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Zhang M, Wei W, Li Q, Chen X, Zhang M, Zuo D, Liu Q. Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111093. [PMID: 34769613 PMCID: PMC8583142 DOI: 10.3390/ijerph182111093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.
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Affiliation(s)
- Miao Zhang
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan 430071, China; (M.Z.); (W.W.); (D.Z.)
| | - Wenshuang Wei
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan 430071, China; (M.Z.); (W.W.); (D.Z.)
| | - Qinmei Li
- Wuhan Center for Disease Control and Prevention, Wuhan 430015, China;
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, FL 32610, USA;
| | - Min Zhang
- Institute of Cancer Prevention and Control, Wuhan 430079, China;
| | - Dan Zuo
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan 430071, China; (M.Z.); (W.W.); (D.Z.)
| | - Qing Liu
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan 430071, China; (M.Z.); (W.W.); (D.Z.)
- Correspondence: ; Tel.: +86-1372-026-4816
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O'Donovan B, Mooney T, Rimmer B, Fitzpatrick P, Flannelly G, Doherty L, Martin C, O'Leary J, O'Connor M, Sharp L. Advancing understanding of influences on cervical screening (non)-participation among younger and older women: A qualitative study using the theoretical domains framework and the COM-B model. Health Expect 2021; 24:2023-2035. [PMID: 34476875 PMCID: PMC8628586 DOI: 10.1111/hex.13346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective screening can prevent cervical cancer, but many women choose not to attend their screening tests. OBJECTIVE This study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM-B models of behaviour change. DESIGN A qualitative study and semistructured phone interviews were conducted with women invited for routine screening tests within the national cervical screening programme in Ireland. SETTING AND PARTICIPANTS Forty-eight women aged 25-65 years were recruited from the national screening register. RESULTS Seven core themes were identified that mapped to three COM-B components and 11 TDF domains: (1) knowledge of cervical cancer and screening, (2) coping with smear tests, (3) competing motivational processes-automatic and reflective, (4) cognitive resources, (5) role of social support, (6) environmental influences and (7) perceputal and practical influences. A range of knowledge about screening, perceived risk of cervical cancer and human papillomavirus infection was evident. Factors that influenced screening behaviours may be hierarchical-some were assigned greater importance than others. Positive screening behaviours were linked to autonomous motivation. Deficits in physical and psychological capability (inadequate coping skills) were barriers to screening, while physical and social opportunity (e.g. healthcare professional 'champions') could facilitate participation. Older women raised age-related issues (e.g. screening no longer necessary) and had more negative attitudes to screening, while younger women identified practical barriers. CONCLUSIONS This study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake. PATIENT OR PUBLIC CONTRIBUTION Women invited for screening tests through the national screening programme were interviewed. A Public & Patient Involvement (PPI) Panel, established to provide input into all CERVIVA research projects, advised the research team on recruitment materials and were given the opportunity to review and comment on the interview topic guide. This panel is made up of six women with various cervical screening histories and experiences.
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Affiliation(s)
| | - Therese Mooney
- Programme Evaluation Unit, National Screening Service, Dublin, Ireland
| | - Ben Rimmer
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Patricia Fitzpatrick
- Programme Evaluation Unit, National Screening Service, Dublin, Ireland.,School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | | | | | - Cara Martin
- Department of Histopathology, Trinity College, University of Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - John O'Leary
- Department of Histopathology, Trinity College, University of Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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Women's knowledge and attitude towards cervical cancer preventive measures and associated factors In South Gondar Zone, Amhara Region, North Central Ethiopia: a cross-sectional study. ACTA ACUST UNITED AC 2021; 79:136. [PMID: 34301336 PMCID: PMC8299606 DOI: 10.1186/s13690-021-00659-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/14/2021] [Indexed: 12/02/2022]
Abstract
Background Cervical cancer is a leading cause of morbidity and mortality among women in Ethiopia, often due to late disease diagnosis. Early prevention of cancer has been shown to be the most effective measure against the disease. Scientific evidences indicate that lack of awareness towards cervical cancer is a barrier to prevention strategies. Therefore, the aim of the current research was to assess women’s knowledge and attitudes towards cervical cancer preventions in South Gondar zone. Methods A community-based cross-sectional study was carried out in South Gondar zone, Ethiopia. The study sample comprised 844 women ≥ 18 years of age. Participants were selected using systematic sampling technique. Binary and multivariable logistic models were used to assess predictors of women’s knowledge and attitude towards cervical cancer. Results About 66 % of the women had heard about cervical cancer. Regarding the main source of information of respondents, 75.4 % were heard from health professionals. Sixty two point 4 % of women knew at least one preventive measure and 82.6 % of participants knew at least one symptom or sign. Among study participants, 25 and 64 % had good knowledge, and favorable attitude towards cervical cancer prevention measures, respectively. Being reside in rural (AOR = 0.21, 95 %CI; 0.18, 0.34), not attending formal education (AOR = 0.50, 95 % CI: 0.3, 0.75), low income (AOR = 0.57, 95 % CI: 0.43, 0.81) and having < 4 children ((AOR = 0.8, 95 % CI: 0.60–0.86) were negatively associated with knowledge toward cervical cancer prevention measures. Conclusions This study found the majority of the respondents had poor knowledge about cervical cancer prevention measures. The majority of the study participants had favorable attitudes regarding cervical cancer prevention. Living in rural areas, not attending formal education low income and having less than four children was negatively associated with respondents’ knowledge towards cervical cancer prevention measures. There is needed to scale up cervical cancer prevention measures and services .Further studies are needed using strong study design.
