Challenges in preventative care and research in primary healthcare facilities: information obtained during implementation of a cervical cancer screening project in the Tshwane Health District

Abstract Objectives: The aim was to identify challenges to conducting research and obstacles to successful cervical cancer screening in public sector primary healthcare clinics (PHCs). Design: Qualitative research was conducted, using semi-structured interviews. Setting and subjects: Study staff and healthcare workers involved in the implementation of a large screening study conducted in existing primary healthcare facilities were interviewed during the study period. Outcome measures: The outcome measure was qualitative data on problems and obstacles to research and cervical cancer screening in public health facilities. Results: Twenty-one participants were interviewed at intervals over three years. It was found that clinical research could only be conducted in PHC facilities if no additional burden was placed on the staff or facilities. Preventative care was not found to be part of the focus of the clinics, which rather concentrated on disease. The need for gynaecological examinations was identified as an important obstacle to screening at PHC clinics. Self-sampling was widely accepted, as was cervical sampling for human papillomavirus. Reporting of screening results to patients presented a huge challenge to PHC facilities. Ineffective communication of the results was identified as another major obstacle to effective screening. Conclusion: Future cervical cancer screening methods should include sampling, without the need for an intimate examination. Finding new ways of calling women in for structured screening at regular intervals and reporting the results to them requires urgent attention.