User-Centered Design of Strategies for Improving Cervical Cancer Screening Literacy Among Rural Women Living with HIV in Eastern Uganda

Background: The uptake of cervical cancer screening services among rural Women Living with HIV (WLHIV) attending several rural public facilities in Eastern Uganda is low at less than 50% of the target. This gap is largely influenced by low screening literacy among these women, difficulties in accessing, understanding and applying cervical cancer screening information due to multiple barriers, including limited education, low socioeconomic status, misconceptions, and fear. Therefore, context-specific and culturally appropriate strategies are needed to overcome these barriers. This study engaged rural WLHIV in Eastern Uganda to co-design three strategies to improve their cervical cancer screening literacy. Methods: This participatory research combined the User-Centered Design (UCD) approach with co-design workshops to design the three strategies. Participants included 16 rural WLHIV from four rural public health facilities in Mayuge and Namayingo districts who had participated in prior studies that identified and selected these strategies. This process involved the ideation and implementation phases of the UCD approach. It was led by a medical illustrator and a Sexual and a Behavioral Change Communication specialist, supported by two healthcare providers. Results: Two IEC charts, one on the importance of cervical cancer screening and the other addressing key misconceptions regarding cervical cancer screening. Both IEC charts had colorful pictures, and few texts in local language, Luganda, explaining the pictures. Two peer educators were trained to provide cervical cancer screening education, address misconceptions about cervical cancer screening, and encourage women to undergo cervical cancer screening. A ten-minute cervical cancer screening education video was designed, comprising a midwife providing cervical cancer screening education and a trained peer educator interacting with a client. Conclusion: Integrating co-design and UCD approaches facilitated the design of context-specific strategies that incorporated preferences for rural WLHIV and targeted barriers to cervical cancer-screening literacy among these women.