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Mahumud RA, Keramat SA, Ormsby GM, Sultana M, Rawal LB, Alam K, Gow J, Renzaho AMN. Wealth-related inequalities of women's knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis. Int J Equity Health 2020; 19:42. [PMID: 32216799 PMCID: PMC7098106 DOI: 10.1186/s12939-020-01159-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/09/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Resource-constrained countries (RCCs) have the highest burden of cervical cancer (CC) in the world. Nonetheless, although CC can be prevented through screening for precancerous lesions, only a small proportion of women utilise screening services in RCCs. The objective of this study was to examine the magnitude of inequalities of women's knowledge and utilisation of cervical cancer screening (CCS) services in RCCs. METHODS A total of 1,802,413 sample observations from 18 RCC's latest national-level Demographic and Health Surveys (2008 to 2017-18) were analysed to assess wealth-related inequalities in terms of women's knowledge and utilisation of CCS services. Regression-based decomposition analyses were applied in order to compute the contribution to the inequality disparities of the explanatory variables for women's knowledge and utilisation of CCS services. RESULTS Overall, approximately 37% of women had knowledge regarding CCS services, of which, 25% belonged to the poorest quintile and approximately 49% from the richest. Twenty-nine percent of women utilised CCS services, ranging from 11% in Tajikistan, 15% in Cote d'Ivoire, 17% in Tanzania, 19% in Zimbabwe and 20% in Kenya to 96% in Colombia. Decomposition analyses determined that factors that reduced inequalities in women's knowledge of CCS services were male-headed households (- 2.24%; 95% CI: - 3.10%, - 1.59%; P < 0.01), currently experiencing amenorrhea (- 1.37%; 95% CI: - 2.37%, - 1.05%; P < 0.05), having no problems accessing medical assistance (- 10.00%; 95% CI: - 12.65%, - 4.89%; P < 0.05), being insured (- 6.94%; 95% CI: - 9.58%, - 4.29%; P < 0.01) and having an urban place of residence (- 9.76%; 95% CI: - 12.59%, - 5.69%; P < 0.01). Similarly, factors that diminished inequality in the utilisation of CCS services were being married (- 8.23%;95% CI: - 12.46%, - 5.80%; P < 0.01), being unemployed (- 14.16%; 95% CI: - 19.23%, - 8.47%; P < 0.01) and living in urban communities (- 9.76%; 95% CI: - 15.62%, - 5.80%; P < 0.01). CONCLUSIONS Women's knowledge and utilisation of CCS services in RCCs are unequally distributed. Significant inequalities were identified among socioeconomically deprived women in the majority of countries. There is an urgent need for culturally appropriate community-based awareness and access programs to improve the uptake of CCS services in RCCs.
