Table 1.
Barriers to CCa Screening Based on Level of Income of the Countries
| Author, Country and Year | Study design and Methodology | Sampling technique and frame | Sample size (n) | Age group (yrs.) | Screening method used | Barriers themes | Quality rating* | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Low income countries | |||||||||||||
| Quantitative studies | |||||||||||||
| Audet CM et al. | Quantitative | Convenience | 101 | 30-56 | VIA | A | Medium | ||||||
| Mozambique, 2012 | Questionnaire survey | In two clinics | B | ||||||||||
| Cunningham MS et al. | Quantitative | Multistage cluster random | 575 | 18-55 | VIA | A B D E |
High | ||||||
| Tanzania, 2015 | Questionnaire survey | In two districts | |||||||||||
| Mupepi SC et al. | Quantitative | Random | 514 | Dec-84 | VIAC | A | High | ||||||
| Zimbabwe, 2011 | Questionnaire survey | In a rural district | D | ||||||||||
| Perng P et al. | Quantitative | Convenience | 300 | 25+ | VIA | A | High | ||||||
| Tanzania, 2013 | Questionnaire survey | In a rural village | B D |
||||||||||
| Qualitative studies | |||||||||||||
| Fort VK et al. | Qualitative | Convenience | 20 | 20-50 | VIA | A D E |
High | ||||||
| Malawi, 2011 | In-depth interview | In one hospital and catchment area | |||||||||||
| Ports KA et al. | Qualitative | Unclear | 30 | 18-49 | VIA | D | Medium | ||||||
| Malawi, 2015 | In-depth interview | In four villages | |||||||||||
| Lower-middle income countries | |||||||||||||
| Quantitative studies | |||||||||||||
| Quantitative | Random | 469 | 25-65 | VIA | A | High | |||||||
| Basu P et al. | Questionnaire survey | In one area | D | ||||||||||
| India, 2006 | |||||||||||||
| Islam RM et al. | Quantitative | Multistage cluster random | 1590 | 30-59 | VIA | A | High | ||||||
| Bangladesh, 2015 | Questinnaire survey | Nationally représentative | B | ||||||||||
| Montgomery MP et al. | Quantitative | Convenience | 202 | 18-44 | Pap smear | A D F |
Low | ||||||
| India, 2015 | Questinnaire survey | In one hospital | |||||||||||
| Quantitative | Systematic random | 388 | 15-49 | Pap smear | A | Medium | |||||||
| Sudenga SL et al | Questionnaire survey | In 4 health facilities in under one district | B | ||||||||||
| Kenya, 2013 | D | ||||||||||||
| Qualitative studies | |||||||||||||
| Ansink AC et al. | Qualitative | Convenience | 220 | 20-49 | VIA | A | Medium | ||||||
| Bangladesh, 2008 | Focus group | In catchment areas of 2 hospitals | Men, women and Adolescents | D | |||||||||
| Garrett JJ et al. | Qualitative | Convenience | 20 | 18-65 | Pap smear | A C D E |
High | ||||||
| Honduras, 2013 | Focus group & in-depth interviews | In rural settings | |||||||||||
| Kim YM et al. | Qualitative | Convenience | 20 received VIA | 25-50 | Cryotherapy after VIA | A | High | ||||||
| Indonesia, 2012 | Focus group | In 7 health centres | |||||||||||
| Ngugi CW et al. | Qualitative | Convenience | 50 | 18+ | VIA/VILLI | A C D |
Medium | ||||||
| Kenya, 2012 | In-depth interviews | In one district hospital | |||||||||||
| Upper middle income countries | |||||||||||||
| Quantitative studies | |||||||||||||
| Augusto EF et al. | Quantitative | Unclear | 351 | 17-79 | Pap smear | B | Medium | ||||||
| Brazil, 2013 | Questinnaire survey | D | |||||||||||
| Budkaew J at al. | Quantitative | Systematic | 195 | 30-60 | Pap smear | A B D |
Medium | ||||||
| Thailand, 2014 | Questionnaire survey & in-depth interviews | In one medical hospital | |||||||||||
