Factors Affecting Utilization of Visual Inspection with Acetic Acid (VIA) as an Alternative Screening Tool for Cervical Cancer Among Rural Health Units and District Hospitals in the province of Iloilo.

Background: Cervical cancer the 2nd most common cancer in women in the Philippines, has long pre-invasive stage is considered preventable when detected early. Pap smear is the most reliable screening method, but it is not available in some areas of the country. Visual inspection with acetic screening method,  and  is considered as a cost-effective and efficient tool. Despite the Establishment of a national program on cervical cancer screening which recommends VIA as an alternative screening method, various factors lead to the underutilization of VIA. Moreover, limited studies have been conducted locally into support the utilization of VIA in cervical cancer screening. 

Objective: This study aimed to determine the factors affecting the utilization of VIA as an alternative screening tool for cervical cancer among RHU and DH in the Province of Iloilo.

Methods: This was a descriptive cross-sectional study on the factors affecting the utilization of VIA as an alternative screening tool for cervical cancer among RHU and DH in the Provence of Iloilo. The 52 respondents included Municipality Health Officers (MHOs) and/or Rural Health Physicians (RHPs) in the RHU, and Medical Officers (MOs), Medical Specialists (MSs), and/or Chief of Hospital (CoH) in the DH. The respondents were asked to answer a self-administered questionnaire with assessed their cervical cancer screening practices and Via Utilization, knowledge on cervical cancer screening and VIA, and perceived benefits and barriers of Via Utilization. Statistic tools used include Mann Whitney U test and ETA correlation coefficient. Data analysis was performed using statistical package for social sciences (SPSS) 21 trial version.

Result: Majority of the study participants perform cervical cancer screening (62.23%) and have undergone training in VIA testing (63.64%) . Both of those who utilize (M=16.7, SD = 1.36) and do not  utilize VIA (M = 17.5, SD = 1.60) have high level of awareness. Result of the Mann-Whitney U test showed that there was no significant difference in the level of awareness between those who utilize VIA and those who do not Utilize Via (U=78.00 P-0.21). There was also no significant association between level of awareness and the utilization of VIA (ETA=0.24, p=0.17. Majority of the respondents acknowledged that VIA was a beneficial screening tool for cervical cancer. However, there was no significant association between the perceived benefits and the utilization of VIA. Most respondents among those who utilize VIA identified patient's dislike or refusal of VIA as a barrier. There was also no significant association between the perceived barriers and the utilization of VIA. The most commonly reported factor for the non-use of any cervical cancer screening tool was the lack of trained personnel to perform the procedure (37.50%). The lack of instruments and supplies (75.00%) was identified by most respondents as the main factor in the non-utilization of VIA. Lastly, lack of educational programs (72.00%) was the most commonly identified reason why only few patients undergo cervical cancer screening.

Conclusions: There was no significant association between the level of awareness, perceived benefits and perceived barriers and utilization of VIA. Factors such as lack of training of personnel, lack of instruments and supplies, and lack of educational programs were identified by respondents as factors affecting cervical cancer screening in Iloilo Province.

Keywords: Cervical Cancer, Visual Inspection with Acetic Acid Test, Rural Health Unit, District Hospital