac, Ahmad, Cleverly, Lofters, Ginsburg, et al., 2016), having a recommendation to attend the screening (Black, Hyslop, & Richmond, 2019 ), Brochure, training and verbal invitation (Kurt & Akyuz, 2019 ). We then asked the following questions: Question 1: I said we may discuss after analyzing the filled questionnaires and you consented. What do you think we can do to improve our participation in cervical cancer screening? Remember we are representing the opinions of the community women. Participants quotes: “We want awareness and health talk on the disease after the health talk then screening” 02. “We will follow women to churches to create awareness and give health talk ” 01, 02 “Some said its only screening they want to go ” 04 Question 2: How can we get the information to the whole women that participated in this study? Participants quoted: “Since they are all not Christians, we have Muslim participants, and some women are not in any of the women groups in their churches, we can print materials to various women church groups” 01. “They should make printed papers for them; they surely have someone in their family that can read” 02. “Not everyone knows how to read so, I prefer women should just go for screening ” 03. “The problem is that getting women together is difficult, so screening is the only option” 04. Question 3: Screening is the only option; how can we do this screening? Participants stated: “JUTH is not far from here” 01, 02,03. “Some women will still not go for the screening for transport fare” 02. “If we bring it to Tollemach primary school, some women that are far will still have challenges” 03. “ Even if we take the screening to the community, some women will still not go because it will be far for them ” 04. " You see some reasons why women may not go for this screening is that some results of samples collected will be exchanged, and they will bring out results for others and give them to others. They will tell you that you have a disease even when the result does not belong to you. People don’t want to do screening because of that” 02. We have to consider those that will collect the samples for the reason you gave that some results from the samples collected could be mistakenly given to others that don’t have the disease. Participants quoted: “ Participants would have to go to JUTH for screening ” 01, 02, 03. “This one, women will want to go but transport will be their challenge” 01. “As it is rightly said, anyone with the intention will go” 02, 03. “Two hundred will not be much to transport to JUTH.”03. “We may even trek to the place” 01, 03, 02. We will print materials and distribute them to the community 01, 03, 02 and 04. At the first meeting, we came up with the following: Free screening for cervical cancer first. Then creating awareness and providing information on cervical cancer and preventive measures as the screening is going on. Information to improve knowledge and awareness should be provided via printed material to community women since we may not be able to gather the women together for health talk. Second Meeting during Ideation Phase We discovered women were reluctant to screen as compared to community women’s verbal willingness to screen and we sought an opinion from an academic expert, researcher supervisors and oncology Midwives responsible for sample collection. We then brainstormed and discussed further with previously recruited participants on how to improve screening participation. Their suggestions as quoted: “We can go through Influencers such as various women leaders or other leaders who may influence women’s participation in cervical cancer screening” Academic expert. " You may have to encourage the women to come for screening " Midwives responsible for sample collection. “We have to go through women leaders of various church groups” 04. We have to go through peers to encourage women to screen .03 What we did after the discussion was to meet with the influencers (women leaders of churches and a staff working in a high school) within the community. Money was given to these influencers to give to willing participants for payment of the screening fees. Remaining money was returned back to the researcher after period slated for data collection has elapsed with more than two months. Phase Three (Implementation phase) At phase three, the user centered developed interventions were tested for its effectiveness on women habit and affect of care seeking behaviour for cervical cancer screening participation. Table 4 Postintervention Affect Item Frequency (f) Percent (%) Mean (X) SD Procedure was embarrassing Yes 0 0,0 2.00 .000 No 63 1000 Total 63 100.0 Procedure was painful Yes 0 0,0 2.00 .000 No 63 1000 Total 63 100.0 I was afraid to expose my private part Yes 0 0,0 2.00 .000 no 63 1000 Total 63 100.0 I was afraid of the procedure and screening room Yes 0 0,0 2.00 .000 No 63 1000 Total 63 100.0 Table 4 . shows that all (63) participants who screened after intervention said the procedure was not embarrassing, or painful, and women were not afraid. Table 5 Postintervention Habits Item Pretest Posttest Pretest Posttest F % f % Mean SD Mean SD I have ever screened Yes 38 11.2 101 29.7 1.89 0.316 1.70 0.458 No 302 88.8 239 70.3 Total 340 100.0 340 100 Year last Screened < 2018 13 34.2 11 10.9 1.87 0.343 1.89 0.313 2018–2021 25 65.8 90 89.1 Total 38 101 100.0 100.0 Experience during previous screening Bad procedural experience 5 13.2 5 5 1.87 0.339 1.95 0.218 Good experience 33 86.8 96 95 Total 38 100.0 101 100.0 Table 5 . shows that the screening rate increased from 11.2% preintervention to 29.7% (average mean screening score from 1.89 ± 0.316 pretests to 1.7000 ± 0.458 posttest), participation in screening increased from 65.8–89.8% between 2018–2021 (1.87 ± 0.343 to 1.87 ± 0.313, good experience during the screening was increased from 86.8 to 95.0% 1.87 ± 0.339 pretest to 1.9500 ± 0.218 posttest. Discussion Of Findings Regarding screening habit, only11.2% had ever screened before intervention, Low screening habit in this community may be due to low socioeconomic status similar to other studies that women with lower socioeconomic status (SES) have fewer rates of cancer screenings (US Preventive Services Task Force, 2018 ), and screening area near residence does not improve screening (Vhuromu et al., 2018 ) as this community is about 4km to 5 km from screening site. Out of the 38 women who had ever screened before intervention, 86.8% had good experience during screening. During ideation the phase, women centered interventions such free screening, provision