Key points
Outreach, community mobilization, health education and counselling are essential components of an effective cervical cancer prevention and control programme to ensure high vaccination coverage, high screening coverage and high adherence to treatment.
Outreach strategies must reach and engage young girls and women who would most benefit from vaccination and screening, respectively, as well as men and boys and leaders in the community, and key stakeholders.
Community mobilization and health education are essential tools for overcoming common challenges that impede access to and utilization of preventive care; these common barriers include social taboos, language barriers, lack of information and lack of transportation to service sites.
Health education ensures that women, their families and the community at large understand that cervical cancer is preventable.
Health education messages about cervical cancer should reflect the national policy and should be culturally appropriate and consistent at all levels of the health system.
Health-care facilities should have a private room that can be used to provide individual women with information and counselling, if appropriate, to help them make the best choices for their health.
Health-care providers should be trained to discuss sexuality in a nonjudgemental way and to address issues related to cervical cancer and human papillomavirus (HPV) while protecting patient privacy and confidentiality.
It is critical that educational messages emphasize that women with abnormal screening results must return for follow-up.
About this chapter
This chapter is based on the following WHO guideline:
Cervical cancer, human papillomavirus (HPV), and HPV vaccines: key points for policy-makers and health professionals. Geneva: WHO; 2007. (http://whqlibdoc.who.int/hq/2008/WHO_RHR_08.14_eng.pdf).
Other articles and publications on which the chapter is based can be found under Further reading at the end of the chapter.
This chapter addresses the need to include outreach, community mobilization, health education and counselling in effective cervical cancer prevention and control programmes. The goal of these strategies is to motivate women and families to seek preventive services, including early detection and treatment of cervical pre-cancer and vaccination of girls, and ultimately to enable people to increase control over and improve their health.
This chapter consists of five main sections. Section 3.1, Increasing the use of cervical cancer prevention and control services, serves as an introduction to the subject of this chapter, with a focus on the central role of health-care providers. The remaining sections, on Outreach (section 3.2), Community mobilization (section 3.3), Preventive health education (section 3.4) and Counselling (section 3.5), provide information on the most effective approaches and key messages for each of these efforts, including helpful resources for implementing them. The transmission of consistent messages requires good communication skills and the use of nontechnical language appropriate to the target population.
The practice sheets for this chapter list the key messages to be included in health education about cervical cancer, provide answers to frequently asked questions (FAQs) about cervical cancer and HPV, give advice on how to involve men in preventing cervical cancer, and provide information on counselling. Some practice sheets for other chapters will also be of support to health-care providers on communication issues, and these will be referred to in this chapter.
Anna's story
Anna, a 32-year-old Kenyan woman, was not sick. In fact she was in high spirits. Shortly before, a community health worker's announcement at a funeral had inspired her. He had spoken about a disease that affects women – cancer of the cervix – and explained that the disease is preventable. If early cervical cancer is not detected and treated, a woman can die from the disease.
The community health worker, a person she knew and trusted, gave Anna a card and told her where she should go to have a screening test. “I felt it was important for me to find out if I had any risk because, after all, I could get help.” When she returned two weeks later, she was told her test was negative, meaning it was normal. “I was greatly relieved,” she said. Now, she only needs to return for another test in five years' time.
Because she was treated so kindly and learnt so much, Anna has begun to speak publicly about her experience. Many women she has spoken to have followed her advice and have been tested. Two of these women have reported to Anna that they were treated for pre-cancer so they would not get cancer. Anna is happy to be helping others: “I don't want anyone to die when there is an opportunity for us to live.”
Source: Adapted from
Women's stories, women's lives: experiences with cervical cancer screening and treatment. Seattle (WA): Alliance for Cervical Cancer Prevention; 2004. .
3.1. Increasing the use of cervical cancer prevention and control services
Prevention saves lives and resources. The cost of losing a woman to cervical cancer is enormous, both for the family and the community. Good community outreach, education and counselling helps people to understand and reduce their personal risk of illness, and the risks to their family members and friends, by accepting and utilizing preventive care options such as vaccination and screening, avoiding harmful behaviours and adopting healthier lifestyles.
