Effectiveness of community health worker-led educational intervention on the uptake of cervical cancer screening in rural Kisumu, Kenya

Abstract

In Kenya, cervical cancer is among the most frequently diagnosed cancer in women and remains a significant contributor to illness and death, despite being preventable through screening. The national and regional cervical cancer screening rate remains low at 17%, with data paucity in rural Kisumu. In 2020, the World Health Organization (WHO) introduced a global initiative aimed at eliminating cervical cancer through a 90-70-90 target: vaccinating 90% of girls, screening 70% of women, and ensuring that 90% of those with precancerous cervical lesions receive appropriate treatment. To achieve these targets, effective, community-based strategies must be developed. Community healthcare workers (CHWs) play a pivotal role in health education and fostering a culture of health prevention. There is, however, very limited local evidence on the effect of CHW-led education on uptake of screening for cervical cancer, especially in rural populations. The main objective of this study was to evaluate the effect of CHW-led education on knowledge, perceived vulnerability, and uptake of cervical cancer screening among women seeking care at Gita and Miranga Sub-county hospitals. A quasi-experimental pre-posttest design with a control group was employed, with Gita Sub-County Hospital serving as the intervention site and Miranga Sub-County Hospital as the control. A total of 274 participants were enrolled at each site. A pretest questionnaire was administered in May and June 2024, followed by a three-month sensitization and education intervention led by trained CHWs in Gita Sub-County. A post-test questionnaire was then administered at both sites. The statistics and data software package (STATA) was used for analysis. Both descriptive and analytical statistical procedures were employed. Socio-demographic characteristics were analyzed descriptively with frequencies and percentages. Paired t-tests, Wilcoxon rank-sum, and McNemar’s tests assessed changes in knowledge, perception, and screening uptake. Generalized Estimating Equations adjusted for confounders. Baseline socio-demographics were similar between the two sites, except for health insurance coverage, which was significantly higher in Gita (25%) than in Miranga (14.4%) (p = 0.02). Knowledge, perceived self-vulnerability, and screening uptake were similar at baseline. The mean knowledge scores were 6.7 (41.8%) in Gita and 5.3 (33.1%) in Miranga. The median self-vulnerability score was 13 (IQR: 9–17), and screening uptake was 31% and 30% in Gita and Miranga, respectively (p = 0.83). Post-intervention, the mean knowledge score in Gita significantly improved from 6.7 to 8.3 (p < 0.001), perceived self-vulnerability increased to a median score of 15 (p < 0.001), and screening uptake rose to 57.7% (p < 0.001). In conclusion, CHW-led educational intervention leads to statistically significant improvements in knowledge, perceived self-vulnerability, and cervical cancer screening rates in rural Kisumu. CHW-led educational programs should be scaled up and integrated into routine community health programs to enhance knowledge and uptake of cervical cancer screening in rural settings such as Kisumu. Policy makers should invest in training, supporting and deploying CHWs as key agents in cervical cancer prevention strategies to contribute to achieving WHO cervical cancer elimination targets.