of printed materials to disseminate information on cervical cancer and pap test, going for screening at the hospital and the the use of influencer to improve care seeking behaviour were identified interventions. Women identification and selection of these interventions could result from lack of screening fees and money for transportation, perception of exchanging someone’s result for another, faster and wider dissemination of information, wiliness to influence others to screen and norms to keep one’s screening results secrets as some quoted: "Some women will still not go for the screening for lack of transport fare" 02 “Participants would have to go to JUTH for screening” 01, 02, 03. "You see some reasons why women may not go for this screening is that some results of samples collected will be exchanged, and they will bring out results for others and give it to others. They will tell you that you have a disease even when the result does not belong to you. People don’t want to do screening because of that" 02. “We have to go through women leaders of various church groups” 04. At this ideation phase, it was found that women preferred to go for screening before being taught what cervical cancer and its preventions which shows their wiliness to screen as quoted: “Let just have the screening and at the same time print the materials and distribute to women” 1,2,3. Postintervention findings indicate that screening improved from 11.2% preintervention to 29.7% (average mean screening score from 1.89 ± 0.316 pretest to 1.7000 ± 0.458 posttest), participation in screening increased from 65.8–89.8% between 2018–2021 (1.87 ± 0.343 to 1.87 ± 0.313) among those who screened. This significant increase might result from care seeking behaviour interventions that were based on women’s needs such as free screening, sample collection by female Midwives, provision of printed materials, verbal invitation, reminder and encouragement by influencers such as the women leaders, peers, and researcher similar to interventions that improved screening participation such as free screening service (Khalil et al., 2019 ; Baussano et al., 2017 ), clients' reminders (Brouwers et al., 2011 ; Antinyan et al., 2021 ), brochure and verbal invitation (Kurt & Akyuz, 2019 ) and use of influencers such as peers (Momberg et al., 2017 ). Good screening experiences has increased from 86.8–95.0% (1.87 ± 0.339 pretest to 1.9500 ± 0.218 posttest). More than 83% participants who show verbal willingness to screen during qualitative data collection and all who expressed willingness during quantitative data collection in inspiration phase are yet to screen as at the time of this evaluation indicating that their willingness did not translate to participation as found by (Lott et al., 2020 ). This could result from social norms, fears in line with (Yang, Li, Chen, & Morgan, 2019). Conclusion This study was conducted to improve the care seeking behaviour of community women towards cervical cancer prevention. Screening in this community was low resulting from fears, embarrassment, cultural norms, dissatisfaction with past experience from other screening services, negative belief and expectations, and low socioeconomic status even though the participants resident near the screening centre. Screening participation significantly increases with intervention. Screening participation among older women was higher compared to younger participants. Free screening, sample collection by female care providers, provision of printed materials to community women, verbal invitation and reminder and encouragement by influencers such as the women leaders, peers, and researcher is likely to increase participation among community women. This study provides insight into care seeking which could be replicated in wider society and other culture. Declarations Ethics approval: Ethical approval to this study was obtained from research ethics committees of Lincoln University College and Jos University Teaching Hospital. All procedures in this study were conducted in accordance with the research ethics committees of Lincoln University College and Jos University Teaching Hospital approved protocol. Written informed consent was obtained from the participants for their anonymized information to be published in this article. Each participant signed or wrote initials on the information sheet to give their informed consent for quantitative data, the audio recording of the qualitative aspect of the inspiration phase and audio-visual recordings of the ideation phase. Consent for publication: Not Applicable. Availability of data and materials: All data generated during this study are included in this published article. Competing interests: There are no competing interest that would affect the decision to publish our manuscript in your journal. Funding: No funding received. Author’s contributions: Author number is the student, author number 2 is the Main Supervisor, and author number 3 is the Co-Supervisor. Author 1 wrote the main manuscript text and prepared figures. The three Authors have reviewed the manuscript before its submission. 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How Could Nurse Researchers Apply Theory to Generate Knowledge More Efficiently? Journal of Nursing Scholarship , 49 (5), 580–589. https://doi.org/10.1111/jnu.12316 Lott, B. E., Trejo, M. J., Baum, C., McClelland, D. J., Adsul, P., Madhivanan, P., Carvajal, S., Ernst, K., & Ehiri, J. (2020). Interventions to increase uptake of cervical screening in sub-Saharan Africa: A scoping review using the integrated behavioral model. BMC Public Health . https://doi.org/10.1186/s12889-020-08777-4 M.-I., H., K.S., C., H.