Submitted:
26 August 2026
Posted:
27 August 2026
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Abstract
Introduction Guyana has one of the highest cervical cancer mortality rates in the Americas, and a national HPV DNA testing voucher programme substantially expanded screening in 2024–25. How that expansion is experienced in remote Indigenous communities, and what shapes prevention there, is poorly described. We compared how Indigenous women in two hinterland regions account for cervical cancer, screening, traditional medicine and care-seeking. Methods Comparative qualitative study using framework analysis of semi-structured interviews with 294 Indigenous women: 137 from 39 communities in Region 1 (Barima-Waini) and 157 from 41 communities in Region 9 (Upper Takutu-Upper Essequibo). The 41-item schedule covered eight domains, from knowledge and awareness to cost. Coding was deductive at domain level with inductive sub-coding of open-text responses, and framework matrices supported within- and cross-region comparison. Because the interviews were structured and answers were often brief, we do not claim thematic saturation. Results Reported screening differed sharply between regions (Region 1, 29.9%; Region 9, 72.6%), but women's explanations located the difference in services rather than in willingness. Region 1 women described screening as unavailable, irregular or unreachable; Region 9 women more often described missing an outreach visit that had taken place. Language was a structural barrier in Region 1, where 86.8% of women who spoke only an Indigenous language named it as an obstacle and only 5.3% had been screened. Knowledge and screening came apart in both directions: women were screened during outreach without prior knowledge, and women with knowledge went unscreened where no service existed. Traditional medicine was learned from mothers, grandmothers and elders rather than from specialist healers, and was used alongside biomedical care. Few women told clinicians about it (Region 1, 12.4%; Region 9, 31.2%), though many asked for plain explanations of ingredients, interactions and side effects. Fear that a neighbour working in the health post would talk, and fear of referral to Georgetown, shaped care-seeking. Conclusion In these communities, cervical cancer prevention depends less on educating women than on putting an acceptable service within reach, in a language women use, with confidentiality they can believe. Traditional medicine is better treated as a subject for routine, non-judgemental clinical enquiry than as competition.
Keywords:
cervical cancer
; qualitative research
; Indigenous health
; traditional medicine
; health services accessibility
; Guyana
Key Messages
What is already known on this topic
- Cervical cancer mortality in Guyana is among the highest in the Americas, and Indigenous women in low-resource settings consistently report distance, cost, fear, embarrassment and discordant communication as barriers to screening.
- Traditional medicine is widely used alongside biomedical care, and most users do not tell their clinicians.
What this study adds
- Two Indigenous regions of the same country, screened under the same national programme, produced opposite explanations for non-screening: an absent service in Region 1 and a missed outreach visit in Region 9.
- Monolingual Indigenous-language speakers in Region 1 were almost entirely unscreened, and described language as bound up with the prospect of referral to the capital rather than as a communication problem alone.
- Women’s objections to combining traditional and biomedical treatment were pharmacological and practical — dose, strength, interactions — not a rejection of biomedical care.
How this study might affect research, practice or policy
- Demand-generation activities in Region 1 are unlikely to raise uptake unless screening capacity is placed in or near communities first.
- Routine, non-judgemental enquiry about traditional remedies, paired with specific answers about interactions and side effects, is a realistic response to the disclosure gap.
- Confidentiality needs designing into services in small communities, not asserting.
Introduction
Cervical cancer is preventable, and the global elimination strategy sets out how: vaccinate girls, screen women with a high-performance test, and treat what is found.1 Where those three things are hard to reach, mortality persists. Guyana is such a place. Cervical cancer is the second leading cause of cancer death among Guyanese women, with a mortality rate of 30.3 per 100 000 in 2022.2 Rates across Latin America and the Caribbean vary several-fold between countries, and the variation tracks access to screening more closely than it tracks differences in risk behaviour.3
Guyana has moved quickly in recent years. HPV DNA testing was introduced through a universal voucher system, and 20 853 women were screened during 2024 and 2025; HPV vaccination coverage among girls aged 9–15 years is estimated at around 70%, and the country switched to the nonavalent vaccine in 2025.2 National figures of this kind, however, say little about the hinterland. Roughly nine-tenths of Guyana’s population lives on the coast; the interior regions are reached by river, light aircraft or unpaved road, and Indigenous communities there differ from one another in language, livelihood and their history of contact with the formal health system.
