Disseminating a cervical cancer screening program through primary physicians in Hong Kong: a qualitative study

Area of Science:

• Public Health
• Health Services Research
• Preventive Medicine

Background:

• Organized screening programs offer superior effectiveness and equity compared to opportunistic approaches.
• Governments encounter significant hurdles in implementing evidence-based public health screening programs.
• This study investigates the low adoption rates of a government-sponsored Cervical Screening Program (CSP) among primary care physicians.

Purpose of the Study:

• To identify the specific reasons behind the limited uptake of the CSP by primary care physicians.
• To understand the influencing factors on physicians' decisions regarding participation in organized screening initiatives.

Main Methods:

• Qualitative study employing in-depth interviews with a diverse sample of Hong Kong primary care physicians (public and private).
• Utilized Rogers' Diffusion of Innovation theory to analyze factors affecting physicians' adoption of the CSP.
• Snowball sampling technique was used to recruit participants.

Main Results:

• Physicians' decisions to promote cervical screening and join the CSP were driven by clinical and business needs, superseding scientific evidence.
• Low CSP adoption rates stemmed from physicians perceiving the program as too complex and incompatible, outweighing its benefits.
• Physicians identified women's knowledge, attitudes, and practices as barriers, which also impeded their own adoption of the CSP.

Conclusions:

• For successful screening program implementation reliant on physician participation, healthcare systems must synchronize program incentives with physician motivators.
• Alternative strategies, such as demand creation policies, may be necessary to achieve public health objectives for screening programs.
• Aligning program design with the practical realities and motivations of healthcare providers is crucial for widespread adoption and program success.