-Y., L., M., S., Y.Y., L., & D.W., S. (2017). Do fears of getting cancer and family history of cancer influence participation in opportunistic screening or organized screening for gastric cancer? Journal of Clinical Oncology . Mbachu, C., Dim, C., & Ezeoke, U. (2017). Effects of peer health education on perception and practice of screening for cervical cancer among urban residential women in south-east Nigeria: A before and after study. BMC Women’s Health . https://doi.org/10.1186/s12905-017-0399-6 Mehrotra, A., An, R., Patel, D. N., & Sturm, R. (2014). Impact of a patient incentive program on receipt of preventive care. American Journal of Managed Care , 20 (6), 494–501. Momberg, M., Botha, M. H., Van Der Merwe, F. H., & Moodley, J. (2017). Women’s experiences with cervical cancer screening in a colposcopy referral clinic in Cape Town, South Africa: A qualitative analysis. BMJ Open , 7 (2), 1–6. https://doi.org/10.1136/bmjopen-2016-013914 Musa, J., Nankat, J., Achenbach, C. J., Shambe, I. H., Taiwo, B. O., Mandong, B., Daru, P. H., Murphy, R. L., & Sagay, A. S. (2016). Cervical cancer survival in a resource-limited setting-North Central Nigeria. Infectious Agents and Cancer , 11 (1), 1–7. https://doi.org/10.1186/s13027-016-0062-0 Musa, J., Silas, O., Mehta, S. D., Murphy, R. L., & Hou, L. (2019). Use of Appropriate Technology to Improve Cervical Cancer Prevention and Early Detection: Experience in Jos, Nigeria. Journal of Global Oncology , 5 (Supplement_1), 7–7. https://doi.org/10.1200/jgo.19.16000 Ndikom, C. M., Ofi, B. A., Omokhodion, F. O., & Adedokun, B. O. (2017). Effects of educational intervention on women’s knowledge and uptake of cervical cancer screening in selected hospitals in Ibadan, Nigeria. International Journal of Health Promotion and Education . https://doi.org/10.1080/14635240.2017.1372693 Nyambe, A., Kampen, J. K., Baboo, S. K., & Hal, G. Van. (2018). The impact of the social environment on Zambian cervical cancer prevention practices . 1–10. Ruffell, A., & Adamcova, L. (2008). Ventilator-associated pneumonia : prevention is better than cure . 13 (1). US Preventive Services Task Force. (2018). Screening for Cervical Cancer . 52242 (7), 674–686. https://doi.org/10.1001/jama.2018.10897 Vhuromu, E. N., T. Goon, D., Maputle, M. S., Lebese, R. T., & Okafor, B. U. (2018). Utilization of Cervical Cancer Screening Services among Women in Vhembe District, South Africa: A Cross-Sectional Study. The Open Public Health Journal , 11 (1), 451–463. https://doi.org/10.2174/1874944501811010451 Yunitasari, E., Rosyda, R., & Santoso, B. (2020). The impact of health talk on cervical cancer screening behavior among women. EurAsian Journal of BioSciences , 14 (1), 1613–1619. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Jul, 2023 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Major revision 08 Feb, 2023 Reviews received at journal 21 Jan, 2023 Reviews received at journal 20 Jan, 2023 Reviewers agreed at journal 13 Jan, 2023 Reviewers agreed at journal 13 Jan, 2023 Reviewers invited by journal 13 Jan, 2023 Editor assigned by journal 13 Jan, 2023 Editor invited by journal 13 Jan, 2023 Submission checks completed at journal 13 Jan, 2023 First submitted to journal 10 Jan, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2463486","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":167392947,"identity":"1d7a8c34-3d31-4f78-9336-a75c9626880b","order_by":0,"name":"Eunice Samuel Ari","email":"","orcid":"","institution":"Lincoln University College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eunice","middleName":"Samuel","lastName":"Ari","suffix":""},{"id":167392948,"identity":"1614b486-cc9a-4881-883c-6ca1b4fc4852","order_by":1,"name":"Regidor III Poblete Dioso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYDCCA2wMDB8KJIAs5gYQQZwWxhkGIC2MJGhh5jFgIEEL3420xMc2BhZ5/O2NbQ8YKqwTG8TOGODVInkj7bBxjoFEscSZg+0GDGfSExukc/BrMbiR3gZUI5G4QSKxTYKx7TBRWtp/W8C1/CNKS9oxZga4lgYitEieeZYs2QPUMuPMwTaJhGPpxm3SaQV4tfAdTzP88KOiLrG/vfmYxIcaa9l+6eQNeLWgggQgZmPgwO8wbID9AclaRsEoGAWjYFgDAGq9RbuTPmpbAAAAAElFTkSuQmCC","orcid":"","institution":"Lincoln University College","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Regidor","middleName":"III Poblete","lastName":"Dioso","suffix":""},{"id":167392949,"identity":"00859d65-7f07-45fe-b41c-2ed346e99513","order_by":2,"name":"John Obafemi Sotunsa","email":"","orcid":"","institution":"Babcock University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"John","middleName":"Obafemi","lastName":"Sotunsa","suffix":""}],"badges":[],"createdAt":"2023-01-10 14:29:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2463486/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2463486/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-023-02353-9","type":"published","date":"2023-07-04T21:31:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44732705,"identity":"521e91ca-a2e9-4858-b3d1-e70c97333586","added_by":"auto","created_at":"2023-10-16 21:58:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":396014,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2463486/v1/45090665-11ef-4a7f-8105-efd9edccc60d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving the Care Seeking Behaviour Toward Cervical Cancer Screening Participation Among Gwafan Community Women, North- Central, Nigeria","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer (CC) is caused by a sexually acquired infection with Human papillomavirus (HPV). Globally, this is the fourth most common cancer in women with an estimated 570,000 new cases and 311,000 deaths in 2018 (Arbyn, Weiderpass, Bruni, Sanjose, Saraiya, Ferlay et al., 2020). At the regional level, Cervical cancer is most common in Africa, with rates seven to ten times higher than in Australia, Western Asia, North America, and New Zealand (Bray, Ferlay, Soerjomataram, Siegel, Torre, Jemal, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In low- and middle-income countries, CC is the second most common cancer and the major cause of death among women in low and middle-income countries, accounting for 88% of deaths (Bray et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Nigerian women aged 15 and above who are at risk of developing cervical cancer are 50.33\u0026nbsp;million, 14943 women are diagnosed and 10403 died yearly (Bruni, Albero, Serrano, Mena, G\u0026acute;omez, Mu˜noz, Bosch, de Sanjos\u0026acute;e, 2019). The worrisome rise in adolescent and young adult patients with malignant epithelial malignancies of the cervix is alarming among patients aged 0\u0026ndash;30 years old, especially 21\u0026ndash;30 years age group (Abudu \u0026amp; Akinbami, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCervical cancer is preventable worldwide through screening, detection, and treatment of precancerous abnormalities (Islam, Billah, Hossain \u0026amp; Oldroyd, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Cervical cancer screening guidelines recommend that women between the ages of 21 and 29 should get a Pap test every three years; women between the ages of 30 and 65 should get an HPV test every five years or a Pap test every three years after consulting with their doctor; and those over the age of 66 should ask their doctors if they need continued screening testing every five year (US Preventive Services Task Force, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). According to projections, the burden of the disease will rise to nearly 460,000 deaths by 2040 if preventive