A mixed-methods assessment of individual and clinic-level factors associated with uptake of cervical cancer screening (CCS) services in family planning (FP) clinics in Mombasa County, Kenya

Despite the high incidence of cervical cancer and the availability of CCS services in different healthcare settings in Kenya, uptake remains low. This mixed methods study, nested within a randomized controlled trial testing the efficacy of an implementation strategy, the Systems Analysis and Improvement Approach (SAIA), for increasing CCS, assessed individual and facility-level barriers and facilitators to CCS in 10 FP clinics randomized to the SAIA intervention in Mombasa, Kenya. At the individual level, use of long-acting reversible contraception was associated with an increased likelihood of CCS. Compared to 3.8% (29/756) of women on short-acting contraceptives who received CCS, 7.9% (10/127) of women on long-acting reversible contraceptives received CCS (PR 2.05, 95% CI 0.97 – 3.95; aPR 2.16, 95% CI 1.09 – 4.28) and providers indicated that they were more likely to offer CCS to women receiving IUCDs. Qualitative interviews identified several individual-level barriers such as fear of the screening procedure and results, sociocultural norms, and negative perceptions about CCS, which helped to explain overall low screening rates. At the clinic level, adequate staff training and availability of supplies and equipment were crucial facility-level facilitators for CCS.