Community-Based Cervical Cancer Screening in Rural Tanzania: Acceptance, Participation and Sociocultural Barriers in Lindi District

Abstract Background Cervical cancer remains a major public health challenge in Tanzania, where screening coverage is low and access to preventive services is uneven. This study evaluated the implementation and perceived significance of a community health programme (CHP) combining health education with on-site cervical cancer screening in rural Lindi District. Methods The CHP provided health education, nutritional counselling, cervical cancer awareness, gender-based violence training and cervical cancer screening using the VIA method by trained assistant nurse practitioners. Programme monitoring data from 2024 to July 2026 were analysed descriptively. A Swahili questionnaire was administered to literate participants from 11 villages between March and July 2026. Of 80 respondents, 79 valid questionnaires were analysed using descriptive statistics, chi-square tests and Cramér’s V. A participatory Most Significant Change approach supported the qualitative assessment. Results In 2024, 6,216 women and 690 men participated, and 2,097 women underwent screening. In 2025, 5,296 women participated and 1,747 attended screening. By July 2026, 3,737 women had participated and 716 had attended screening. Screening uptake declined from 45.2% in 2024 to 19.2% in 2026. Most respondents considered screening important (91.2%) and the information understandable (96.2%). However, 49.4% perceived screening as controversial, significantly associated with gender (p = 0.005; Cramér’s V = 0.404). Cultural or religious beliefs were barriers for 72.7%, and 96.1% feared negative community reactions. Conclusions The programme was positively perceived, but stigma, cultural and religious beliefs, gender norms and fear of social reactions limited uptake. Culturally sensitive communication, community involvement and confidential service delivery are needed.