services are not scaled up quickly (Bray et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCervical cancer screening rates have declined in Western countries (Mayo Clinic, 2019), and among women between ages 45 and 65 in the United State ((Donatus, Nina, Sama, Nkfusai, Bede, Shirinde \u0026amp; Cumber, 2019). Screening uptake is declining in low-resource countries (Achampong, et al, 2018). In Nigeria, there is paucity of information on screening rate, but some studies conducted in parts of the country found that cervical cancer screening coverage by conventional cytology is less than 9% in the populace (Musa, Silas, Mehta., Murphy, \u0026amp; Hou 2019), 10.2% among Federal Civil Servants in North Central Nigeria (Hyacinth, Adekeye, Ibeh, and Osoba \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), and 32.6% among health workers at JUTH and its environs (Eka, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). It was found that most cervical cancer cases (72.3%) are diagnosed at advanced stages(Musa, Nankat, Achenbach, Shambe, Taiwo, \u0026amp; Mandong, 2016). Women use cervical cancer screening services at a relatively late age, with a median age of 37 (Musa et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), 40\u0026ndash;49 years (Egbodo, Edugbe, Akunaeziri, Ayuba, Oga, Shambe et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLow uptake may result from fear, embarrassment (Hahm, Choi, Lee, Suh, Lee, Shin et al., 2017; (Frerichs, Rhode, Bell, Hunt, Lowery, Brooks, et al., 2018; Alexis \u0026amp; Worsley, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Nyambe, Kampen, Baboo, \u0026amp; Hal, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Ifemelumma et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Momberg, Botha, Van Der Merwe, \u0026amp; Moodley, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Lor, Backonja \u0026amp; Lauver, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Joffe, Ayeni, Norris, Mccormack, Ruff, Das, et al., 2018); Vhuromu. Goon, Maputle, Lebese, \u0026amp; Okafor, 2018), low socioeconomic status (US Preventive Services Task Force, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), unsatisfied previous screening experience (Al-Amoudi, Ca\u0026ntilde;as, Hohl, Distelhorst, \u0026amp; Thompson, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Al Dasoqi, Zeilani, Abdalrahim, \u0026amp; Evans., 2013), while experiencing gynaecological symptoms (Ndejjo et al., 2017; Momberg et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Nyambe et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) may encourage participation.\u003c/p\u003e \u003cp\u003eFacilitating conditions for screening which were effective in some settings did not achieve their desired aim in other settings as found in these studies: free screening did not increase screening rate (Donatus et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), Availability of screening centres nears women homes (5km away from their homes) did translate to screening (Vhuromu et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), Educational interventions were not very effective overall (Mbachu Cyril, \u0026amp; Uche, 2017; (Lott, Trejo, Baum, McClelland, Adsul, Madhivanan et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Economic incentivization interventions were moderately effective, increased uptake but still achieving less than 20% coverage ((Mehrotra, An, Patel and Sturm, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), very high willingness to screen, even pre-intervention, but that intent was not always well-translated to the uptake of cervical cancer screening ((Ndikom, Ofi, Omokhodion, Adedokun \u0026amp; Ndikom, 2017), increase from 75.8 to 91.0% in willingness to screen yet no change in actual screening (Lott et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), significant improvement in uptake without any community health educators (Chigbu, Onyebuchi, Onyeka, Odugu and Dim, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), pre-invitation leaflet nor online booking did not increase uptake by three months (18.8% pre-invitation leaflet vs. 19.2% control and 17.8% online booking vs. 17.2% control. The offer of a nurse navigator, a self-sample kit on request, and choice between timed appointments and nurse navigator were ineffective (Kitchener, Gittins, Cruickshank, Moseley, Fletcher, Albrow et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Health talk did not affect practice (Yunitasari, Rosyda, \u0026amp; Santoso, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In the absence of facilitating conditions, barriers to screening ensued.\u003c/p\u003e \u003cp\u003eTo reduce the burden of cervical cancer, women must take up cervical screening services which will detect the presence of HPV to prevent precancerous cells from transforming to the cancerous cell especially in a country where human papilloma vaccine is not readily available and accessible. Effective CC screening interventions based on women's needs are a critical component of the prevention that will eventually reduce the global burden of in cervical.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eA Pragmatic Multiphase Mixed Methods Design was adopted for this study and three phases of Human Centered Design process was used for data collection. Thematic analysis was used for qualitative data while SPSS for the quantitative data analysis. 340 women purposively recruited after meeting inclusion criteria: women aged 21\u0026ndash;65 years, sexually active, no diagnosis of cervical cancer, intact cervix, residing in Gwafan Community and willing to participate.\u003c/p\u003e \u003cp\u003eBaseline and endline data on affect and habit regarding care seeking behaviour for cervical cancer screening was assessed.\u003c/p\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePhase One (Inspirational phase):\u003c/h2\u003e \u003cp\u003eThis phase used quantitative approach to collect data on socioeconomic variables, affect and habit regarding care seeking behaviour for cervical cancer screening participation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency (f)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAge in years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e21\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c2\" namest=\"c1\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAnnual Income in Naira\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;284,700.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e284,700.00-479,500.