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Affiliation(s)
- Rashidul Alam Mahumud
- School of Social Sciences, Western Sydney University, Penrith-2751, New South Wales, Australia. .,Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia. .,Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Dhaka, 1212, Bangladesh. .,Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia. .,School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.
| | - Syed Afroz Keramat
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Gail M Ormsby
- Professional Studies, Faculty of Business, Education, Law and Arts, University of southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Marufa Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh.,Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Lal B Rawal
- School of Health Medical and Allied Sciences, CQUniversity Sydney, Sydney, New South Wales, Australia
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Andre M N Renzaho
- School of Social Sciences, Western Sydney University, Penrith-2751, New South Wales, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
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Li Q, Liu Q, Chen X, Tan X, Zhang M, Tuo J, Xiang Q, Yu Q, Zhu Z. Protection motivation theory in predicting cervical cancer screening participation: A longitudinal study in rural Chinese women. Psychooncology 2019; 29:564-571. [PMID: 31823462 DOI: 10.1002/pon.5307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine factors longitudinally associated with cervical cancer screening uptake among rural Chinese women, guided by protection motivation theory (PMT). METHODS A large sample of women (n = 2408, aged 35-65 years old) was randomly selected from a rural county in China in 2015 and followed up for 2 years. Data for demographic factors, knowledge of cervical cancer screening, screening outcome, and six PMT constructs measured at the baseline in 2015 were used to predict cervical cancer screening participation at the follow-up in 2017 using structural equation model method. RESULTS Among the 2408 women at the baseline, 1879 (78.03%) participated in the screening services at the follow-up. In addition to significant direct effect of age, social status and baseline screening outcome, and three (perceived severity, fear arousal and response efficacy) of the six PMT subconstructs, four variables (age, social status, knowledge of cervical cancer screening, and baseline screening outcome) at the baseline were indirectly associated with screening participation, mediated by the three significant PMT subconstructs. CONCLUSIONS Findings of this study indicate that the rate of participating in cervical cancer screening for rural women needs to be further improved. In addition to the commonly reported influential factors, PMT subconstructs play important roles in encouraging rural women in China to participate in cervical cancer screening. These longitudinal findings provided data much needed for future research to develop evidence-based intervention programs to enhance cervical cancer screening among rural women in China.
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Affiliation(s)
- Qinmei Li
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Qing Liu
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xinguang Chen
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, China.,Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Xiaodong Tan
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Min Zhang
- Office of Cancer Prevention and Treatment, Institute of Cancer Prevention and Control, Wuhan, China
| | - Jiyu Tuo
- Office of Cancer Prevention and Treatment, Institute of Cancer Prevention and Control, Wuhan, China
| | - Qunying Xiang
- Family Planning Service Center, Maternal and Child Health Care Hospital, Wufeng, China
| | - Qiuli Yu
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Zhu Zhu
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, China
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Larsen SH, Virgilsen LF, Kristiansen BK, Andersen B, Vedsted P. Strong association between cervical and breast cancer screening behaviour among Danish women; A register-based cohort study. Prev Med Rep 2018; 12:349-354. [PMID: 30450274 PMCID: PMC6234495 DOI: 10.1016/j.pmedr.2018.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/30/2018] [Accepted: 10/21/2018] [Indexed: 12/13/2022] Open
Abstract
High coverage is essential for the effectiveness of national screening programmes. Identifying non-screeners across different screening programmes may help inform strategies to improve uptake. This study aims to analyse the association between previous cervical cancer screening (CCS) coverage and participation in breast cancer screening (BCS). This historical register-based cohort study included 91,787 Danish women aged 50-64 years who were invited to participate in the first organised round of BCS in the Central Denmark Region (CDR) in 2008-09. CCS coverage was defined as having a smear registered in the 5 1/2 years preceding the BCS, and BCS participants were divided into participants and non-participants and further categorised as active non-participants (ANP) if they cancelled and passive non-participants (PNP) if they abstained from the appointment. Of all 91,787 women included in the study, 62,391 (68%) were covered both by CCS and participated in BCS. Women not covered by CCS were more likely to be non-participants in BCS than women covered by CCS (PRRadjusted = 2.80, 95% CI: 2.68-2.93). Both PNP (PRRadjusted = 3.99, 95% CI: 3.80-4.19) and ANP (PRRadjusted = 2.50, 95% CI: 2.34-2.68) were more likely not to be covered by the CCS. In conclusion, non-coverage by CCS was strongly associated with nonparticipation in BCS. Specific groups of women only participated in one screening programme. To increase uptake, future interventions may specifically target these groups.
