Abstract 95: “Women Are Reluctant to Make Long Journeys to Seek Screening Services While They Do Not Have Any Pain:” Providers' Experience on Cervical Cancer Screening in Primary Health Care Centers in Rwanda
Authors: Ingabire Charles , Pierz Amanda , Gasana Josephine , Umwiza Francine , Drown Laura , Munyaneza Athanase , Businge Lydia , Kubwimana Gallican , Murenzi Gad , Uwinkindi François , Adler Alma , Castle Philip , Randall Thomas C. 
Published: July 2021

Abstract
Purpose: Cervical cancer screening reduces cervical cancer incidence and mortality. In Rwanda, cervical cancer screening is conducted predominately at primary health care centers. However, a significant number of age-eligible women who have not undergone screening present at primary health care centers with cervical cancer. The aim of our paper is to understand barriers and facilitators of cervical cancer screening from providers' perspectives.
Methods: We selected the ten top- and ten bottom-performing health centers for cervical cancer screening in the past five years within Rwanda. We identified three health care providers at each health center as key informants to be interviewed. A thematic analysis was conducted.
Results: We interviewed 33 providers. Providers consistently reported barriers for women to attend cervical cancer screening included: 1) women not seeking cervical cancer screening service while asymptomatic; 2) never having given birth at a health facility; 3) too busy with daily responsibilities to seek care; 4) being unfamiliar with gynecological service procedures; and 5) feeling uncomfortable with undergoing a pelvic exam and exposing their genitals. Reported facilitators to screening women included, health education activities, and providing multiple health services at the health center Services, such as family planning and child vaccination that attract women, which makes it easier for health care providers to provide them with educational information and offer them screening.
Conclusion: Health care providers reported patients with limited health-seeking behaviors as a barrier to cancer screening services but felt that educational sessions facilitated uptake among eligible women. Use of mass media to disseminate information on cervical cancer screening and prevention may encourage women to come to the clinic, at which time they may receive the education they need to undergo screening. Cervical cancer screening policies should evaluate and address existing health-seeking behaviors within their target population in order to achieve effective coverage.
Citation Format: Charles Ingabire, Amanda Pierz, Josephine Gasana, Francine Umwiza, Laura Drown, Athanase Munyaneza, Lydia Businge, Gallican Kubwimana, Gad Murenzi, François Uwinkindi, Alma Adler, Philip Castle, Thomas C. Randall. “Women Are Reluctant to Make Long Journeys to Seek Screening Services While They Do Not Have Any Pain:” Providers' Experience on Cervical Cancer Screening in Primary Health Care Centers in Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 95.