The Use of health promotion to increase the uptake of cervical cancer screening program in Nyangabgwe Hospital, Botswana

Abstract

BACKGROUND: In Botswana, cervical cancer is the most common cancer among women (18), and the Southern Africa regional prevalence rate of cervical cancer is 15.5% (25). In Nyangabgwe Referral Hospital, cervical cancer is the most common malignancy admitted in the gynecology ward, contributing 73% and 78% of all malignancy admissions in 2007 and 2008 respectively. It is estimated that 200,000 to 300,000 women die from cervical cancer every year, mostly in poor countries (1). The study intends to create more awareness on the importance cervical cancer screening in Nyangabgwe Referral Hospital and catchment areas. Purpose: The purpose of the study is to improve the uptake of cervical cancer screening by integrating a health promotion component to the standard program. Methods: The study was an interventional quantitative research. Two populations were selected for the study namely women attending Nyangabgwe Referral Hospital and the clinics in Francistown (the research group) and women attending Princess Marina Hospital (the control group). The population of women attending Nyangabgwe Referral Hospital was exposed to health promotion. The second population of women attending Princess Marina Hospital was unexposed to the health promotion intervention. A pre-test quantitative trend of cervical cancer screening patterns was collected from June to September 2009 in the health facilities before the intervention from October 2009 to January 2010. Intervention was conducted in the study sites and was followed by a post - test quantitative measure of cervical cancer screening trends in both the research group and the control groups. Instruments for the health promotion were; flyers with translations in English and Setswana given to participants, posters which were posted at various strategic positions in the hospital and as well as in female wards. The population of study was all women attending Nyangabgwe Referral Hospital and its catchment clinics (the study site). Interactive health education sessions were provided to the population. Questionnaires which had Setswana translation were administered to respondents who were screened for cervical cancer in the study and control sites.

Results: The analysis of finding revealed that the total uptake of Pap smear test was higher during the period of intervention than in the pre-intervention period in all the sites and for all the age groups. Among the health promotion activities, the effect of health education talks in the hospital and clinics was greater (67%), than the effects of flyer or pamphlets (35%) and posters in hospitals and clinics (17%) in escalating uptakes of cervical cancer screening services. Conclusions: The standard cervical cancer screening program alone as designed and executed by health care workers is not enough to stimulate the desired response of increase access to cervical cancer screening services, because many women usually are left out. Recommendations: The study results call for the need of instituting a visible and accountable comprehensive health promotion component to the standard cervical cancer screening program in order to sustain a steady cervical cancer screening uptake that will result in the expected decline in morbidity and mortality due to cervical cancer disease.