Cervical cancer screening utilisation among female health workers at Mulago National Referral Hospital.

Abstract

Background: Cervical cancer is a leading cause of cancer-related mortality among women and is largely preventable through screening. However, uptake remains low in Uganda, including among female health workers who are expected to model preventive health behaviors. Objectives: To assess utilization of cervical cancer screening services and associated factors among female health workers at Mulago National Referral Hospital. Methods: A cross-sectional quantitative study design and case study qualitative designs were conducted at Mulago National Referral Hospital. Quantitative data were collected from 264 female health workers and analyzed using descriptive statistics, chi-square tests, and modified Poisson regression. Qualitative data were collected through 7 key informant interviews and 16 in-depth interviews and analyzed thematically. Results: The study included 264 female health workers with a mean age of 38.6 years (SD ± 9.4). Most participants had diploma or bachelor’s level education and the majority had at least one child. Overall, 96 participants (36.4%; 95% CI: 30.6–42.5%) had ever undergone cervical cancer screening. Screening utilization was significantly higher among women aged 50 years and above (aPR = 1.71; 95% CI: 1.08–2.72), those with easy access to screening services (aPR = 1.90; 95% CI: 1.15–3.12), and those who received provider recommendations (aPR = 1.46; 95% CI: 1.08–1.98). Participants with lower educational attainment and those who were nulliparous or primiparous were less likely to have been screened. Qualitative findings addressed the study objectives by explaining barriers and facilitators to screening utilization: knowledge gaps, fear, heavy workload, inadequate privacy, and discomfort with peer examiners limited uptake, while peer encouragement, institutional support, provider recommendation, and motivation to lead by example facilitated screening. Conclusion: Cervical cancer screening utilization among female health workers at Mulago National Referral Hospital was suboptimal and influenced by sociodemographic, reproductive, and institutional factors. Qualitative findings provided contextual explanations for observed quantitative associations. Addressing both individual and workplace-level barriers is critical to improving screening uptake among health workers.