All ETDs from UAB

Advisory Committee Chair

Eric A Chamot

Advisory Committee Members

Diane M Grimley

Mirjam-Colette Kempf

Linda Moneyham

Moses Sinkala

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


Invasive cervical cancer (ICC) is the second most commonly diagnosed malignancy worldwide, and approximately 85% of the disease burden occurs in underdeveloped countries. In 2006, the Zambian government launched a cervical screening program within primary health clinics using visual inspection with acetic acid (VIA) coupled with immediate treatment via cryotherapy. The objective of this dissertation was to determine whether the VIA screening program is responsive to the needs and concerns of Zambian women in an effort to improve screening uptake, and for human immunodeficiency virus (HIV) positive women who are potentially subject to increased ICC screening and treatment, increase long-term retention in ICC preventative care. Understanding women's disease conceptualization, associated causal beliefs, and perceived disease risk provides a basis for care providers to develop or refine patient-centered communications regarding screening benefits and risks. A qualitative study design was employed using focus group discussions (FGD) and in-depth interviews (IDI) with women who accepted to undergo VIA screening and with care providers to elicit women's conceptualization of ICC, including perceived disease risk. Additionally, women discussed their primary motivation for screening, their screening preferences, and the influence of social networks on their decision for cervical screening. Between September, 2009 and July, 2010, a total of 60 women eligible for screening, 10 screening nurses, and 11 lay peer educators participated in 8 FGD and 10 IDI. Common perceived symptoms of ICC included prolonged bleeding, stomach pain, and weakness. Illness causation incorporated both traditional and biomedical elements, and departed from other lay causation models worldwide. Few women appeared to understand the concept of precancerous cervical lesions. Women were motivated to undergo cervical screening for numerous reasons, often prompted by peers and immediate family members. Women clearly articulated their screening preferences. The decision to undergo cervical screening was largely influenced by spouses, friends, and women who had already undergone screening. Interventions to formally integrate family members, particularly spouses, in the screening process and encourage peers to serve as screening `role models' are warranted.

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