Many women and families may need support to overcome challenges that prevent them from receiving services. These challenges can range from fear of finding out they have an infection or disease, or shame about undergoing an exam of the genital organs, to confusion about the safety and effectiveness of the HPV vaccine, and/or lack of time or affordable transportation to reach the service facility. Community mobilization involves a process of working with the community to identify these challenges and develop strategies to overcome them.
3.1.1. The role of the health-care provider
Health-care providers play a central role in preventing and managing cervical cancer by increasing the use of vaccination and screening services by those who are most likely to benefit. The health-care providers who play this role could be doctors, nurses, trained midwives or community health workers – anyone who provides clinical or community services. These providers are key players on a larger team that together can compile and convey information about HPV infection and cervical cancer, how to prevent them, screen for them, and treat women with abnormal screening results. Experience has shown that direct communication between health-care providers and those seeking health services is the most effective method of sharing important health information and influencing health seeking behaviour. Individuals and families look to the provider for health information and services.
Using clear and sensitive language during interpersonal communications, conveying key messages that contain consistent and accurate information, and providing supportive woman-centred services that are conveniently accessible can make a difference in the success of efforts to reduce cervical cancer. See Box 3.1 for the characteristics of a health-care provider who can be a good health educator on the topic of cervical cancer.
Characteristics and communication skills of an effective health educator on the topic of cervical cancer. Knowledgeable: Have correct understanding about cervical cancer and how to prevent it, including the reasons for prioritizing particular age groups (more...)
3.2. Outreach
Outreach refers to the efforts made beyond the walls of the health-care facility to reach target populations with the goals of increasing knowledge about specific health issues (cervical cancer prevention is one example) and improving access to health services.
The role of the health-care provider includes outreach activities, which need to be carefully planned. The first step in developing an outreach plan is to identify the target population for the particular message, and to be able to clearly communicate the reasoning and importance of prioritizing that target group for the services. Refer to in Chapter 2, which identifies the age groups affected and those that can benefit most from particular interventions. Working in partnership with the community creates support for prevention, which will facilitate reaching target populations. At the stage of planning outreach activities it is crucial to understand the key obstacles that may be preventing women and girls from receiving preventive health services.
The goal of outreach is to maximize coverage and utilization of cervical cancer prevention and control services. To achieve this there are five target or priority groups that need to be reached with messages relating to cervical cancer prevention:
Young adolescents (and their families): Research indicates that the HPV vaccines are most effective if provided to girls and/or women prior to the onset of sexual activity and exposure to HPV infection; therefore, the target population for the HPV vaccine, as recommended by WHO, is young adolescent girls aged 9–13 years.
1 However, it is important to include boys in awareness and informational campaigns.
Adult women: The greatest benefit from cervical screening can be gained by limiting the use of screening resources to women in the 30–49 age group, as recommended by WHO. This is because most women are infected with HPV in their teens and twenties and the virus normally takes 10–15 years to produce precancerous changes. Inclusion of family members and particularly male partners when conveying related health education messages is critical to ensuring acceptance of screening services.
Vulnerable groups: Evidence shows that services tend to be used least by those most at risk. It is not enough to set up services and assume that girls and women who are at risk will arrive to make use of those services. Special efforts need to be made to reach the most vulnerable populations. These groups include:
- –
girls who are hard to reach, especially those not attending formal education;
- –
women who live far from services and have fewer resources;
- –
migrant workers, refugees and other marginalized groups;
- –
women and girls living with HIV and other immunosuppressed individuals who may require a more intensive screening schedule.
Community leaders and champions: Engaging community leaders can greatly facilitate outreach efforts. A few strong leaders who become champions of the cause can bring in community support that will ensure a successful programme. Their contributions may include getting buy-in from local men, securing financial support for families in need, arranging transport to services or providing a venue for a talk or campaign event.