The qualitative literature on Indigenous women and cervical screening is reasonably consistent across settings. Reviews describe embarrassment and fear of the examination, fatalism about cancer, a shortage of female providers, the burden of travelling for care, and the effects of colonial history on trust in health services.4 5 What that literature less often provides is a within-country comparison: two Indigenous populations, one national programme, and an account of why uptake diverges. Guyana’s Regions 1 and 9 offer exactly that contrast. Both are remote and predominantly Indigenous. They differ in language profile, in the density of health infrastructure, and — as our data show — in what women say when asked why they have not been screened.
We set out to describe, comparatively, how Indigenous women in Regions 1 and 9 talk about cervical cancer and screening, how they learn and use traditional medicine, what they think about combining traditional and biomedical treatment, and what they say makes care reachable or unreachable.
Methods
Design
This was a comparative qualitative study using the framework method, chosen because it accommodates a predefined topic structure while leaving room for themes to emerge from open-text responses, and because it supports systematic comparison across cases through matrix charting.6 Our material was a corpus of structured interviews rather than a set of long-form qualitative interviews. That shaped what we could do with it: we could compare recurring meanings across many women and communities, but we could not probe, follow up or return to participants, and we make no claim to theoretical saturation. We report on the study in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ), noting where the available documentation does not allow an item to be addressed.7
Setting and Participants
Region 1 (Barima-Waini) lies in Guyana’s north-west, bordering Venezuela; Region 9 (Upper Takutu-Upper Essequibo) covers the Rupununi savannah in the south, bordering Brazil. Both are administrative regions with dispersed Indigenous communities served by health posts, health centres and periodic outreach.
We analysed interviews with 294 women: 137 from 39 communities in Region 1 and 157 from 41 communities in Region 9. Age distributions were similar (Region 1: mean 33.3 years, median 30, range 18–65; Region 9: mean 32.1 years, median 30, range 19–65), with about two-thirds of women in each region aged 18–34 years. Educational and language profiles differed considerably (Table 1). Participants were recruited from the selected Indigenous communities in Regions 1 and 9. The sampling approach considered the population size of each community, with approximately 10 eligible women selected from each participating community using simple random sampling from a community sampling frame. The sampling frame was based on registers maintained at the respective health posts/health centres and included women who accessed these facilities. Community health workers reviewed the available community registers and randomly selected eligible women for recruitment. Where initially identified HPV-positive women did not attend or were unavailable, other eligible women were selected from the sampling frame to maintain the intended recruitment approach. Women aged 18–65 years were eligible to participate. Community health workers who were trusted members of their respective communities contacted the selected women and invited them to attend the health post or health centre for an interview.
Across the study period, 410 women were approached for participation, of whom 116 declined and 294 completed the interview, resulting in a participation proportion of 71.7%. The reasons for non-participation were not systematically documented and therefore cannot be interpreted quantitatively. The recruitment process is reported transparently to allow readers to assess the potential for selection and non-participation bias.
The Health worker contacted 10 women to visit the health post/centre for interviews, the setting of interviews were in the health facility, closed/ private room, ages 18-65 yrs, sampling approach was simple random sampling from a community sampling frame This was done by checking the women population of each community and to select ten (10) women, initially they contacted HPV positive women but some didn’t show up, this selection was done from a register that they have comprised of all the women that visits the Health Post/Centre.
The dates of data collection were November 2025, February- May 2026, number approached were a total of 410 with a total of 116 declining, and the roles of the interview are trusted health workers of the community, training was done face to face for one day in November 2025, gender were male and female and community relationship of the interviewers are actually persons from the community that went for training and came back to serve their respective community.
