Effects of a peer advocacy intervention on cervical cancer screening among social network members - results of a randomized controlled trial in Uganda

Sep 24, 2026

Cervical cancer is the leading cancer among women in Uganda, yet lifetime screening remains very low. A randomized controlled trial tested whether training women who had been screened to deliver peer advocacy could increase cervical cancer screening within social networks. Forty recently screened women (index participants) were assigned to a peer-facilitated 7-session group intervention or wait-list control and recruited up to three unscreened female alters each. All were assessed at baseline and 6 months. Intervention alters showed higher screening uptake at month 6 (67% vs 16%; adjusted OR 12.13). The intervention also increased engagement in prevention advocacy among both index and alters.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Trial design and participants

Outcomes at baseline and month 6

Engagement in prevention advocacy

Trial registration and keywords

Effects of a peer advocacy intervention on cervical cancer screening among social network members: results of a randomized controlled trial in Uganda Glenn J. Wagner1 · Joseph K. B. Matovu2,3 · Margrethe Juncker4 · Eve Namisango5 · Kathryn Bouskill1 · Sylvia Nakami4 · Jolly Beyeza-Kashesya6,7 · Emmanuel Luyirika5 · Laura M. Bogart1 · Harold D. Green8 · Rhoda K. Wanyenze2 Received: 15 September 2022 / Accepted: 3 May 2023 / Published online: 13 September 2023 © The Author(s) 2023 Abstract Cervical cancer (CC) is the most common cancer among women in Uganda, yet lifetime CC screening is as low as 5% . Training women who have screened for CC to engage in peer advocacy could increase uptake of CC screening in social networks. We conducted a randomized controlled trial of a peer-facilitated, manualized, 7-session group intervention to train women to engage in CC prevention advocacy. Forty women recently screened for CC (index participants) enrolled and were assigned to receive the intervention (n = 20) or wait-list control (n = 20) . Each index was asked to recruit up to three female social network members (alters) who had not been screened for CC (n = 103 enrolled alters) . All index and alter participants were assessed at baseline and month-6 follow-up. All but one (n = 39; 98%) index and 98 (95%) alter participants completed the month 6 assessment. In multivariate regression models controlling for baseline outcome measures and demographic covariates, intervention alters were more likely to have been screened for CC at month 6 [67% vs. 16%; adjusted OR (95% CI) = 12.13 (4.07, 36.16)], compared to control alters. Data also revealed significant increased engagement in CC prevention advocacy, among both index and alter participants in the intervention group at month 6, compared to the control group. The intervention was highly effective in increasing CC screening uptake among social network members, and engagement in CC prevention advocacy among not only intervention recipients, but also targets of advocacy, suggesting the potential for wide dissemination of CC knowledge. Trial Registration. NIH Clinical Trial Registry NCT04960748 ([clinicaltrials.gov](clinicaltrials.gov)). Keywords Cervical cancer · Prevention · Peer advocacy · Intervention · Social network · Stigma · Uganda 􀀍 Glenn J. Wagner [gwagner@rand.org](gwagner@rand.org) 1 RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA 2 School of Public Health, Makerere University, Kampala, Uganda 3 Faculty of Health Sciences, Busitema University, Mbale, Uganda 4 Rays of Hope Hospice Jinja, Jinja, Uganda 5 African Palliative Care Association, Kampala, Uganda 6 Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda 7 School of Medicine, Makerere University, Kampala, Uganda 8 University of Indiana Bloomington School of Public Health, Bloomington, IN, USA Introduction Cervical cancer (CC) is the most common cancer and accounts for ~ 25% of all cancer related deaths among women in Uganda, who have one of the highest incidence rates in the world at 54.8 per 100,000 (African Cancer Registry Network, 2018; Ferlay et al., 2018; International Agency of Cancer Registries, 2018). CC screening via visual inspection of the cervix with acetic acid (VIA), and thermal therapy for pre-cancerous lesions, are available for free or a low cost in some areas of Uganda. In contrast, radiotherapy is prescribed for advanced disease but scarcely available and too costly for most women. This highlights the importance of timely and periodic screening to prevent onset of cancerous lesions, yet it is estimated that as few as 5% of Ugandan women have ever screened for CC (Bruni et al., 2019; Nakisige et al., 2017; Ndejjo et al., 2016), and most (80%) have advanced disease (stage III or higher) when initiating care (Nakisige et al., 2017) . WHO and Ugandan policy recommends CC screening every three years, which has evidence for preventing CC and promoting ea

FAQs

What intervention was tested in this randomized controlled trial?

A peer-facilitated, manualized 7-session group intervention trained women to engage in cervical cancer prevention advocacy within their social networks.

How were participants assigned and followed up?

Forty women who had recently been screened were assigned to intervention (n=20) or wait-list control (n=20), and both index participants and recruited alters were assessed at baseline and at 6 months.

What were the main results regarding screening uptake?

At month 6, intervention alters were more likely to have been screened for cervical cancer than control alters (67% vs 16%; adjusted OR 12.13).

Did the study evaluate advocacy engagement as well as screening?

Yes. Significant increases in engagement in cervical cancer prevention advocacy were observed in the intervention group among both index and alter participants compared with the control group.

Sep 24, 2026

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