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Affiliation(s)
- S H Larsen
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - L F Virgilsen
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - B K Kristiansen
- Department for Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930 Randers, Denmark
| | - B Andersen
- Department for Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930 Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - P Vedsted
- Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholins Allé 2, 8000 Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
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Australian women's cervical cancer screening attendance as a function of screening barriers and facilitators. Soc Sci Med 2018; 220:396-402. [PMID: 30529797 DOI: 10.1016/j.socscimed.2018.11.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/16/2018] [Accepted: 11/26/2018] [Indexed: 01/12/2023]
Abstract
RATIONALE Cervical cancer screening registry data indicate that 43% of eligible Australian women did not screen in the latest reporting period (2014-2015). However, few prior empirical studies have examined whether the screening barriers and facilitators experienced by women can affect their screening attendance. Such information is required to inform the development of future tailored health promotion strategies. OBJECTIVE This study examined whether the cervical cancer screening barriers and facilitators identified by women were related to their screening history, from November 2015 and January 2016. At this time, Australian women typically undertook a Pap test every two years. They were deemed overdue for screening if they have not screened in the past 27 months (i.e., overdue by more than three months). METHOD In this study, a large sample (N = 338) of women were asked about their screening history including screening status (i.e., up-to-date vs. overdue) and prior screening (i.e., never screened vs. screened), and the psychological and practical screening barriers or facilitators they had experienced. RESULTS Logistic regression analysis indicated that screening status was related to a greater number of psychological barriers, but not practical barriers or facilitators. In contrast, prior screening was related to more practical and psychological screening barriers and fewer practical facilitators, but not psychological facilitators. Some individual psychological screening barriers (e.g., anxiety, embarrassment), practical barriers (e.g., lack of time) and practical facilitators (e.g., low cost of test) were related to women's screening status and prior screening. CONCLUSIONS Results suggest that addressing practical cervical cancer screening facilitators (e.g., reminder prompts) and psychological screening barriers may help to optimize screening attendance in women who have never screened or are overdue for cervical cancer screening.
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Basu P, Hassan S, Fileeshia F, Mohamed S, Nahoodha A, Shiuna A, Sulaiman AI, Najeeb N, Saleem FJ. Knowledge, attitude and practices of women in maldives related to the risk factors, prevention and early detection of cervical cancer. Asian Pac J Cancer Prev 2015; 15:6691-5. [PMID: 25169510 DOI: 10.7314/apjcp.2014.15.16.6691] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A population-based cervical cancer screening program using visual inspection with acetic acid was launched in Maldives in 2014. Our study aimed to assess the knowledge, attitude and practices of women in relation to risk factors of cervical cancer, early detection of the disease and its prevention. MATERIALS AND METHODS The questionnaire based survey was conducted among 20 to 50 year old women, systematically sampled to represent three regions of Maldives. Trained investigators interviewed a total of 2,845 women at home. RESULTS The prevalence of the risk factors of cervical cancer like early age at marriage and childbirth, multiple marriages, multiple marriages of the husbands, and multiple pregnancies was high. More women knew about breast cancer than cervical cancer. Even among the small number of women who knew of cervical cancer, only 34.6% had the knowledge of at least one early symptom. Very few women knew that the cancer could be prevented by any test. Only 6.2% of the women reported having ever undergone a Pap smear. Many women had the misconception that cervical cancer was infectious. In Maldives the younger women have high literacy rate due to the policy of universal free education and those with higher levels of education had improved knowledge of cervical cancer and its risk factors. The prevalence of risk factors also reduced with improved literacy. CONCLUSIONS Awareness about risk factors and prevention of cervical cancer is limited among Maldivian women in spite of having high exposure to some of the risk factors. A universal literacy program in the country has helped to improve the knowledge of cervical cancer prevention and to reduce the exposure to various risk factors in the younger population.
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Affiliation(s)
- Partha Basu
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India E-mail :
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Grandahl M, Tydén T, Gottvall M, Westerling R, Oscarsson M. Immigrant women's experiences and views on the prevention of cervical cancer: a qualitative study. Health Expect 2015; 18:344-54. [PMID: 23252449 PMCID: PMC5060783 DOI: 10.1111/hex.12034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many Western countries have cervical cancer screening programmes and have implemented nation-wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer. OBJECTIVE To explore immigrant women's experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use. DESIGN An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework. SETTING AND PARTICIPANTS Eight focus group interviews, 5-8 women in each group (average number 6,5), were conducted with 50 women aged 18-54, who studied Swedish for immigrants. Data were analysed by latent content analysis. RESULTS Four themes emerged: (i) deprioritization of women's health in home countries, (ii) positive attitude towards the availability of women's health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check-ups. CONCLUSION The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health-care providers. Therefore, information needs to be in different languages and provided through different sources. Health-care professionals should also consider immigrant women's difficulties concerning cultural norms and pay attention to their experiences.
