Background
Cervical cancer remains a major public health concern in Nigeria, where screening uptake remains persistently low. Women’s perceptions, awareness, and health system challenges within primary health care (PHC) settings, significantly influence screening behaviors and service delivery. Understanding these factors is essential for developing context-appropriate implementation strategies that strengthen cervical cancer prevention.
Objectives: To explore perceptions, awareness, barriers to cervical cancer screening (CCS) among women attending PHCs and health care workers in PHCs, and to identify feasible implementation strategies to improve CCS uptake in PHC settings in Nigeria.
Methods: A qualitative study was conducted between September and November 2024 across six PHC facilities in the Federal Capital Territory, Nasarawa and Rivers States in Nigeria. Seventy in-depth interviews were conducted with 20 PHC providers (doctors, nurses, and community health extension workers) and 50 women aged 25–65. Participants were purposively selected to ensure representation of key stakeholder groups with relevant knowledge and experience of women’s health and service delivery. Interviews were conducted in English and local languages using interview guides structured using the Health Belief Model (HBM). Data were transcribed, translated into English and thematically analyzed using an iterative, inductive-deductive approach. Themes were synthesized around perceptions, awareness, barriers, and implementation strategies.
Results: Perceived susceptibility to and severity of cervical cancer and screening reflected knowledge gaps and misconceptions shaped by cultural beliefs, fear, stigma and experiences of cancer-related deaths. Awareness of CCS and its perceived benefits was generally low, with few women reporting previous screening experience.
Perceived barriers were multidimensional. Health system barriers included inadequate equipment and infrastructure, long waiting times, insufficient trained staff, heavy workloads and distance to facilities. Individual barriers comprised financial constraints, transportation challenges, cost of screening, privacy concerns and fear. Sociocultural barriers included spousal approval, preference for female providers, and reliance on traditional remedies. 
Spousal approval and community sensitization emerged as important cues to action, while self-efficacy was enhanced through counselling, trust in providers and facility readiness.
To address these barriers, participants recommended implementation strategies such as targeted awareness campaigns, subsidized screening, community outreaches, engagement of local leaders, health worker capacity building, provision of incentives and transport support, improved infrastructure and integration of screening into routine PHC services.
Conclusions / Implications for practice or policy
Women’s and health workers’ perspectives highlight critical gaps in awareness, perceptions, and service delivery that limit the effectiveness of cervical cancer screening within PHC settings. Strengthening community engagement, workforce capacity, and financial support could substantially improve screening uptake, with implications for cervical cancer prevention in low- and middle-income countries