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;479500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows out of the 84 women who responded to annul income earned\u0026thinsp;\u0026lt;\u0026thinsp;284,700.00 Naira (693.5 Dollar), 9.5% earned between 284,700.00-479,500.00 and \u0026gt;\u0026thinsp;479,500 Naira, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre-intervention Affect.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (f)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eThe procedure is embarrassing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eProcedure is painful\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eFear of exposing my private part\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eFear of the procedure and screening environment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eFear of being diagnosed with the disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. shows that majority (52.1%) felt the procedure for cervical cancer screening is embarrassing, 53.2% felt the procedure is painful, 77.4% said fear of exposing my private part, 64.7% said they are afraid of cervical cancer screening procedure and environment, 75.9% said they are afraid of being diagnosed with cervical cancer.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre-intervention Habit\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (f)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eI have ever screened for\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ecervical cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eYear Screened\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eExperience during previous\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eScreening\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBad procedural experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. shows that majority (88.8%) of the women had never screened for cervical cancer while only 11.2% have screened for cervical cancer. Out of the 38 women who had screened, 86.8% had a good experience during screening while 5 (13.2%) had bad experiences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePhase two (Ideation phase):\u003c/h2\u003e \u003cp\u003ePhase two- focused on data collected through Focus Group discussion with 4 community women on the development of care seeking behaviour intervention. The opinions of an academic expert, researcher\u0026rsquo;s supervisor, and Midwives responsible for sample collection was also sought at this phase.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eFirst meeting\u003c/h2\u003e \u003cp\u003eWe discussed and brainstormed at some interventions that may improve screening from previous studies and these interventions include offering transport (Brouwers. De Vito, Bahirathan, Carol, Carroll, Cotterchio,et al., 2011), having health insurance (Khalil, Hatch, Price, Palakurty, Simoneit, Radisic,et al., 2019), free screening services (Vhuromu et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Egbodo et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Musa et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), alternative clinic sites, female family Doctors (Hulme, Moravac, Ahmad, Cleverly, Lofters, Ginsburg, et al., 2016), having a recommendation to attend the screening (Black, Hyslop, \u0026amp; Richmond, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), Brochure, training and verbal invitation (Kurt \u0026amp; Akyuz, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe then asked the following questions:\u003c/p\u003e \u003cp\u003e Question 1: I said we may discuss after analyzing the filled questionnaires and you consented. What do you think we can do to improve our participation in cervical cancer screening? Remember we are representing the opinions of the community women. Participants quotes:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We want awareness and health talk on the disease after the health talk then screening\u0026rdquo;\u003c/em\u003e 02.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We will follow women to churches to create awareness and give health talk\u003c/em\u003e\u0026rdquo; 01, 02\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some said its only screening they want to go\u003c/em\u003e\u0026rdquo; 04\u003c/p\u003e \u003cp\u003eQuestion 2: How can we get the information to the whole women that participated in this study?\u003c/p\u003e \u003cp\u003eParticipants quoted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Since they are all not Christians, we have Muslim participants, and some women are not\u003c/em\u003e in \u003cem\u003eany of the women groups in their churches, we can print materials to various women church groups\u0026rdquo; 01.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;They should make printed papers for them; they surely have someone in their family that can read\u0026rdquo;\u003c/em\u003e 02.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Not everyone knows how to read so, I prefer women should just go for screening\u003c/em\u003e\u0026rdquo; 03.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The problem is that getting women together is difficult, so screening is the only option\u0026rdquo; 04.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eQuestion 3: Screening is the only option; how can we do this screening? Participants stated:\u003c/p\u003e \u003cp\u003e\u0026ldquo;JUTH is not far from here\u0026rdquo; 01, 02,03.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some women will still not go for the screening for transport fare\u0026rdquo;\u003c/em\u003e 02.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If we bring it to Tollemach primary school, some women that are far will still have challenges\u0026rdquo;\u003c/em\u003e 03.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eEven if we take the screening to the community, some women will still not go because it will be far for them\u003c/em\u003e\u0026rdquo; 04.\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eYou see some reasons why women may not go for this screening is that some results of samples collected will be exchanged, and they will bring out results for others and give them to others. They will tell you that you have a disease even when the result does not belong to you. People don\u0026rsquo;t want to do screening because of that\u0026rdquo;\u003c/em\u003e 02.