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Affiliation(s)
- Maria Grandahl
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Tanja Tydén
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Maria Gottvall
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Ragnar Westerling
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Marie Oscarsson
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
- School of Health and CaringLinnaeus UniversityKalmarSweden
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Cervical cancer screening and psychosocial barriers perceived by patients. A systematic review. Contemp Oncol (Pozn) 2014; 18:153-9. [PMID: 25520573 PMCID: PMC4269002 DOI: 10.5114/wo.2014.43158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 05/26/2013] [Accepted: 07/16/2013] [Indexed: 12/02/2022] Open
Abstract
Aim of the study This study aimed at integrating research discussing the role of perceived psychosocial barriers in cervical cancer screening (CCS) uptake. In particular, we analyzed the evidence for the associations between CCS uptake and perceived psychosocial barriers and frequency of psychosocial barriers identified by women. Material and methods A systematic search of peer-reviewed papers published until 2011 in 8 databases yielded 48 original studies, analyzing data obtained from 155 954 women. The majority of studies (k = 43) applied correlational design, while 5 had experimental design. Results Experimental research indicated a positive effect of 75% of psychosocial interventions targeting barriers. The interventions resulted in a significant increase of CCS uptake. Overall 100% of correlational studies indicated that perceiving lower levels of barriers significantly predicted higher CCS uptake. 53 psychosocial barriers were listed in at least 2 original correlational studies: 9.5% of barriers were related to CCS facilities/environment, 67.9% dealt with personal characteristics of the patient, and 22.6% addressed social factors. As many as 35.9% of perceived barriers referred to negative emotions related to CCS examination procedures and collecting CCS results, whereas 25.7% of barriers referred to prior contacts with health professionals. Conclusions Leaflets or discussion on psychosocial barriers between patients and health professionals involved in CCS might increase CCS uptake and thus reduce cervical cancer mortality rates. Communication skills training for health professionals conducting CCS might focus on the most frequently reported barriers, referring to emotions related to CCS examination and collecting CCS results.
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11
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Chan CWH, Yang SB, Gu C, Wang X, Tao L. Perception of cervical cancer risk and screening behavior: a literature review. Int J Nurs Knowl 2014; 26:2-18. [PMID: 24673974 DOI: 10.1111/2047-3095.12028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE This review examines women's risk perception of cervical cancer, the factors influencing this perception, and the relationship between risk perception of cervical cancer and screening behavior. METHODS Integrative literature review method was used. FINDINGS The search procedure resulted in the identification of 42 studies, including 1 literature review and 41 primary studies. Trends and discrepancies in the literature are presented with interpretations and recommendations. CONCLUSION Existing theories of health behavior appear inadequate for understanding screening behavior, and further studies are recommended to enrich the knowledge base of nursing diagnoses in knowledge deficit and health-seeking behavior. IMPLICATIONS FOR NURSING PRACTICE Efforts would be made to improve nurses' understanding of risk perception of cervical cancer within specific cultural context.
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Affiliation(s)
- Carmen W H Chan
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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Donta B, Begum S, Nair S, Naik DD, Mali BN, Bandiwadekar A. Awareness of cervical cancer among couples in a slum area of Mumbai. Asian Pac J Cancer Prev 2013; 13:4901-3. [PMID: 23244078 DOI: 10.7314/apjcp.2012.13.10.4901] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
To assess the awareness of cervical cancer among couples, data were collected from two urban slums community in Mumbai. A total of 1958 married women aged from 18 to 49 and their husbands were selected using simple random sampling. Women (37.7%) were significantly more aware of cervical cancer than husbands (8.7%). A slight agreement (kappa statistics=0.16) was observed between husbands and wives on awareness of cervical cancer. Significantly higher percentages of wives were aware of pap smear test than husbands. Overall, awareness of cervical cancer and pap smear test among couples is low. There is need to educate and motivate both of them to participate in cervical cancer screening program.
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Affiliation(s)
- Balaiah Donta
- Department of Biostatistics, National Institute for Research in Reproductive Health, (ICMR), JM Street, Parel, India.
