Abstract
The use of handheld colposcopy in nurse-led cervical cancer screening programs could enhance screening quality and diagnostic accuracy, especially in high-burden regions like sub-Saharan Africa. This study assessed the feasibility of using the Pocket colposcope (Calla Health Foundation, Durham, NC) among healthcare providers in western Kenya. Feasibility was defined in terms of acceptability and image quality. A mixed-methods approach was employed, involving healthcare providers from three clinics offering cervical cancer screening. These providers used the Pocket colposcope more than once within 2 months of the survey. Semi-structured interviews were conducted to explore provider experiences and the device's acceptability, which was measured using Likert scale questions based on Sekhon's Theoretical Framework of Acceptability (TFA). This framework evaluates affective attitude, burden, ethicality, perceived effectiveness, intervention coherence, self-efficacy and opportunity cost. Additionally, expert gynecologists assessed the quality of cervical images from visual inspection with acetic acid and/or human papillomavirus-positive patients (n = 123), rating them on a scale of 1 to 3. Interobserver agreement was assessed using Cohen's kappa. Quantitative and qualitative data were analysed using STATA 18.0 and Dedoose 9.0.17, respectively. Among the eight providers interviewed, including five nurses, the average experience in cervical cancer screening was 4.2 years. The Pocket colposcope received a mean acceptability score of 4.18 (SD = 0.27) out of five based on the seven TFA constructs. Qualitative findings highlighted positive aspects, such as better cervix visualisation, improved post-treatment monitoring, easier external consultations and enhanced patient education. However, challenges incl‑uded camera and software issues and limited personnel for documentation. Image quality was rated 2.23 out of 3, with fair interobserver agreement (Cohen's kappa 0.36, p < 0.001). The study concluded that the Pocket colposcope is acceptable in nurse-led cervical cancer screening programs but emphasised the need for improvements in image quality and technology reliability. Expanding training could further enhance its utilisation.