Exploring Indonesian midwives' training experiences and knowledge related to cervical screening and HPV DNA testing in East Nusa Tenggara province.

Abstract

BackgroundIndonesia has the highest rates of cervical cancer mortality in Southeast Asia, mainly due to poor access to and low uptake of cervical screening. Indonesian midwives are primarily responsible for conducting cervical screening, yet there is very limited research on their relevant knowledge, training and capacity to provide screening.ObjectiveThis study explored midwives' experiences of cervical screening training and their knowledge related to CC, cervical screening using Visual Inspection with Acetic Acid (VIA), and Human Papillomavirus (HPV) DNA testing in East Nusa Tenggara, Indonesia.DesignA qualitative study design was employed, based on primary data collected through fieldwork using semi-structured interviews and supplemented by a knowledge assessment questionnaire.MethodsTwenty-four midwives across two districts, one semi-urban and one rural, participated. Qualitative data were analysed using a codebook thematic analysis approach, and questionnaire data were descriptively analysed.ResultsMidwives' mean knowledge score was 75%, with midwives trained in cervical screening scoring higher than untrained midwives. Our findings highlighted inequitable access to training, with midwives in the more urban district having more access to training and higher knowledge. Midwives emphasised that adequate training and continuous practice of the VIA were crucial to building confidence in service delivery. Key knowledge gaps included poor understanding of the relationships between HPV infection, pre-cancer lesions, cervical cancer and its prevention. Midwives' poor knowledge of cervical cancer aetiology and asymptomatic pre-cancer lesions resulted in only recruited women who came with associated symptoms.ConclusionsGeographical inequality in human resource investment in remote areas limits women's access to quality cervical screening and impedes progress towards cervical cancer elimination. Supporting midwives through thorough and up-to-date training, including HPV DNA testing, is essential to increase screening access and uptake, and for the transition to HPV DNA testing.