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Macedo A, Waller J, Patnick J, Marlow L. Cervical Screening Uptake, Political Interest and Voter Turnout: A Population-Based Survey of Women in England. J Med Screen 2012; 19:189-94. [DOI: 10.1258/jms.2012.012073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To examine the relationship between cervical screening uptake and political engagement, and to test whether political engagement and voting behaviour mediate the association between age and cervical screening uptake Setting A population-based survey of women in England in 2010. Methods Women aged 26-64 took part in home-based computer-assisted interviews ( n = 890). Women were classified as ‘up to date’ or ‘overdue/never been screened’ for cervical screening. Results Most women (81%) were up-to-date with screening; 19% were overdue. Age and marital status were associated with screening status. Women who were not registered to vote, had not voted in previous general elections, and those who showed less interest in elections and lower intention to engage in political activities were more likely to be overdue for screening. In multivariate analyses (adjusting for all significant measures) ‘being on the electoral register’ was the only significant independent predictor of screening status. ‘Being on the electoral register’ was also the only measure of voting behaviour that mediated the association between age and screening status. Conclusion We found limited evidence for the hypothesis that falling attendance for cervical screening could be associated with a broader phenomenon of disillusionment as indexed by reported voting behaviour and other measures of political engagement. Alternative explanations should be considered in order to better understand falling cervical screening uptake, particularly among younger women.
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Affiliation(s)
- Ana Macedo
- Research Associate, Department of Epidemiology and Public Health, Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, UK
| | - Jo Waller
- Senior Research Associate, Department of Epidemiology and Public Health, Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, UK
| | | | - Laura Marlow
- Post-doctoral research fellow, Department of Epidemiology and Public Health, Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, UK
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Luszczynska A, Durawa AB, Scholz U, Knoll N. Empowerment beliefs and intention to uptake cervical cancer screening: three psychosocial mediating mechanisms. Women Health 2012; 52:162-81. [PMID: 22458292 DOI: 10.1080/03630242.2012.656187] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Three studies tested if the associations between women's empowerment beliefs and intentions to attend cervical cancer screening could be explained by mediating psychological mechanisms: control-related beliefs, well being-related beliefs, and beliefs and evaluations referring to social functioning. Data were collected from January to March 2011 in the rural and urban areas across regions of Poland. Study 1 (N = 386) indicated that women with strong empowerment harbored stronger self-efficacy and beliefs that screening participation would make them feel in control of their own health and body. These two types of cognitions were, in turn, associated with stronger cervical cancer screening intentions. Results of Study 2 (N = 527) confirmed three significant well being-related mediators in the relationship between empowerment beliefs and cervical cancer screening: perceived benefits of screening related to well being, appearance satisfaction, discomfort- and shame-related barriers for screening. Finally, Study 3 (N = 424) showed that empowerment enabled receiving higher social support for cervical cancer screening, promoted perceiving fewer barriers for cervical cancer screening-related communication and more social benefits of engaging in cervical cancer screening. Support for cervical cancer screening, social barriers, and benefits were, in turn, related to screening intentions. Across the studies similar shares of intention variance were explained, and thus the hypothesized mediating mechanisms may have similar explanatory power.
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Affiliation(s)
- Aleksandra Luszczynska
- Trauma, Health, & Hazards Center, University of Colorado, Colorado Springs, Colorado 80933-7150, USA.
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15
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Waller J, Jackowska M, Marlow L, Wardle J. Exploring age differences in reasons for nonattendance for cervical screening: a qualitative study. BJOG 2011; 119:26-32. [DOI: 10.1111/j.1471-0528.2011.03030.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Moss EL, Askew S, Jones PW, Redman CWE, Pearmain P. Implementing the national invasive cervical cancer audit: correlation between local and regional classification. J Med Screen 2011; 17:190-4. [PMID: 21258129 DOI: 10.1258/jms.2010.010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the accuracy of information recorded regionally and locally on the screening classification of cervical cancer cases using the national invasive cervical cancer audit categories. METHODS Comparison of the audit categorization of all cervical cancer cases diagnosed at the University Hospital of North Staffordshire (UHNS) between January 2003 and December 2006 with the classification assigned by the West Midlands Cervical Screening Quality Assurance Reference Centre (WMQARC). RESULTS Eighty-seven cases of cervical cancer were diagnosed during the three-year study period. There was agreement between the UHNS and WMQARC classification of cases in 52 cases (59.7%), moderate agreement κ = 0.51 (95% CI 0.39-0.63). The greatest disparity was seen in the classification of lapsed attenders, with nine of the 26 cases categorized as 'lapsed' by the UHNS being assigned to the 'lost to follow-up' category by WMQARC. Three cases were deemed unclassifiable by WMQARC using the national classification since the women were over the age of 70 years but had previously been enrolled in the screening programme, and currently there is no national category for these women. CONCLUSIONS Accurate and consistent classification of invasive cervical cancer cases is essential in order to obtain useful information on the efficiency of the national screening programme at a local, regional and national level. The use of a national algorithm would provide reassurance that all data used in the national evaluation of the NHS Cervical Screening Programme are consistent, meaning that robust conclusions could then be drawn from the data.
