Finding Barriers and Designing Solutions to Promote Women s Cancer Screening in South Africa

Study Overview
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Brief Summary
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The primary aim of the study explore drivers of cervical cancer screening and barriers contributing to low screening coverage among women in South Africa. Secondary aims are determining preferences for cervical cancer prevention services using a discrete choice experiment and developing a multi-level package of interventions that will address barriers to cervical cancer screening and improve engagement in care among women.

Detailed Description
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Cervical cancer is a leading cause of cancer death among South African women. Despite a comprehensive national cancer control policy, cervical screening coverage is low and attrition during on-ward referrals for diagnostic confirmation and treatment remains common. This study uses a sequential mixed-methods design: Phase 1) A qualitative exploratory phase using focus groups and in-depth interviews with women, men, other stakeholders will inform our design and interpretation of quantitative findings from a multi-cohort DCE. Phase 2) Women will be recruited to participate in the DCE and determine their preferences for cancer screening services. Phase 3) Design Thinking to co-create an intervention package for cervical cancer screening and enhanced linkage between screening, diagnosis, and treatment will be created.

Official Title
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Finding Barriers and Designing Solutions to Promote Women s Cancer Screening in South Africa

Conditions
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Cervical Cancer

Intervention / Treatment
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* Other: Semi-structured focus group discussions - Women
* Other: semi-structured focus groups discussions - Men
* Other: In-depth key stakeholders interviews
* Other: Discrete Choice Experiment - Women
* Other: Development and User Pre-testing Workshops


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Focus Groups with HIV-positive Women HIV-positive Women 18 years and older Participants should be willing and able to provide written informed consent Focus Groups with HIV-negative Women HIV-negative Women 18 years and older Participants should be willing and able to provide written informed consent Focus Groups with Men Male partners who are 18 years and older Participants should be willing and able to provide written informed consent In-depth Interviews with Key Stakeholders Healthcare providers working within the public health system and other key stakeholders Individuals 18 years and older Participants should be willing and able to provide written informed consent Exclusion Criteria: Focus Groups with HIV-positive Women Women younger than 18 years Unwilling or unable to provide written informed consent Focus Groups with HIV-negative Women Women younger than 18 years Unwilling or unable to provide written informed consent Focus Groups with Men Male partners younger than 18 years Participants unwilling or unable to provide written informed consent In-depth Interviews with Key Stakeholders Providers who do not work in the public health system Individuals younger than 18 years Participants unwilling or unable to provide written informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Phase 1: 24 Women - FGDs<br>Focus groups enrolling HIV-positive, previously screened for cervical cancer; HIV-positive, not previously screened for cervical cancer; HIV-negative, previously screened for cervical cancer; HIV-negative, not previously screened for cervical cancer. | Other: Semi-structured focus group discussions - Women<br>* Semi-structured focus group discussions to explore women's experiences with cervical cancer screening and treatment.<br>|
| Phase 1: 16 Men - FGDs<br>Focus groups enrolling male partners referred by women previously screened or treated for cervical cancer and by women not previously screened for cervical cancer. | Other: semi-structured focus groups discussions - Men<br>* Semi-structured focus group discussions to explore partner dynamics related to women's ability to access cancer screening.<br>|
| Phase 1: 12 Key Stakeholders - IDIs<br>Stakeholder interviewers with women's groups, women's health providers, laboratory personnel, NGOs, and public health organizations. | Other: In-depth key stakeholders interviews<br>* In-depth interviews to contextualise findings from women and men focus group discussions.<br>|
| Phase 2: 300 women - DCE<br>Discrete Choice Experiment enrolling women 18 years of age and older. | Other: Discrete Choice Experiment - Women<br>* Discrete Choice Experiment to determine preferences to different cancer screening models.<br>|
| Phase 3: 36 Women, women's health providers, and policy makers<br>Stakeholder groups comprising individuals 18 years and older who participated in Phase 1 will be eligible. | Other: Development and User Pre-testing Workshops<br>* Development and User Pre-testing Workshops to explore acceptability and feasibility of proposed interventions designed using findings from Phases 1 &2.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Phase 1: Barriers to cancer screening and engagement | Barriers and enablers will be explored through focus groups and in-depth interviews with women, men, and other stakeholders. | Single visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Phase 2: Woman preferences for cancer screening services | Preferences for cancer screening will be determined through the relative importance of the attribute according on how it is scored in the Discrete Choice Experiment. | Single visit | 
| Phase 3: Acceptability and feasibility of multi-level package of interventions addressing barriers to cancer screening. | Acceptability and feasibility will be measured through development and user pre-testing workshops. | Single visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HIV, sequential mixed-methods, screening