| Gan DEH et al. | Quantitative | Multistage random | 959 | 20-64 | Pap smear | A B E |
High | ||||||
| Malaysia, 2013 | Questinnaire survey | In 5 rural districts | |||||||||||
| Fernandes JV et al. | Quantitative | Stratified | 267 | 15-69 | Pap smear | B D E |
Low | ||||||
| Brazil, 2009 | Questinnaire survey | In a city | |||||||||||
| Jia Y et al. | Quantitative | Convenience | 5929 | 26-65 | VIA/VILLI/Colposcopy | A B D F |
High | ||||||
| China, 2013 | Questinnaire survey | In 3 high incidence towns | |||||||||||
| Kangmennaang J et al. | Quantitative | Stratified random | 6542 | 15-64 | Pap smear | A | High | ||||||
| Namibia, 2015 | Questinnaire survey | Nationally representative | D | ||||||||||
| Marvan M L et al. | Quantitative | Convenience | 384 | 26-64 | Pap smear | A B D |
Medium | ||||||
| Mexico, 2013 | Questinnaire survey | In one urban and 2 rural areas | |||||||||||
| Nwankwo KC et al. | Quantitative | Convenience | 815 | 18-70 | Pap smear | A | Medium | ||||||
| Nigeria, 2011 | Questinnaire survey | In a church-based mandatory annual meeting | D | ||||||||||
| Reis N et al. | Quantitative | Random | 387 | Average age 34.4 years | Pap smear | A | Medium | ||||||
| Turkey, 2012 | Questinnaire survey | In outpatient clinics of 2 cities | B D F |
||||||||||
| Watkins MM et al. | Quantitative | Convenience | 97 | 16-66 | Pap smear | A | Medium | ||||||
| Mexico, 2002 | Questinnaire survey | In a rural village | B D |
||||||||||
| Agurto I et al. | Combination of 5 Qualitative studies | Convenience | Unclear | 25-64 | Pap smear | C | Low | ||||||
| Latin America, 2004 | Focus group and in-depth interviews | In 6 areas in 5 countries | D | ||||||||||
| Duran ET | Qualitative | Convenience | 11 | 15-49 | No specific CCa screening | A | Low | ||||||
| Turkey, 2011 | Case studies | In 2 hospitals in a small city | C D |
||||||||||
| Ersin F et al. | Qualitative | Random | 35 | 40+ | Pap smear | A | Low | ||||||
| Turkey, 2013 | Focus group | In one district | B D |
||||||||||
| Lazcano-ponce EC et al. | Qualitative | Convenience | 4 FG | 25-35 | Pap smear | A | High | ||||||
| Mexico, 1999 | Focus group | One urban and one rural city | (each 7/8) | B D E |
|||||||||
| Markovic M et al. | Qualitative | Convenience | 62 | 35-55 | Pap smear | A | Medium | ||||||
| Serbia, 2005 | Focus group | In 2 cities | C D E |
||||||||||
| McFarland D M | Qualitative | Convenience | 30 | 30+ | Pap smear | A | High | ||||||
| Botswana 2003 | Questionnaire and | In capital city | D | ||||||||||
| semi-structured interview | E | ||||||||||||
| Paz-Soldan VA et al. | Qualitative | Convenience | 177 | 18-40 | Pap smear | A | Medium | ||||||
| Peru, 2010 | Focus group | In 4 cities | C | ||||||||||
Note: CCa, Cervical cancer; VIA, Visual inspection with acetic acid; VIAC, Visual inspection with acetic acid and camera; VILLI, Visual inspection with Lugol’s iodine, colposcopy; A, Barriers related to lack of knowledge and awareness about cervical cancer, and screening methods; B, Demographic factors include age, marital status, occupation; C, Psychological factors include fear, anxiety, depression etc.; D, structural barriers include education, income and cost associated with screening and treatment, distance to the service centres, access and availability to screening; E, Socio-cultural and religious barriers include that family does not allow screening, modesty mostly associated with religion, believing the disease caused by a curse; and F, Perceived barriers, particularly the health belief model.