Men: As with other aspects of women's reproductive health, it is crucial to reach and involve men. Men are often the “gatekeepers” of access to services for their wives and daughters, so their support (or, in extreme cases, their permission) may be needed if women are to attend services. Increasing men's knowledge and understanding of women's health issues helps them make better health decisions for themselves and for their partners and helps build stronger programmes. Information about HPV and cervical cancer can be given to men in clinical and community settings with messages about the importance of encouraging their partners to be screened and treated when necessary (see
Practice Sheet 3.3).
Once the target populations have been defined, an outreach plan can include:
community health workers and peer-to-peer communication strategies to provide information and motivate populations to seek services;
mobile screening units and/or vaccine brigades to bring services to communities;
posters, pamphlets, radio, television and internet-based social media to reach all segments of the target populations, as well as people who can influence them.
See section 3.4.3(c) later in this chapter for more information about delivering health education in the community.
3.3. Community mobilization
Community mobilization is a process of engaging communities and generating support for all those in need of health services (for example, cervical cancer prevention and control), resulting in sustainable community ownership and participation.
Promotion of preventive services can be a challenge in any setting. People are often more likely to seek care if they or their family members are sick than to seek preventive services, and women often relegate their own preventive care to the lowest priority. Effective preventive care at health-care facilities requires not only setting up the service, but – equally important – engaging the community so that they understand and utilize it.
3.3.1. Engaging the community for prevention
Health-care providers are often overburdened with caring for patients, which makes it difficult to get out into the community. Community health workers, volunteers and facility managers can be mobilized to provide community education and outreach. Community partners – including community leaders, religious leaders, teachers and members of local women's groups – can all help to identify members of the target populations, and can also help to address barriers to access and treatment (see Box 3.2). Community mobilization efforts can expand the reach and impact of the limited resources of health centres and providers.
Communities can make the difference. More than 25 million families worldwide earn their living through coffee production. In many coffee-growing communities, small farmers have organized themselves into cooperatives, or unions, in order to share processing (more...)
3.3.2. Working with community health workers
Many health systems use trained community health workers (CHWs) to educate community members about prevention and to promote available health services. CHWs can serve as a bridge between health services and the community and are recognized worldwide as an essential part of any health-care team. Their peer-to-peer approach helps to gain the trust of families who can benefit from information and advice on both vaccination and screening programmes, addressing any fears or concerns that may be present. For example, when a woman is found to have a positive screening result, the CHW can explain the importance of returning to the clinic for further management; and if parents have concerns about the safety of the HPV vaccine, accurate information can help them to understand about the safety and benefits of the vaccine. Welcoming CHWs to accompany individual women when they attend services at a health centre or hospital, if the woman wishes it, can demonstrate to the community that CHWs are valued and knowledgeable team members.
When health-care providers have a good working relationship with CHWs, this can help facilitate:
communities learning about cervical cancer prevention services, and their importance;
families electing to have their daughters vaccinated, thus protecting more girls from infection with high-risk HPV types;
women getting the support they need to make an informed decision about screening;
eligible women in the community being screened and thus more cervical pre-cancers and cancers being detected early;
women with positive results receiving treatment and care; and
women who are referred for further care getting to those appointments.
If there is a group of community health workers or promoters already working on other health issues, it is best to incorporate cervical cancer information into their existing outreach work, by upgrading their knowledge on the issue. If CHWs do not exist in the community, community leaders and other stakeholders can assist in identifying and recruiting a group for training and service provision (see Practice Sheet 3.7).
3.4. Preventive health education
Health education is an exchange of information with the purpose of increasing awareness and knowledge about how to keep healthy and prevent diseases (such as cervical cancer), including information about resources that are available and the benefits of accessing services.
3.4.1. Preventive education for individuals and communities
Many barriers to HPV vaccination and cervical cancer prevention and control programmes can be addressed by educating and engaging the community. Resistance to cancer screening may reflect lack of understanding that cervical cancer is preventable through screening and early treatment. It can also be difficult for women to put their own health first when they have so many competing demands on their time and resources. This situation can be exacerbated by gender bias, which can contribute to low uptake of prevention services for women and girls. In addition, community misunderstandings and concerns about vaccine programmes may create obstacles.
