Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina

Autores
Arrossi, Silvina; Straw, Cecilia; Baena, Armando; Hernandez, Mariluz; Bloem, Paul; Almonte, Maribel; Paolino, Melisa Delia
Año de publicación
2026
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background: The 2021 World Health Organization (WHO) guidelines for cervical cancer screening and treatment provide evidence-based recommendations to accelerate cervical cancer elimination. However, the adoption of these recommendations depends on how they are interpreted, disseminated, and endorsed within national health systems. Previous research in Argentina showed that health providers primarily rely on recommendations issued by Professional Medical Associations (PMAs) rather than consulting WHO guidelines directly. We conducted a qualitative study to examine how PMAs develop their cervical cancer screening recommendations, their perceptions of the 2021 WHO guidelines, and potential opportunities for collaboration to strengthen dissemination and adoption. Methods: A qualitative study was conducted based on individual, semi-structured interviews with representatives of national and provincial PMAs involved in cervical cancer screening guideline development (n=17). Data were analyzed thematically using constructs from the Consolidated Framework for Implementation Research to explore perceptions regarding WHO recommendations, guideline development processes, and perceived barriers and facilitators for implementation. Results: National PMAs reported formal processes for guideline development involving expert committees, literature review, and adaptation to local contexts. In contrast, provincial PMAs generally do not develop their own guidelines but adopt or adapt those produced by national PMAs, creating a cascade relationship in which national recommendations shape clinical practice nationwide. Across PMAs, international guidelines from high-income countries were the most frequently cited references for developing recommendations. Although WHO was widely perceived as a credible and authoritative institution, its guidelines were rarely used as primary references and were often viewed as broad frameworks requiring adaptation to Argentina s clinical and health system context. Interviewees expressed strong support for HPV-based screening with triage, highlighting its higher sensitivity and efficiency compared with cytology. However, they largely rejected elements such as 10-year screening intervals and treatment without histological confirmation. The screen-and-treat strategy without triage was widely perceived as incompatible with current professional standards, although some participants considered it acceptable in populations with limited access to follow-up. Most PMAs reported limited engagement with WHO in guideline dissemination and little incorporation of quality assurance systems in their recommendations. Nevertheless, PMA representatives expressed willingness to collaborate with WHO in guideline dissemination, professional training, and implementation activities. Conclusions: Professional Medical Associations play a central role in shaping clinical practice and mediating the adoption of global recommendations within decentralized health systems. The cascade relationship between national and provincial PMAs reinforces their influence on clinical standards nationwide. Strengthening collaboration between WHO, national health authorities, and PMAs particularly in guideline dissemination, training, and development of quality assurance systems may facilitate the integration of WHO recommendations into clinical practice and accelerate progress toward cervical cancer elimination.
Fil: Arrossi, Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Straw, Cecilia. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Baena, Armando. No especifíca;
Fil: Hernandez, Mariluz. Organizacion Mundial de la Salud; Argentina
Fil: Bloem, Paul. Organizacion Mundial de la Salud; Argentina
Fil: Almonte, Maribel. Organizacion Mundial de la Salud; Argentina
Fil: Paolino, Melisa Delia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; Argentina
Materia
WHO cervical cancer guidelines
Implementation
Dissemination
Adoption Argentina
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/290199
Acceder
id CONICETDig_1277d50a033c500dedc05427704d5003
oai_identifier_str oai:ri.conicet.gov.ar:11336/290199
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from ArgentinaArrossi, SilvinaStraw, CeciliaBaena, ArmandoHernandez, MariluzBloem, PaulAlmonte, MaribelPaolino, Melisa DeliaWHO cervical cancer guidelinesImplementationDisseminationAdoption Argentinahttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: The 2021 World Health Organization (WHO) guidelines for cervical cancer screening and treatment provide evidence-based recommendations to accelerate cervical cancer elimination. However, the adoption of these recommendations depends on how they are interpreted, disseminated, and endorsed within national health systems. Previous research in Argentina showed that health providers primarily rely on recommendations issued by Professional Medical Associations (PMAs) rather than consulting WHO guidelines directly. We conducted a qualitative study to examine how PMAs develop their cervical cancer screening recommendations, their perceptions of the 2021 WHO guidelines, and potential opportunities for collaboration to strengthen dissemination and adoption. Methods: A qualitative study was conducted based on individual, semi-structured interviews with representatives of national and provincial PMAs involved in cervical cancer screening guideline development (n=17). Data were analyzed thematically using constructs from the Consolidated Framework for Implementation Research to explore perceptions regarding WHO recommendations, guideline development processes, and perceived barriers and facilitators for implementation. Results: National PMAs reported formal processes for guideline development involving expert committees, literature review, and adaptation to local contexts. In contrast, provincial PMAs generally do not develop their own guidelines but adopt or adapt those produced by national PMAs, creating a cascade relationship in which national recommendations shape clinical practice nationwide. Across PMAs, international guidelines from high-income countries were the most frequently cited references for developing recommendations. Although WHO was widely perceived as a credible and authoritative institution, its guidelines were rarely used as primary references and were often viewed as broad frameworks requiring adaptation to Argentina s clinical and health system context. Interviewees expressed strong support for HPV-based screening with triage, highlighting its higher sensitivity and efficiency compared with cytology. However, they largely rejected elements such as 10-year screening intervals and treatment without histological confirmation. The screen-and-treat strategy without