Barriers and facilitators for adherence to follow-up by HR-HPV-positive women with premalignant cervical lesions - a mixed-design study in Mexico

Sep 21, 2026

Uploaded by Riley

Mexico reports low follow-up completion among women with abnormal cervical cancer screening results. This mixed-design study identifies barriers and facilitators to follow-up adherence among women with human papillomavirus (HPV) infection and premalignant cervical lesions, conducted in Mexico between February and April 2019. Quantitative evidence draws on information-system data and questionnaires, complemented by semi-structured interviews, content analysis, and process risk evaluation to support strategies for the Early Detection Program.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Cervical cancer burden in Mexico

Early detection program and limitations

Methods

Results

Conclusions

Aguilar‑Linares et al. BMC Women’s Health (2024) 24:550 [https://doi.org/10.1](https://doi.org/10.1) 186/s12905‑024‑03379‑3 BMC Women’s Health RESEARCH Open Access Barriers and facilitators for adherence to follow‑up by HR‑HPV‑positive women with premalignant cervical lesions: a mixed‑design study in Mexico Gengly Aguilar-Linares1, Margarita Márquez-Serrano2, Sergio Meneses-Navarro2,3, Blanca Estela Pelcastre-Villafuerte2, Lorena E. Castillo-Castillo4, Jesús A. Estévez-García5, Tania O. Valadez-George6, Margarita Bahena-Román7, Vicente Madrid-Marina7 and Kirvis Torres-Poveda3,7* Abstract Background Mexico reports low follow-up completion rates among women with abnormal cervical cancer screenings. This study aimed to identify barriers and facilitators to follow-up adherence among women with human papillomavirus (HPV) infection and premalignant cervical lesions in Mexico. Methods A mixed-methods study was conducted from February to April 2019. Participants included women undergoing follow-up care for high-risk human papillomavirus (HR-HPV) and premalignant lesions, along with health personnel from the Women’s Healthcare Center (CAPASAM) in Mexico. Quantitative data were obtained from the Women’s Cancer Information System and through a questionnaire about factors affecting follow-up adherence. Additionally, the health personnel involved completed a compliance checklist regarding care regulations. Descriptive statistics were used for analysis. Qualitative data were collected via semi-structured interviews with both groups, followed by a content analysis based on identified categories. The Hazard Analysis and Critical Control Point System confirmed care process risks. Proposals to enhance the Early Detection Program for Prevention and Control of Cervical Cancer were collected from a CAPASAM health personnel nominal group. Results Identified barriers to follow-up included low income among CAPASAM users, family provider roles limiting time for appointments, long waits for testing and results delivery, distant facilities, insufficient service hour communication, inadequate health personnel training, and a lack of systematic counseling. Hesitation toward follow-up was also linked to shame, apprehension, uncertainty, test aversion, fear of positive results, and limited cervical cancer and screening knowledge. Patriarchal attitudes of partners and limited access to the now-discontinued PROSPERA government program further discouraged follow-up. Facilitators comprised respectful treatment by CAPASAM staff, no-cost services, health campaigns, and positive user attitudes. Conclusions The study found more barriers than facilitators to follow-up adherence, highlighting the need for strategies to bolster the Early Detection Program. Future strategies must address the comprehensive array offactors and incorporate stakeholder perspectives. Keywords Barriers, Facilitators, Adherence, HPV, Uterine cervical neoplasia, Secondary prevention, Mexico, Women *Correspondence: Kirvis Torres-Poveda [kjtorres@insp. mx](kjtorres@insp. mx) Full list of author information is available at the end of the article © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by st

FAQs

What was the study’s primary aim in Mexico?

To identify barriers and facilitators affecting follow-up adherence among women with HR-HPV infection and premalignant cervical lesions.

Which barriers to follow-up adherence were identified?

Barriers included low income, limited appointment time due to family provider roles, long waits for testing and results, distant facilities, insufficient communication about service hours, inadequate staff training, lack of systematic counseling, shame or fear, and limited knowledge of cervical cancer and screening.

What strategies or factors supported follow-up adherence?

Facilitators included respectful treatment by CAPASAM staff, no-cost services, health campaigns, and positive user attitudes.

Sep 21, 2026

Uploaded by Riley