\u003c/p\u003e \u003cp\u003eWe have to consider those that will collect the samples for the reason you gave that some results from the samples collected could be mistakenly given to others that don\u0026rsquo;t have the disease. Participants quoted:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eParticipants would have to go to JUTH for screening\u003c/em\u003e\u0026rdquo; 01, 02, 03.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;This one, women will want to go but transport will be their challenge\u0026rdquo;\u003c/em\u003e 01.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;As it is rightly said, anyone with the intention will go\u0026rdquo;\u003c/em\u003e 02, 03.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Two hundred will not be much to transport to JUTH.\u0026rdquo;03.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We may even trek to the place\u0026rdquo;\u003c/em\u003e 01, 03, 02.\u003c/p\u003e \u003cp\u003e \u003cem\u003eWe will print materials and distribute them to the community\u003c/em\u003e 01, 03, 02 and 04.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eAt the first meeting, we came up with the following:\u003c/h2\u003e \u003cp\u003eFree screening for cervical cancer first.\u003c/p\u003e \u003cp\u003eThen creating awareness and providing information on cervical cancer and preventive measures as the screening is going on. Information to improve knowledge and awareness should be provided via printed material to community women since we may not be able to gather the women together for health talk.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSecond Meeting during Ideation Phase\u003c/h2\u003e \u003cp\u003e We discovered women were reluctant to screen as compared to community women\u0026rsquo;s verbal willingness to screen and we sought an opinion from an academic expert, researcher supervisors and oncology Midwives responsible for sample collection. We then brainstormed and discussed further with previously recruited participants on how to improve screening participation.\u003c/p\u003e \u003cp\u003eTheir suggestions as quoted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We can go through Influencers such as various women leaders or other leaders who may influence women\u0026rsquo;s participation in cervical cancer screening\u0026rdquo;\u003c/em\u003e Academic expert.\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eYou may have to encourage the women to come for screening\u003c/em\u003e\" Midwives responsible for sample collection.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We have to go through women leaders of various church groups\u0026rdquo;\u003c/em\u003e 04.\u003c/p\u003e \u003cp\u003e \u003cem\u003eWe have to go through peers to encourage women to screen\u003c/em\u003e.03\u003c/p\u003e \u003cp\u003eWhat we did after the discussion was to meet with the influencers (women leaders of churches and a staff working in a high school) within the community. Money was given to these influencers to give to willing participants for payment of the screening fees. Remaining money was returned back to the researcher after period slated for data collection has elapsed with more than two months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePhase Three (Implementation phase)\u003c/h2\u003e \u003cp\u003eAt phase three, the user centered developed interventions were tested for its effectiveness on women habit and affect of care seeking behaviour for cervical cancer screening participation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostintervention Affect\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (f)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean (X)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eProcedure was embarrassing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eProcedure was painful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eI was afraid to expose my private part\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eI was afraid of the procedure and screening room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. shows that all (63) participants who screened after intervention said the procedure was not embarrassing, or painful, and women were not afraid.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostintervention Habits\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePosttest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003ePosttest\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eI have\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eever screened\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eYear last Screened\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eExperience\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eduring\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eprevious screening\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBad procedural experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. shows that the screening rate increased from 11.2% preintervention to 29.7% (average mean screening score from 1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.316 pretests to 1.7000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.458 posttest), participation in screening increased from 65.8\u0026ndash;89.8% between 2018\u0026ndash;2021 (1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.343 to 1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.313, good experience during the screening was increased from 86.8 to 95.0% 1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.339 pretest to 1.9500\u0026thinsp;\u0026plusmn;\u0026thinsp;0.218 posttest.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion Of Findings","content":"\u003cp\u003eRegarding screening habit, only11.2% had ever screened before intervention, Low screening habit in this community may be due to low socioeconomic status similar to other studies that women with lower socioeconomic status (SES) have fewer rates of cancer screenings (US Preventive Services Task Force, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and screening area near residence does not improve screening (Vhuromu et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) as this community is about 4km to 5 km from screening site.\u003c/p\u003e \u003cp\u003eOut of the 38 women who had ever screened before intervention, 86.8% had good experience during screening.