triage was widely perceived as incompatible with current professional standards, although some participants considered it acceptable in populations with limited access to follow-up. Most PMAs reported limited engagement with WHO in guideline dissemination and little incorporation of quality assurance systems in their recommendations. Nevertheless, PMA representatives expressed willingness to collaborate with WHO in guideline dissemination, professional training, and implementation activities. Conclusions: Professional Medical Associations play a central role in shaping clinical practice and mediating the adoption of global recommendations within decentralized health systems. The cascade relationship between national and provincial PMAs reinforces their influence on clinical standards nationwide. Strengthening collaboration between WHO, national health authorities, and PMAs particularly in guideline dissemination, training, and development of quality assurance systems may facilitate the integration of WHO recommendations into clinical practice and accelerate progress toward cervical cancer elimination.Fil: Arrossi, Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; ArgentinaFil: Straw, Cecilia. Centro de Estudios de Estado y Sociedad; ArgentinaFil: Baena, Armando. No especifíca;Fil: Hernandez, Mariluz. Organizacion Mundial de la Salud; ArgentinaFil: Bloem, Paul. Organizacion Mundial de la Salud; ArgentinaFil: Almonte, Maribel. Organizacion Mundial de la Salud; ArgentinaFil: Paolino, Melisa Delia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; ArgentinaEuropean Society of Medicine2026-04info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/290199Arrossi, Silvina; Straw, Cecilia; Baena, Armando; Hernandez, Mariluz; Bloem, Paul; et al.; Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina; European Society of Medicine; Medical Research Archives; 14; 4; 4-2026; 1-172375-19162375-1924CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://esmed.org/MRA/mra/article/view/%207502info:eu-repo/semantics/altIdentifier/doi/10.18103/mra.v14i4.7502info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T14:56:06Zoai:ri.conicet.gov.ar:11336/290199instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-08-25 14:56:06.436CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina
title Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina
spellingShingle Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina
Arrossi, Silvina
WHO cervical cancer guidelines
Implementation
Dissemination
Adoption Argentina
title_short Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina
title_full Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina
title_fullStr Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina
title_full_unstemmed Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina
title_sort Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina
dc.creator.none.fl_str_mv Arrossi, Silvina
Straw, Cecilia
Baena, Armando
Hernandez, Mariluz
Bloem, Paul
Almonte, Maribel
Paolino, Melisa Delia
author Arrossi, Silvina
author_facet Arrossi, Silvina
Straw, Cecilia
Baena, Armando
Hernandez, Mariluz
Bloem, Paul
Almonte, Maribel
Paolino, Melisa Delia
author_role author
author2 Straw, Cecilia
Baena, Armando
Hernandez, Mariluz
Bloem, Paul
Almonte, Maribel
Paolino, Melisa Delia
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv WHO cervical cancer guidelines
Implementation
Dissemination
Adoption Argentina
topic WHO cervical cancer guidelines
Implementation
Dissemination
Adoption Argentina
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background: The 2021 World Health Organization (WHO) guidelines for cervical cancer screening and treatment provide evidence-based recommendations to accelerate cervical cancer elimination. However, the adoption of these recommendations depends on how they are interpreted, disseminated, and endorsed within national health systems. Previous research in Argentina showed that health providers primarily rely on recommendations issued by Professional Medical Associations (PMAs) rather than consulting WHO guidelines directly. We conducted a qualitative study to examine how PMAs develop their cervical cancer screening recommendations, their perceptions of the 2021 WHO guidelines, and potential opportunities for collaboration to strengthen dissemination and adoption. Methods: A qualitative study was conducted based on individual, semi-structured interviews with representatives of national and provincial PMAs involved in cervical cancer screening guideline development (n=17). Data were analyzed thematically using constructs from the Consolidated Framework for Implementation Research to explore perceptions regarding WHO recommendations, guideline development processes, and perceived barriers and facilitators for implementation. Results: National PMAs reported formal processes for guideline development involving expert committees, literature review, and adaptation to local contexts. In contrast, provincial PMAs generally do not develop their own guidelines but adopt or adapt those produced by national PMAs, creating a cascade relationship in which national recommendations shape clinical practice nationwide. Across PMAs, international guidelines from high-income countries were the most frequently cited references for developing recommendations. Although WHO was widely perceived as a credible and authoritative institution, its guidelines were rarely used as primary references and were often viewed as broad frameworks requiring adaptation to Argentina s clinical and health system context. Interviewees expressed strong support for HPV-based screening with triage, highlighting its higher sensitivity and efficiency compared with cytology. However, they largely rejected elements such as 10-year screening intervals and treatment without histological confirmation. The screen-and-treat strategy without triage was widely perceived as incompatible with current professional standards, although some participants considered it acceptable in populations with limited access to follow-up. Most PMAs reported limited engagement with WHO in guideline dissemination and little incorporation of quality assurance systems in their recommendations. Nevertheless, PMA representatives expressed willingness to collaborate with WHO in guideline dissemination, professional training, and implementation activities. Conclusions: Professional Medical Associations play a central role in shaping clinical practice and mediating the adoption of global recommendations within decentralized health systems. The cascade relationship between national and provincial PMAs reinforces their influence on clinical standards nationwide. Strengthening collaboration between WHO, national health authorities, and PMAs particularly in guideline dissemination, training, and development of quality assurance systems may facilitate the integration of WHO recommendations into clinical practice and accelerate progress toward cervical cancer elimination.
