Determinants of cervical screening in Ghana: a systematic review
Clinical Snapshot
PICO Framework
| P — Population | Women in Ghana of screening-eligible age |
| I — Intervention | Cervical cancer screening (any modality: VIA, Pap smear, HPV testing) |
| C — Comparator | No screening / non-participation in cervical screening |
| O — Outcomes | Barriers and facilitators (determinants) of cervical screening uptake, including individual, interpersonal, health system, socio-cultural and structural factors |
Bottom Line
This systematic review synthesises evidence from 32 studies on why Ghanaian women do or do not participate in cervical cancer screening — a critical public health question given Ghana's high cervical cancer burden and persistently low screening coverage. The review identifies a coherent set of barriers spanning poor knowledge, fear, financial hardship, geographic inaccessibility, and restrictive social norms, alongside facilitators including provider recommendation, community support, and cost-free access. The methodology is sound — prospectively registered, PRISMA-compliant, and inclusive of grey literature — but the absence of meta-analysis, GRADE certainty ratings, and formal synthesis methodology limits the precision and certainty of conclusions. Risk of bias was assessed across all included studies, with most rated low risk. For clinicians and policymakers, the key message is that no single intervention will suffice: effective cervical screening programmes in Ghana must simultaneously address knowledge deficits, structural access barriers, and socio-cultural norms. For Australian practitioners, these findings inform culturally sensitive care for women from West African backgrounds who may present with unscreened cervical pathology.
Key Findings
P Value: Not reported
Effect Size: Not applicable — narrative synthesis; no pooled effect sizes calculated
Primary Outcome: Determinants of cervical screening uptake among Ghanaian women, categorised as barriers and facilitators across five ecological levels
Nnt Or Sensitivity: Not applicable for this review type. Key barriers identified: poor knowledge and awareness, fear of diagnosis and procedure, limited geographic and financial access, social and cultural norms discouraging screening. Key facilitators: health knowledge and awareness, healthcare provider recommendation, social support networks, positive health perceptions, improved healthcare access and cost-related enablers (e.g., free or subsidised screening)
Confidence Interval: Not reported — no meta-analysis performed
Clinical Application
The identified determinants are largely modifiable and amenable to multi-level intervention. Community health worker programmes, provider-initiated screening recommendations, mobile screening units, and subsidised or free screening services are all feasible strategies aligned with the review's findings. Implementation will require coordinated effort across Ghana Health Service, community organisations, and international partners. Direct clinical applicability to Australia is limited, as Australia operates a well-established National Cervical Screening Programme with high coverage, TGA-approved HPV self-collection options, and Medicare-funded screening. However, the findings are highly relevant to Australian clinicians working with Ghanaian-born or West African immigrant women, who may carry culturally embedded barriers (fear, stigma, limited prior screening experience) identified in this review. RACGP guidelines recommend culturally sensitive screening approaches for women from culturally and linguistically diverse (CALD) backgrounds. Australian public health practitioners and global health researchers may also draw on these findings to inform international development programmes or partnerships with Ghana Health Service. Women of screening-eligible age in Ghana, particularly those in rural or low-resource settings with limited access to formal healthcare. Findings may have broader relevance to women in comparable sub-Saharan African settings with similar socio-cultural and health system profiles.
Abstract
BACKGROUND: Cervical cancer remains a leading cause of morbidity and mortality among women in Ghana, yet screening coverage is extremely low and organised national programmes are limited. Although several studies have examined determinants of screening, no comprehensive synthesis has summarised the evidence to guide effective policy and intervention design. OBJECTIVE: To synthesise existing evidence on determinants of cervical screening in Ghana and identify opportunities to strengthen national screening strategies. DESIGN: This is a systematic review conducted following Aromataris and Pearson's methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches across PubMed Central, CINAHL, Web of Science, Scopus and grey literature (January 2000-July 2025) identified studies reporting barriers and facilitators of cervical screening in Ghana. Risk of bias was assessed using standard appraisal tools. SETTING: This study was conducted in the context of Ghana. RESULTS: Of 7833 records screened, 32 studies met inclusion criteria. Barriers to cervical screening spanned individual, interpersonal, health system, socio-cultural and structural factors, including poor knowledge, fear, limited access, financial constraints and social norms. Facilitators included knowledge and awareness, provider recommendation, social support, positive health perceptions, healthcare access and cost-related enablers. Overall, 23 studies were rated low risk of bias, while nine were rated moderate risk of bias. CONCLUSION: Cervical screening behaviour in Ghana is influenced by structural, cultural, psychological and informational factors. The reviewed evidence suggests that these determinants do not operate in isolation but interact in ways that may vary across contexts and populations. OSF REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/M4XKT.
References
- 1.Lanyo, G. S., Nabe, B., Tutu, A. O., Asore, M. A., Gyamfi-Samakome, A., Atitsogbey, G., Nyator, P., Howe, V. B., Amoadu, M., & Ebu Enyan, N. I. (2026). Determinants of cervical screening in Ghana: a systematic review. BMJ Open. https://doi.org/10.1136/bmjopen-2025-111770
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