TABLE 1.

Themes and categories.

Themes	Categories	Subcategories: Direct quotes
Lack of knowledge	Symptoms	‘You cannot just find yourself at the hospital whilst you are not sick. As long as one is not feeling well there is no need to go to the clinic.’ ‘If someone is not feeling well and they suspect they have cervical cancer, then they should be screened but if they are fine there will be no need.’ ‘I am not sure if it is really important to get screened, but I think as long as one is having vaginal bleeding and foul-smelling vaginal discharges, they should be screened.’ ‘I will not go to the clinic when I am not sick, it is a waste of time. It’s only those who are sick who needs a nurse or a doctor.’
	Incurable disease	‘I don’t see any reason of going at the clinic because I was told that Cancer is a killer disease that cannot be cured.’ ‘What is the use of getting to know that I have a disease when the nurses cannot cure the cancer disease?’ ‘We grew up being told that cervical cancer cannot be treated and people with cancer eventually die from the disease.’
	Side effects	‘My friend told me that they insert a metal object in the cervix which they scrap with an object during screening.’ ‘I fear contacting other diseases such as HIV and AIDS as I have heard that most doctors that have been treating patience end up catching the disease.’
Stigmatisation	Attitudes	‘Cervical cancer is disease which many people including me do not discuss about with friends and neighbours because people may gossip and laugh thereafter.’ ‘Every woman should get screened in time to ensure that they get treated early if any signs of cancer is detected.’ ‘I am not ready now; I have other important things that I need to be attending to.’ ‘People in this community believe that if a person is said to have such a disease is a curse because bad luck falls upon them due to doing some bad things such as sinning.’
Cultural beliefs and values	Trust and embarrassment	‘The only problem I got was when I was told to remove my clothes, but later I realized they were fellow women. I looked at them, I became strong and removed the clothes.’ ‘Cervical cancer is considered to be a sexually transmitted disease and having such a disease will lead to loss of trust for the wife by her husband who may think that the wife was sleeping around with other men.’
	Traditional medicine	‘My grandmother when she got cancer visited an herbalist who resides in our village.’ ‘I don’t see any reason for screening at a health centre because cancer is only treated by herbs and not the modern medicine.’
	Husbands’ involvement	‘My husband decides whether I should go for screening or not.’ ‘If I want to go to the clinic, I seek permission from my husband and if he doesn’t want me to go for cancer screening, I have to be obedient.’ ‘Men are not comfortable with their women being checked their private parts.’ ‘Our culture does not allow women to go for medical examination alone without any male members of the family, this means that I can go to the clinic for screening only when my husband is around and willing to accompany me.’ ‘Our men do not want anyone who goes to check especially the private parts of the body, they will become suspicious if you start talking of private parts examination and this can destabilize a marriage if you do without their permission.’ ‘My husband may divorce me if he knows that I have cervical cancer.’ ‘This disease is associated with cheating in marriages, therefore getting screened will cause male partners to marry another healthier woman.’
Religion	Spiritual leaders	‘Some spiritual leaders opt for prayers and in case a person is infected they will be prayed for, and they get healed.’ ‘My pastor always gives me holy water every when I go to church, and I am sure that will help me not to suffer from cervical cancer.’ ‘There is discussion held mostly in Pentecostal churches where people interact and teach about the importance of cervical cancer screening.’ ‘There is nothing as such hidden from our church as everything is revealed to them through the prophets. The prophets will pray for us so that we do not contract diseases including cancer.’
	Religious beliefs	‘I believed cervical cancer is a disease that is unavoidable, and it is in only in God’s nature in control.’ ‘People in this community believe it’s a curse to have such a disease as cancer and therefore cleansing by holy water and prayers is needed.’
Lack of resources	Policies	‘There is lack of cervical cancer testing services that motivate us in the rural areas to seek cervical cancer screening.’ ‘Cervical cancer screening should be done for free in all clinics whether government of private.’ ‘We need this educational forum so that we can understand. It is the same as when HIV started, there was little information given, but when they started laying it out then people started to understand.’
	Lack of equipment	‘Sometimes when you go to the clinic they say some things are not there (speculums) so we have to go and check with bigger hospital.’ ‘The clinic is far, and also long queues and also sometimes they say they don’t have tools.’
	Lack of human resources	‘Nurses are few compared to the patients in the rural areas, they fail to meet the demand.’ ‘I once went to the clinic and I came back before screening after waiting the whole day without being attended to.’

HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome.