Factors influencing cervical cancer screening among pregnant women in Nairobi, Kenya

Angela Adhiambo Omondi, Mary Shaw-Ridley, Amr Soliman


To characterize cervical cancer screening knowledge, beliefs, behaviors, and sociodemographic factors among women aged 25-45 years who access and utilize prenatal care services in Nairobi, Kenya. A descriptive cross-sectional design using a convenience sample of pregnant women receiving prenatal health services at a public and a private hospital in Nairobi, Kenya. Constructs from the Health Belief Model (HBM) guided the design, interpretation of the results, and recommendations. Data were analyzed using SPSS version 24. Bivariate analyses were conducted to examine associations between variables. There was a significant association (p=0.001) between knowledge and screening behaviors. There was no association (p=0.066) between cervical cancer beliefs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy) and screening behaviors. Knowledge and beliefs influence cervical cancer screening behavior. Low cervical cancer screening uptake substantiates the need for tailoring culturally specific health behavior change communication to address misconceptions about cervical cancer screening in Kenya. (Afr J Reprod Health 2022; 26[11]: 46-54).

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World Health Organization. Cervical cancer. Available from: https://www.who.int/health-topics/cervical-cancer

International Agency for Research on Cancer. Cancer today. Available from: https://gco.iarc.fr/today/data/factsheets/cancers/23-Cervix-uteri-fact-sheet.pdf

Centers for Disease Control and Prevention. Cervical cancer statistics. Available from: https://www.cdc.gov/cancer/cervical/statistics/index.html.

Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gomez, D, Munoz J, Bosch, FX and de Sanjose S. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Kenya. Summary Report 22 October 2021.

UNICEF. Cross-sector indicator. Available from: https://data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=KEN.MNCH_ANC4.&startPeriod=1970&endPeriod=2021

Do M, Wang W, Hembling J and Ametepi P. Quality of antenatal care and client satisfaction in Kenya and Namibia. International Journal of Quality in Health Care. 2017;29(2): 183-193.

Ministry of Health, Kenya. Kenya National Cancer Screening Guidelines. Available from: https://www.health.go.ke/wp-content/uploads/2019/02/NATIONAL-CANCER-SCREENING-GUIDELINES-launched-.pdf.

National Cervical Cancer Prevention Program Strategic Plan 2012-2015. Available from: https://extranet.who.int/ncdccs/Data/ken_B5_National%20Cervical%20Cancer%20Prevention%20Plan%20FINALFeb%202012.pdf.

Kenya Demographic Health Survey. Non-communicable diseases and other health issues. Available from: https://www.dhsprogram.com/pubs/pdf/sr227/sr227.pdf.

Buchanan Lunsford N, Ragan K, Lee Smith J, Sarai and Aketch M. Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya. Oncologist. 2017;22(2): 173-181.

Rosser JI, Hamisi S, Njoroge B and Huchko MJ. Barriers to cervical cancer screening in rural Kenya: Perspectives from a provider survey. Journal of Community Health. 2015;40(4): 756-761.

Adewumi K, Nishimura H, Oketch SY, Adsul P and Huchko M. Barriers and facilitators to cervical cancer screening in Western Kenya: A qualitative study. Journal of Cancer Education. 2022;37(4): 1122-1128.

Gatumo M, Gacheri S, Sayed AR and Scheibe A. Women's knowledge and attitudes related to cervical cancer and cervical cancer screening in Isiolo and Tharaka Nithi counties, Kenya: a cross-sectional study. BMC Cancer. 2018;18(1): 745.

Watson-Jones D, Mugo N, Lees S, Mathai M, Vusha S, Ndirangu G and Ross DA. Access and attitudes to HPV vaccination amongst hard-to-reach populations in Kenya. PLoS One. 2015;10(6): e0123701.

Vermandere H, van Stam MA, Naanyu V, Michielsen K, Degomme O and Oort F. Uptake of the human papillomavirus vaccine in Kenya: Testing the health belief model through pathway modeling on cohort data. Global Health. 2016;12(1): 72.

Mabeya H, Menon S, Weyers S, Naanyu V, Mwaliko E, Kirop E, Orango O, Vermandere H and Broek DV. Uptake of three doses of HPV vaccine by primary school girls in Eldoret, Kenya: A prospective cohort study in a malaria endemic setting. BMC Cancer. 2018;18: 557

Oketch SY, Kwena Z, Choi Y, Adewumi K, Moghadassi M, Bukusi EA and Hucko MJ. Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study. BMC Women’s Health. 2019;19(1): 75.

Rosenstock IM. Historical origins of the Health Belief Model. Health Education Monographs. 1974;2(4): 328-335.

Bazargan M, Lucas-Wright A, Jones L, Vargas R, Vadgama JV, Evers-Manly S and Maxwell AE. Understanding perceived benefit of early cancer detection: Community-partnered research with African American women in South Los Angeles. Journal of Women’s Health. 2015;24(9): 755-761.

Marlow LA, Waller J and Wardle J. Barriers to cervical cancer screening among ethnic minority women: a qualitative study. Journal of Family Planning Reproductive Health Care. 2015;41(4): 248-254.

