Health Care Determinants of Cervical Cancer Screening in Harare Zimbabwe

Health Care Determinants of Cervical Cancer Screening in Harare Zimbabwe by Dominic Chifamba MHA, Franklin University, 2014 BS, Franklin University, 2002 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Services Walden University August 2019 Abstract Cervical cancer is the second leading cause of cancer deaths among women of all age groups in Zimbabwe, and mortality and incidence continue to increase. The purpose of this quantitative cross-sectional study was to assess the factors that influence the utilization of cervical cancer screening services by Zimbabwean women living in Harare, Zimbabwe. Because personal beliefs influence screening, this study was guided by the health belief model (HBM). A total of 394 women whose ages ranged from 18 to 65 years were recruited from a health care facility in Harare. A 40-item closed-ended questionnaire was used to assess participants’ knowledge, attitudes, beliefs, and cervical screening practices. Descriptive analysis was used to characterize the sample, and logistic regression was used to explore the effects of the hypothesized predictor variables. Results indicated that the strongest predictors of screening were monthly income, marital status, and the HBM construct perceived barriers. The study may promote positive social change as findings may be used to formulate policies that may encourage women to adopt preventive screening practices, which may save lives and reduce costs associated with treating cervical cancer when diagnosed at an advanced stage.Cervical cancer is the second leading cause of cancer deaths among women of all age groups in Zimbabwe, and mortality and incidence continue to increase. The purpose of this quantitative cross-sectional study was to assess the factors that influence the utilization of cervical cancer screening services by Zimbabwean women living in Harare, Zimbabwe. Because personal beliefs influence screening, this study was guided by the health belief model (HBM). A total of 394 women whose ages ranged from 18 to 65 years were recruited from a health care facility in Harare. A 40-item closed-ended questionnaire was used to assess participants’ knowledge, attitudes, beliefs, and cervical screening practices. Descriptive analysis was used to characterize the sample, and logistic regression was used to explore the effects of the hypothesized predictor variables. Results indicated that the strongest predictors of screening were monthly income, marital status, and the HBM construct perceived barriers. The study may promote positive social change as findings may be used to formulate policies that may encourage women to adopt preventive screening practices, which may save lives and reduce costs associated with treating cervical cancer when diagnosed at an advanced stage. Health Care Determinants of Cervical Cancer Screening in Harare Zimbabwe by Dominic Chifamba MHA, Franklin University, 2014 BS, Franklin University, 2002 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Services Walden University August 2019 Dedication This project is dedicated to the Almighty for giving me the strength and divine guidance in the relentless pursuit and completion of this academic milestone. My wife and best friend, Naomi, has been a constant source of support, encouragement, and unfailing love during this doctoral journey. I am truly thankful for having you in my life. This work is also dedicated to my parents who have always loved me unconditionally, for their unwavering support and for setting the perfect foundation in my life. Their exemplary life instilled in me the importance of hard work to accomplish my goals. Acknowledgments This dissertation would have remained a dream had it not been for the Almighty. I thank you Dear Lord. I would like to express my deepest appreciation to my dissertation chair, Dr. Richard Palmer, and my committee member, Dr. Gudetta Fufaa, for their support, advice, encouragement, recommendations, and most of all patience throughout the entire process. I would also like to thank my university research reviewer, Dr. Lee Caplan, for his timely review and insightful recommendations. My special thanks to the love of my life, my wife, Naomi, who encouraged and supported me throughout this dissertation journey. Naomi, you have remained my biggest fan, you believed in me, and prayed for me ceaselessly even when I doubted my capabilities. To my children, Munyaradzi, Roy, Trevor, and Leah, I thank you all for the continued encouragement. Thanks to my sister, Spiwe, for her words of encouragement during the course of my dissertation journey. To all of my family members who encouraged me through their prayers and believed in me, I sincerely express my heartfelt gratitude to all of them. To the women who participated in this study. Thank you for your cooperation.