Investigator(s)
| Submitter |
Kinley Dorji NA Kinley Dorji 
|
| Principal Investigator |
Kinley Dorji NA Kinley Dorji
|
| Co-Investigator(s) |
Karma Chuendup NA Karma Chuendup
|
| Co-Investigator(s) |
Tendri Wangchuk NA Tendri Wangchuk
|
Title(s) and abstract
| Scientific title | Knowledge, Screening Practices, and Factors Associated with Cervical Cancer Screening Uptake Among Women Aged 30–65 Years in Paro District, Bhutan |
| Public title | NA |
| Background | Globally, cervical cancer is the fourth most common cancer among women, with approximately 604,000 new cases and 342,000 deaths reported in 2020. Projections indicate the global burden will rise to roughly 700,000 annual cases by 2030. Bhutan faces a significant challenge, as it is the most frequently diagnosed cancer and leading cause of cancer death among Bhutanese women, with an age-adjusted incidence of 19.5 per 100,000. More than half of these cases are diagnosed in late stages, leading to high mortality. Bhutan is committed to the WHO 90-70-90 elimination targets through intensified public health interventions. The country achieved over 90% HPV vaccination coverage after launching a quadrivalent vaccine program for girls in 2010 and expanding to boys in 2020. Screening strategies shifted in 2020 to HPV-DNA testing for women aged 30–65. While the Health Flagship Program reports national screening reach of 90.8%, real coverage remains uneven, with lower participation in rural areas. Although Bhutan guarantees free universal healthcare, complex treatments like radiation require referrals to India, imposing substantial financial and non-medical costs on patients. In Paro District, 33 cases were reported between 2019 and 2022. Despite Paro’s role as an early pilot site, district-level data accuracy is often uncertain. Knowledge gaps and misconceptions persist, hindering early detection. This study aims to assess women’s knowledge, behaviors and risk factors in Paro to inform targeted interventions and progress toward elimination. |
| Objectives | The objective of this study is to assess the knowledge, screening practices, and risk factors of CC among women in Paro District, Bhutan. |
| Study Methods | Study design: The study will adopt a community based cross-sectional descriptive design. Data will be collected using validated tools adapted from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and other peer-reviewed studies that have been consistently used in cross-sectional research. The instrument consists of five sections comprising 30 structured dichotomous questions and a 3-point Likert scale to assess respondents’ levels of agreement. |
| Expected outcomes and use of results | Expected outcomes • Quantified baseline measures: proportion of women with adequate knowledge of cervical cancer and HPV, percentage ever screened, and current HPV-based screening uptake in Paro District. • Risk factor profile: identification of key demographic, behavioural, and health-service factors independently associated with lack of screening and with abnormal screening results. • Barriers and facilitators: documented, ranked list of common structural, cultural, and informational barriers to screening, and factors that facilitate uptake (e.g., service proximity, prior health education). • Service mapping: assessment of coverage and capacity of district screening sites (which centres provide services, testing frequency, referral pathways, and turnaround time). • Priority subgroups: identification of high-risk or underserved subpopulations (by age, residence, education, parity, or other factors) for targeted outreach. • Programmatic indicators: estimates of potential increases in screening coverage and numbers of treatable precancerous lesions detectable under enhanced strategies. Use of results • Local program design: tailor community education, mobilization, and outreach strategies to address the most common knowledge gaps and barriers identified. • Targeted interventions: prioritise high-risk and low-coverage subgroups for point-of-care HPV screening, mobile clinics, or self-sampling initiatives. • Health-system strengthening: inform allocation of human resources, training needs (e.g., colposcopy, VIA, sample handling), and supply-chain planning to improve screening quality and referral completion. • Policy and budgeting: provide district-level evidence to support health authority decisions on sustaining HPV testing, scaling self-sampling, or expanding same visit treatment; support grant proposals and budget requests. • Monitoring & evaluation: define measurable indicators and baseline values to track progress toward WHO 90–70–90 targets and local screening coverage goals. • Knowledge dissemination: share findings with stakeholders. |
| Keywords | Cervical cancer, knowledge, screening practice, risk factors, Paro district |
Research Details
| Student research | No |
| Start Date | 30-Sep-2026 |
| End Date | 28-Feb-2027 |
| Key Implementing Institution | Not applicable |
| Multi-country research | No |
| Nationwide research | No |
| Bhutan | |
| Research Domain(s) | Maternal, Reproductive and Child Health |
| Research field(s) | Reproductive Health |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | No |