Williams M, Moneyham L, Kempf MC, Chamot E and Scarinci I. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama. AIDS Patient Care STDS. 2015;29(1): 13-19.

Gichangi P, Estambale B, Bwayo J, Rogo K, Ojwang S and Temmerman M. Knowledge and practice about cervical cancer and Pap smear testing among patients at Kenyatta National Hospital, Nairobi, Kenya. International Journal of Gynecological Cancer. 2003;13(6): 827-833.

Sudenga SL, Rositch AF, Otieno WA and Smith JS. Knowledge, attitudes, practices, and perceived risk of cervical cancer among Kenyan women: brief report. International Journal of Gynecological Cancer. 2013;23(5): 895-899.

Champion V. Instrument development for health belief model constructs. Advances in Nursing Science. 1984;6(3): 73-85.

Champion V. Revised susceptibility, benefits, and barriers scale for mammography screening. Research in Nursing & Health. 1999;22: 341-348.

Champion V, Skinner CS and Menon U. Development of a self-efficacy scale for mammography. Research in Nursing & Health. 2005;28: 329-336.

Acharya PR and Karmacharya E. Cervical cancer screening behavior and associated factors among women of Ugrachandi Nala, Kavre, Nepal. European Journal of Medical Research. 2017;22(1): 32.

Liu T, Li S, Ratcliffe J and Chen G. Assessing knowledge and attitudes towards cervical cancer screening among rural women in Eastern China. International Journal of Environmental Research and Public Health. 2017; 14(9): 67.

Ojeaga A, Alema-Mensah E, Rivers D, Azonobi I and Rivers B. Racial disparities in HPV-related knowledge, attitudes, and beliefs among African American and White women in the USA. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education. 2019;34(1): 66–72.

Gatumo M, Gacheri S, Sayed AR and Scheibe A. Women's knowledge and attitudes related to cervical cancer and cervical cancer screening in Isiolo and Tharaka Nithi counties, Kenya: A cross-sectional study. BMC Cancer. 2018;18(1): 745.

Lukorito J, Wanyoro A and Kimani H. Uptake of cervical cancer screening among HIV positive women in comprehensive care centers in Nairobi, Kenya. Research in Obstetrics and Gynecology. 2017;5(1): 1-6.

Ndejjo R, Mukama T, Musabyimana A and Musoke D. Uptake of Cervical Cancer Screening and Associated Factors among Women in Rural Uganda: A Cross Sectional Study. PLoS One. 2016;11(2): e0149696.

Rositch AF, Gatuguta A, Choi RY, Guthrie BL, Mackelprang RD, Bosire R, Manyara L, Kiarie JN, Smith JS and Farquhar C. Knowledge and acceptability of pap smears, self-sampling and HPV vaccination among adult women in Kenya. PLoS One. 2012;7(7): e40766.

Ducray JF, Kell CM, Basdav J and Haffejee F. Cervical cancer knowledge and screening uptake by marginalized population of women in inner-city Durban, South Africa: Insights into the need for increased health literacy. Womens Health (Lond). 2021 Jan-Dec;17:17455065211047141. doi: 10.1177/17455065211047141. PMID: 34553644; PMCID: PMC8474337.

Mahumud RA, Keramat SA, Ormsby GM, Sultana M, Rawal LB, Alam K, Gow J, AND Renzaho AMN. Wealth-related inequalities of women’s knowledge of cervical cancer screening utilization in 18 resource-constrained countries: evidence from pooled decomposition analysis. International Journal for Equity in Health. 2020; 19(42)

Margolis KL, Lurie N, McGovern PG, Tyrrell M and Slater JS. Increasing breast and cervical cancer screening in low-income women. J Gen Intern Med. 1998;13(8):515-521. doi:10.1046/j.1525-1497.1998.00161.x

Wangeci G and Macharia D. Factors influencing utilization of cervical cancer screening services in Kenya: The case of Nyeri County. International Journal of Public Health Science. 2018;7(4): 236-274

Gemeda EY, Kare BB, Negera DG, Bona LG, Derese BD, Akale NB, Kebede KM, Koboto DD and Tekle AG. Prevalence and predictor of cervical cancer screening service uptake among women aged 25 years and above in Sidama Zone, Southern Ethiopia, using health belief model. Cancer Control.


Wright KO, Kuyinu YA and Faduyile FA. Community education on cervical cancer amongst market women in an urban area of Lagos, Nigeria. Asian Pacific Journal of Cancer Prevention. 2010;11(1): 137-140.

Mock J, McPhee SJ, Nguyen T, Wong C, Doan H, Lai KQ, Nguyen KH, Nguyen TT and Bui-Tong N. Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women. American Journal of Public Health. 2007;97(9): 1693-1700.

Osingada CP, Ninsiima G, Chalo RN, Muliira JK and Ngabirano T. Determinants of uptake of cervical cancer screening services at a no-cost reproductive health clinic managed by Nurse-Midwives. Cancer Nursing. 2015;38(3): 177-184.


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