Fil: Arrossi, Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Straw, Cecilia. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Baena, Armando. No especifíca;
Fil: Hernandez, Mariluz. Organizacion Mundial de la Salud; Argentina
Fil: Bloem, Paul. Organizacion Mundial de la Salud; Argentina
Fil: Almonte, Maribel. Organizacion Mundial de la Salud; Argentina
Fil: Paolino, Melisa Delia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Estudios de Estado y Sociedad; Argentina
description Background: The 2021 World Health Organization (WHO) guidelines for cervical cancer screening and treatment provide evidence-based recommendations to accelerate cervical cancer elimination. However, the adoption of these recommendations depends on how they are interpreted, disseminated, and endorsed within national health systems. Previous research in Argentina showed that health providers primarily rely on recommendations issued by Professional Medical Associations (PMAs) rather than consulting WHO guidelines directly. We conducted a qualitative study to examine how PMAs develop their cervical cancer screening recommendations, their perceptions of the 2021 WHO guidelines, and potential opportunities for collaboration to strengthen dissemination and adoption. Methods: A qualitative study was conducted based on individual, semi-structured interviews with representatives of national and provincial PMAs involved in cervical cancer screening guideline development (n=17). Data were analyzed thematically using constructs from the Consolidated Framework for Implementation Research to explore perceptions regarding WHO recommendations, guideline development processes, and perceived barriers and facilitators for implementation. Results: National PMAs reported formal processes for guideline development involving expert committees, literature review, and adaptation to local contexts. In contrast, provincial PMAs generally do not develop their own guidelines but adopt or adapt those produced by national PMAs, creating a cascade relationship in which national recommendations shape clinical practice nationwide. Across PMAs, international guidelines from high-income countries were the most frequently cited references for developing recommendations. Although WHO was widely perceived as a credible and authoritative institution, its guidelines were rarely used as primary references and were often viewed as broad frameworks requiring adaptation to Argentina s clinical and health system context. Interviewees expressed strong support for HPV-based screening with triage, highlighting its higher sensitivity and efficiency compared with cytology. However, they largely rejected elements such as 10-year screening intervals and treatment without histological confirmation. The screen-and-treat strategy without triage was widely perceived as incompatible with current professional standards, although some participants considered it acceptable in populations with limited access to follow-up. Most PMAs reported limited engagement with WHO in guideline dissemination and little incorporation of quality assurance systems in their recommendations. Nevertheless, PMA representatives expressed willingness to collaborate with WHO in guideline dissemination, professional training, and implementation activities. Conclusions: Professional Medical Associations play a central role in shaping clinical practice and mediating the adoption of global recommendations within decentralized health systems. The cascade relationship between national and provincial PMAs reinforces their influence on clinical standards nationwide. Strengthening collaboration between WHO, national health authorities, and PMAs particularly in guideline dissemination, training, and development of quality assurance systems may facilitate the integration of WHO recommendations into clinical practice and accelerate progress toward cervical cancer elimination.
publishDate 2026
dc.date.none.fl_str_mv 2026-04
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/290199
Arrossi, Silvina; Straw, Cecilia; Baena, Armando; Hernandez, Mariluz; Bloem, Paul; et al.; Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina; European Society of Medicine; Medical Research Archives; 14; 4; 4-2026; 1-17
2375-1916
2375-1924
CONICET Digital
CONICET
url http://hdl.handle.net/11336/290199
identifier_str_mv Arrossi, Silvina; Straw, Cecilia; Baena, Armando; Hernandez, Mariluz; Bloem, Paul; et al.; Dissemination and adoption of WHO guidelines for cervical cancer screening, diagnosis and treatment: perceptions of Professional Medical Associations from Argentina; European Society of Medicine; Medical Research Archives; 14; 4; 4-2026; 1-17
2375-1916
2375-1924
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://esmed.org/MRA/mra/article/view/%207502
info:eu-repo/semantics/altIdentifier/doi/10.18103/mra.v14i4.7502
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv European Society of Medicine
publisher.none.fl_str_mv European Society of Medicine
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.24418

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