Data Collection
Data collection was conducted in November 2025 and from February to May 2026. Interviews were conducted by trained male and female community health workers in closed, private rooms within health posts or health centres. The interviewers were members of the communities in which they served and were therefore familiar with the local social and cultural context. Before commencing data collection, interviewers received one day of face-to-face training in November 2025 on administration of the interview instrument and appropriate conduct of interviews. The interview schedule contained 41 questions across eight domains: demographics; knowledge and awareness; traditional medicine; access to modern care; integration of traditional and biomedical care; culture; barriers and facilitators; and cost and economics. The corpus contained 12 054 question-level responses, with a mean of approximately 40 of 41 items answered per woman. Question wording was taken verbatim from the transcripts.
Interview language(s) were carib, Wapishanna, Makushi and English, The Medex and Community Health care workers present at the health post/Centre were bilingual, verbal translation were done, the interviews were done via written transcription method, interview duration was a total of 30-45 mins, and Field notes were kept.
Analysis
Source formatting was inconsistent, particularly in the Region 1 documents, where respondent headings were unreliable. We therefore delimited records using the Question 1 marker, which recovered 137 Region 1 and 157 Region 9 complete records.
Coding was deductive at the level of the eight domains. Within domains, we developed inductive sub-codes after reading through the distribution of responses, then applied them systematically across the corpus. Closed responses were assigned to mutually exclusive categories; open-text responses were multi-coded where a single answer contained more than one idea. The final framework held eight parent nodes and 44 child nodes, and the coded evidence base comprised 3918 text segments, each linked to node, case identifier, community and source question (see online supplemental table S1).
We charted codes into framework matrices and compared them within and across regions. Frequencies appear in the results where they convey how widely shared or how unusual an account was; they are not offered as prevalence estimates for Indigenous women in Guyana. We paid deliberate attention to accounts that did not fit — women who used traditional medicine and screened readily, women with good knowledge who had never been screened — because these cases did most to shape our interpretation.
The parent study also generated cross-tabulations and χ2 tests. We report these in online supplemental table S3 for completeness but do not treat them as the evidentiary basis of this paper. Two of them illustrate why. Insurance appeared negatively associated with screening when regions were pooled, yet the association disappeared within Region 9 and reversed direction in Region 1; education appeared inversely related to screening at higher levels in Region 1, but the pattern was confounded by community and language. Pooling two regions with very different service environments produces associations that describe both region.
Reflexivity
Coding was carried out by a single analyst, so we did not assess inter-rater agreement and report no κ statistic. This is a real limitation, and we have tried to offset it by retaining the full framework and quote bank for audit. Where responses were brief, ambiguous or lacked context, we coded conservatively and avoided inferring meaning that the words did not carry. The research team recognised that researchers’ professional backgrounds, relationships with the study communities, and assumptions about Indigenous health and traditional medicine could influence both data collection and interpretation. Interviews were conducted by male and female community health workers who were trusted members of the respective communities. These interviewers were themselves from the communities in which they served and had received a one-day, face-to-face training in November 2025 before returning to their communities to conduct the interviews. Their established relationships and familiarity with local cultural contexts were considered important strengths for facilitating trust and communication around sensitive issues, including cervical cancer, reproductive health and traditional medicine.
At the same time, the research team recognised that familiarity between interviewers and participants could influence disclosure. Participants might have felt more comfortable speaking with trusted community health workers, but they might also have been reluctant to disclose sensitive or potentially stigmatising information to someone known within their community. Interviews were therefore conducted in closed, private rooms within health facilities to enhance privacy and confidentiality. The interviewers were trained to administer the study instrument consistently and to approach participants respectfully and without judgement.
