Effectiveness of a Community-Based Cervical Cancer Stigma Reduction Intervention on Cancer Stigma and Cervical Cancer Screening Uptake in Nepal: A Cluster-Randomized Controlled Trial
- 1Kathmandu University School of Medical Sciences
Abstract
Cancer stigma contributes to low cervical cancer screening rates among Nepali women. However, no stigma reduction interventions have been implemented thus far in Nepal. This study assessed the effectiveness of a muticomponent cervical cancer stigma reduction intervention on cancer stigma scores and cervical cancer screening uptake rates among urban Nepali women.
A two-arm, parallel cluster-randomized trial was conducted in Budanilkantha Municipality, Kathmandu District, Nepal. Twelve administrative wards were randomized in a 1:1 ratio to the intervention or control group, with wards serving as the unit of randomization and individual women as the unit of analysis. A total of 310 women aged 30-60 years who had not undergone cervical cancer screening during the previous five years were enrolled. The three-hour intervention included cervical cancer education, a video featuring cervical cancer survivors, participatory group discussions, and myth-versus-fact activities addressing cancer stigma. Cancer stigma was assessed two months after the intervention using the Nepali version of the Cancer Stigma Scale. Cervical cancer screening uptake was assessed six months after the intervention. Data were analyzed using intent-to-treat and as treated approaches with a generalized estimation equation with logistic regression.
From June 2022 to February 2023, 310 women were enrolled. At 2 months, stigma data were available for 248 participants (120 intervention, 128 control). In the intention-to-treat analysis, the odds of cancer stigma were lower in the intervention group than in the control group (OR 0.25, 95% CI 0.08 to 0.8; p=0.022). Odds were also lower for the severity domain (OR 0.31, 95% CI 0.10 to 0.90; p=0.048) and awkwardness domain (OR 0.21, 95% CI 0.08 to 0.56; p=0.001) with no differences in other subdomains. At 6 months, the odds of cervical cancer screening was 3.9 times greater in the intervention group than in the control group (95% CI: 1.1- 13.20, p=0.028). As treated analysis reinforced these findings, with lower odds of stigma (AOR:0.09, 95% CI: 0.01-0.53, p=0.007), severity (AOR:0.16, 95% CI: 0.06-0.42, p<0.001), and awkwardness (AOR:0.1, 95% CI: 0.02-0.44, p=0.02). Cervical cancer screening odds was 4.02 times higher in the intervention group (95% CI:1.1-13.7, p=0.026).
Compared with the control condition, participants allocated to a community-based multicomponent intervention designed to reduce cancer stigma had lower odds of elevated cancer stigma two months after the intervention and higher odds of cervical cancer screening by six months. Larger cluster-randomized trials with more clusters and longer follow-up are needed to assess the reproducibility, durability, and generalizability of these findings.
Trial Registration: ClinicalTrials.gov, NCT05489978.
Related
- Blood Biomarkers of Alzheimer's Disease Neuropathology, Cognition, and Response to a Multidomain Lifestyle Intervention: Secondary analysis of the FINGER Randomized Controlled Dementia Risk Reduction Trial
- Participant Characteristics Associated With Loneliness Reduction During a Digital Social Robot Intervention Among Older Adults Living Alone in Japan: Secondary Analysis of a Randomized Controlled Trial
- mHealth-based lifestyle intervention for hypertension in community-dwelling adults: a cluster-randomized controlled trial with exploratory multi-omics analyses
- Pilot Feasibility Study of a Community Health Worker-delivered Tobacco Cessation Intervention During Pregnancy: The Smoke-Free HOPE Randomized Controlled Trial
- The effectiveness of a therapeutically applied Dungeons and Dragons group intervention in a community mental health setting – Protocol for a randomised controlled trial.
BibTeX
@misc{timsina2026effectiveness,
title = {{Effectiveness of a Community-Based Cervical Cancer Stigma Reduction Intervention on Cancer Stigma and Cervical Cancer Screening Uptake in Nepal: A Cluster-Randomized Controlled Trial}},
author = {P. Timsina and B. Paneru and M. Shrestha and A. Ghemosu and S. Lee and L. Poudel and Y. S. Ranjit and D. Spiegelman and S. S. Sheth and A. Stangl and A. Shrestha},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.24.26363856},
url = {https://www.medrxiv.org/content/10.64898/2026.09.24.26363856v1},
note = {CC0},
}
RIS
TY - UNPB
TI - Effectiveness of a Community-Based Cervical Cancer Stigma Reduction Intervention on Cancer Stigma and Cervical Cancer Screening Uptake in Nepal: A Cluster-Randomized Controlled Trial
AU - P. Timsina
AU - B. Paneru
AU - M. Shrestha
AU - A. Ghemosu
AU - S. Lee
AU - L. Poudel
AU - Y. S. Ranjit
AU - D. Spiegelman
AU - S. S. Sheth
AU - A. Stangl
AU - A. Shrestha
PY - 2026
DA - 2026/09/24
PB - medRxiv
DO - 10.64898/2026.09.24.26363856
UR - https://www.medrxiv.org/content/10.64898/2026.09.24.26363856v1
AB - Cancer stigma contributes to low cervical cancer screening rates among Nepali women. However, no stigma reduction interventions have been implemented thus far in Nepal. This study assessed the effectiveness of a muticomponent cervical cancer stigma reduction intervention on cancer stigma scores and cervical cancer screening uptake rates among urban Nepali women. A two-arm, parallel cluster-randomized trial was conducted in Budanilkantha Municipality, Kathmandu District, Nepal. Twelve administrative wards were randomized in a 1:1 ratio to the intervention or control group, with wards serving as the unit of randomization and individual women as the unit of analysis. A total of 310 women aged 30-60 years who had not undergone cervical cancer screening during the previous five years were enrolled. The three-hour intervention included cervical cancer education, a video featuring cervical cancer survivors, participatory group discussions, and myth-versus-fact activities addressing cancer stigma. Cancer stigma was assessed two months after the intervention using the Nepali version of the Cancer Stigma Scale. Cervical cancer screening uptake was assessed six months after the intervention. Data were analyzed using intent-to-treat and as treated approaches with a generalized estimation equation with logistic regression. From June 2022 to February 2023, 310 women were enrolled. At 2 months, stigma data were available for 248 participants (120 intervention, 128 control). In the intention-to-treat analysis, the odds of cancer stigma were lower in the intervention group than in the control group (OR 0.25, 95% CI 0.08 to 0.8; p=0.022). Odds were also lower for the severity domain (OR 0.31, 95% CI 0.10 to 0.90; p=0.048) and awkwardness domain (OR 0.21, 95% CI 0.08 to 0.56; p=0.001) with no differences in other subdomains. At 6 months, the odds of cervical cancer screening was 3.9 times greater in the intervention group than in the control group (95% CI: 1.1- 13.20, p=0.028). As treated analysis reinforced these findings, with lower odds of stigma (AOR:0.09, 95% CI: 0.01-0.53, p=0.007), severity (AOR:0.16, 95% CI: 0.06-0.42, p<0.001), and awkwardness (AOR:0.1, 95% CI: 0.02-0.44, p=0.02). Cervical cancer screening odds was 4.02 times higher in the intervention group (95% CI:1.1-13.7, p=0.026). Compared with the control condition, participants allocated to a community-based multicomponent intervention designed to reduce cancer stigma had lower odds of elevated cancer stigma two months after the intervention and higher odds of cervical cancer screening by six months. Larger cluster-randomized trials with more clusters and longer follow-up are needed to assess the reproducibility, durability, and generalizability of these findings. Trial Registration: ClinicalTrials.gov, NCT05489978.
ER -