Optimizing Global Cervical Cancer Control: Lessons From Nigerian Women on Communicating Inconclusive Screening Results From the HPV-Automated Evaluation (PAVE) Project in Ikire, Nigeria

PURPOSE In global efforts to control cervical cancer, screening programs in resource-limited settings (RLS) face numerous challenges, including clinical uncertainty from limited squamocolumnar junction (SCJ) visibility in older women, particularly those who had no vaginal delivery. This uncertainty can undermine screening effectiveness and follow-up. We explored how women in the Nigeria PAVE project perceive and respond to unclear screening results and their preferences for risk communication to inform culturally appropriate implementation strategies for HPV-based screening. METHODS We conducted four focus group discussions with 25 women from 7,966 women aged 25–49 years, who participated in the Ikire PAVE project. Participants were purposively selected by age and HPV status. Discussions were conducted in Yoruba, transcribed, translated into English, and analyzed using iterative, thematic coding to identify key patterns in their experiences and preferences. RESULTS Inconclusive cervical screening results caused strong emotional distress, including fear, anxiety, and anger in women. Participants' understanding of risk was shaped by emotional, spiritual, and experiential factors, describing risk as "sorrowful," "harmful," and linked to "death." Women expressed a strong desire for full, empathetic disclosure from clinicians, preferring visual aids, local analogies, and simple, clear language. While trust in doctors was high, with many deferring to their authority, some women expressed a desire for autonomy when given clear information and time for reflection. Family, peers, and older women were key influencers, acting as both sources of support and misinformation. CONCLUSION Women's responses to uncertain screening results were shaped by their sociocultural norms, where faith, trust, and community relationships are paramount. For global cervical cancer research and control programs to succeed in similar settings, implementation strategies should go beyond simple information to include transparent engagement. Screening programs should include clear communication strategies that acknowledge clinical limitations and leverage community and family support systems to foster informed, shared decision-making.