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Introduction: Understanding community women's relational and financial empowerment in social entrepreneurship could be the key to scaling up community-based human papillomavirus (HPV) self-sampling programs in low- and middle-income countries. The Hope Project, social entrepreneurship in Peru, trains women (Hope Ladies) to promote HPV self-sampling among other women in their communities. This study aims to evaluate the Hope Ladies' relational and financial empowerment after participating in the program. Materials and Methods: We evaluated the Hope Ladies' experiences of empowerment in social entrepreneurship using a parallel convergent mixed methods design. The Hope Ladies participated in semi-structured in-depth interviews (n = 20) and an eight-questions five-point Likert scale survey that evaluated their relational (n = 19)/financial (n = 17) empowerment. The interview and the survey questions were developed using three empowerment frameworks: Kabeer's conceptual framework, International Center for Research on Women's economic empowerment indicators, and the Relational Leadership Theory. Deductive content analysis was used to evaluate the interviews with pre-determined codes and categories of empowerment. Descriptive statistics were used to analyze the survey results. Qualitative and quantitative data were integrated through a cross-case comparison of emergent themes and corresponding survey responses during the results interpretation. Results: All Hope Ladies reported experiencing increased empowerment in social entrepreneurship. Interviews: The women reported challenges and improvement in three categories of empowerment: (1) resources (balancing between household and Hope Lady roles, recognition from the community as a resource, camaraderie with other Hope Ladies); (2) agency (increased knowledge about reproductive health, improved confidence to express themselves, and ability to speak out against male-dominant culture); and (3) achievement (increased economic assets, improved ability to make financial decisions, and widened social network and capital, and technology skills development). Survey: All (100%) agreed/totally agreed an increase in social contacts, increased unaccompanied visits to a healthcare provider (86%), improved confidence in discussing reproductive topics (100%), improved ability to make household decisions about money (57% pre-intervention vs. 92% post-intervention). Conclusions: The Hope Ladies reported improved relational and financial empowerment through participating in community-based social entrepreneurship. Future studies are needed to elucidate the relationship between empowerment and worker retention/performance to inform the scale-up of HPV self-sampling social entrepreneurship programs.

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Background: Cervical cancer is one of the leading causes of death among Peruvian women. Women seeking screening or treatment services experience delays in receiving screening results provided at community clinics or district hospitals, and lack sufficient resources to pay out-of-pocket to travel to the capital city of Lima for specialized treatment. Continued disparities in health outcomes and systemic barriers to accessing services suggest there are gaps between policy measures and implementation. Objectives: We aim to understand why national policies and clinical pathways that are aligned to global standards have been insufficient in improving cervical cancer screening and treatment in Peru, particularly among women who experience systemic exclusion from health services. Methods: We conducted a policy analysis based on a literature review (2005-2020), in Spanish and English, on PubMed, Global Health, Scopus, EconLit, Lilacs, and Scielo using a value-based care framework. Findings: The main barriers included unequal distribution of health infrastructure and health care workforce, and differences in access to health insurance. Additional barriers, including limited political will and support, limit efforts to prioritize the implementation of cervical cancer policies. We propose policy considersations in redesigning payment models, expanding healthcare workforce, generating costing and policy evidence, and reviewing policies for point-of-care technologies. Conclusions and Recommendations: The barriers identified in this literature review are applicable not only to cervical cancer care, but to primary health care in Peru. Systematic policy changes that address root causes of health inequities and are implemented at scale are needed to advance health reform efforts.

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Background: Barriers that prevent adherence to cervical cancer screening programs in low-income communities include, among others, fear of and discomfort associated with the speculum during pelvic exams and difficulties in accessing health facilities. To address these barriers, a low-cost medical device, the Callascope was developed for self-imaging of the cervix. The device has a 2 MP camera connected to a smartphone and a disposable inserter with an asymmetrical tip to replace the speculum. A pilot study was performed to 1) evaluate the feasibility, acceptability, and comfort of women imaging their own cervix with the Callascope, 2) collect information to improve the design of the Callascope prototype, and 3) identify factors related with the ease of use, discomfort of the self-exam technique and quality of images. Methods: The pilot study included women (n=15) who were either current or former community-health volunteers from Ventanilla, Peru with the HOPE program. Participants completed a pre-exam survey to assess demographics and establish reproductive medical history. Each participant was provided with a self-exam kit. They were asked to perform a self-exam and take pictures of their cervix with the Callascope at home at their convenience. They submitted an audio reflection immediately post-examination via WhatsApp. A post-insertion survey to assess user experience and a focus group discussion were performed 72 hours post-insertion. Conclusions: The Callascope self-imaging of the cervix was reported to be more acceptable and comfortable than the traditional speculum-based gynecologic exam. All participants indicated that they would use the device again and recommend to a friend. Recommendations to improve the prototype design were identified: lengthen handle, overlay asymmetrical tip with softer silicon, and optimize manual focus mechanism. The Body Mass Index (BMI) was found to be a factor associated to the ease of device use and comfort.