Article Text

Download PDFPDF

Competing needs: a qualitative study of cervical cancer screening attendance among HPV-positive women in Tanzania
  1. Ditte Søndergaard Linde1,2,3,
  2. Vibeke Rasch1,2,
  3. Julius D Mwaiselage4,
  4. Tine M Gammeltoft5
  1. 1 Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
  2. 2 Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
  3. 3 OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
  4. 4 Department for Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
  5. 5 Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Ditte Søndergaard Linde; dsondergaard{at}


Objectives The aim of this study was to understand causes of attendance and non-attendance to a follow-up cervical cancer screening among human papillomavirus (HPV)-positive women.

Design Semistructured, individual interviews with HPV-positive women and cervical cancer screening nurses. The interview guide and initial data analysis were guided by existing health behaviour theories. However, as the theories limited the potential of the data material, a grounded theory framework guided the final data analysis.

Setting Interviews were conducted in Dar es Salaam, Tanzania, at Ocean Road Cancer Institute (ORCI) or in the homes of screening clients.

Participants 15 interviews were conducted with women who had tested HPV-positive during a patient-initiated screening and been appointed for a follow-up screening 14 months later. Nine women had not attended the follow-up appointment, four had delayed attendance and two had attended on the scheduled date. Further, individual interviews were conducted with the two nurses working at ORCI’s screening clinic.

Results Perceived benefits for attending a patient-initiated screening include treatment of gynaecological symptoms and prevention of disease. The key perceived benefit of a health provider-initiated follow-up screening is prevention, which is challenged by the circumstance that it is seen by women as having merely potential benefit and therefore can be postponed when competing needs are present. Perceived challenges for screening attendance include emotional costs, in the form of fear of the disease, fear of the gynaecological examination as well as direct and indirect economic costs, such as transportation costs, lost income and waiting time.

Conclusion Cervical cancer screening is one among many tasks that women living in a low-income setting must attend to. Since health provider-initiated follow-up screening is seen as having only potential benefit, attendance can be postponed when competing needs exist.

Trial registration number NCT02509702.

  • cervical cancer
  • screening
  • HPV
  • behaviour
  • interviews
  • Tanzania

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors DSL conducted the interviews, drafted the manuscript and contributed to conceptualising and designing the study. VR, TMG and JDM contributed to conceptualising and designing the study and critically revised the manuscript. All authors approved the final manuscript.

  • Funding The study is funded by the Danish Ministry of Foreign Affairs through Danish International Development Agency (Danida), Danish Fellowship Centre (DFC) and the University of Southern Denmark.

  • Competing interests None declared.

  • Ethics approval Ethical clearance for the overall CONCEPT study was obtained from the National Institute for Medical Research in Tanzania for all study sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional unpublished data concerning perceptions of the SMS intervention are available. This includes interview data nurses and screening clients and focus group data with outreach nurses who perform home visits to HPV-positive clients informing them of their HPV status. We aim to publish these findings in the future.

  • Patient consent for publication Obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.