Barriers to adherence of posttreatment follow-up after positive primary cervical cancer screening in Ethiopia: a mixed-methods study

Background: Even though it is preventable, cervical cancer contributes significantly to cancer-related mortality among Ethiopian women. Follow-up visits after treatment of precancerous lesions are essential to monitor lesion recurrence. In our previous study, we found a level of adherence to follow-up of 44.7%, but the reasons for low adherence have not been comprehensively explored within the Ethiopian context. This study aimed to identify these reasons by interviewing 167 women who had missed their follow-up appointments as well as 30 health professionals with experience in the field.

Methods: The study employed a mixed-methods approach: Quantitative data were collected through a telephone questionnaire conducted with 167 women who had a positive visual inspection with acetic acid (VIA) and had missed their follow-up appointments. Subsequently, in-depth interviews were conducted with 30 healthcare professionals, and an inductive content analysis was carried out.

Results: In the patient interviews, the reasons given most often were "lack of information about the follow-up" (35; 21.1%), "forgetting the appointment" (30; 18.1%), and "not seeing the need for follow-up" (24; 14.5%). Healthcare professionals identified various reasons such as lack of knowledge, living in a remote area/changing living area, forgetfulness, fear, poor counseling, a shortage of trained healthcare providers to give counseling and follow-up, and reminder-related barriers.

Conclusion: Lack of knowledge, forgetfulness, poor health-seeking behavior, and a lack of reminders were identified as barriers contributing to the low uptake of rescreening. Further interventions should target these by creating community awareness, improving patient counseling, tracing patients in need of follow-up, and making reminder calls or using SMS.