Cervical Cancer Prevention Advocacy Among Ugandan Women Who Have Screened for Cervical Cancer: Cross-Sectional Evaluation of a Conceptual Framework

Background : Cervical cancer (CC) is the most prevalent cancer among Ugandan women, yet about 10% of women have ever been screened. One approach to increasing CC screening is to empower screened women to encourage women in their social network (alters) to get screened. Based on our conceptual framework for psychosocial drivers of advocacy engagement, we examined correlates of CC prevention advocacy among screened women in Uganda. Methods : 160 women who had screened for CC were surveyed. We assessed two measures of CC prevention advocacy (a general measure of frequency of discussions with other women about six specific CC prevention topics in the past 6 months, and an alter-specific measure of percentage of alters whom the respondent encouraged to get screened in the past 6 months), internalized CC stigma, sharing of personal CC screening experience, CC knowledge, and self-efficacy related to both CC service utilization and CC prevention advocacy, as well as socio-demographic and social network characteristics. Bivariate and multiple linear regression analyses were conducted to assess cross-sectional correlates of CC prevention advocacy. Results : Each psychosocial construct in our conceptual framework was significantly associated with at least one of the two measures of CC prevention advocacy; however, In multiple regression analysis that controlled for each of the psychosocial constructs, the percentage of alters with whom the respondent shared their CC screening result was an independent correlate of both the general [beta (SE) = 1.04 (.23); p<.001] and alter-specific measure of CC prevention advocacy [beta (SE) = .62 (.08); p<.001]; CC knowledge was also an independent correlate of the general measure [beta (SE) = .16 (.03); p<.001]. The general CC prevention advocacy measure was significantly correlated with percentage of alters perceived to have ever screened for CC (r= .25, p= .002). Conclusions : These findings support the validity of our conceptual framework regarding engagement in CC prevention advocacy and suggest the importance of sharing of one’s personal CC screening experience and CC knowledge for laying a foundation for advocacy and the need for peer advocacy training to focus on these components.