Preventing cervical cancer in rural India

Two Ryerson University researchers from the Daphne Cockwell School of Nursing will test a new strategy for preventing cervical cancer in India after securing a $250,000 grant from the Fund for Innovation and Transformation (FIT). In collaboration with Amrita University in India and Dr. Aisha Lofters from Women’s College Hospital in Toronto, professors Mandana Vahabi and Josephine P. Wong will introduce a self-sampling method for the human papilloma virus (HPV), which is the primary cause of cervical cancer.

By providing self-sampling kits that women can take home and use in private, the researchers aim to detect HPV and cervical cancer at an early stage, and to arrange treatment for those who test positive. This will help to decrease the high cervical cancer mortality rates that women face in rural areas of India. As HPV is sexually transmitted, the program will be supported by a sexual health education campaign that is culturally appropriate and empowering.

Professors Vahabi and Wong identified the need for HPV screening in rural India during previous studies with Indian immigrant women in Canada. Take-up of the traditional Papanicolaou (Pap) test is low in these areas because of stigma, cost and poor access to doctors.

“Cervical cancer is the second leading cause of death among women in India, particularly younger women aged 15 to 44,” said professor Vahabi. “Because women in rural areas often don’t have access to the Pap test and so aren’t screened for HPV, by the time they are being diagnosed with cervical cancer, it is at the later stage of the disease.”

Addressing sexual health literacy with storytelling

The 15-month project will take place in 10 villages in the northern states of Bihar and Uttarakhand. The participants who are found to be HPV positive after the self-sampling will have medical follow-up Pap tests. Cervical cancer treatment will be arranged by the team’s Indian partners.

To improve sexual health literacy, the Ryerson team will use a novel storytelling approach, employing graphic novels, community theatre plays, and testimonials by service providers and health professionals to provide women with information about HPV and cervical cancer. According to the researchers, storytelling is a well-established and well-accepted means of cultural learning and empowerment in India.

Infographics and illustrations will help women learn how to use the self-sampling kits. Gender-specific information sessions will also be arranged, with a total of 150 women and 150 supportive men involved in the project as a whole. The researchers hope their strategy will promote a collective commitment to family-centred wellness that includes supporting women to make healthful, personalized cervical screening decisions.

“Because HPV is sexually transmitted, there is a lot of stigma with it and that makes it very difficult for people to talk about,” said professor Wong. “The impact of this research project could be on multiple levels. We’re talking about saving the lives of women, but we’re not only there to screen people. We’re also there to promote health literacy and caring communities.”

Conducting research with impact

With the help of a local research team, the Ryerson professors will collect data to document the impact of the project and understand women’s screening preferences. Data collection techniques will include one-on-one survey interviews before and after the sexual health education sessions, surveys on self-sampling intention, the gathering of self-sampling results, and the facilitation of focus groups after the intervention.

“This innovative research project has the power to change lives and to make a lasting impact on the communities in which it will take place,” said Steven N. Liss, vice-president, research and innovation at Ryerson. “The area of health and well-being is one of Ryerson’s core research strengths, and this project highlights how our researchers work collaboratively with community partners to address crucial real-world issues across the globe.”

Insights and lessons learned from the project will be used to inform the adaptation and scale-up of HPV self-sampling among women across India and in other countries.

FIT is a new program of the Inter-Council Network, a coalition of Canada’s eight Provincial and Regional Councils for International Cooperation. In its first round of funding, FIT selected eight small- and medium-sized organizations in Canada, including Ryerson, to receive support for innovative research projects.