Abstract
BACKGROUND: Despite the high incidence of cervical cancer and availability of cervical cancer screening (CCS) services in different healthcare settings in Kenya, uptake remains low. The primary aim of this mixed-methods study was to examine individual client-level and clinic-level factors associated with the uptake of CCS in family planning (FP) clinics in Mombasa County, Kenya. METHODS: This study was a convergent, mixed-methods analysis nested within a randomized controlled trial testing the efficacy of an implementation strategy, the Systems Analysis and Improvement Approach (SAIA), for increasing CCS in FP clinics in Mombasa, Kenya. This analysis included the 10 FP clinics randomized to the SAIA intervention. Individual client-level data were abstracted from FP registers. Clinic-level variables were obtained from a baseline in-depth survey. Face-to-face in-depth interviews with clinic managers and staff in the intervention clinics were conducted. Log-binomial regression using a generalized linear mixed-effects model to adjust for clustering by FP clinic was used to estimate adjusted prevalence ratios (aPRs) for the association between individual client-level characteristics and CCS. A Fisher's exact test was used to examine associations between each clinic-level characteristic and CCS. Qualitative data were analyzed using content analysis to identify recurring themes and high-level concepts. RESULTS: At the individual client-level, use of long-acting reversible contraception was associated with an increased likelihood of CCS. Cervical cancer screening was provided at 7.9% (10/127) of visits by women on long-acting reversible contraceptives compared to 3.8% (29/756) of visits by women on short-acting contraceptives (PR 2.05, 95% CI 0.97 - 3.95; aPR 2.16, 95% CI 1.09 - 4.28). Providers indicated that they were more likely to offer CCS to women receiving intrauterine contraceptive devices (IUCDs). Qualitative interviews identified barriers, including clients' fear and negative perceptions about CCS. At the facility level, adequate staff training and availability of supplies and equipment were crucial facilitators for CCS. CONCLUSION: The findings emphasize the need to address barriers at multiple levels to improve uptake of CCS. Additionally, these results highlight actionable strategies, such as healthcare provider training, that can be adopted to enhance the provision of CCS services to women attending FP clinics.