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Asia Pac J Oncol Nurs. 2019 Dec 10;7(1):18-27. doi: 10.4103/apjon.apjon_48_19. eCollection 2020 Jan-Mar.

Exploring Complicity of Cervical Cancer Screening in Malawi: The Interplay of Behavioral, Cultural, and Societal Influences.

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College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.
College of Nursing, Daeyang University, Lilongwe, Malawi.
College of Nursing, Ewha Womans University, Seoul, Korea.
Malawi University of Science and Technology, Malawi.
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.



Cervical cancer is preventable, and early diagnosis is possible using low-cost technologies, but a scant number of women receive cancer screening in Malawi. This study aims to identify facilitators and barriers that influence the uptakes of cervical cancer screening behavior in Malawi.


A rapid ethnographic approach with the goal of optimizing planning for a future intervention study was utilized. Data were collected from three focus groups and seven individual interviews with adults in their communities, stakeholders, and health-care providers.


Three categories (sociocultural influences, access to the health-care system, and individual factors) have emerged as facilitators or barriers to cervical cancer screening among Malawian women. The findings also showed that cervical cancer screening behavior is situated socially through cultural and health-care services of a given community.


Cancer screenings are only sought when illness symptoms persist or worsen. Awareness and knowledge of cervical cancer and cervical cancer screening is low among both health-care providers and the general population. Health-care systems are donor driven and focus on a single disease, health-care access is the greatest challenge to cervical cancer screening, and health-care providers are not adequately prepared to work for rapid increase in the prevalence of cervical cancer. Integrating cervical cancer screening into the existing health-care system is sustainable way forward, and nurses prepared to handle cervical cancer management can play an essential role to promote cervical cancer screening in a health resource-constrained setting.


Behavior; HIV; cervical cancer screening; culture; global health disparities; rapid ethnography; resource-limited settings; women

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