Knowledge Mediates the Effects of Game Changers for Cervical Cancer Prevention (GC-CCP) Intervention on Increased VIA Screening Advocacy in Uganda.

Game Changers for Cervical Cancer Prevention (GC-CCP), a group advocacy training intervention, has been shown to increase cervical cancer (CC) prevention and screening advocacy. In this secondary analysis, we examined mediators and moderators of this effect. A randomized controlled trial of GC-CCP-- a 7-session, peer led intervention designed to empower women to engage in CC prevention advocacy-was conducted with women who had recently been screened by visual inspection of the cervix with acetic acid (VIA) for CC. Participants were assessed at baseline and month 6 follow-up. CC-related constructs targeted by the intervention were examined as mediators using multivariate linear regression analysis. Individual and social network characteristics were examined as moderators. Change in CC knowledge fully mediated the intervention effect on increased CC prevention advocacy; change in CC risk management self-efficacy was a partial mediator. Moderators of the effect included no secondary education, having a main sex partner, and having trustworthy, supportive, non-stigmatizing peers. The effect of GC-CCP on CC prevention advocacy seems largely driven by its impact on CC knowledge, and the intervention may be most effective among women who are partnered, less educated, and have trusting, supportive social networks.