Perceived Barriers to Cervical Cancer Screening in Nicaragua

Abstract

Nicaragua has a high rate of incidence and mortality related to cervical cancer when compared to other Latin American countries. Cervical cancer is related to persistent infections of oncogenic Human Papillomavirus (HPV), which can be detected by recommended Papanicolaou screenings. Current public health initiatives are focused on decreasing rates of cervical cancer by increasing rates of screening. Exposing and analyzing perceived barriers to obtaining the recommended screening within target populations could lead to a positive overall effect on the associated mortality rate in Nicaragua. Nicaraguan women were surveyed using a Likert-type 4- point scale evaluating perceived barriers commonly reported in the published literature. The most frequently reported barrier in the study was the concern that the examiner may not be female. Other commonly reported barriers were fear of a cancer diagnosis, fear that results would not be private, and embarrassment regarding exposing genitals for the exam. Weaker positive responses were seen regarding long wait times at the clinic. In contrast, a lack of spousal/partner support, previous negative experience with having the Papanicolaou exam, and knowledge deficit regarding need or risk showed the strongest disagreement in the survey. Mild disagreement was noted regarding fear of pain during the exam. Unexpected findings included females reporting issues with continuity of care, and not receiving results of screenings. Knowledge of barriers may improve exam adherence and early detection for future healthcare professionals working within this population of females. Applying knowledge of perceived barriers, public health officials and providers will be equipped to maximize effectiveness of cervical cancer screening initiatives.

Keywords: Papanicolaou screenings, Pap, cervical cancer, Nicaragua