Practice of opportunistic cervical cancer screening and health education among health workers in Ogun State, Nigeria: A qualitative study of barriers and facilitators

The burden of cervical cancer is highest in low- and middle-income countries. In Nigeria, where organized cervical cancer screening programs are lacking, opportunistic screening during maternal healthcare visits may enhance screening uptake. This study is aimed at understanding the practice of opportunistic cervical cancer screening and health education, and the barriers and facilitators experienced by health workers practicing in antenatal and postnatal clinics in Ogun State, Nigeria.

Methods

This is a qualitative cross-sectional study. In-depth interviews were conducted among 43 health workers – doctors, nurses and community health extension workers, working in antenatal and postnatal clinics in public primary, secondary and tertiary health facilities selected by quota sampling. A hybrid thematic data analysis approach, combining deductive and inductive methods was employed.

Results

Health education on cervical cancer prevention was not done in most health facilities. Where cervical cancer health education was practiced, it was done mostly prior to family planning provision, and sometimes at antenatal, postnatal/infant immunization clinics. Facilities for cervical cancer screening was not available in most of the health facilities and patients had to travel long distances to tertiary facilities to have a Pap smear done. Barriers to cervical cancer screening and health education include, high cost of screening, manpower shortage, fear of positive result among patients, poor awareness among patients, and religious and cultural beliefs. The major facilitators to screening and health education mentioned were passion for their work and the desire that no woman should die from preventable cancers.

Conclusion

To address identified barriers, the government should enhance health worker training, ensure adequate staffing, improve the availability of screening equipment and reagents and make screening free/affordable. Community mobilization efforts should be intensified to increase awareness and promote accessibility. Integrating cervical cancer health education and screening into routine antenatal and postnatal care is essential for improving uptake.