The research team also recognised the potential influence of a biomedical and public-health perspective on the interpretation of traditional medicine. Traditional medicine did not treat a priori as an inferior or competing system of care. Instead, participants’ accounts were interpreted in relation to their own health-seeking practices and experiences, including circumstances in which traditional and biomedical approaches were viewed as complementary. The analysis deliberately retained divergent and potentially contradictory accounts, including positive and negative experiences of both forms of care, rather than imposing a predetermined interpretation.
Throughout the analysis, the team remained attentive to the possibility that researchers’ professional perspectives and the interviewers’ community positions could shape the data and its interpretation. Findings were therefore interpreted cautiously, with emphasis on recurring patterns across participants and communities rather than if individual accounts represented all Indigenous women in the study regions. This reflexive approach was intended to strengthen the credibility, cultural sensitivity and transparency of the analysis.
Patient and Public Involvement
The Indigenous community members, toshaos, village councils or the National Toshaos Council were contacted to give their consent to interview the women in their communities, but they were not involved in designing the instrument, The Medex/Community Health worker in the respective community was present and conducted the interviews, interpreting findings and planed dissemination; The results will be given to the Toshoas in each participating communities via the Amerindian Affairs.
Ethics
Consent to participate was obtained from each participant before the interview. This was separate from consent for publication; because the manuscript contains no identifiable participant information, consent for publication was not applicable.
Research approval was obtained by the Ministry of Health Institutional review board/committee reference number no.113/2025; and each village councils were contacted to give consent; the consent procedure were done both orally and verbally. Each woman was given a consent form to fill before the questions started for the interviewed, some were done in English while some were done in an Indigenous language. Each participant was given an ID code and written notes/forms were stored in locked cabinet.
Results
Table 2 summarises the regional contrasts that anchor the five themes below. Quotations are reproduced as transcribed, with respondent identifiers where available.
Screening Reads as a Supply Problem, Not a Motivation Problem
Reported screening differed sharply: 29.9% in Region 1 and 72.6% in Region 9. The explanations women gave for not screening differed just as sharply, and not along the lines of willingness. Region 1 women described a service that was not there.
“no screening is not done every day at the hospital.”(R1-123)
“no, service not offered regularly.”(R1-083)
“That is no Person offering the screening at the hospital”(R1-085)
“No, Service is not offered in Baramita area”(Region 1 respondent)
“far away from the outreach”(R1-058)
Region 9 women described a service that had come and gone without them.
“Didn’t get to screen, was working in another area when the outreach occured”(R9-053)
“I Don’t be around when the health workers come”(R9-039)
“Because I didn’t get to attend the outreach program”(R9-038)
Fear appeared in Region 9 too, but as a residual rather than a dominant explanation: “Never had one, I was afraid” (R9-023). Service unavailability was the largest single category of stated barriers in Region 1; missed outreach and fear were the largest in Region 9.
The community-level data make the same point more bluntly. Screening in Region 1 ranged from 0% in several communities, including Wallaba, Log Hill, Barama Line and Cassie Creek, to 80% in Hosororo and 71.4% in Kamwatta (online supplemental table S2). Motivation is unlikely to vary that much between neighbouring villages. Service reach does.
Language Is a Structural Barrier, Not a Literacy Problem
The two regions had almost inverted language profiles. Region 9 had 53 women who spoke English and an Indigenous language; Region 1 had one. Region 1 had 38 women who spoke only an Indigenous language, Region 9 had 28.
Among Region 1’s monolingual Indigenous-language speakers, 86.8% named language as a barrier, against 7.1% of the equivalent group in Region 9. Screening in that Region 1 group was 5.3%, compared with 39.8% among women who spoke English or Creolese. It is the widest gap in our data.
What women said about language, though, was rarely about the consultation itself.
“language barrier, fear of going to Georgetown if they are unable to treated here.”(R1-106)
“lack of medicine, language barrier, fear of being sent to Georgetown is more expensive etc.”(R1-104)
Language sat inside a chain of anticipated consequences: not being understood locally, being sent onward, arriving in a city where the cost and unfamiliarity would be borne alone. Treating it as a health literacy deficit misses what the women are describing, which is a system they cannot navigate.