Quality health education involves communicating accurate information in simple, understandable language to individuals or groups with the goal of raising awareness, changing behaviour and reducing illness and deaths.
Health education is not a one-time event; it should be a continuous activity and requires constant effort to keep provider knowledge up to date. In cervical cancer prevention and control programmes, key health education objectives include:
informing people about cervical cancer, its causes (especially HPV) and natural history;
promoting HPV vaccines for girls, when they are available for that community;
promoting screening for women in the eligible age group;
ensuring that women who screen positive receive prompt treatment;
increasing awareness of the signs and symptoms of cervical cancer and encouraging women to seek care if they have them; and
addressing ignorance, fear, embarrassment and stigma related to HPV and cervical cancer.
3.4.2. How to provide health education
An effective health educator must have a strong knowledge base of relevant information, as well as comfort with the topic and sensitivity in choice of words. The characteristics and communication skills of an effective health educator on the topic of cervical cancer are detailed in Box 3.1 in section 3.1 of this chapter. But an effective health educator must also be proficient in presentation to ensure that his or her messages are fully understood and that participants remain engaged.
Some presentation tips:
Give accurate information in a sensitive and nonjudgemental manner.
Make sure the material is easy to understand and appropriate for the audience.
Keep core messages consistent, regardless of the audience, but also strive to make messages both locally and culturally appropriate and tailor language to the audience using commonly understood terms whenever possible.
Develop messages in accordance with national guidelines, but also use input from the community and pretest the draft messages and materials with people from the community; use their feedback and advice to revise the messages to ensure they will be fully understood and effective.
Develop messages to address common fears and misconceptions, as well as the stigma sometimes attached to cancer and sexually transmitted infections (see
section 3.4.4 and ).
Improve communication skills through practice. It's important to overcome any discomfort in talking about sexual matters or diseases that affect the genitals.
Box 3.3Essential knowledge about cervical cancer
WHAT is pre-cancer?
WHAT is cervical cancer?
HOW can cervical cancer be prevented?
WHO should be vaccinated?
WHO should be screened?
WHICH prevention services are available locally?
WHERE and WHEN can these local services be accessed?
Remember: Effective communication can increase rates of vaccination and screening, and save women's lives.
3.4.3. Developing and delivering an educational presentation on preventive health
In order to be most effective in outreach and education efforts it is important to understand the topic well and to have practice presenting the information. The fact that cervical cancer is linked to HPV, which is transmitted through sexual contact, raises some difficult questions that health-care providers need to be prepared to answer. Messages should be developed using nontechnical and culturally appropriate language.
a. Using key messages
Though cervical cancer prevention and control can be a complicated topic, the key messages can be kept short and simple to help people understand and make good choices.
Five key messages about the HPV vaccine
There is a safe, effective vaccine that can protect against cervical cancer.
The HPV vaccine works best if received before sexual activity begins.
All girls in the age cohort or in the school class/grade/year identified as the target population by the national programme should receive the HPV vaccine.
HPV vaccines do not treat or get rid of existing HPV infections.
Girls who are already sexually active can also be given the HPV vaccine, though it may be less effective.
Five key messages about screening and treatment
Cervical cancer is a disease that can be prevented.
There are tests to detect early changes in the cervix (known as pre-cancers) that may lead to cancer if not treated.
There are safe and effective treatments for these early changes.
All women aged 30–49 years should be screened for cervical cancer at least once.
No one needs to die from cervical cancer.
The specific messages developed for use in each country need to comply with the country's national guidelines, including the specified target populations (i.e. age ranges for vaccination of girls against HPV and for women's cervical cancer screening).
