Developing a stigma responsive educational program to promote uptake of HPV-based cervical cancer screening and treatment in Kisumu, Kenya

Background: Despite increasing availability of preventative HPV vaccines and screening strategies, uptake of these effective measures in Kisumu, Kenya is limited by cultural and logistical barriers. Limited understanding and societal perceptions of HPV and cervical cancer are potential sources of stigma that could negatively impact screening behavior. By designing and implementing a stigma-responsive educational intervention, we sought to improve understanding and risk perception and increase the likelihood cervical cancer screening.

Methods: We carried out a study of a stigma responsive strategy to deliver HPV-based cervical cancer prevention services in Kisumu, Kenya. Focus group discussions (FGDs) explored experiences of HPV and cervical cancer screening, health messaging and potential stigma sources. Qualitative analysis of the FGDs informed the development of a stigma-responsive educational video. Four Kisumu County healthcare facilities were randomized to either watch the video or receive standard HPV and cervical cancer education, after which participants at both sites completed a survey to measure HPV- and cervical cancer stigma. Stigma scores were compared between control and intervention groups using linear regression.

Results: Thirty women participated in the focus group discussions. Drivers of stigma included concerns about confidentiality and disclosure of HPV results, fears of cancer or implications of a sexually transmitted infection diagnosis. Anticipated outcomes included illness or death, financial hardship or family abandonment. The FGDs findings informed development of the educational video. A total of 288 women, 109 in the intervention group, completed the stigma survey. Mean HPV and cervical cancer scores were found to be statistically lower in the intervention arm, with Dholuo language associated with higher stigma levels in both arms.

Conclusions: This multi-step study explored knowledge, attitudes and beliefs specific to HPV and cervical cancer health messaging in western Kenya in order to develop and test a stigma-responsive education strategy. The stigma-responsive video demonstrated a quantitative decrease in stigma survey response means for those who watched the video. The pre-pilot design will drive a larger pilot study to examine the effect of the educational video on HPV self-sampling.