\u003c/p\u003e \u003cp\u003eDuring ideation the phase, women centered interventions such free screening, provision of printed materials to disseminate information on cervical cancer and pap test, going for screening at the hospital and the the use of influencer to improve care seeking behaviour were identified interventions. Women identification and selection of these interventions could result from lack of screening fees and money for transportation, perception of exchanging someone\u0026rsquo;s result for another, faster and wider dissemination of information, wiliness to influence others to screen and norms to keep one\u0026rsquo;s screening results secrets as some quoted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Some women will still not go for the screening for\u003c/em\u003e lack of \u003cem\u003etransport fare\"\u003c/em\u003e 02\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Participants would have to go to JUTH for screening\u0026rdquo; 01, 02, 03.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"You see some reasons why women may not go for this screening is that some results of samples collected will be exchanged, and they will bring out results for others and give it to others. They will tell you that you have a disease even when the result does not belong to you. People don\u0026rsquo;t want to do screening because of that\"\u003c/em\u003e 02.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We have to go through women leaders of various church groups\u0026rdquo;\u003c/em\u003e 04.\u003c/p\u003e \u003cp\u003eAt this ideation phase, it was found that women preferred to go for screening before being taught what cervical cancer and its preventions which shows their wiliness to screen as quoted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Let just have the screening and at the same time print the materials and distribute to women\u0026rdquo;\u003c/em\u003e1,2,3.\u003c/p\u003e \u003cp\u003ePostintervention findings indicate that screening improved from 11.2% preintervention to 29.7% (average mean screening score from 1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.316 pretest to 1.7000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.458 posttest), participation in screening increased from 65.8\u0026ndash;89.8% between 2018\u0026ndash;2021 (1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.343 to 1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.313) among those who screened. This significant increase might result from care seeking behaviour interventions that were based on women\u0026rsquo;s needs such as free screening, sample collection by female Midwives, provision of printed materials, verbal invitation, reminder and encouragement by influencers such as the women leaders, peers, and researcher similar to interventions that improved screening participation such as free screening service (Khalil et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Baussano et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), clients' reminders (Brouwers et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Antinyan et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), brochure and verbal invitation (Kurt \u0026amp; Akyuz, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and use of influencers such as peers (Momberg et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Good screening experiences has increased from 86.8\u0026ndash;95.0% (1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.339 pretest to 1.9500\u0026thinsp;\u0026plusmn;\u0026thinsp;0.218 posttest).\u003c/p\u003e \u003cp\u003eMore than 83% participants who show verbal willingness to screen during qualitative data collection and all who expressed willingness during quantitative data collection in inspiration phase are yet to screen as at the time of this evaluation indicating that their willingness did not translate to participation as found by (Lott et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This could result from social norms, fears in line with (Yang, Li, Chen, \u0026amp; Morgan, 2019).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This study was conducted to improve the care seeking behaviour of community women towards cervical cancer prevention. Screening in this community was low resulting from fears, embarrassment, cultural norms, dissatisfaction with past experience from other screening services, negative belief and expectations, and low socioeconomic status even though the participants resident near the screening centre. Screening participation significantly increases with intervention. Screening participation among older women was higher compared to younger participants. Free screening, sample collection by female care providers, provision of printed materials to community women, verbal invitation and reminder and encouragement by influencers such as the women leaders, peers, and researcher is likely to increase participation among community women.\u003c/p\u003e \u003cp\u003eThis study provides insight into care seeking which could be replicated in wider society and other culture.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u0026nbsp;Ethical approval to\u0026nbsp;this study\u0026nbsp;was obtained from research ethics committees of Lincoln University College and Jos University Teaching Hospital.\u003c/p\u003e\n\u003cp\u003eAll procedures in this study were conducted in accordance with the\u0026nbsp;research ethics committees of Lincoln University College and Jos University Teaching Hospital\u0026nbsp;approved protocol.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the\u0026nbsp;participants\u0026nbsp;for their anonymized information to be published in this article.\u0026nbsp;Each participant signed or wrote initials on the information sheet to give their informed consent for\u0026nbsp;quantitative data,\u0026nbsp;the audio recording of the qualitative aspect of the inspiration phase and audio-visual recordings of the ideation phase.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication: \u003c/strong\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials: \u003c/strong\u003eAll data\u0026nbsp;generated during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests: \u003c/strong\u003eThere are no competing interest that would affect the decision to\u0026nbsp;publish\u0026nbsp;our manuscript in your journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003eNo funding received.