Barriers and Facilitators to Cervical Cancer Screening in Northern Uganda: Qualitative Insights from Healthcare Workers and Administrators
by
and
Noemi Maria Felisi
1,2,*, 
David Oyet
3,
Kayeny Miriam Melody Yung
4,
Emmanuel Ochola
4,5,
Riccardo Vecchio
6
and
Anna Odone
7,8 1
Department of Medicine and Surgery, Università Vita-Salute San Raffaele, 20121 Milan, Italy
2
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
3
Department of Paediatric Oncology, St. Mary’s Hospital, Lacor, Gulu P.O. Box 180, Uganda
4
Department of HIV, Research and Documentation, St. Mary’s Hospital, Lacor, Gulu P.O. Box 180, Uganda
5
Department of Public Health, Faculty of Medicine, Gulu P.O. Box 166, Uganda
6
PhD National Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
7
Department of Public Health, Experimental and Forensic Medicine, School of Public Health, University of Pavia, 27100 Pavia, Italy
8
Medical Direction, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2025, 32(11), 591; https://doi.org/10.3390/curroncol32110591
Submission received: 31 August 2025
/
Revised: 7 October 2025
/
Accepted: 10 October 2025
/
Published: 23 October 2025
(This article belongs to the Section Gynecologic Oncology)
Simple Summary
Cervical cancer is the leading cause of cancer-related deaths among women in Uganda, yet screening uptake remains low. To understand how to improve access, we interviewed healthcare workers and administrators at St. Mary’s Hospital Lacor and its peripheral health centres. Participants described multi-level barriers, including limited awareness, stigma, transport costs, staff shortages, and stock-out of supplies. They also identified facilitators, such as targeted health education, routine referrals from all care entry points, outreach screening, and free services. Most participants supported self-collected HPV testing, which they felt was more acceptable to women than pelvic examination and feasible for outreach, provided supplies and laboratory capacity were sustained. These findings suggest practical strategies that facilities and policymakers can adopt to increase screening coverage. By improving awareness, referral practices, and supply reliability, and by expanding access to self-collected HPV testing, Uganda could substantially reduce the burden of cervical cancer.
Abstract
Background: Cervical cancer (CC) is the most common cancer among Ugandan women and the leading cause of cancer mortality. Screening has proven to be a cost-effective method in reducing its burden, yet uptake among women of reproductive age remains alarmingly low, with national adherence rates under 10%. Objective: This study explored healthcare workers’ (HWs) perspectives on barriers and facilitators to screening and attitudes toward implementing human papillomavirus (HPV) DNA testing with self-collection. Methods: A qualitative research design was employed. Twenty semi-structured interviews were conducted with purposively sampled healthcare providers and administrators across different cadres at a referral hospital and three peripheral health centres in Northern Uganda. Interviews were analysed thematically using the Social Ecological Model. Data collection and analysis proceeded iteratively until thematic saturation. Reporting follows the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Participants described individual and interpersonal barriers such as limited awareness, poor preventive health-seeking, fear of results, stigma, and limited male involvement. Organisational barriers included staff shortages, weak referral practices, and stock-outs of supplies, while policy constraints included limited governmental support and competing priorities. Facilitators included targeted health education, routine referrals from all service entry points, outreach screening, and donor support. Most respondents favoured scaling up of self-collected HPV testing, citing higher acceptability and feasibility for outreach, contingent on sustained supplies, laboratory capacity, and training. Conclusions: Multi-level interventions are needed to strengthen facility workflows, staff capability, community engagement, and reliable supply chains. Expanding access to self-collected HPV testing may overcome major barriers and represents a promising strategy to increase screening uptake in Uganda and similar low resource settings.
