A comparative socio-ecological analysis of psychosocial barriers to breast and cervical cancer screening across three Nigerian states: Significance of location.

Abstract

e13624 Background: Community-based screening programs and the availability of community cancer care facilities are vital to improving cancer outcomes in Nigeria. However, the uptake of these services remains low despite the rising disease burden. While some studies in Low and Middle Income Countries (LMICs) have cited fear as a strong barrier, the underlying dimensions of this fear are rarely examined comparatively across diverse settings. The main objective is to explore how fear is experienced, perceived, and articulated within communities, and how it shapes participation in screening programs and by association, community care facilities. Methods: A qualitative, multi-site study was conducted across three purposively selected Nigerian states. The Federal Capital Territory (FCT), Nasarawa, and Rivers, between September and November 2024. The study was implemented in collaboration with the community leaders and local health authorities. Data was collected through 12 semi-structured focus group discussions and 60 in-depth interviews with community women and key stakeholders (community leaders, community influencers, and traditional healers). Transcripts were analyzed using Dedoose software and findings interpreted using the Socio-Ecological Model (SEM) to explore context specific, fear related themes shaping behavior. Results: The analysis identified multiple, interrelated domains of fear. In the FCT, the predominant SEM domains were interpersonal and organizational. The domains centered around social and institutional stigma, fear of discrimination by providers, concerns regarding privacy, distrust with sterility of screening process and procedural discomfort. On the other hand, in Nasarawa State, the societal/structural domain was at the fore. Economic vulnerability was the primary driver, with hospital-based care perceived as more expensive than traditional and herbal alternatives. In Rivers State, the community domain was most prevalent, characterized by experiential and observational fears stemming from community members witnessing the morbid effects of the disease on fellow community members. Conclusions: Fear is a multidimensional barrier to breast and cervical cancer screening. Whether rooted in social neglect, economic hardship, or situational trauma, these fears influence how communities engage with screening services. Interventions must move beyond "one-size-fits-all" approaches, prioritizing context adapted strategies, and culturally responsive communication to improve screening uptake and care-seeking behavior in Nigeria.