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Affiliation(s)
- E L Moss
- University Hospital of North Staffordshire, Stoke on Trent, UK
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Lee HY, Park EC, Jun JK, Hahm MI, Jung KW, Kim Y, Han MA, Choi KS. Trends in socioeconomic disparities in organized and opportunistic gastric cancer screening in Korea (2005-2009). Cancer Epidemiol Biomarkers Prev 2010; 19:1919-26. [PMID: 20647409 DOI: 10.1158/1055-9965.epi-09-1308] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND A growth of consensus and increasing activities related to organized cancer screening programs has occurred in Korea since 1999. It is important to assess disparities in the fight against cancer, and it is crucial to identify particular groups that may be experiencing a high burden of cancer-related illness. METHODS Data from 8,160 men and women ages >40 years from the 2005 to 2009 Korean National Cancer Screening Survey were used to analyze the relationship between socioeconomic position and receiving upper gastrointestinal series or upper endoscopy within the past 2 years. We used absolute and relative concentration indexes, that is, summary measures of disparity based on both rate differences and rate ratios. RESULTS For organized screening, the education disparity declined, but the income disparity index increased, indicating that participation in organized screening was relatively more concentrated among the lower-income groups. For opportunistic screening, income and education disparities increased due to the widening of socioeconomic differences. CONCLUSIONS The results of this study suggested progress toward socioeconomic disparity-related goals in organized screening for gastric cancer. However, the income disparity trends in organized screening may change in a manner similar to those in opportunistic screening in the future because of the much faster rate of organized screening uptake by those higher on the socioeconomic scale. IMPACT This study addresses the routine monitoring of coverage of screening among different socioeconomic groups and could be used to inform policies to reduce disparity in coverage.
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Affiliation(s)
- Hoo-Yeon Lee
- National Cancer Control Institute, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
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Malmi H, Ruutu M, Määttänen L, Stenman UH, Juusela H, Tammela TL, Auvinen A. Why do men opt out of prostate-cancer screening? Attitudes and perception among participants and non-participants of a screening trial. BJU Int 2010; 106:472-7. [DOI: 10.1111/j.1464-410x.2010.09165.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Blomberg K, Forss A, Ternestedt BM, Tishelman C. From 'silent' to 'heard': professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear. Soc Sci Med 2008; 68:479-86. [PMID: 19081661 DOI: 10.1016/j.socscimed.2008.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Indexed: 11/25/2022]
Abstract
While there is a large body of research on cervical cancer screening, fewer studies address the experiences of women receiving abnormal Pap smear results after routine screening. Those studies highlighting such experiences tend to concentrate on resulting psychosocial distress, with an absence in the literature about women's experiences of their bodies during medical follow-up for dysplasia, and no studies were found that explore such experiences over time. In this article, we focus on bodily experiences over time during medical follow-up of an abnormal Pap smear among a group of women in Sweden. This qualitative analysis is based on interview data from a total of 30 women, and with in-depth analysis of the content of 34 transcribed interviews with nine women who were followed longitudinally. We found that medical follow-up involved an experience of both "having" and "being" a body, which changed over time. Women described a process that ranged from having a cervix that was neither felt, 'heard', nor seen, to having a body that became known to them first indirectly through professional mediation and later through direct experience after professional manipulation. The conceptualization of bodily boundaries appeared to change, e.g. through visualization of the previously unfamiliar cervix, pain, vaginal discharge, and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Thus, bodily experiences appear to be an intrinsic part of medical follow-up of an abnormal Pap smear through which health, disease, and risks in the past, present, and future were reconceptualised.
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Affiliation(s)
- Karin Blomberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
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20
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Merchant RC, Gee EM, Bock BC, Becker BM, Clark MA. Negative opinions about cancer screening and contraceptive measures by female emergency department patients. J Prim Prev 2008; 29:517-33. [PMID: 19011970 DOI: 10.1007/s10935-008-0154-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Accepted: 10/23/2008] [Indexed: 11/26/2022]
Abstract
We sought to determine the extent to which adult female emergency department participants viewed two women's cancer screening and two contraceptive measures negatively. The study also explored the relationship between having a negative opinion about these measures and participant demography, lack of knowledge, and lack of usage of these measures. Few women expressed negative opinions about these measures. Lack of knowledge about and lack of use of these measures were associated with having negative opinions on these cancer screening and contraceptive measures. Having any negative opinion about one cancer screening or contraceptive measure was associated with a higher risk of having any negative opinion on another measure. The results suggest that influencing opinion and knowledge about these measures might impact the success of emergency department-based cancer screening and contraceptive health programs. Editors' Strategic Implications: Emergency departments (and primary care settings) provide key opportunities for prevention. Replication is needed, but the authors present important data on knowledge, attitudes, and characteristics that might influence women's receptivity to consent to and engage in behaviors consistent with prevention, screening, and health promotion.
