Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Haeok Lee

Second Advisor

Carol Ellenbecker

Third Advisor

Lingling Zhang


Malawi, a sub-Saharan Africa, reports high cervical cancer incidence (67.9/100,000 women/year) and mortality (51.5/100,000 women/year), which is five folds higher incidence (13.3) and seven folds higher mortality (7.25) than the world average. The HPV screening test has the potential to increase cervical cancer screening coverage in Malawi through self-sampling. Therefore, this study aimed to (a) describe cervical cancer prevention behavior with a specific focus on willingness and uptake of the self-sampled HPV screening test, (b) identify multi-level factors that are associated with the willingness for the self-sampled HPV screening test, and (c) determine the relationship between the factors and willingness after controlling for other determinants. This study used a community-based participatory approach and was conducted in two stages. In Stage 1, an instrument for HIV-infected Malawian women’s cervical cancer screening behavior study was revised to target general Malawian women, focusing on their self-sampled HPV screening behavior and related factors. The revised instrument was translated using the forward translation method and was reviewed through ten cognitive interviews. In Stage 2, the revised instrument was implemented at an urban and a rural hospital in Lilongwe to 130 Malawian women. Inclusion criteria were Malawian women aged between 20 and 49 years who can understand Chichewa (a local Malawian language) or English and had not received a hysterectomy. Data were collected through the computer-assisted personal interview (CAPI) using tablet computers. Seventy-eight percent of women were willing to perform the self-sampled HPV screening test. Forty-three percent of participants had heard about HPV. Among those who were aware of HPV, 56% had heard about the self-sampled HPV screening test. Literacy, knowledge, and geographical accessibility were significantly associated with the willingness. For participants from an urban hospital, knowledge was a significant factor, whereas literacy was significant for participants from a rural hospital. Culturally appropriate education that considers low literacy among Malawian women should be developed to increase their awareness about cervical cancer and screening including the self-sampled HPV screening test. Future studies should evaluate the capability of community health workers for the at-home self-sampled HPV screening to overcome geographic accessibility.


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