Perspectives of women and healthcare providers on facilitators and barriers to cervical cancer screening in the rural Kilimanjaro region Tanzania: a qualitative study

Abstract

BACKGROUND: Cervical cancer can be prevented and treated if detected early through regular screening. However, 88% of women aged 30 to 49 have never been screened in Tanzania. OBJECTIVE: This study explored facilitators and barriers to cervical cancer screening among women and healthcare providers in rural Kilimanjaro, Tanzania, using the Theoretical Domains Framework and the Capability, Opportunity, Motivation-Behavior model. METHODS: An exploratory qualitative design was employed; data were collected from March to October 2024. Six focus group discussions were conducted with 54 women aged 30-50 years, and twelve in-depth individual interviews with healthcare providers. Data were transcribed, coded, and thematically analyzed using QDA Miner Lite v2.0.8. RESULTS: Four main themes emerged, each with sub-themes: (1) knowledge about cervical cancer and screening (disparities in knowledge between screened and non-screened women; healthcare providers' knowledge and training needs; age and parity as knowledge mediators); (2) power of social influence (social facilitation; social barriers); (3) emotional and structural influences on cervical cancer screening (emotional barriers and coping; structural and logistical barriers); and (4) enhancing cervical cancer screening uptake (targeted community education and outreach; improving service accessibility). Barriers include limited knowledge, misconceptions, fear of pain and positive results, limited access to services, and a shortage of trained healthcare providers. Social support from families, peers, community leaders, and healthcare providers was identified as a strong facilitator. CONCLUSION: Increasing cervical cancer screening uptake in rural communities requires targeted, theory-informed interventions that incorporate education to enhance awareness, strengthen social support, and improve health services.