Reducing Barriers and Sustaining Utilization of a Cervical Cancer Screening Program in Rural Senegal
Condition: Cervical Cancer; Behavior
MeSH terms: Uterine Cervical Neoplasms
Study type: Interventional

Summary: 
      This research project will investigate the determinants of cervical cancer screening uptake
      and sustained utilization in this region and develop and evaluate a context-specific peer
      education behavioral intervention to improve uptake. Research supports the effectiveness of
      peer education in increasing cancer screening rates but, currently, no cervical cancer
      screening peer education program specific to rural Senegal exists. To inform the
      participatory development of this program, the investigators will assess barriers and
      facilitators of screening at multiple levels: individuals (women aged 30 to 59), households
      (family or principle social unit of at-risk women), and the community (immediate village or
      neighborhood with common amenities of at-risk women). We hypothesize that a peer education
      program that adapts to changing contexts over time and is targeted at a multi-level audience
      will result in early, widespread uptake and sustained use of the VIA cervical cancer
      screening program. Study findings will inform programmatic planning in Kedougou and the peer
      education curriculum we develop can serve as a template for maximizing early impact of new
      cervical cancer screening services implemented in other areas of rural Senegal. Our long-term
      goal is to inform national-level policy to guide the implementation of cervical cancer
      screening programs in other rural Senegal regions.
    

Detailed description: 
      The goal of this study is to inform the sustainable implementation of cervical cancer
      screening services in low-resource areas of Senegal naïve to cancer screening programs by

        1. investigating the access barriers and determinants of initial uptake and

        2. developing and adapting a peer education health promotion intervention to diverse and
           dynamic contexts to achieve sustained utilization.

      Framework: Implementation Science is the study of how proven technical solutions are
      applicable to real world settings. The investigators will study how the implementation of
      VIA, as a proven intervention, can be optimized and how the screening service can best "fit"
      into the local context. Established complementary frameworks will guide our study. The
      investigators will apply

        1. the Patient-Centered Access Framework to assess the demand-side barriers and
           facilitators of uptake in aim 1,

        2. the Integrated Theory of Health Behavior Change to evaluate how a peer education program
           facilitates self-management behavior of women in aim 2, and

        3. the Dynamic Sustainability Framework to evaluate the initial uptake and sustained
           utilization of the health service in aim 3.

      The investigators seek to understand the dynamic nature of the influential factors within the
      local context and the process by which the investigators can facilitate responsive
      adaptations to the intervention in order to reduce barriers, maximize early uptake, and
      sustain utilization.

      Overview of Study Data Collection: To achieve all aims, the investigators will conduct a
      cluster-randomized stepped wedge study across three representative clusters (each containing
      a district center and two rural sites) in the Kedougou region. For each aim the investigators
      will collect data at baseline and at 6-month intervals in each cluster (data collection
      intervals coincide with the initiation of the intervention in a new cluster). In aim 1, the
      investigators will develop (through a participatory approach), pilot, and conduct surveys of
      eligible clients and household questionnaires as well as focus groups (FG) (women ages 30-44
      and 45-59) and in-depth interviews of men (ages 30-59). For aim 2, the investigators will
      describe the development, piloting, implementation, and adaptation of an aim 1-informed
      context-specific multi-level peer education curriculum across clusters through the stepped
      wedge approach in the Kedougou region. The investigators will collect quantitative program
      reach data and qualitative process evaluation data at each time period. These data will be
      used to adapt the intervention over time. To achieve aim 3, the investigators will collect
      aggregated health service level utilization data and individual surveys.
    

Intervention name(s): Care Group Cervical Cancer Screening Education Curriculum
Intervention type(s): Behavioral
Intervention description(s): a multi-modal peer education curriculum directed at a multi-level audience and aimed at motivating women to seek cervical cancer screening services.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: a cluster-randomized stepped wedge study across three representative clusters (each containing a district center and two rural sites) in the Kedougou region. For each aim we will collect data at baseline and at 6-month intervals in each cluster (data collection intervals coincide with the initiation of the intervention in a new cluster).
Masking: None (Open Label)
Primary purpose: Screening