Practice Sheet 3.1 provides more detailed messages for use in health promotion and Practice Sheets 3.2 and 4.1 present answers to frequently asked questions (FAQs) about cervical cancer and the HPV vaccine, respectively. These resources can make the health educator's job easier; they can be modified to suit the needs of the provider as well as those of the local community.
b. Resources
To assist education efforts, additional materials and resources can be developed. Communication strategies and materials are most effective when they have been adapted or created with input from members of the target audience.
Consider using the following tools and resources:
Flipcharts are especially good for group education sessions. Pictures should be easy to see and understand. Telling a story of a woman going for screening and getting treatment can be more effective and easier to understand than complicated pictures of anatomy and viruses.
Brochures can give simple information and prevention messages for community members to take home and discuss with their families and others.
Drama and role-playing can occur in marketplaces or at community meetings and can capture people's attention and teach through storytelling. Peer experiences can be used either in live events or as case studies for drama and role-playing.
Radio and video programmes are effective for telling stories and for transmitting short messages or announcements. Taking part as a guest on a radio or television talk programme enables the presentation of a lot of information to reach many people at once. Local radio stations are particularly useful for announcing services and campaigns and reminding the untreated screen-positive women to return for treatment.
c. Delivering health education
In health-care facilities
Whenever possible, cervical cancer education (including information on HPV vaccination and screening) should be made available when women arrive at a health-care facility for any service, either for themselves or for a family member. Information can be provided to groups in waiting areas through posters, health talks, videos and/or written materials. Information and education on prevention of cervical cancer can be provided to more men and women by integrating it into health talks on antenatal and postnatal care, family planning, care for chronic illnesses, and sexually transmitted infections (STIs), including HIV/AIDS.
In the community
Community education may take place in a variety of settings, such as community centres, places of worship and schools, at sports activities, on local health awareness days, or in the context of a screening campaign. Selected members of the community can be trained to deliver key messages: medical professionals, teachers, community leaders, community health workers, traditional healers and midwives. Messages about the benefits of the HPV vaccine (if it is available) should be tailored for girls, boys and their parents or guardians, while messages about the benefits of screening should be targeted at women and their partners.
Examples of community outreach activities include:
Community health education: Information sessions organized by health-care providers or trained CHWs can increase utilization of cervical cancer prevention and control services. These are also very popular if they are done well and provided in locations where women congregate or wait in a line (queue) for any reason (e.g. food aid, school registration, etc.).
Home visits: CHWs or other community or social workers can provide information about preventive health services, address concerns and questions, and assist women in making arrangements to attend the health-care facility. If a male partner and/or other family members are present, and all present agree, they can be included in the discussion.
Client word of mouth: Satisfied clients can be encouraged to discuss HPV vaccination and cervical cancer screening with their friends and family members. A brochure can serve as a visual aid.
Community cultural activities: Information tables and/or announcements at community events, fairs or festivals are useful opportunities to present messages to the wider community. Market days, too, where both the merchants and buyers are predominantly women, lend themselves to community education.
3.4.4. Managing misinformation and preventing stigma in health education on HPV and cancer
Stigma relating to HPV and cancer can interfere with access to care and treatment. Often there is stigma related to diseases of the reproductive tract, particularly STIs, including HPV. Parents may be concerned about vaccinating their daughters with a new vaccine. Women may fear that screening will be painful and may be embarrassed about genital examinations, as well as having concerns about lack of privacy and confidentiality, which may keep them from attending services.
Educating parents on the safety of the vaccine and its effectiveness in protecting their daughters from cervical cancer in the future reduces concerns. Educating a woman privately about what is involved in screening and reassuring her that the screening procedure is safe and painless is a key way of addressing any fears and misconceptions. If such information is followed by skilful, respectful provision of services, women and their families will be more likely to utilize prevention services and will be more likely to recommend vaccination and screening to their friends and family.
Health-care providers play an important role in preventing misinformation and stigma about cervical cancer prevention. Review the messages in , and talk to co-workers and community members about common local misconceptions and how to share information about cervical cancer prevention in a way that does not create stigma or fear. Also see Practice Sheet 3.1 for key messages and Practice Sheet 3.2 for answers to FAQs about cervical cancer.
