Exploring provider-perceived determinants of cervical pre-cancer treatment implementation at primary care level: a qualitative study in a health district in South Africa
1
Community Health, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
2
Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
3
Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
4
District Clinical Specialist Team, Johannesburg Health District, Johannesburg, South Africa
5
Obstetrics and Gynaecology, University of Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2995
ABSTRACT
BACKGROUND:
Cervical cancer is a leading cause of cancer-related mortality among South African women 1. Large Loop Excision of the Transformation Zone (LLETZ) is an evidence-based procedure with proven success in treating precancerous lesions (precancer) for cervical cancer prevention2,3. Currently, LLETZ services in Johannesburg health district are predominantly available at tertiary hospitals, creating significant access barriers and low precancer treatment coverage4,5. Providing LLETZ services at primary care level is proposed to overcome this implementation failure4. Evidence regarding potential barriers to successful LLETZ implementation at primary care level is lacking but crucial in the pre-implementation phase to inform targeted implementation support strategies. This study utilises the Consolidated Framework for Implementation for Research (CFIR) to explore stakeholder-perceived determinants of LLETZ implementation at primary care level in Johannesburg Health District.
METHODS:
A descriptive, qualitative exploratory study using semi-structured interviews with 32 purposively selected stakeholders: healthcare workers from primary care health facilities, gynaecologists and managers from three referral hospitals where LLETZ is provided, and women’s health programme administrators at sub-district, district and provincial levels. Data collection will utilise a CFIR-informed interview guide, with audio-recorded interviews transcribed verbatim. Thematic analysis using NVivo software will employ deductive and inductive coding approaches.
RESULTS:
The study is expected to be completed in July 2026. Findings will be reported as stakeholder-perceived barriers and facilitators of decentralised LLETZ implementation within each CFIR domain – specifically, determinants operating at the level of the LLETZ intervention, the individuals (stakeholders), the inner setting (district); the outer setting (provincial) and implementation processes.
CONCLUSIONS:
The study findings will identify determinants that may impede LLETZ implementation at primary care level. This evidence can be used to inform context-specific implementation strategies to address the identified barriers and enhance LLETZ implementation success at primary care level.
Cervical cancer is a leading cause of cancer-related mortality among South African women 1. Large Loop Excision of the Transformation Zone (LLETZ) is an evidence-based procedure with proven success in treating precancerous lesions (precancer) for cervical cancer prevention2,3. Currently, LLETZ services in Johannesburg health district are predominantly available at tertiary hospitals, creating significant access barriers and low precancer treatment coverage4,5. Providing LLETZ services at primary care level is proposed to overcome this implementation failure4. Evidence regarding potential barriers to successful LLETZ implementation at primary care level is lacking but crucial in the pre-implementation phase to inform targeted implementation support strategies. This study utilises the Consolidated Framework for Implementation for Research (CFIR) to explore stakeholder-perceived determinants of LLETZ implementation at primary care level in Johannesburg Health District.
METHODS:
A descriptive, qualitative exploratory study using semi-structured interviews with 32 purposively selected stakeholders: healthcare workers from primary care health facilities, gynaecologists and managers from three referral hospitals where LLETZ is provided, and women’s health programme administrators at sub-district, district and provincial levels. Data collection will utilise a CFIR-informed interview guide, with audio-recorded interviews transcribed verbatim. Thematic analysis using NVivo software will employ deductive and inductive coding approaches.
RESULTS:
The study is expected to be completed in July 2026. Findings will be reported as stakeholder-perceived barriers and facilitators of decentralised LLETZ implementation within each CFIR domain – specifically, determinants operating at the level of the LLETZ intervention, the individuals (stakeholders), the inner setting (district); the outer setting (provincial) and implementation processes.
CONCLUSIONS:
The study findings will identify determinants that may impede LLETZ implementation at primary care level. This evidence can be used to inform context-specific implementation strategies to address the identified barriers and enhance LLETZ implementation success at primary care level.
| eISSN: | 2654-1459 |
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