Knowledge and Screening Come Apart in Both Directions
Some substantive knowledge of cervical cancer was recorded for 48.9% of Region 1 women and 42.0% of Region 9 women — that is, slightly more in the region with far less screening. Causal understanding was rare everywhere: across all 294 interviews, 12 women linked cervical cancer to a transmissible virus.
“Cervical cancer is a common virus passed through sexual contact, and it develops in the cell of the cervix”(Region 9 respondent)
“Cancer that hurts and damages your inside, move from one place to another”(Region 9 respondent)
“It causes bleeding (heavy), pains to pelvic”(Region 1 respondent)
Health workers and facilities were the leading information sources in both regions (37.2% and 42.7%). Schools mattered more in Region 1 (24.8% vs 5.1%), while a quarter of Region 9 women (25.5%) had either never heard of cervical cancer or could name no source at all.
That last figure sits alongside 72.6% screening coverage in the same region. Women were being screened during outreach without knowing much about what they were being screened for. In Region 1 the reverse held: knowledge without an available service produced no screening. Neither pattern supports an education-first model.
Traditional Medicine Is Family Knowledge, and It Goes Undisclosed
Traditional medicine use was reported by 77.7% of Region 9 women and 38.7% of Region 1 women. In both regions it was learned at home. Family, elders, mothers and grandmothers accounted for nearly all reported transmission; a specialist healer was named once, in Region 1 (Table 3).
“the community members are their own traditional healers”(R9-005)
“Not sure, the culture is dying”(R9-081)
“I never heard about bush doctors”(R9-038)
The pharmacopoeias were regionally distinct. Region 1 women named sweet broom, garlic, ginger and lemongrass; Region 9 women named Kaimbey bush or bark, bitters, neem and soursop, and more often referred to unnamed bush preparations (online supplemental table S4).
“Kaimbe bark - boil and drink in the morning, midday and afternoon, 3-6 weeks then decrease from 500ml to 200 ml”(R9-048)
“Sweetbroom bush use for weakness of the back/hemorrhage.”(R1-011)
“Combination of garlic, ginger, lemon when drink helps to regulate period.”(R1-023)
A small number of accounts described practices with potential for harm: several Region 9 women mentioned neem in connection with abortion or menstrual suppression, and one Region 1 woman described douching as infection prevention. We report these not to characterise traditional medicine as dangerous — the great majority of what women described was benign and used alongside clinic care — but because they are precisely the cases where a clinician would want to know.
Mostly, clinicians do not. Disclosure of traditional medicine use to a health worker was reported by 12.4% of Region 1 women and 31.2% of Region 9 women. Women were not, however, hostile to biomedical care: 82.5% and 66.9% respectively said they would choose modern care if costs were equal, and 66.4% and 51.0% described positive experiences of it.
What Women Want from Integration Is Information
Willingness to try a combined treatment plan (38.7% in Region 1, 56.1% in Region 9) exceeded the belief that the two systems can work together (26.3% and 19.1%). The reservations women voiced were specific and pharmacological.
“Yes. However not all. It might be too strong and weaken the body.”(R1-027)
“No - risk of overdose if combined”(R9-037)
“To know what these treatments are made up of, what side effects they can cause.”(R1-023)
“If the hospital explains things clearly”(R9-017)
“friendly & approachable health workers.”(R1-093)
These are answerable questions. Women were asking what is in a treatment, how strong it is, and what happens if it meets something else — the same questions a pharmacist field daily.
Confidentiality Is Structural in a Small Community
Cultural and reproductive-health beliefs were reported by many women (35.8% in Region 1, 55.4% in Region 9), and taboos around discussing cervical health by roughly a quarter in each. But few women gave these as their own reason for not attending. Confidentiality was different.