3.4.5. Educational information about the HPV vaccine
As with any new health-care product or service, there will be some questions, fears and misconceptions related to the HPV vaccine. Naturally, families want to know about vaccine safety, how well it works, how long it will protect and whether there are any common adverse reactions or events. Such concerns can be addressed by raising awareness about vaccination, using examples of childhood immunizations that also need multiple doses to provide full protection.
Experiences in a number of countries have shown that, when promoting the HPV vaccine, informational messages should not overemphasize that the vaccine prevents an STI; rather, they have found that it is more relevant and more effective to focus on the potential of the vaccine to prevent cancer.
Providing some details about the testing of the vaccines in clinical trials and their excellent safety record will encourage parents to make sure that their daughters receive the vaccine and adhere to the recommended schedule. For community leaders, printed materials about cervical cancer and HPV vaccines are useful in helping them respond to questions from their constituents. Some common misconceptions and key facts about the HPV vaccine are presented in . Complete information on HPV vaccination can be found in Chapter 4 and its practice sheets.
Misconceptions and facts about the HPV vaccine.
3.5. Counselling
Counselling refers to advice or guidance (usually one-on-one) from a knowledgeable person to facilitate personal decision-making. Counselling is generally conducted privately and confidentially. Counselling requires good listening and communication skills as well as knowledge of the subject being discussed. A good counsellor uses verbal and nonverbal communication skills and helps the client feel at ease by empathizing with her situation, reassuring her, and fostering a sense of partnership in addressing her problem.
Providers involved in cervical cancer control at all levels should be trained in basic counselling skills so that they can communicate effectively with clients (see Practice Sheet 3.4).
The content of the counselling encounter will vary according to the client's problems or concerns and her individual circumstances. It can cover prevention, screening, follow-up, referral, diagnosis, treatment of precancerous lesions, treatment of invasive cancer and/or palliative care. The chapters and practice sheets that provide more specific information on how to talk with a woman under each of these circumstances are indicated in the relevant sub-sections in the remainder of this chapter.
3.5.1. Who needs counselling?
All women and men who need to make a decision about their health and whether to have a service, medication or treatment may benefit from counselling that includes provision of correct information and a two-way private conversation about the available options, including how the choice to receive or decline a service (e.g. a screening test) might affect her or his present and future health. See Practice Sheet 3.5 for standard counselling steps for before, during and after a client has a test, procedure or treatment.
Girls and their parents can be counselled together or individually about HPV vaccination. Joint counselling provides an opportunity to have a conversation about sexual health with girls and to encourage cervical cancer screening for their mothers. See Practice Sheet 4.1 for answers to FAQs about HPV vaccination.
Women and girls who are living with HIV need to receive information and counselling about their greater vulnerability to HPV infection and their increased likelihood of developing cervical cancer at an earlier age. Women and girls living with HIV should be counselled to start regular screening as soon as possible after they learn of their positive status and to promptly receive treatment for any abnormality found. See Practice Sheet 3.6 on counselling for women living with HIV, and see Chapter 5 for further information on screening for women living with HIV, in section 5.2.5(a), and on diagnostic procedures for women living with HIV, in section 5.4.6(c).
Every woman who tests positive on a cervical screening test for precancerous lesions will need counselling. Ensuring treatment and preventing loss to follow-up may be the most important component of a successful screening effort (see the next section in this chapter, and see Practice Sheet 5.7 in Chapter 5 for how to counsel a patient after a positive screening result).
Counselling should be structured to:
educate the woman about the natural history of HPV infection and cervical cancer;
review and explain the screening results and the importance of follow-up care and treatment, if required;
present alternative services and procedures; and
answer all of the client's questions and concerns with appropriate information. It is also fine to acknowledge that you don't have immediate answers to all questions and to say that you will find the correct information and either contact her directly with the information or find another provider who can do this.
3.5.2. Key components of counselling for women with positive results on a test or examination and for women with cervical cancer
Be sure to include the following in the counselling:
If a client had a positive screening test and is eligible for cryotherapy or LEEP
Does she understand the purpose of the screening test and the possibility of preventing cancer through early treatment?
