Background: Located in south-eastern Africa, Malawi is a low income country with a
population of 16.4 million. It is currently estimated to have the highest age-standardized rate of
cervical cancer in the world at 75.9 per 100,000 population. Cervical cancer accounts for 28% of
all reported female cancers in the country, and 80% of women diagnosed with the disease die
from it, making cervical cancer a public health priority for the country. Despite the fact that
cervical cancer screening services (by visual inspection with acetic acid (VIA)) has been offered
free of charge at public health facilities in the country since 2004, the services remain
underutilized across the country. The purpose of this study was to explore potential factors
associated with the acceptability and utilization of cervical cancer screening services among
adult women in the Neno district of Malawi, and to identify their service delivery preferences in
order to guide the design of effective cervical cancer education and screening programs.
Methods: This study employed an exploratory qualitative research study design. Data was
collected between July and August 2015 in the district of Neno, Malawi by conducting in-depth
semi-structured interviews within a sample of 50 women between the ages of 18-55 years.
Participants were recruited among women attending health facilities and community screening
events within the district using a purposive sampling technique. Constructs from the Health
Belief Model and Socio-Ecological Model were used to construct a conceptual framework for
this study.
Results: Several themes emerged from the data, namely: misconceptions about how cervical
cancer develops, low perceptions of risk of the disease, effects of interpersonal interactions on
preventative behaviors, barriers limiting access to cervical cancer screening services, and service
preferences for the integration of cervical cancer screening. Despite limited understanding about
the transmission and development of cervical cancer, knowledge about its risk factors and signs
and symptoms was relatively high among the study sample. Perceived barriers to using cervical
cancer prevention services included: distance from health facilities, challenges in accessing
transportation, limited availability and awareness of services, logistical factors, and a low
perception of risk. Facilitators to using the services were based on: high satisfaction with
healthcare, strong desires to know about one’s health status, interpersonal interactions with
health professionals, husband’s approval, and faith in the curative abilities of western medicine.
Women in the sample reported high acceptability and intention to obtain screening if the services
were available at a nearby location. The study sample was also highly receptive of integrated
approaches to receiving cervical cancer screening both at health facilities and community
screening events
Conclusions: Knowledge and awareness about cervical cancer and its risk factors among the
study sample was relatively high, indicating that sporadic health education and awareness raising
about the disease has been taking place throughout health facilities within the Neno district.
Misconceptions about the disease however highlight the importance of having a systematic
method and coordinated strategy for delivering cervical cancer health education. The expansion
of cervical cancer screening services across all health centers in the district is needed in order to
address barriers to accessing preventative services and to increase coverage and utilization rates
for VIA screening services in Neno.