Open Access
Open access
AIMS Medical Science, volume 11, issue 2, pages 99-112

Recruitment strategies for cervical cancer screening in three Mediterranean low and middle-income countries: Albania, Montenegro, and Morocco

Elisa Camussi 1
, 
Lina Jaramillo 1
, 
Roberta Castagno 1
, 
Marta Dotti 1
, 
Gianluigi Ferrante 1
, 
Latifa Belakhel 2
, 
Youssef Chami Khazraji 3
, 
Alban Ylli 4
, 
Kozeta Filipi 4
, 
Đjurđjica Ostojić 5
, 
Milica Stanisic 5
, 
Luigi Bisanti 6
, 
Livia Giordano 1
Show full list: 13 authors
1
 
Epidemiology and Screening Department – CPO Piedmont, AOU Città della Salute e della Scienza di Torino - Via Cavour 31, 10123 Turin, Italy | 
2
 
Non-communicable diseases unit, Epidemiology and Disease Control Department, Ministry of Health, 335 Ave Mohammed V, Rabat 10020, Morocco | 
3
 
Lalla Salma Foundation, Prevention and Treatment of Cancer, Villa No. 1 Touarga Fouaka Mechouar Said 10700 Rabat, Morocco | 
4
 
Institute of Public Health of Albania, Rruga Aleksander Moisiu, nr 80, Tirane, Albania | 
5
 
Institute for Public Health of Montenegro, bb Džona Džeksona, Podgorica, Montenegro | 
6
 
Epidemiologia & Prevenzione Scientific Board, via Giusti 4, 21053 Castellanza (VA), Italy | 
Publication type: Journal Article
Publication date: 2024-05-31
wos Q4
SJR: —
CiteScore: —
Impact factor: 0.4
ISSN: 23751576, 2375155X
Abstract
<abstract><sec> <title>Introduction</title> <p>Cervical cancer (CC) poses a substantial burden in low-and middle-income countries (LMICs), where challenges in implementing effective screening programs and achieving high participation rates persist.</p> </sec><sec> <title>Aims</title> <p>This study sought to compare different strategies for recruiting women for CC screening in Albania, Montenegro, and Morocco, and compared usual care (ongoing invitation method) with an alternative approach (intervention strategy).</p> </sec><sec> <title>Methods</title> <p>Within each country, the following comparisons were made: face-to-face (FF) invitations versus phone calls (PCs) in Albania, PCs versus letter invitations in Montenegro, and FF invitations to women attending healthcare centers versus a combined approach termed “Invitation made in Morocco” (utilizing PC and FF for hard-to-reach women) in Morocco. Questionnaires that assessed facilitators and barriers to participation were administered to women who either attended or refused screening.</p> </sec><sec> <title>Results</title> <p>In Albania, significant differences in the examination coverage were observed between the invitation methods (PC: 46.1% vs. FF: 87.1%, p &lt; 0.01) and between the rural and urban settings (rural: 89.1% vs. urban: 76.3%, p &lt; 0.01). In Montenegro, the coverage varied based on the recruitment method (PC: 17.7% vs. letter invitation: 7.6%; p &lt; 0.01), the setting (urban: 28.3% vs. rural: 13.2%; p &lt; 0.01), and age (&lt;34 years: 10.9% vs. 34+: 9.6%, p &lt; 0.01). In Morocco, no significant differences were observed. Common screening facilitators included awareness of CC prevention and understanding the benefits of early diagnosis, while key barriers included a limited perception of personal CC risk and the fear of testing positive.</p> </sec><sec> <title>Discussion</title> <p>FF appeared to be effective in promoting participation, but its broader implementation raised sustainability concerns. PC invitations proved feasible, albeit necessitating updates to population registries. Restricting FF contacts for hard-to-reach communities may enhance the affordability and equity.</p> </sec></abstract>

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