Does she understand that a positive test probably means that she has early cell changes, and only rarely does it mean she has cancer?
Is there any reason she may have difficulty returning for care, such as an unsupportive or opposing partner, lack of transport, or financial difficulties? If so, discuss possible solutions and help her make a plan to obtain the services she needs.
If a client's examination was suspicious for cancer
Ask her if she has someone with her today that she would like to have present for the discussion.
Express concern about the seriousness of the findings, but do NOT tell her she has cancer as it is too early at this point to be sure of that diagnosis. Do tell her that she had a positive screening test and that she needs to be referred for further testing/evaluation.
Do reassure her that she will receive the help she needs.
Provide her with clear information about where to go for diagnosis and treatment.
Invite her to return with any questions she may have.
For more information on counselling for screen-positive women when the results are suspicious for cancer and when they are not suspicious for cancer, see Practice Sheet 5.7.
If a client had a definitive diagnosis of cancer
Ask her if she has someone with her today that she would like to have present for the discussion.
Express concern about the findings, but reassure her that most cases of cervical cancer can be successfully treated when found early enough.
Describe the nature and the course of her disease and discuss the prospect of treatment and the chances of cure. In every situation, be sure that the information given is correct and understood.
Ask questions to test the client's understanding and take the time to answer any questions or address confusion.
See Practice Sheet 6.2 for more information on counselling after a diagnosis of cancer, and Practice Sheet 6.4 (for cancer specialists) on talking to a patient about her cancer and treatment. Also see Chapter 6, section 6.6.1 for counselling guidance related to managing cervical cancer in pregnant women.
If a client is diagnosed with invasive cervical cancer and her case is beyond cure:
Provide empathetic counselling and support. She will need information and psychological and spiritual support as well as arrangements for palliative care to alleviate pain and keep her as comfortable as possible.
Such counselling may involve only the patient or also her partner and other family members, especially if decisions concerning severe disease or costly treatment need to be made.
In Chapter 7, see section 7.5 on keeping the patient and her support circle informed, and Practice Sheet 7.3 for further guidance on having a conversion with a patient who is returning home under palliative care.
For more complete information:
on cervical cancer screening and treatment, see
Chapter 5on treatment of invasive cancer, see
Chapter 6
Further reading
Alliance for Cervical Cancer Prevention (ACCP).
Planning and implementing cervical cancer prevention and control programmes: a manual for managers. Seattle (WA): ACCP; 2004. [18 July 2014].
http://www.rho.org/files/ACCP_mfm.pdf.
Burns AA, Lovich R, Maxwell J, Shapiro K, Niemann S, Metcalf E, editors. Where women have no doctor: a health guide for women. Berkeley (CA): Hesperian Foundation; 2010.
Herman Z. Community health guides: making materials relevant, effective, and empowering. Washington (DC): United States Agency for International Development, Health Care Improvement Project; 2012.
Hubley J. Communicating health: an action guide to health education and health promotion. London: Macmillan; 1993.
Kirby D, Laris BA, Rolleri LA. Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world.
J Adolesc Health. 2007;40(3):206–17. [
PubMed: 17321420] [
CrossRef]
Rinehart W, Rudy S, Drennan M.
Population Reports, Series J. Baltimore (MD): Johns Hopkins School of Public Health, Population Information Program; 1998. [18 July 2014]. GATHER guide to counselling.
http://pdf.usaid.gov/pdf_docs/Pnacp920.pdf.
United Nations Educational, Scientific Cultural Organization (UNESCO).
Volume I: the rationale for sexuality education. Paris: UNESCO; 2009. [18 July 2014]. International technical guidance on sexuality education: an evidence-informed approach for schools, teachers and health educators.
http://unesdoc.unesco.org/images/0018/001832/183281e.pdf.
- 1
Girls do not need to be asked about sexual activity before giving the vaccine. Asking such a young population about this gives the wrong message and can create fear and mistrust.
