Reducing Barriers and Sustaining Utilization of a Cervical Cancer Screening Program in Rural Senegal

The goal of this study is to inform the sustainable implementation of cervical cancer
screening services in low-resource areas of Senegal naïve to cancer screening programs by

1. investigating the access barriers and determinants of initial uptake and

2. developing and adapting a peer education health promotion intervention to diverse and
dynamic contexts to achieve sustained utilization.

Framework: Implementation Science is the study of how proven technical solutions are
applicable to real world settings. The investigators will study how the implementation of
VIA, as a proven intervention, can be optimized and how the screening service can best "fit"
into the local context. Established complementary frameworks will guide our study. The
investigators will apply

1. the Patient-Centered Access Framework to assess the demand-side barriers and
facilitators of uptake in aim 1,

2. the Integrated Theory of Health Behavior Change to evaluate how a peer education program
facilitates self-management behavior of women in aim 2, and

3. the Dynamic Sustainability Framework to evaluate the initial uptake and sustained
utilization of the health service in aim 3.

The investigators seek to understand the dynamic nature of the influential factors within the
local context and the process by which the investigators can facilitate responsive
adaptations to the intervention in order to reduce barriers, maximize early uptake, and
sustain utilization.

Overview of Study Data Collection: To achieve all aims, the investigators will conduct a
cluster-randomized stepped wedge study across three representative clusters (each containing
a district center and two rural sites) in the Kedougou region. For each aim the investigators
will collect data at baseline and at 6-month intervals in each cluster (data collection
intervals coincide with the initiation of the intervention in a new cluster). In aim 1, the
investigators will develop (through a participatory approach), pilot, and conduct surveys of
eligible clients and household questionnaires as well as focus groups (FG) (women ages 30-44
and 45-59) and in-depth interviews of men (ages 30-59). For aim 2, the investigators will
describe the development, piloting, implementation, and adaptation of an aim 1-informed
context-specific multi-level peer education curriculum across clusters through the stepped
wedge approach in the Kedougou region. The investigators will collect quantitative program
reach data and qualitative process evaluation data at each time period. These data will be
used to adapt the intervention over time. To achieve aim 3, the investigators will collect
aggregated health service level utilization data and individual surveys.

Inclusion Criteria:

Women. Criteria for inclusion include:

- female Senegal citizen between the ages of 30 and 59,

- Resident in Kedougou Region,

- eligible to seek cervical cancer prevention services at a designated intervention or
control health center in the Kedougou Region, Senegal,

- willing to participate in survey assessments; 5) able to give informed consent.

Men. Criteria for inclusion include:

- male Senegal citizen between the ages of 30 and 59,

- Resident in Kedougou Region,

- living in a household with at least one woman eligible to seek cervical cancer
prevention services at a designated intervention or control health center in the
Kedougou Region, Senegal,

- willing to participate in survey assessments;

- able to give informed consent.

Exclusion Criteria:

- No additional exclusion criteria exist.