Barriers and Facilitators of Cervical Cancer Screening Uptake Among Women Aged 18 to 49 Years at Victoria Chitepo Provincial Hospital, Mutare, Zimbabwe, 2025

Abstract

Cervical cancer is the fourth most common cancer in women worldwide and overall, cervical cancer ranks as the second most common cancer in Africa and is responsible for over one‐fifth of all female cancers in the continent according to Global Cancer Observatory (GLOBOCAN) estimates for 2018. Cervical cancer is the most frequently occurring cancer in women of all races and ages in Zimbabwe, with a burden of 19%. This study sought to establish the facilitators and barriers affecting uptake of cervical cancer screening among women aged between 19 and 49 seeking services at Victoria Chitepo Provincial Hospital (VCPH) in Mutare in February 2025. Data from VCPH showed that cervical cancer screening of all eligible women aged 18 to 49 years was at 34% for the period January to June 2024, which is low against a WHO target of 70%. A mixed methods cross-sectional study was conducted at VCPH, a provincial referral hospital that offers cervical cancer screening services in Mutare urban. The source population of this study was female patients aged 18 to 49 years accessing services at VCPH. A total sample size of 158 participants was used for this study. Convenience sampling of the participants was done at VCPH. 16 consenting purposively sampled staff members were interviewed as key informants to gain in-depth insights on the facilitators and barriers to cervical cancer screening. Data was collected using an interviewer administered structured questionnaire and a key informant interview guide was used to conduct key informant interviews. Data was analysed using SPSS version 28. About 90.1 % of participants had heard of cervical cancer. 60.1% of participants had ever been screened for cervical cancer. The highest predictor of cervical cancer screening was having heard about VIAC or other methods of cervical cancer screening, with an odds ratio of 4.2 (95% CI [1.9, 8.9] p<0.001), and place of residence (OR= 1.9, CI [1.2,3.0] p=0.005). High perceived benefit of cervical cancer screening (OR=0.4, CI [0.2,0.7] p<0.001), and perceived susceptibility to cervical cancer, (OR= 0.5 CI [0.3,0.8] p<0.001) were significant behavioral factors affecting cervical cancer screening uptake. The sociodemographic predictors of cervical cancer screening were employment status (OR= 0.4, CI [0.3, 0.8] p = 0.005), and level of income (OR=0.6, CI [0.4,1.0] p=0.055). Key barriers to cervical cancer screening included lack of knowledge, the belief that cervical cancer screening is painful (OR=0.3, CI [0.1; 0.9] p<0.001), and the notion the cervical cancer screening is expensive (OR=0.1 CI [0.1; 0.2] p<0.001). Perceived benefit of cervical cancer screening, and knowledge of cervical cancer screening methods were significant facilitators of cervical cancer screening, therefore there is need to develop educational programs teaching women on the importance of cervical cancer screening and addressing myths and misconceptions to significantly improve cervical cancer screening uptake in Mutare.