| The purpose of this study was to elucidate factors that may operate as barriers and facilitators to women's engagement in existing cervical cancer prevention programs and acceptance of future interventions targeting HPV vaccination in Malawi. A sub-Saharan country, Malawi has a population of 15 million people and at least 31 out of every 100,000 women develop cervical cancer; approximately 80% of them die from this malignancy. Many Malawian women have limited access to resources for prevention of cervical cancer, including routine Pap smears and treatments for removal of precancerous/cancerous lesions; therefore, HPV vaccination may provide a vital strategy for primary prevention of cervical cancer. The World Health Organization's guidelines for knowledge, attitudes, and practice surveys guided in-depth, semi-structured interviews with 30 Malawian women above 18 years of age from the Chiradzulu District. Women's knowledge and beliefs about cervical cancer and prevention, as well as those practices or health behaviors that women engage in were explored. Following the principles of grounded theory, data collection and analysis occurred in tandem, allowing the researcher to refine interview questions and explore pertinent themes. Contextual factors such as gender norms and logistics regarding health care services (e.g., distance to facilities, availability of medical resources) thought to be invariant to Malawian culture and society influenced both barriers and facilitators to participation in cervical cancer prevention. Identified barriers to women's participation in cervical cancer prevention included: distance to health facilities, limited access to medical resources, low knowledge about cervical cancer, waiting until symptoms manifested before seeking medical care, stigma and risk perceptions. Facilitators included: receptiveness to vaccination, maternal responsibility, satisfaction with healthcare, desire to be peer health leaders, health education and recommendations from medical professionals. These data will be used to inform current and future cervical cancer prevention programs and health policy in Malawi. |
