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

Abstract

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 (CFIR) 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
PMAs 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.