Scoping review The proposed scoping review will be conducted in accordance with Arksey and O’Malley’s (2005) scoping review framework. (24) indicates that the following steps should be undertaken when conducting scoping reviews: (a) identifying the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data and (e) collating, summarising and reporting the results. The review will also follow the steps and guidelines outlined in the PRISMA-Extension for Scoping Reviews (PRISMA-ScR) checklist (25) .
Identifying the research question
The proposed hypothesis for this review is: CC management needs improvement in SSA. The main research question is: What evidence is there on CC management in SSA? The sub research questions include:
- What is the usage/coverage of HPV vaccine in SSA?
- What are barriers to CC screening uptake in SSA?
- At what stage of CC are most diagnoses made?
- Which drugs are being used for chemotherapy in CC treatment in SSA?
- What is the status of radiotherapy in CC management in SSA?
The aim of this review is to map evidence on CC management in SSA. The objectives of the study are:
- To explore on the coverage/usage of HPV vaccine in SSA;
- To determine the barriers to CC screening uptake in SSA;
- To find out the stages at which most CC is diagnosed in SSA;
- To establish the status of radiotherapy in CC management in SSA and
- To determine the drugs that are being used in CC treatment.
Identifying relevant studies
An initial search was performed to determine whether a previous review addressing this topic in SSA was conducted or was in progress. There were no complete or in-process reviews focusing on the coverage of cervical cancer prevention and treatment services in SSA. Based on the review question, the search strategy was developed by identifying the key concepts using the PICO (Problem/Intervention/Comparison/Outcome) approach (26) and further developing the search strategy using controlled vocabulary such as MeSH (Medical Subject Headings) terms. Papers published on CC management will be reviewed for each of the following topics: CC prevention, detection (screening and diagnosis) and treatment. A healthcare librarian from the University of Zimbabwe was consulted for the search strategy of electronic databases. The following key search words will be used: CC management or CC control; CC screening or VIAC or PAP smear or HPV testing; CC prevention or HPV vaccine’s; CC surgery; CC treatment or chemotherapy; CC radiotherapy. African country names and truncated terms such as ‘east* Africa’ will also be used to ensure that articles indexed using African country specific names or regional terms are retrieved.The operator ‘or’ will be used to combine synonyms; and the operator ‘and’ to filter to results which contain all the required terms. Peer Review of Electronic Search Strategies (PRESS) Checklist is used for the search strategy. The databases to be searched include: PubMed, Ebsco Host, Scopus and Cochrane Database of Systematic Review.
Two independent reviewers will conduct abstracts and full article screening. The literature will include published peer-reviewed journal articles with evidence of empirical design utilising either qualitative, quantitative or mixed method research approach addressing the research questions. The screening procedure will be guided by Higgins and Deeks’ framework (27). All articles identified to be potentially eligible for inclusion in this review will be obtained in full texts. These articles will be then be exported to reference management software, EndNote version X7. Duplicates will then be removed before further screenings (abstract and full article) are conducted. The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart will be used to display screening results of studies (28) (Fig. 1).
The inclusion criterion was guided by the following principles to determine articles relevant for this review:
- Studies presenting evidence on cervical cancer
- Studies presenting evidence conducted in SSA
- No limits will be applied for publication date of included studies.
- All study designs will be considered
Studies that do not focus on humans, as well as those written in languages other than English will be excluded. Non-empirical material like book chapters, opinion papers, commentaries and editorials will also not be included.
Data extraction and charting
A data collection instrument (Table 1) was developed to confirm study characteristics as well as relevance. Data will be extracted by the principal investigator. The data extraction form will include the following elements: author(s), year of publication, title of study, country, study aim(s) or research question, study design, study setting (urban/rural), study population, sample size, key findings that relate to the review question, study limitations and implications and interpretations and conclusions from the authors. Data will be entered into Access and qualitative data will be uploaded in NVivo, a computer assisted qualitative data analysis software.
A narrative synthesis will be used, with data synthesised and interpreted using sifting, charting and sorting based on themes, key issues and type of study. Citation tracking will be done using Reference Manager Software in Endnote version X7. Data analysis and tabulation of the findings will be done using Review Manager (RevMan) (29). The narrative synthesis approach (30) will help summarise and identify patterns across studies using tabulations, clustering, textual descriptions, conceptual triangulation (concept mapping) and thematic analysis. Textual data summary will be tabulated from qualitative, mixed methods and quantitative studies. Descriptive statistics will also be used to quantify studies based on the patterns identified. Directed content analysis methods will be used on abstracted data to identify patterns or themes that characterise factors that affect CC management.
Quality control and assessment
Studies that will be published between the research and report writing will be obtained by subscribing to updates to databases using the search domains used during literature search. Data will be extracted by principal investigator and accuracy will be checked by a second reviewer. Studies with uncertainties about their inclusion will be discussed with a third reviewer.
The quality of evidence will be assessed based on guidance in National Institute for Health and Care Excellence single technology appraisal Specification for Manufacturer/Sponsor Submission of Evidence adapted from the Centre for Reviews and Dissemination’s guidance for undertaking reviews in health care (30). Mixed Method Quality Appraisal Tool will be used for quality assurance (13), with aspects like: published in a peer reviewed journal and evidence of sample size calculation will be used to assess quality of included studies. Dissemination of the results will include publications in journals and presentations at health conferences.