Asking physicians how best to implement cervical cancer prevention services in India: A qualitative study from Mysore

Prajakta Adsul; Sasha Herbst de Cortina; Rashmi Pramathesh; Poornima Jayakrishna; Vijaya Srinivas; Suzanne Tanya Nethan; Kavitha Dhanasekaran; Roopa Hariprasad; Purnima Madhivanan

doi:10.1371/journal.pgph.0000570

Asking physicians how best to implement cervical cancer prevention services in India: A qualitative study from Mysore

PLOS Glob Public Health. 2022 Jun 2;2(6):e0000570. doi: 10.1371/journal.pgph.0000570. eCollection 2022.

Authors

Prajakta Adsul^{1

2}, Sasha Herbst de Cortina^{1

3

4}, Rashmi Pramathesh¹, Poornima Jayakrishna¹, Vijaya Srinivas¹, Suzanne Tanya Nethan⁵, Kavitha Dhanasekaran⁵, Roopa Hariprasad⁵, Purnima Madhivanan^{1

6

7

8}

Affiliations

¹ Public Health Research Institute of India, Mysore, India.
² Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America.
³ School of Public Health, University of California Berkeley, Berkeley, California, United States of America.
⁴ School of Medicine, University of California Irvine, Irvine, California, United States of America.
⁵ Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, India.
⁶ Health Promotion Sciences Department, Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.
⁷ Division of Infectious Diseases, Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States of America.
⁸ Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States of America.

Abstract

Cervical cancer is the second most common cancer among Indian women. Screening is an effective prevention strategy, but achieving high screening rates depend upon identifying barriers at multiple levels of healthcare delivery. There is limited research on understanding the perspectives of providers who deliver cancer prevention services. The objective of this study was to explore physician perspectives on cervical cancer prevention, barriers to effective implementation, and strategies to overcome these barriers in India. Guided by the "Multilevel influences on the Cancer Care Continuum" theoretical framework, we conducted semi-structured interviews with physicians in Mysore, India. From November 2015- January 2016, we interviewed 15 (50.0%) primary care physicians, seven (23.3%) obstetrician/gynecologists, six (20.0%) oncologists, and two (6.7%) pathologists. We analyzed interview transcripts in Dedoose using a grounded theory approach. Approximately two-thirds (n = 19, 63.3%) of the participants worked in the public sector. Only seven (23.3%) physicians provided cervical cancer screening, none of them primary care physicians. Physicians discussed the need for community-level, culturally-tailored education to improve health literacy and reduce stigma surrounding cancer and gynecologic health. They described limited organizational capacity in the public sector to provide cancer prevention services, and emphasized the need for further training before they could perform cervical cancer screening. Physicians recommend an integrated strategy for cervical cancer prevention at multiple levels of uptake and delivery with specific efforts focused on culturally-tailored stigma-reducing education, community-level approaches utilizing India's community health workers, and providing physician training and continuing education in cancer prevention.

Copyright: © 2022 Adsul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health [under training grant # TW009338 to PA]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.