Globally, cervical cancer is the fourth most common cancer (1), and a leading cause of death (2). An estimated 569,847 new cervical cancer cases and 311,365 deaths worldwide occur annually (3). The rate of new cervical cancer cases is 7.5 per 100,000 women per year, and the death rate is 2.2 per 100,000 women per year (4). Cervical cancer can often be prevented by having regular screenings to find any precancerous conditions and treat them (5). Even though the World Health Organization (WHO) has adopted a global strategy for eliminating cervical cancer by ensuring that 70% of the population is screened and 90% of those diagnosed with cervical cancer disease are treated (6), the screening status remains unsatisfactory in developing countries (7).

The incidence rate of cervical cancer in Tanzania is 54 per 100,000 (8–10), which is the fifth highest in the world (11). Despite the fact that cervical cancer screening (CCS) services in Tanzania are free of cost (12, 13), only 6%–21% of women participate in CCS (14). A knowledge deficit about the disease and screening remains a predominant factor for poor participation in CCS (15). Public health education is a recommended approach to improve the proportion of screening uptake (16).

Harold P. Freeman initiated patient navigation in the 1990s to eliminate barriers to a timely diagnosis of breast cancer and treatment and reduce cost, whereby the result was a drop in late-stage diagnosis from 50% to 20% and an increase in survival from 39% to 70% (17). The patient navigation approach has been widely applied to promote CCS behavior in women (9). In many studies, patient navigators are referred to as community health workers (CHWs) (18–22). Patient navigators have successfully influenced many women to utilize CCS services (18, 19, 20–27, 28, 29), with increased participation of women in screening ranging from 56% to 89% (19, 20, 23, 24, 27, 28). This is because CHWs not only deliver education but also help women overcome screening barriers (18, 30, 31). Women who receive education from patient navigators have an increased knowledge and positive perception of CCS (19, 22). Education delivered by patient navigators is provided in a culturally accepted manner as they live in the same community as the women who receive the teaching (32), and follow-ups conducted by patient navigators for the women who receive the education are very effective (9, 33). Even though patient navigation is an important approach to increasing CCS uptake, there is a lack of studies in Tanzania concerning how to prepare patient navigators and the effect of a patient navigation strategy in promoting screening uptake. Therefore, the proposed study aims to assess a systematic approach to preparing patient navigators and assess the impact of patient navigation on promoting screening uptake, knowledge, awareness, health beliefs, and intention.

Since the study involves the preparation of patient navigators and the implementation of patient navigation for community women (COMW), separate detailed methodologies are described below.

More funds have been spent to train health professionals and send them to communities to promote awareness of the disease and speak on the significance of screening tests (51). Despite these efforts, the proportion of women utilizing screening services remains small (16, 50–53). Several factors have been reported that hinder women from attending screening services in Tanzania in different studies, including a lack of support from their husbands, long distance to the screening clinics, and cultural norms (11), but a knowledge deficit about cervical cancer is considered the main hindrance and this should be addressed to increase the participation of women in CCS services (52).

The training of patient navigators in Tanzania is possible as women with a secondary education level and above are available and most of them are not employed. Furthermore, the training of patient navigators is possible because Tanzania currently has nurses and doctors in oncology who are capable of conducting the training of patient navigators.

The outcome of patient navigation is hypothetically assumed to be positive, with increases in screening uptake and knowledge, positive health beliefs, and intention. This should be associated with the proximity of the patient navigators and the COMW. Since they live in the same area, know each other, and share most of the cultural elements, they are likely to listen to each other and cooperate on whatever is agreed. When patient navigators deliver health education, it is likely to be well received and understood because it is delivered in a non-formal structure. Furthermore, when the patient navigators ask the COMW to screen for cervical cancer, they are likely to do so because the patient navigators could conduct a follow-up at any time at their homes. Therefore, COMW may screen not because of health education, but because they know the patient navigators will conduct a follow-up. Meanwhile, when women are asked to become patient navigators, they accept because they know it will benefit them financially. Since they consider this work as employment, an allowance inevitably amplifies their commitment to learning and implementing. Therefore, based on the definition that patient navigators can be volunteer or be paid, in the Tanzanian context, paying patient navigators is good, as volunteering could be associated with the poor implementation of patient navigation. This is consistent with a previous study that reported that patient navigators’ incentives and remuneration are core issues that affect the performance of individual patient navigators and the overall performance of the CHW program. This previous study recommends that patient navigators receive a financial package that corresponds to their job demands, complexity, number of hours worked, training, and the roles they undertake (54).

The patient navigators will deliver education to community women aged ≥21 and ≤75 years old (18–23, 25, 27–29). They must be willing to participate in the study (21–23), have no previous history of cancer or medical problem (20, 23, 25, 27, 28), speak their native language or English (19, 21, 23), have no plan to change their living residence during the study period (19, 23, 27), be non-adherent to the screening test guidelines (20, 25, 28), and have not undergone previous screening tests (21, 22). A one-time education session conducted by trained lay personnel lasting for 2 h is recommended to be adequate for imparting knowledge to women (21, 28). The education should be conducted in small groups of four to eight community women (19–23, 28). Community women should complete the screening test within 6 months after receiving the education from the trained lay personnel (18, 19, 21, 23, 29). The educational sessions conducted by trained lay personnel should be paired with other educational materials (18–23, 25, 29). After the educational intervention, the patient navigators will provide navigation services to women including financial assistance, organizing transportation services and childcare, and assisting women with language barriers to attend the screening tests (19–21, 24, 25). The patient navigators will also schedule appointment dates for the women (24, 25). The patient navigators will conduct a follow-up by telephone, a letter, mail, or home visits (19–24, 28) to remind the women to go for screening or identify their barriers to doing so. The follow-up is commonly conducted 6 months after the education is delivered to the community women (20, 21, 28).