Term of Award

Spring 2020

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Samuel Opoku

Committee Member 1

Bettye Apenteng

Committee Member 2

Linda Kimsey


Introduction: The purpose of this study was to assess the perceived barriers and strategies for improvement of timely detection, treatment, and management of cervical cancer among Ghanaian women in a tertiary hospital setting. Methods: Sixty semi-structured interviews, comprised of thirty-five cervical cancer patients and twenty-five healthcare professionals who provide cervical cancer care, were conducted. Two focus groups were conducted, including four healthcare professionals and another with two healthcare professionals—the data were analyzed using NVivo 12. A theoretical thematic analysis was utilized to identify common themes and sub-themes that arose from the participant interviews. The social-ecological model framework was employed to classify themes. Results: Lack of knowledge about the disease, screening, perceived lack of susceptibility and seriousness, cost of diagnostic test, treatment, travel, and accommodations coupled with a low socio-economic status are barriers at the individual level. Lack of financial and social support from family and normative gender relations were the barriers at the interpersonal level. The sociocultural beliefs in the communities associated with the causes of the disease, stigmatization, and alternative healing were barriers at the community level. There are several barriers at the organizational level that effect timely detection, treatment, and management. These barriers are associated with the availability and access to adequate health systems and trained health professional such as lack of diagnostic facilities, high levels of misdiagnosis, delay in release of results, inefficient referral process, poor patient-provider communication, difficult patient navigation, lack of treatment equipment, maintenance and resources, lack of psychosocial support, and lack of palliative care services. Lack of government-sponsored education programs, funding allocated for health facilities and trained healthcare professionals in the rural settings and tertiary health facilities, drug stockpile, inadequate insurance coverage, and timely reimbursement of insurance claims for hospitals pose significant barriers at the policy level. Strategies proposed for improvement were centered around education, community outreach and sensitization, health system improvements, and increased community organization and government support. Discussion: Cervical cancer early detection, treatment, and management outcomes face several barriers at the various level of the SEM. To improve detection time, treatment, and management issues, these barriers at all levels must be addressed simultaneously.

OCLC Number


Research Data and Supplementary Material