Table 5.

Themes from interviews and focus groups

Theme	Sub-themes & triangulation
	Providers	Women receiving care
Limited availability of services at the primary care level	Lack of in-service training on cervical cancer and screening Lack of infrastructure and supplies for screening and treatment Lack of supportive services for cervical cancer patients	Women leapfrog primary care facilities to seek care from secondary facilities Lack of supportive services for cervical cancer patients: family as main support
Weak referral networks	Few systems in place to follow up on referred patients Ad hoc systems used to track patients
Barriers to initiating and continuing care	Patients’ low awareness and low perception of risk Lack of finances and transport for follow up care/referrals	Patients’ low awareness and low perception of risk: Women do not think they are at risk if they are monogamous or not sexually active Lack of finances and transport for follow up care/referrals Stigma, which delays care initiation and seeking follow-up care Societal barriers, namely rural women’s need for partner approval to seek care
Sources of delay in accessing appropriate treatment	Loss to follow-up after referrals, mainly due to financial barriers and long wait times for referral appointments	Misdiagnosis of cervical cancer Lack of equipment, laboratory services, and beds Long wait times for referral appointments
Patient-provider communication	Difficulty communicating due to shy and uncomfortable patients	Unclear or missing communication, particularly about diagnosis Power imbalance and fear of repercussions in asking questions Difficulty communicating due to language barriers
Recommendations for change	Expand and decentralize the provision of services: Increase training, availability of supplies, and equipment at local level Expand health education and outreach for the general public and leaders	Expand and decentralize the provision of services: Increase service availability at local level Expand health education and outreach, especially for rural community members

Italicized sub-themes were found in both patient and provider data