Identifying determinants of cervical cancer prevention services for at-risk women in rural and tribal communities of India: A photovoice study with community workers

Cervical cancer is the second most common cancer diagnosed among women in India but current estimates indicate that very few are screened. The goal of this study was to identify determinants to seeking, receiving, and delivering preventive health care with a focus on cervical cancer screening, among women residing in rural and tribal areas.

To gather in-depth perspectives, we used photovoice with Anganwadi community workers with a total of 14 women between 30-51 years, residing in rural and tribal villages around Mysore, participating in the project. A consistent theme that came up during data collection, was the lack of knowledge about cervical cancer and how it affects women. Participants reported misconceptions about screening exams and several also reported a strong sense of despair as it related to cervical cancer. Religion and health were often inter-twined in these narratives.

We believe that findings from this study could encourage the participation of women in cervical cancer screening activities, correct misconceptions that may exist and contribute to designing appropriate educational materials that promote a culture of prevention and cancer screening behaviors, currently non-existent in this population.

Submitted by:

Prajakta Adsul

What lies underneath?

Kalavathi said, “This river may look beautiful, but what you don’t know is that these algae grow because of garbage. Likewise, women believe that nothing is wrong with them, but only a doctor can see inside and tell if anything is wrong,” thus highlighting the importance of screening tests.

Photographer: Kalavathi

It’s itchy and painful

When Renuka clicked this picture, she was thinking about the pelvic exam which created a fear in her mind. She wondered if the exam would cause itching like the worm seen on this flower? Will it cause pain?” Perhaps talking to previously screened women may help, she said.

Photographer: Renuka

Temple vs. clinic

“When women fall sick in my community, they prefer visiting their temple and ask God to cure them than visit the clinic to see the doctors. They can’t afford to get expensive medicine or travel for treatment instead, having their priests perform rituals and provide blessings is economical.”

Photographer: Prabhavati

Listening to health worker

Community workers can have a lot of influence on the knowledge and beliefs of women in the community. Jayamma, clicked this picture of a worker in her community saying, “We could train them to provide cancer prevention education, preferably easy-to-understand pamphlets with pictures which could be shared with family members.”

Photographer: Jayamma

Does anyone survive cancer?

Prabhavati took a picture of a cemetery, and said, “many women in my community strongly believe that cancer is a fatal disease and no screening test can prevent this. If we see and hear more people living healthy after a cancer diagnosis and appropriate treatment, then these beliefs might change.

Photographer: Prabhavati