Improving primary health care workers’ knowledge of cervical cancer and visual inspection screening techniques through competency-based training: prospects for expanding coverage in developing countries

Ibiyemi J. Umuago, Irikefe P. Obiebi, Godson U. Eze, Nnamdi S. Moeteke


Background: Health workers in resource-poor settings have not demonstrated a comprehensive knowledge of visual staining procedures for cervical cancer screening. This study adopted competency-based training (CBT) to determine if it will improve their knowledge, and potentially expand screening coverage.

Methods: A quasi-experimental (pretest-posttest) design was adopted in this study conducted among primary health care workers in Ethiope-West Local Government Area of Delta State, Southern Nigeria. The participants had a competency-based training following an initial assessment of their knowledge. Data were analysed using SPSS version 22. The main outcome measures were baseline knowledge of cervical cancer, its prevention, and visual inspection screening techniques, as well as the effect of CBT on knowledge.

Results: Participants demonstrated correct knowledge of cervical anatomy/physiology and cervical cancer epidemiology/symptomatology to varying degrees, although their knowledge of visual inspection with acetic acid or Lugol’s iodine (VIA/VILI) was grossly inadequate as only half had adequate knowledge. Knowledge of prevention, performance of VIA and VILI, as well as overall knowledge, improved significantly to 100% post-intervention (p=0.002, p<0.001 and p=0.003 respectively). Mean knowledge scores drastically increased among the PHWs between pre-CBT and post-CBT. The lowest mean difference was recorded for knowledge of cervical anatomy/physiology: 17.58 (CI: 8.16 - 27.00); while the highest was for knowledge of VILI/VIA technique: 41.01 (CI: 29.40 - 52.62).

Conclusions: CBT significantly improved knowledge of cervical cancer prevention and visual inspection screening methods (VIA and VILI), indicating a window of opportunity for expanding screening services at primary health care level.


Cervical cancer screening, Competency-based training, Health workers, Primary health care, Visual inspection

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