Assessment of psychological barriers to cervical cancer screening among women in Kumasi, Ghana using a mixed methods approach

Afr Health Sci. 2013 Dec;13(4):1054-61. doi: 10.4314/ahs.v13i4.28.


Background: Cervical cancer is the leading cause of cancer death among women in Ghana, West Africa. The cervical cancer mortality rate in Ghana is more than three times the global cervical cancer mortality rate. Pap tests and visual inspection with acetic acid wash are widely available throughout Ghana, yet less that 3% of Ghanaian women get a cervical cancer screening at regular intervals.

Objective: This exploratory study was to identify psychological barriers to cervical cancer screening among Ghanaian women with and without cancer using a mixed methods approach.

Methods: Semi-structured interviews were conducted with 49 Ghanaian women with cancer and 171 Ghanaian women who did not have cancer.

Results: The results of the quantitative analysis indicated that cancer patients where not more likely to have greater knowledge of cancer signs and symptoms than women without cancer. Analysis of the qualitative data revealed several psychological barriers to cervical cancer screening including, common myths about cervical cancer, misconceptions about cervical cancer screening, the lack of spousal support for screening, cultural taboos regarding the gender of healthcare providers, and the stigmatization of women with cervical cancer.

Conclusion: The results of this study can be used to inform the development of culturally relevant cervical cancer education interventions aimed at addressing the psychological barriers to cervical cancer screening perceived by Ghanaian women.

Keywords: Cancer; developing countries; disease prevention; knowledge; qualitative methods.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Culture
  • Early Detection of Cancer / psychology*
  • Female
  • Ghana
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Interviews as Topic
  • Mass Screening / psychology*
  • Middle Aged
  • Papanicolaou Test / psychology
  • Patient Acceptance of Health Care / psychology*
  • Qualitative Research
  • Social Stigma
  • Surveys and Questionnaires
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / prevention & control
  • Uterine Cervical Neoplasms / psychology
  • Vaginal Smears / psychology*
  • Young Adult