“Even with one Man, but with many women, you can get cervical cancer”: Qualitative exploration of women’s perceptions and experiences of cervical cancer screening in Uganda: A community-based study

Cervical cancer is a leading cause of cancer-related morbidity and mortality among women in low-resource settings, with Uganda being disproportionately affected. Despite the availability of screening services in Uganda, uptake remains unacceptably low, yet population-level data on women's perceptions and experienced barriers to screening remain limited. This hinders the development of targeted community-based interventions for cervical cancer screening in the country. To close this gap, we explored perceptions, attitudes, knowledge, and barriers to cervical cancer screening among women aged 25-65 years in the urban and rural areas of Wakiso District, Uganda. We conducted six focus group discussions - three in rural and three in urban with sixty women, and four key informant interviews with District health officers and healthcare providers in the urban and rural communities. Knowledge levels varied regarding cervical cancer risk factors, causes, signs, symptoms, and prevention. Participants in the focus group discussions linked cervical cancer to risky sexual behaviors, particularly involving multiple sexual partners or sexual intercourse with uncircumcised men, while some key informants said that some women believed that the disease was due to witchcraft. Concerns were also raised about family planning methods such as Intrauterine Devices (IUDs) and pills, which some participants believed to cause cervical cancer. Poor hygiene practices, including the use of unclean public toilets and poor menstrual hygiene, were also seen as risk factors. Myths and misconceptions about cervical cancer screening, such as fears of removal of the cervix during screening, were prevalent. Although some women had positive experiences with screening, concerns about pain, discomfort, and limited privacy during screening were commonly reported. While knowledge of cervical cancer exists among women in Wakiso District, significant misconceptions, fears, and systemic barriers impede screening uptake. Culturally sensitive health education and accessible, respectful screening services are critical to improving participation.