Assessment of facility-level factors influencing the adequacy of cervical screening specimens in community health centres and clinics
1
1 Community Health (Public Health Medicine), University of the Witwatersrand, Johannesburg, South Africa
2
2 Public Health Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
3
3 Family Medicine, Johannesburg Health District, Johannesburg, South Africa
4
4 Family Medicine, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Cervical screening is an essential tool for cervical cancer prevention.1-3 The accuracy of cervical screening tests depends on the adequacy of the cervical specimen collected.3 Inadequate specimens cannot be reliably assessed, require repeat testing, delay diagnosis, and increase costs for both patients and health services.4,5 South African National guidelines specify a minimum screening specimen adequacy rate of 70%.3 However, evidence suggests variation amongst primary healthcare facilities in Johannesburg Health District in consistently meeting these standards. Whether facility-level factors may explain this variation has not been determined. This study aims to assess cervical smear adequacy and associated facility-level factors at Johannesburg primary healthcare facilities for 2025.
METHODS:
A cross sectional study with an analytical component will be conducted using routinely collected aggregated cervical cytology data for January to December 2025. Monthly smear adequacy rates will be described for all primary healthcare facilities and sub-districts in Johannesburg Health District. Facilities will be categorised as high performing (≥70% adequacy) or low performing (<70%). A stratified random sample of 30 facilities (15 high and 15 low) will then be selected for a structured facility survey assessing key facility-level factors in five domains, including staffing, training, supervision and quality assurance, equipment availability, and workflow processes. Composite domain scores will be generated, and logistic regression will be used to assess for associations between facility-level domains and smear adequacy.
RESULTS:
The study will describe smear adequacy profiles across Johannesburg Health District. The proportion of facilities meeting national adequacy targets will be reported, as well as differences in facility-level domains between high and low performing facilities and the facility-level factors associated with smear adequacy.
CONCLUSIONS:
Findings on the modifiable facility-level factors associated with smear adequacy will inform targeted quality improvement strategies to improve cervical screening adequacy.
Cervical screening is an essential tool for cervical cancer prevention.1-3 The accuracy of cervical screening tests depends on the adequacy of the cervical specimen collected.3 Inadequate specimens cannot be reliably assessed, require repeat testing, delay diagnosis, and increase costs for both patients and health services.4,5 South African National guidelines specify a minimum screening specimen adequacy rate of 70%.3 However, evidence suggests variation amongst primary healthcare facilities in Johannesburg Health District in consistently meeting these standards. Whether facility-level factors may explain this variation has not been determined. This study aims to assess cervical smear adequacy and associated facility-level factors at Johannesburg primary healthcare facilities for 2025.
METHODS:
A cross sectional study with an analytical component will be conducted using routinely collected aggregated cervical cytology data for January to December 2025. Monthly smear adequacy rates will be described for all primary healthcare facilities and sub-districts in Johannesburg Health District. Facilities will be categorised as high performing (≥70% adequacy) or low performing (<70%). A stratified random sample of 30 facilities (15 high and 15 low) will then be selected for a structured facility survey assessing key facility-level factors in five domains, including staffing, training, supervision and quality assurance, equipment availability, and workflow processes. Composite domain scores will be generated, and logistic regression will be used to assess for associations between facility-level domains and smear adequacy.
RESULTS:
The study will describe smear adequacy profiles across Johannesburg Health District. The proportion of facilities meeting national adequacy targets will be reported, as well as differences in facility-level domains between high and low performing facilities and the facility-level factors associated with smear adequacy.
CONCLUSIONS:
Findings on the modifiable facility-level factors associated with smear adequacy will inform targeted quality improvement strategies to improve cervical screening adequacy.
| eISSN: | 2654-1459 |
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