“Fear of health care worker spreading information about their illness throughout the community,”(R9-042)
“They are ashamed and afraid that workers of the health facilities, there is a lack of confidentiality”(R9-096)
“No - worried people will spread my business”(R9-021)
“Culture of being shy to male healthcare workers”(R1-082)
“Fear and shyness to open their legs”(R9-012)
In a village of a few hundred people the health worker is a neighbour, a cousin, someone’s mother. The risk women described was not a breach of professional standards in the abstract but being seen entering the health post at all. Requests for female providers appeared in both regions.
Distance and transport were the most coded access problems overall (54.0% in Region 1, 40.1% in Region 9), and cost entered mainly through them. Most women paid nothing for care itself; among those who did, median spending was GYD 4000 in Region 1 and GYD 5000 in Region 9. What women asked for was fare, a boat, a place to stay.
“money to travel & our place to stay in Georgetown while accessing better health care. - or provide buses/tractors, ATV with proper roads.”(R1-106)
“A complete health care package for all women to clear all expense.”(R1-082)
Asked how they would prefer to receive information, women in both regions chose community meetings and outreach (44.5% in Region 1, 57.3% in Region 9) and health workers (32.8% and 47.1%). Radio retained some reach in Region 1 (13.9%); internet and messaging were negligible in both.
Discussion
Two Indigenous regions of one small country, covered by the same national screening programme, produced opposite accounts of why women go unscreened. In Region 9 the service arrived and some women missed it. In Region 1 it largely did not arrive. The 43-percentage-point gap in reported screening is better read as a map of where the 2024–25 voucher programme reached than as a measure of two populations’ attitudes to prevention.2
That reading has a direct programmatic consequence. Demand-generation work in Region 1 — campaigns, education, encouragement — will meet an absent service and may spend the trust it needs. Where supply is the constraint, supply must move first. HPV testing on self-collected samples is the most obvious lever: self-sampling performs comparably to clinician collection for high-risk HPV detection with validated assays, and reliably raises participation among under-screened women.8 9 Reviews of women’s own preferences suggest it is generally acceptable, though preferences are context-dependent and worth establishing locally before scale-up.10 Self-collection is already under consideration nationally.2 Our data suggest a further reason to pursue it in Region 1: it shortens the encounter, reduces exposure to a male provider, and removes some of what women told us they dread.
Language was the sharpest inequity we found. A 5.3% screening rate among Region 1’s monolingual Indigenous-language speakers is not a communication inconvenience; it is near-total exclusion. And the women themselves framed language as inseparable from referral — from the prospect of being sent to Georgetown without the means to understand or afford what happens there. Training and deploying community health workers who speak the local languages, and delivering consent, results and follow-up in spoken form, will do more than translating printed materials. We note one point that requires the authors’ attention before submission: the language groups in Region 1 should be named accurately from the source records rather than assumed, since Barima-Waini includes Warrau, Carib and Arawak communities with different distributions.
The traditional medicine findings sit comfortably in a wider literature. Concurrent use of traditional and biomedical care is the norm rather than the exception in many settings, and disclosure to clinicians is consistently low — pooled at around a third for biologically based therapies, and lower still in several African studies, where non-disclosure runs from 55.8% to 100%.11 12 The reasons given elsewhere match ours almost exactly: clinicians do not ask, patients anticipate disapproval, and patients assume plant-based remedies are safe enough not to mention. Our 12.4% and 31.2% disclosure rates are therefore unremarkable internationally, which is the point — this is a solvable, generic clinical communication problem, not an Indigenous-specific one.
What our data adds is the shape of women’s questions. They asked about composition, strength, interaction and overdose. A clinician who opens with “are you taking any bush medicine, and can you tell me what’s in it?” is answering a question woman are already asking and is far more likely to hear about the neem than one who opens by advising against traditional remedies in general. The WHO Global Traditional Medicine Strategy 2025–2034 frames integration in similar terms — evidence, safety, regulation and respect for Indigenous knowledge — and this kind of routine, non-judgemental history-taking is the clinical end of that agenda.13
Confidentiality deserves to be treated as a design problem. Women were not asking to be reassured that staff behave professionally; they were describing the geometry of a small village, where attendance itself is visible. Private registration, results delivered without an audience, female providers where staffing allows, and consideration of staff rotation for sensitive services are structural answers. Self-collection, again, addresses part of it.
