Cervical Cancer Screening Promotion in Eswatini: A Cross-Sectional Survey of Community Health Workers' Perceived Barriers

Background: This study examined community health workers' perceived barriers to discussing cervical cancer screening with women eligible for screening and explored factors associated with endorsing a greater number of barriers. Additional exploratory analyses assessed factors associated with endorsing a specific barrier. Methods: A telephone survey of 172 community health workers was conducted between July and August 2021. Descriptive analyses were performed to assess participants' socio-demographic and service-related characteristics. Regression analyses were used to assess: the association between socio-demographic characteristics and 1) endorsing a greater number of barriers and 2) endorsing a specific barrier or combination of barriers. Results: Commonly endorsed barriers included: perceived inability to convince women to undertake screening, inadequate time to discuss screening, lack of confidence to talk to older women about screening, and women's lack of interest in screening advice. Community health workers with at least some secondary school level education endorsed 40% more barriers than those without secondary school level education. Community health workers in Lubombo and Shiselweni endorsed 47% and 35% fewer barriers than community health workers in Hhohho. Community health workers in Lubombo were less likely to endorse: 1) barrier combination consisting of 'inability to talk to women in a way that will convince them to undertake cervical cancer screening' and 'lack of confidence to talk to older women about screening', and 2) barrier combination consisting of 'thinking that cervical cancer screening is not important' and 'thinking that health education is not effective in promoting cervical cancer screening'. Conclusion: Improvements to the training of community health workers with respect to screening-related health promotion may be useful in addressing most of the identified barriers.