Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach

• Published in: PloS one Vol. 17; no. 7; p. e0271874
• Main Authors: Barrera Ferro, David, Bayer, Steffen, Bocanegra, Laura, Brailsford, Sally, Díaz, Adriana, Gutiérrez-Gutiérrez, Elena Valentina, Smith, Honora
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 22-07-2022; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Cancer; Cancer screening; Care and treatment; Cellular biology; Cervical cancer; Cervix; Content analysis; Cytology; Data collection; Developing countries; Diagnosis; Ethics; Health aspects; Health education; LDCs; Low income groups; Medical diagnosis; Medical research; Medical screening; Medicine and Health Sciences; Medicine, Preventive; Methods; Mixed methods research; Mortality; Navigation behavior; Pap smear; Patients; Poor women; Population; Poverty; Preventive health services; Qualitative analysis; Qualitative research; Quantitative analysis; Risk factors; Social aspects; Womens health; Colombia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0271874

The global burden of cervical cancer remains a concern and higher early mortality rates are associated with poverty and limited health education. However, screening programs continue to face implementation challenges, especially in developing country contexts. In this study, we use a mixed-methods approach to understand the reasons for no-show behaviour for cervical cancer screening appointments among hard-to-reach low-income women in Bogotá, Colombia. In the quantitative phase, individual attendance probabilities are predicted using administrative records from an outreach program (N = 23384) using both LASSO regression and Random Forest methods. In the qualitative phase, semi-structured interviews are analysed to understand patient perspectives (N = 60). Both inductive and deductive coding are used to identify first-order categories and content analysis is facilitated using the Framework method. Quantitative analysis shows that younger patients and those living in zones of poverty are more likely to miss their appointments. Likewise, appointments scheduled on Saturdays, during the school vacation periods or with lead times longer than 10 days have higher no-show risk. Qualitative data shows that patients find it hard to navigate the service delivery process, face barriers accessing the health system and hold negative beliefs about cervical cytology.