Community-based intervention for cervical cancer screening uptake in nepal: a cluster randomized controlled trial (cobin-c)



To evaluate the effect of FCHVs led community based educational intervention through home visits for increasing cervical cancer screening uptake.

Specific Objectives:

  • To estimate the screening rate of cervical cancer in semi-urban area of Pokhara Metropolitan (Former Lekhnath Municipality)
  • To assess the knowledge attitude and cervical cancer screening practice among women
  • To test whether FCHV led community-based intervention increase cervical cancer screening uptake in semi-urban area of Pokhara Metropolitan (Former Lekhnath Municipality)
  • To compare the level of knowledge among FCHVs on cervical cancer screening and prevention before and after the training



A community-based, open-label, two-armed, cluster-randomized trial [seven clusters (geographical wards) randomized for the intervention, and seven for the control arm]. The participants are recruited from a population-based survey with a sample size of 884. Based on population proportion size, 277 women will be recruited for the intervention group and 413 women recruited for the control group. A 12-month community-based health education intervention will be administered mobilizing the FCHVs, based on the Health Belief Model. The primary outcome measure of the study will be the difference in percentage of cervical cancer screening uptake between the two study arms. The primary outcomes will be modeled by using mixed-effect logistic regression analysis.


After randomization, the FCHVs in intervention wards received training, health education materials and a recording register. After receiving training, they provided education to women of their respective ward on cervical cancer screening and prevention through home visits and maintained records in their service register. They conducted two reinforcement visits in one-year intervention period where they talked about cervical cancer screening and prevention providing information and encouraging the target group regarding uptake of freely available VIA screening at the local health facility. 

The health workers conducting screening at the local health facility in the intervention group received orientation about the study to ensure that women referred by FCHVs receives VIA screening. They recorded information, provided psychosocial counselling to the case positives and referred for further confirmation and treatment to the referral centre. 


Ethical approval is obtained from Nepal Health Research Council. Written consent will be received from the participants prior to data collection. 



Prevalence, knowledge, attitude and cervical cancer screening practices will be measured in baseline survey. The primary outcome is the increase of women participation in the cervical cancer-screening program and the difference in knowledge and awareness level will be measured as secondary outcomes.



The PhD timeline is Sep 1, 2018 to August 31, 2021



The COBIN-C study is the first investigation of a community-based intervention to increase cervical cancer screening uptake in Nepal. We expect that a community-based, culturally tailored education intervention delivered by community health workers such as FCHVs will play a key role in increasing cervical cancer screening uptake in the study area. Indeed, community health workers can play an important role in understanding the cultural barriers including community health practices, cultural identity, and coping practices that can promote positive health outcomes.

In our study, FCHV in the intervention group will make three home visits to educate and empower women for cervical cancer screening uptake that is available free of cost at the local health facilities. 

The health promotion package is a simple, feasible, and potentially effective approach. It may contribute in the implementation of the National Cervical Cancer Screening and Prevention policy and help reduce cervical cancer mortality in the long term in Nepal and if successful may be adapted to similar settings elsewhere.