Knowledge and Perceptions of Cervical Cancer Screening in Nhlambeni, Eswatini: Understanding Facilitators and Barriers for Prevention Interventions.

Background: Cervical cancer (CC) is a leading cause of cancer mortality in Eswatini. Preventative programs are readily available at the primary health facilities. Recently, the Human Papilloma Virus (HPV) vaccine has been introduced targeting both in- and out-of-school girls ages between 9 and 14 years old. The government of Eswatini has integrated cervical cancer screening into existing services and health activities, especially in HIV clinics, however, the uptake of screening remains low.

Aim: This study explored women's perceptions, knowledge, intervention strategies, facilitators and barriers to scaling up cervical cancer prevention in Nhlambeni community in Eswatini.

Methods: A qualitative approach was utilized for this study and key informant semi-structured interviews were conducted in November 2019. Purposive sampling was undertaken in this study and MAX QDA software was utilized for data analysis.

Results: In total, 19 key informants were enrolled, the participants were from public facilities 7(37%), non-governmental organization 9 (47%) and patients 3 (16%). The age range for participants was between 25 - 40 years. Five themes were inductive and deductive which included: current interventions that are targeted for cervical cancer screening, women's source of information about cervical cancer screening activities, what promotion strategies could increase cervical cancer screening, understanding about cervical cancer symptoms/diagnosis of cervical cancer and cultural beliefs and attitudes involved in cervical cancer screening activities.

Conclusions: Despite limited knowledge of cervical cancer and misconceptions about screening, the concept of screening for prevention and providers' influence were motivators for participation in screening. Cervical cancer screen-and-treat programs should consider utilizing language that communicates the need for cervical cancer screening and treatment and utilize prevention concepts that may already be familiar to women living there. In order to enhance cervical cancer prevention initiatives, reduce the stigma associated with the disease, and boost cervical cancer screening rates, it is imperative that there be ongoing community education and engagement on cervical cancer, aimed at both men and women.