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K. Kumaravel
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Designing for Continuity in Cervical Cancer Screening Pathways
A Mixed-Methods Socio-Technical Study in Low-Resource Settings
Master thesis
(2026)
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K. Kumaravel, P.B.M. Vandekerckhove, V.E. Scholten, H. Torkamaan, Marlieke de Fouw
Cervical cancer remains a major cause of cancer-related morbidity and mortality among women in low- and middle-income countries, despite being largely preventable through HPV vaccination, screening, timely follow-up, and treatment. While substantial attention has been given to increasing screening uptake, screening alone does not guarantee prevention. Women must also receive their results, understand their meaning, attend follow-up, and remain connected to appropriate care.
This thesis investigates continuity within cervical cancer screening pathways in Uganda and Bangladesh using a sequential explanatory mixed-methods design. Quantitative programme data were analysed through funnel analysis to identify where documented continuity loss occurred across screening and HPV-positive follow-up stages. Qualitative interviews with women, healthcare workers, programme stakeholders, and experts were analysed thematically to explain behavioural, social, organisational, and technological factors influencing continuity.
The findings show that continuity loss was concentrated after HPV-positive results, particularly at follow-up and management-action stages. Qualitative findings identified six themes shaping continuity: health literacy and awareness, fear and emotional barriers, family and social influence, practical access barriers, communication and trust, and continuity support mechanisms. The thesis argues that continuity should not be understood only as an individual behavioural outcome, but as a socio-technical capability produced through interactions between women, families, communities, healthcare workers, programme routines, information systems, communication practices, and technologies.
The study contributes to cervical cancer screening research, continuity of care literature, and Management of Technology by reframing pathway completion as a socio-technical system capability. It also proposes a Continuity Companion Ecosystem as an evidence-informed intervention concept combining human support, community engagement, trusted communication, follow-up tracking, and context-appropriate digital support. ...
This thesis investigates continuity within cervical cancer screening pathways in Uganda and Bangladesh using a sequential explanatory mixed-methods design. Quantitative programme data were analysed through funnel analysis to identify where documented continuity loss occurred across screening and HPV-positive follow-up stages. Qualitative interviews with women, healthcare workers, programme stakeholders, and experts were analysed thematically to explain behavioural, social, organisational, and technological factors influencing continuity.
The findings show that continuity loss was concentrated after HPV-positive results, particularly at follow-up and management-action stages. Qualitative findings identified six themes shaping continuity: health literacy and awareness, fear and emotional barriers, family and social influence, practical access barriers, communication and trust, and continuity support mechanisms. The thesis argues that continuity should not be understood only as an individual behavioural outcome, but as a socio-technical capability produced through interactions between women, families, communities, healthcare workers, programme routines, information systems, communication practices, and technologies.
The study contributes to cervical cancer screening research, continuity of care literature, and Management of Technology by reframing pathway completion as a socio-technical system capability. It also proposes a Continuity Companion Ecosystem as an evidence-informed intervention concept combining human support, community engagement, trusted communication, follow-up tracking, and context-appropriate digital support. ...
Cervical cancer remains a major cause of cancer-related morbidity and mortality among women in low- and middle-income countries, despite being largely preventable through HPV vaccination, screening, timely follow-up, and treatment. While substantial attention has been given to increasing screening uptake, screening alone does not guarantee prevention. Women must also receive their results, understand their meaning, attend follow-up, and remain connected to appropriate care.
This thesis investigates continuity within cervical cancer screening pathways in Uganda and Bangladesh using a sequential explanatory mixed-methods design. Quantitative programme data were analysed through funnel analysis to identify where documented continuity loss occurred across screening and HPV-positive follow-up stages. Qualitative interviews with women, healthcare workers, programme stakeholders, and experts were analysed thematically to explain behavioural, social, organisational, and technological factors influencing continuity.
The findings show that continuity loss was concentrated after HPV-positive results, particularly at follow-up and management-action stages. Qualitative findings identified six themes shaping continuity: health literacy and awareness, fear and emotional barriers, family and social influence, practical access barriers, communication and trust, and continuity support mechanisms. The thesis argues that continuity should not be understood only as an individual behavioural outcome, but as a socio-technical capability produced through interactions between women, families, communities, healthcare workers, programme routines, information systems, communication practices, and technologies.
The study contributes to cervical cancer screening research, continuity of care literature, and Management of Technology by reframing pathway completion as a socio-technical system capability. It also proposes a Continuity Companion Ecosystem as an evidence-informed intervention concept combining human support, community engagement, trusted communication, follow-up tracking, and context-appropriate digital support.
This thesis investigates continuity within cervical cancer screening pathways in Uganda and Bangladesh using a sequential explanatory mixed-methods design. Quantitative programme data were analysed through funnel analysis to identify where documented continuity loss occurred across screening and HPV-positive follow-up stages. Qualitative interviews with women, healthcare workers, programme stakeholders, and experts were analysed thematically to explain behavioural, social, organisational, and technological factors influencing continuity.
The findings show that continuity loss was concentrated after HPV-positive results, particularly at follow-up and management-action stages. Qualitative findings identified six themes shaping continuity: health literacy and awareness, fear and emotional barriers, family and social influence, practical access barriers, communication and trust, and continuity support mechanisms. The thesis argues that continuity should not be understood only as an individual behavioural outcome, but as a socio-technical capability produced through interactions between women, families, communities, healthcare workers, programme routines, information systems, communication practices, and technologies.
The study contributes to cervical cancer screening research, continuity of care literature, and Management of Technology by reframing pathway completion as a socio-technical system capability. It also proposes a Continuity Companion Ecosystem as an evidence-informed intervention concept combining human support, community engagement, trusted communication, follow-up tracking, and context-appropriate digital support.