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions: \u003c/strong\u003eAuthor number is the student, author number 2 is the Main Supervisor, and author number 3 is the Co-Supervisor. Author 1 wrote the main manuscript text and prepared figures. The three Authors have reviewed the manuscript before its submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements: \u003c/strong\u003eI would like to thank the management of Lincoln University Malaysia at all levels for the funding opportunity, without which my study would have not been possible. I also acknowledge the support of management of Jos University Teaching Hospital, and community women who participated and contributed to this project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbudu, E. K., \u0026amp; Akinbami, O. S. (2016). Cancers in young patients in Uyo (Niger-delta region of Nigeria): Magnitude of the problem and histopathological prolife. \u003cem\u003eRare Tumors\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(1), 6\u0026ndash;9. https://doi.org/10.4081/rt.2016.6124\u003c/li\u003e\n \u003cli\u003eAl-Amoudi, S., Ca\u0026ntilde;as, J., Hohl, S. 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Impact of a patient incentive program on receipt of preventive care. \u003cem\u003eAmerican Journal of Managed Care\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(6), 494\u0026ndash;501.\u003c/li\u003e\n \u003cli\u003eMomberg, M., Botha, M. H., Van Der Merwe, F. H., \u0026amp; Moodley, J. (2017). Women\u0026rsquo;s experiences with cervical cancer screening in a colposcopy referral clinic in Cape Town, South Africa: A qualitative analysis. \u003cem\u003eBMJ Open\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(2), 1\u0026ndash;6. https://doi.org/10.1136/bmjopen-2016-013914\u003c/li\u003e\n \u003cli\u003eMusa, J., Nankat, J., Achenbach, C. J., Shambe, I. H., Taiwo, B. O., Mandong, B., Daru, P. H., Murphy, R. L., \u0026amp; Sagay, A. S. (2016). 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(2018). \u003cem\u003eScreening for Cervical Cancer\u003c/em\u003e. \u003cem\u003e52242\u003c/em\u003e(7), 674\u0026ndash;686. https://doi.org/10.1001/jama.2018.10897\u003c/li\u003e\n \u003cli\u003eVhuromu, E. N., T. Goon, D., Maputle, M. S., Lebese, R. T., \u0026amp; Okafor, B. U. (2018). Utilization of Cervical Cancer Screening Services among Women in Vhembe District, South Africa: A Cross-Sectional Study. \u003cem\u003eThe Open Public Health Journal\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 451\u0026ndash;463. https://doi.org/10.2174/1874944501811010451\u003c/li\u003e\n \u003cli\u003eYunitasari, E., Rosyda, R., \u0026amp; Santoso, B. (2020). The impact of health talk on cervical cancer screening behavior among women. \u003cem\u003eEurAsian Journal of BioSciences\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(1), 1613\u0026ndash;1619.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Care-seeking behaviour, Cervical cancer, Human Centre Design, Screening participation","lastPublishedDoi":"10.21203/rs.3.rs-2463486/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2463486/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Cervical cancer is the fourth most common cancer in women globally and the second in low-Middle income countries, its screening rate is yet to reach 70% WHO target. Most interventions that proved effective in improving screening participation in some communities did not achieve the desired behavioural outcome in some settings.\u003c/p\u003e \u003cp\u003eAim: This study aimed at evaluating the care seeking behaviour interventions on cervical cancer screening participation.\u003c/p\u003e \u003cp\u003eMethod: A Pragmatic Multiphase Mixed Methods Design was adopted for this study and three phases of Human Centered Design process was used for data collection. Thematic analysis was used for qualitative data while SPSS for the quantitative data analysis.\u003c/p\u003e \u003cp\u003eResults: Findings indicate that most (57.4%) participants were within 30\u0026ndash;65 years, most (81.0%) were extremely poor with annual income\u0026thinsp;\u0026lt;\u0026thinsp;284,700.00 Naira. Before intervention, most (77.4%) were afraid of exposing their private parts, 75.9% were afraid of being diagnosed with cervical cancer; 52.1% felt the procedure was embarrassing, 53.2% felt the procedure was painful; 11.2% had ever screened; majority (88.8%) said involving husband, (86.5%) welcoming attitude of care provider are among facilitators for screening. Screening participation improved from 11.2% preintervention to 29.7% postintervention (average mean screening score from 1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.316 to 1.7000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.458), all participants who screened postintervention said the procedure was not embarrassing, painful, and were not afraid of procedure and screening room.\u003c/p\u003e \u003cp\u003eIn conclusion, screening habit in the community was low preintervention as this may result from social norms, affect, utility, influence of sociodemographic variables and lack of facilitating conditions. Care-seeking behaviour interventions has significantly increased screening participation.\u003c/p\u003e","manuscriptTitle":"Improving the Care Seeking Behaviour Toward Cervical Cancer Screening Participation Among Gwafan Community Women, North- Central, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-16 08:45:32","doi":"10.21203/rs.3.rs-2463486/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-02-08T10:04:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-01-21T10:38:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-01-20T07:40:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85cbb108-9873-4a65-a87d-e9fe4e0a36b1_SNPRID","date":"2023-01-13T10:06:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3fa398d6-2dcd-4160-be00-eb2bcf13671f","date":"2023-01-13T09:05:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-01-13T08:11:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-01-13T06:56:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-01-13T06:49:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-01-13T06:43:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2023-01-10T14:14:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b3be5e84-2a83-4a4e-905d-1efedd034474","owner":[],"postedDate":"January 16th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T21:42:19+00:00","versionOfRecord":{"articleIdentity":"rs-2463486","link":"https://doi.org/10.1186/s12905-023-02353-9","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2023-07-04 21:31:34","publishedOnDateReadable":"July 4th, 2023"},"versionCreatedAt":"2023-01-16 08:45:32","video":"","vorDoi":"10.1186/s12905-023-02353-9","vorDoiUrl":"https://doi.org/10.1186/s12905-023-02353-9","workflowStages":[]},"version":"v1","identity":"rs-2463486","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2463486","identity":"rs-2463486","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}