Date of Conferral

1-8-2026

Date of Award

January 2026

Degree

Ph.D.

School

Health Sciences

Advisor

Harrison Ndetan

Abstract

Persistent high-risk human papillomavirus (HPV) infection causes cervical cancer. Age-related changes at the cervical squamocolumnar junction (SCJ) can compromise screening accuracy in older women, risking missed precancerous or invasive lesions. Informed by risk-based management and shared decision-making (SDM) frameworks, this study examined the relationship between age and SCJ visibility (controlling for parity, HIV status, reviewer, and study site) and explored experts’ and women’s perspectives on communicating SCJ visibility-related uncertainty and SDM. Contingency tables and logistic regression were used to analyze 5,992 cervical images from countries participating in the HPV-Automated Visual Evaluation (PAVE) Consortium. Qualitative thematic synthesis drew on 14 interviews with PAVE scientific experts and 4 focus group discussions with 25 women in the PAVE study, Ikire, Nigeria. Results were indicative of higher odds of nonvisible SCJ among women aged 30–34 (OR = 1.6, 95% CI [1.0, 2.5], p = .042); 35–39 (OR = 2.9, 95% CI [1.8, 4.6], p < .001); 40–44 (OR = 4.7, 95% CI [3.0, 7.4], p < .001); and 45–49 (OR = 6.8, 95% CI [4.3, 10.7], p < .001), compared with those aged 25–29. Experts described an ethical tension in disclosing SCJ visibility uncertainty—balancing respect for autonomy with perceived beneficence. Women reported navigating uncertainty through faith, trust in clinicians, and seeking reassurance. Respectful, transparent communication tailored to local norms and contexts can facilitate understanding of screening strategies and support women’s participation in cervical screening and SDM. Implementing these findings may strengthen cervical cancer screening programs as countries pursue cervical cancer elimination.

Download

Available for download on Friday, January 08, 2027

Included in

Public Health Commons

Share

 
COinS