Barriers to cervical screening: women's and health workers' perceptions

Cancer of the cervix is the most common cause of cancer mortality among Black South African women. Mortality can be reduced by an effective screening programme. Such a programme is being considered for implementation in South Africa. It is important that the implementation of a national screening programme be based on solid understanding of the current situation as well as the anticipated barriers to the effectiveness of the programme. This qualitative study was done at three rural sites in order to explore the barriers to effective utilisation of cervical screening from the perspectives of women and health workers. The aim was to inform the local service organisers as well as the policy process when planning the new screening programme. There were interesting similarities and differences between the barriers that were identified by the health workers and those by the women. Those identified by the health workers included several structural problems associated with the service such as busy clinics and problems of access including lack of transport, the mobility of the people and opposition from men. None of the women spoke of these service and access factors. Women emphasised issues surrounding the actual procedures which were based on their experiences and information they had gained from friends and other community networks. The barriers identified by women are amenable to change through careful attention to health education and the circumstances of the test. If the new screening policy is to be implemented nationally and be successful in recruiting cervical cancer cases, nurses will have a key role in identifying and overcoming barriers to smear uptake at a local level. This study has shown the importance of listening to patients in this process.