Finally, the pooled associations in our supplementary analysis are a caution worth stating. Insurance and education both appeared related to screening across the combined sample in ways that dissolved or reversed within regions. Where opportunity to be screened is determined largely by geography and programme reach, individual-level correlates will mislead.
Strengths and Limitations
The main strength is scope: 294 interviews across 80 communities in two contrasting regions, with a documented framework, a retained quote bank and deliberate attention to disconfirming cases.
The limitations are substantial and we would not want them read past. The material is structured interview data with short answers, not depth interviews or focus groups; we could not probe, and we do not claim saturation. Coding was done by one analyst without a second coder or reliability assessment. Rule-based classification of brief open-text answers will misclassify some idiosyncratic responses. Screening status was self-reported, and some women were unsure which test they had received. The sample was young — about two-thirds aged 18–34 — which limits what we can say about women in the age bands where cervical cancer risk is highest and where HPV-based screening is targeted. Recruitment and sampling are not documented in the material available to us, so we cannot rule out that facility-based recruitment inflated reported screening. The data are cross-sectional and support no causal claim. And the χ2 analyses reported in the supplement involve sparse cells in places and no correction for multiple comparisons; they are contextual, not confirmatory.
Our firmer conclusions are those resting on repeated accounts, regional contrast and convergence across domains, rather than on any single figure.
Conclusions
Women in Regions 1 and 9 did not describe cervical screening as something they were unwilling to do. They described it as something that was, or was not, available to them in a form they could reach, understand and trust. Region 1 needs the service brought closer and delivered in the languages women speak. Region 9, having achieved substantial coverage, needs repeat visits, better timing and attention to the women who were away or afraid. In both, traditional medicine is part of family life rather than a rival system, and the immediate clinical task is to make it safe to talk about.
The obvious next step is qualitative work that can go where structured interviews cannot: purposively sampled in-depth interviews and focus groups with women, traditional-knowledge holders and health workers, designed and interpreted with the communities involved. Longitudinal mixed-methods evaluation could then test whether community-based, language-responsive screening changes uptake, follow-up and safety over time.
Supplementary Materials
The following supporting information can be downloaded at the website of this paper posted on Preprints.org. Table S1, coding framework (8 parent nodes, 44 child nodes) with regional frequencies. Table S2, community-level screening. Table S3, cross-tabulations and χ2 tests from the parent analysis. Table S4, named remedies by region.
Author Contributions
Validum, S.A.D.: Conceptualization, Methodology, Data Curation, Formal Analysis, Writing - Original Draft, Writing - Review & Editing, Project Administration. Tomori, M.O.: Writing - Review & Editing, Analysis, Supervision. Adegoke, K,: Writing, Review & Editing, Analysis & Co-Supervision.
Funding
There was no specific grant for this research from any funding agency in the public, commercial or not-for-profit sector. It was self-funded by the main author.
Institutional Review Board Statement
This analysis relies on baseline data collected under the ethical approval already in place for the parent cohort study, which included review by the relevant Institutional Review Board of the Ministry of Health, reference no. 113/2025, and the establishment of Community Advisory Boards in participating Region 1 communities, in line with community-based participatory research protocols. All participants gave written informed consent before enrollment and data collection began.
Informed Consent Statement
Not applicable. The manuscript contains no identifiable individual participant information, photographs, case details or other material requiring consent for publication.
Data Availability Statement
The datasets analyzed in this study are not publicly available due to the ongoing nature of the parent cohort study and the terms of the community-based participatory research agreements with participating Region 1 and Region 9 communities, which restrict onward sharing of individual-level data. De-identified data may be made available by the corresponding author upon reasonable request and with permission from the relevant Community Advisory Boards.
