Cervical Cancer Prevention in Malawi: A Qualitative Study of Women’s Perspectives KATIE A. PORTS 1 , DIANE M. REDDY 2 , and ANJALI RAMESHBABU 2 1 Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, Virginia, USA 2 Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin, USA Researchers posit that cervical cancer knowledge is central to participation in prevention behaviors. However, of the many barriers to cervical cancer prevention in low- and middle-income countries, cervical cancer knowledge remains severely limited among com- munities at great risk for the disease. Malawi is one such country where the burden of cervical cancer is considerably high. Formative research targeting cervical cancer prevention is needed, particularly research that explores ways to deliver cervical cancer infor- mation efficiently and effectively to Malawian women. In this study, the authors aimed to garner Malawian women’s understanding of cervical cancer and to shed light on preferences for health information delivery, including community health advocacy. Qualitat- ive, in-depth interviews were conducted with 30 Malawian women and analyzed for recurring themes. In general, women had limited cervical cancer knowledge, which supported misperceptions about the disease, including factors pertaining to risk and prevention. Nonetheless, women reported that receiving cervical cancer information from trusted sources would help promote preventive behaviors. Women noted that they received most of their health information from hospital personnel, but distance was a barrier. Women also expressed interest in community health advocacy. Perspectives from Malawian women may be vital toward informing efforts to increase cervical cancer knowledge and prevention. Cervical cancer is a significant health threat to women in low-resource countries (World Health Organization, 2006). Malawi, a low-income country and the site for this research, is located in Sub-Saharan Africa, which remains a global epicenter for cervical cancer incidence and mortality. Data from the World Health Organization (2006) indicate not only that 80% of cervical cancer cases occur in low- and middle-income countries but also that a woman who develops cervical cancer in Sub-Saharan Africa has at least a 79% chance of dying from this malignancy. In high- resource countries that have initiated and maintained widespread cervical cancer prevention programs, the odds of a woman dying from cervical cancer are less than 30% (National Cervical Cancer Coalition, 2010; World Health Organization, 2006). Cervical cancer can be largely prevented through cervical screening and human papillomavirus (HPV) vaccination. Malawi’s Ministry of Health and Population has championed for greater accessibility of visual inspection with acetic acid as a means to screen for and treat cervical cancer. However, despite efforts to increase cervical cancer prevention services, existing data suggest that when available, regular screening and follow-up care is generally underused by Malawian women (Fort, Makin, Siegler, Ault, & Rochat, 2011; Taulo, 2008). Although the HPV vaccine is not currently included in Malawi’s national immunization program, the Global Alliance for Vaccines and Immunization includes the HPV vaccine in their vaccine assistance program (Nguyen et al., 2011), and preliminary research supports that HPV vaccination is a logical option for Malawi’s cervical cancer prevention efforts (Ports, Reddy, & Rameshbabu, 2013). Studies have documented that a host of psychological and sociocultural factors contribute to nonparticipation in cervical cancer prevention, including limited knowledge about cervical cancer and screening; stigma, cultural beliefs, and perceptions related to the reproductive organs and symp- toms; limited finances; lack of time; and not wanting to know more about cervical cancer status (Anorlu, 2008; Francis et al., 2011; Fort et al., 2011; Horo et al., 2012; Taulo, 2008; Wellensiek, Moodley, Moodley, & Nkwanyana, 2002). Studies have also documented that health care work- ers often have poor knowledge about cervical cancer and that weak health infrastructure impedes screening (Ayinde & Omigbodun, 2003; Tarwireyi, Chirenje, & Rusakaniko, 2003). Health behavior theories, including the health belief model and the theory of planned behavior provide additional support for theoretical constructs such as perceived risk, intention, attitudes and self-efficacy as explanations of people’s participation in preventive health behaviors (Fort et al., 2011; Ngugi, Boga, Muigai, Wanzala, & Mbithi, 2012; Ory, Jordan, & Bazzarre, 2002; Rosenstock, 1966). Although barriers to cervical cancer prevention are numerous, there is evidence to support that cervical cancer Address correspondence to Katie A. Ports, Department of Social and Behavioral Health, Virginia Commonwealth Univer- sity, P.O. Box 980149, Richmond, VA 23298, USA. E-mail: kaports@vcu.edu Journal of Health Communication, 20:97–104, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 1081-0730 print/1087-0415 online DOI: 10.1080/10810730.2014.908986