Assessment of client & provider acceptability of VIA & cryotherapy to screen & treat cervical cancer in Cambodia

Significance: Cancer of the cervix, one of few preventable cancers, is the second most common cancer in women worldwide and a leading cause of cancer-related death in women in developing countries. Cervical cancer incidence and mortality rates are the highest of all cancers in Cambodia. These statistics are alarming since the Reproductive Health Association of Cambodia (RHAC) offers the highly sensitive and specific one-stop visual inspection with acetic acid (VIA) screening method in 15 of the country's 23 provinces. Objective: This assessment qualitatively examined women's perceptions and experiences and provider practices with VIA to explain the low uptake of cryotherapy for treating precancerous cervical lesions to recommend improvements in provider practices and client education. Methods: Focus group discussions were conducted with 51 women ages 21-45 in Kampong Speu province (rural) and in Phnom Penh (urban). Interviews were conducted with 15 cervical cancer screening clients of RHAC clinics in Phnom Penh. Clinic providers were also interviewed. Thematic analysis was conducted of focus group and interview results. Results: Themes emanating from the analysis included; factors that influence the women's health care decisions, knowledge and beliefs about cervical cancer and screening, experiences with providers, and perceived barriers to health care. Recommendations based on these results included: adult learning methods for clinic education sessions (e.g. participator games), culturally appropriate cervical cancer education video for clinic waiting rooms using novella story-telling, resources for rural health volunteers (e.g. flyer illustrating prevention, detection, and treatment), and posters for providers to aide in cervical cancer screening counseling.