Influence of Provider Initiated Calls on Uptake of Cervical Cancer Screening in Kirinyaga County, Kenya
Monicah, Wambugu W.
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Every day women die from cervical cancer in the world with majority of deaths occurring in developing countries like Kenya. In Kenya, cervical cancer screening uptake is low at 3.2% for all women (GLOBOCAN 2018), below the 25% projection by National Cervical Cancer Prevention Program. Kirinyaga County like the rest of Kenya has no effective reminder mechanism to enhance uptake of cervical cancer screening. This study examined the influence of provider-initiated call reminders on uptake of cervical cancer screening. Using a single blinded randomized controlled trial study design; „two-stage‟ random sampling was used to select eligible women from a sampling frame of 19572 within four randomly selected Wards of Kirinyaga Central sub-county. Participants were randomly allocated to the control (received placebo calls) and intervention (received call reminders) arms at a ratio of (1:1). The data collection tools were interviewer administered questionnaires, Key informant guides and a checklist .The intervention was three provider initiated calls that contained; five education points on cervical cancer, reminder to attend screening and answers for two questions on cervical cancer and screening. Thematic content was used to analyze qualitative data. Categorical variables were summarized using descriptive statistics to proportions and frequencies while measures of central tendency were used to summarize continuous variables. Inferences were drawn using logistic regressions to determine factors associated with uptake of cervical screening and effects of the intervention. The final sample analyzed was 173. The mean ages of participants was 40.4 ± 9.4, majority had attained secondary education 57.4% and were of a low economic status 78.4%. Only 14.6% of women aged 25 years and above at baseline had ever been screened for cervical cancer and only 6.04% were on the recommended regular screening schedule. Participants who attended cervical cancer screening at end line were 67% from the intervention arm and 22.4% from the control arm. Provider initiated call reminders increased the probability of uptake of cervical cancer screening by 11 times (OR 11.04; CI 95% 8.56-26.89; p<0.001). There was a significant mean difference in perception on cervical cancer before and after the call reminders; perceived susceptibility(t=8.46,df=86,p=0.001); seriousness, (t=8.93,df=86,p=0.001);perceived benefits (t=8.13,df=86,p=0.001); barriers (t=3.46,df=86, p=0.001) in the intervention arm. There was also a significant mean difference of knowledge level on cervical cancer before and after intervention p<0.001 in the intervention arms. On the multivariate analysis, increased knowledge on cervical cancer increased chances of screening uptake by up to 7.09 times (OR 7.09; CI 95%3.72-11.95; P<0.001). High perception of being susceptible to cervical cancer increased the chances of screening uptake by up to 4.26 times (OR 4.26 P<0.0001). Forgetting was the major reason participants gave for not attending the scheduled screening. This study concluded that, many women residing in the study county had not been screened for cervical cancer despite being at risk. Calling those women to remind them to attend screening had potential to increase uptake of screening. Knowledge and perception on cervical cancer increased after using call reminders. The management of Kirinyaga County and the Ministry of Health should adopt a reminder system like the provider initiated calls in order to enhance cervical cancer screening uptake. Further studies should be conducted on the number of voice calls necessary for an optimal attendance for cervical cancer screening; national enrollment into routine screening and pathway analysis of factors associated with enrollment into routine screening.