Inclusion of Zambian men in cervical cancer prevention: A missing link?

Background: Developing countries incur the largest disease burden from invasive cervical cancer (ICC) worldwide. Associated morbidity and mortality comes as a failure to identify high-risk women. Affordable, low-tech ICC screening modalities are becoming increasingly available in developing countries.

Purpose: Qualitative methods, e.g., focus group discussions (FGD) and in-depth interviews (IDI) were employed to identify interpersonal factors which influence women's decision to undergo cervical cancer screening using visual inspection with acetic acid (VIA) screen-and-treat methods in a primary care clinic in Lusaka, Zambia.

Methods: Between September, 2009-July, 2010, we conducted a total of 8 FGDs (6 with women eligible for screening, 1 with screening nurses, 1 with lay peer educators). Low-level, thematic content analysis was performed (QSR Nvivo, v.8.0) by a team of Zambian and American investigators. Subsequently, 10 IDIs were held with individual women to compare initial findings from FGDs and discuss identified themes in detail.

Results: While a majority of women said that they sought their partner's permission for screening or treatment, others felt this was a personal decision. Some women conveyed a fear of undergoing screening or treatment due to spousal repercussions, e.g., divorce, infidelity, or abuse. Healthcare personnel articulated a need to include men in ICC education and screening promotion. Peer educators suggested lay male counselors be identified and trained to educate men in the community about ICC prevention.

Recommendations: The role of male peer educators should be further investigated to involve Zambian men in discussions regarding the importance of VIA screening and treatment as ICC prevention.