Loss to follow-up of cervical cancer screening program beneficiaries at Rural Health Training Center in South India – An explanatory mixed method study

Background: In India, routine Pap smear screening is an ongoing process for the detection of cervical cancer, but the follow-up component remains unaddressed. The objectives of the present study were to find out the proportion of abnormal Pap smear results among women aged 30 years screened through the cervical cancer screening program at RHTC, their follow-up status, and explore the reasons and solutions for loss to follow-up (LTFU). Methodology: An explanatory mixed-method study (quantitative: A record-based cohort study followed by qualitative: Five in-depth interviews with loss to follow-up patients and 14 key informant interviews with stakeholders who were purposively selected to identify barriers and possible solutions for LTFU using an interview guide) was conducted in RHTC over 3 months. Ethical principles were adhered to. Results: The results showed that 307 of the 1328 women screened had abnormal Pap smear results. Of the 31 women with precancerous lesions, 26 (83.9%) were on regular follow-ups, and 5 (16.1%) were on irregular follow-ups. Manual content analysis showed five broad categories as barriers to LTFU, namely: (1) general awareness and practical issues; (2) family-related issues; (3) economic issues; (4) cultural issues; and (5) healthcare-associated issues. Community-level awareness generation for capacity building through health education constantly; displaying creative health information models (information, education, and communication); a positive deviance approach; a family and partner-centered approach; the formation of support groups; proactive intervention; and an incentive-based follow-up approach were possible solutions to mitigate the rate of LTFU. Conclusion: Improper knowledge, socio-cultural myths, and a lack of support from partners and family members were the main barriers identified for LTFU. Hence, to strengthen the follow-up component after the initial screening test, periodical sensitization and initiating an incentive-based follow-up approach should be recommended.