Table 2.

Patient quotes on their perceptions and experiences, smartphone-based VIA cervical cancer screening, Accra, Ghana, 2015

Theme	Quote
Knowledge and attitude regarding cancer and screening and health decision-making process
Lack of prior knowledge	“…when I heard about the disease at that time I did not take it seriously because I did not really understand it very well but when the nurse came to explain then I knew how important it was to go for the screening.” [SP6] Even though I heard about it I was not scared of it because when I started life as a young lady I did not insert those things that people put into their private part and I did not do those rough things. So even though I heard about it I never went to check or screen.” [SP2]
Low education levels	“Where I live, most of the people there have low educational background so I think they don’t (know) much about health so maybe for them if they experience any problem in their private part they can grind pepper and insert it there and (for) such people it is not easy to convince them to come for this screening.” [SP5]
Misperceptions about screening	“In fact it was not easy convincing them (other women) because some of them were saying that when you go they will be inserting hands in their vagina and others were saying all sorts of things so I told them that when I went I did not experience that.” [SP2] “she (another woman in community) was saying if she comes they will say this today and that tomorrow and she does not know what they will be inserting into her” [SP5]
Support of partners for screening	“Well, I explained to the man I live with about the screening but I had decided to do the screening already so when I explained it to him too he said it was good so I should come and do it so that if they give medicine I can also get some.” [SP4]
Support of men in the community for screenings	“…the day the nurse was telling me about the screening, there was a man there and he was even more interested in listening to what the nurse had to say and he even said he will tell his wife and sister to go for the screening” [SP6]
Appreciation for effort of CHNs	“Well she educated me, first of all she explained to me what cervical (cancer) is and how it is contracted…and she explained to me how everything is going inside. I was asking a lot of questions so she kept explaining to me.” [SP3]
Photos as an educational tool	“…When they came to my workplace they showed the picture to us, I mean to the nursing mothers as well telling them how the disease looks like, so it was the pictures that I saw that got me scared so I decided to come for the screening.” [SP7]
Shyness as barrier to screening	:“…they (other women) support it but it is just that some of them are shy.” [SP13]
Patients’ expectations and experiences of screening and logistical barriers
Importance for preventing cancer fatality	“…you can see that it is dangerous, I saw the pictures. If you have this infection (disease) how will you know, so if they are able to check and see if you have the disease and they cure it for you then it is good and if they check and they see that you don’t have it then you can protect yourself. So it will be good if it is detected early rather than you will wait till the disease becomes worse when nothing can be done about it.” [SP2] “…even though the time they did the screening I had to go to work I decided to use that time to come…because I wanted to know if I had the cancer or not.” [SP12]
Trust for CHNs	“I did not have any expectations and I also trust the nurse who came to inform me about the screening.” [SP1].
Screening was less complex than expected	“I thought that when I come they were going to do an operation or something of that sort before they can see it but when I came they said it was not like that, they made me lie down and they put under me and took a picture of it and showed it to me” [SP15] “as for me when they say they want to look at the mouth of the womb I think (hahahahah) they will remove it and wash and then they can see if it has a disease or not so that is what I think…” [SP2].
Minor discomfort	“I was ok I did not experience any discomfort, it was just a little bit painful but later it was ok.” [SP15]
No cost as a motivator	“…when she said the screening is free I decided to come” [SP2]
Importance of improving awareness	“I think that the announcement and awareness should be more, because the nursing mothers they came to speak to, at my workplace, are just a few women so they should speak to a lot of people so that they can also come for the screening.” [SP11]
Cervicography and smartphone-based VIA, and cryotherapy
Smartphone as a reassurance	“…if she does not take a picture of it how would she know if I have the disease or not and how will she be able to show it to me? Because I have to see it myself, if I don’t see it I may say she is telling lies because I have been to a number of places and they say I don’t have any problem but I don’t see it.” [SP15]
Trust of providers and professionalism	“I was ok with it because she has to do it and that is her work, you are a woman when you go for consultation you need to be free and let the person do her work so that she will know what is happening to you so I wasn’t having any problem with it.” [SP3]
Experience of cryotherapy	“I was very comfortable.” [SP5] “it was ok, the time, she came on Saturday it was ok because if she had come within the week I would not have been able to come but the time she came it was favorable.”[SP1].

SP indicates patients; numbers indicate the specific patients.

CHN, community health nurse; VIA, visual inspection with acetic acid.