Health Systems Determinants of Uptake of Cervical Cancer Preventive Services Among Female University Students at Kenyatta University, Kenya

Abstract

Globally, cervical cancer accounted for more than 600,000 new cases and 340,000 deaths in 2020 (Sung et al., 2021). In Kenya, screening uptake remains low (Kenya National Bureau of Statistics, 2014), and recent analyses indicate a rising cancer burden, including increasing cervical cancer incidence (Jani et al., 2021). Kenya continues to bear one of the highest age-standardised incidence rates of cervical cancer in East Africa (Bruni et al., 2022). Despite the availability of free cervical cancer preventive services (CCPS) at Kenyatta University’s health facilities, uptake among young women remains low. Persistent knowledge gaps continue to be a major barrier to CCPS uptake among young populations in Kenya and Uganda (Masika et al., 2015; Mukama et al., 2017). This study examined the health system determinants influencing the utilisation of CCPS among female university students. Materials and Methods:  This study draws on endline data from a cluster randomised controlled trial (cRCT) conducted at Kenyatta University, Kenya. The parent trial evaluated a structured educational intervention promoting CCPS uptake from 210 female university students, following a 12-week structured health education intervention. Data from both study arms were pooled to assess health system determinants, including service visibility, provider encouragement and perceived service quality of CCPS utilisation. Bivariate associations were assessed using chi-square tests to evaluate the determinants of CCPS utilisation, and multivariable logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals. Data was collected using a validated self-administered questionnaire assessing socio-demographic attributes, awareness of CCPS availability, perceived service quality and experiences of provider engagement. The primary outcome was self-reported CCPS uptake, while secondary outcomes included awareness of service availability, perceived service quality and provider encouragement. Results: Overall, 25.7% (54/210) of participants reported utilising CCPS. Awareness of service availability was the strongest determinant of uptake (aOR = 3.52, 95% CI: 1.78–6.94, p < 0.001). Provider encouragement (aOR = 1.81, p = 0.092) and perceived service quality (aOR = 1.44, p = 0.068) were positively but not significantly associated. Conclusion: Awareness of service availability was the most significant determinant of CCPS uptake, underscoring the critical role of health system communication.