Acknowledgments
I would like to acknowledge participating women, village councils and toshaos, all interviewers and health staff that contributed to this study.
Conflicts of Interest
None declared.
Provenance and peer review
Not commissioned; externally peer reviewed.
Use of Artificial Intelligence
Claude AI-assisted technology used in the preparation of the manuscript; it was used to compile background information and format for the study. Authors remain responsible for the entire content.
References
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- Pan American Health Organization. Strengthening Guyana’s cervical cancer prevention and control: PAHO/WHO and MD Anderson support national efforts. Georgetown: PAHO, 27 March 2026. Available: https://www.paho.org/en/news/27-3-2026-strengthening-guyanas-cervical-cancer-prevention-and-control-pahowho-and-md-anderson.
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- Validum SAD, Tomori MO. Knowledge, attitudes and practices related to cervical cancer screening and traditional medicine use among Indigenous women in Guyana’s Region 9: a baseline cross-sectional assessment. Texila Int J Acad Res 2026;13(2). [CrossRef]
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Table 1.
Characteristics of participating women, by region.
| Characteristic | Region 1 (n=137) | Region 9 (n=157) |
| Age 18–24 years | 31 (22.6%) | 39 (24.8%) |
| Age 25–34 years | 58 (42.3%) | 68 (43.3%) |
| Age 35–44 years | 24 (17.5%) | 25 (15.9%) |
| Age 45–54 years | 15 (10.9%) | 19 (12.1%) |
| Age 55+ years | 9 (6.6%) | 6 (3.8%) |
| No formal schooling | 25 (18.2%) | 0 (0.0%) |
| Primary education | 37 (27.0%) | 86 (54.8%) |
| Secondary education | 44 (32.1%) | 50 (31.8%) |
| Tertiary education | 18 (13.1%) | 17 (10.8%) |
| English/Creolese only | 98 (71.5%) | 72 (45.9%) |
| English + Indigenous language | 1 (0.7%) | 53 (33.8%) |
| Indigenous language only | 38 (27.7%) | 28 (17.8%) |
| Insurance/government access | 89 (65.0%) | 28 (17.8%) |
| Communities represented | 39 | 41 |
Table 2.
Key indicators by region.
| Indicator | Region 1 | Region 9 |
| Ever screened for cervical cancer | 29.9% | 72.6% |
| Screened by HPV test (among screened) | 51.2% | 66.7% |
| Screening dated to 2024–25 (among dated records) | 16/27 | 67/82 |
| Some substantive knowledge of cervical cancer | 48.9% | 42.0% |
| Traditional medicine used at least occasionally | 38.7% | 77.7% |
| Language reported as a barrier | 20.4% | 0.6% |
| Positive experience of modern treatment | 66.4% | 51.0% |
| Comfortable discussing women’s health with providers | 90.5% | 80.9% |
| Uses traditional and modern medicine together | 15.3% | 21.7% |
| Believes the two systems can work together | 26.3% | 19.1% |
| Willing to try a combined treatment plan | 38.7% | 56.1% |
| Discloses traditional medicine use to a clinician | 12.4% | 31.2% |
| Cultural beliefs around reproductive health reported | 35.8% | 55.4% |
| Taboos around discussing cervical health | 27.7% | 23.6% |
| Ever avoided care because of cost | 4.4% | 18.5% |
| Would choose modern care if costs were equal | 82.5% | 66.9% |
Table 3.
Reported source of traditional-medicine knowledge, by region.
| Source | Region 1 | Region 9 |
| Family (general) | 18.2% | 40.8% |
| Elders | 13.9% | 31.2% |
| Mother | 0.7% | 10.2% |
| Grandmother | 2.2% | 9.6% |
| Community/friends | 0.0% | 4.5% |
| Traditional healer | 0.7% | 0.0% |
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