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Affiliation(s)
- Roland C Merchant
- Emergency Medicine and Community Health, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, Claverick Building, Providence, RI 02903, USA.
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Oscarsson MG, Wijma BE, Benzein EG. Nonattendance in a cervical cancer screening program - what happens if women's requirements are met? Health Care Women Int 2008; 29:183-97. [PMID: 18350423 DOI: 10.1080/07399330701738242] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this study we focus on women who have no registered cervical smear during the previous 5 years, their requirements for attendance, and promotive efforts performed. Of the 400 women randomly selected to answer a telephone-based questionnaire about future attendance at cervical cancer screening (CCS), 120 would consider having a cervical smear taken, and 50 of them wanted help to accomplish that. When meeting the women's requirements, such as being assured friendly treatment and a suitable appointment time, the numbers of registered cervical smears were higher for the study group compared with a control group. Still, the most highly resistant women did not attend.
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22
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Do "rapid" PSA assays reduce anxiety and stress of prostate cancer patients undergoing regular review? A prospective evaluation. Urology 2008; 71:567-72. [PMID: 18387384 DOI: 10.1016/j.urology.2007.10.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 10/06/2007] [Accepted: 10/26/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Waiting for prostate-specific antigen (PSA) results may create anxiety for patients. Recently developed "rapid" PSA assays have become available, which achieve laboratory sensitivity and specificity. The manufacturers claim these assays will help to reduce anxiety associated with PSA testing. The aim of this study was to test the hypothesis that rapid received PSA results reduce patient anxiety. METHODS One hundred eighty-eight (n = 188) patients participated in a prospective randomized study. After obtaining informed consent, 67 patients were assigned to receive PSA results within 15 minutes of the blood sample being drawn, facilitating a discussion with the physician while in-clinic. One hundred twenty-one (n = 121) patients were assigned to receive their results within 1 to 4 days by telephone. Patients completed a baseline questionnaire about PSA testing and a follow-up questionnaire after they had received their PSA result by either method. RESULTS There were no significant differences in patient demographics between the "rapid" and "delayed" PSA test groups. Baseline measurements of stress and anxiety were low and not significantly different between the groups. Receiving a rapid PSA result did not significantly reduce stress and anxiety compared with a delayed result. However, 89% of patients receiving a rapid result would elect to have this method again. CONCLUSIONS The rapid PSA test did not prove to alleviate stress or anxiety associated with receiving results. However, the cohort assigned to the rapid PSA test would prefer to have their results rapidly to facilitate discussion regarding their future management.
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Zhang Y, Borders TF, Rohrer JE. Correlates of Intent to Seek Unnecessary Pap Tests Among Elderly Women. Womens Health Issues 2007; 17:351-9. [DOI: 10.1016/j.whi.2007.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 04/17/2007] [Accepted: 06/01/2007] [Indexed: 10/22/2022]
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Basen-Engquist K, Fouladi RT, Cantor SB, Shinn E, Sui D, Sharman M, Follen M. Patient assessment of tests to detect cervical cancer. Int J Technol Assess Health Care 2007; 23:240-7. [PMID: 17493310 DOI: 10.1017/s0266462307070171] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study was undertaken to understand how women view characteristics of tests for cervical dysplasia, because these characteristics can affect patient decision-making about screening and follow-up. METHODS We recruited women who participated in a clinical trial of optical spectroscopy for the diagnosis of cervical dysplasia and used conjoint analysis to assess the women's preferences concerning test attributes. One group of women had a history of an abnormal Papanicolaou smear (diagnostic sample), while the other group did not (screening sample). Participants rated pairs of test scenarios that varied on characteristics such as test sensitivity and painfulness. Based on their responses, the relative importance of test sensitivity, specificity, timing of results feedback and treatment, and pain were calculated, and a cluster analysis was done to identify subgroups of participants with different preference patterns. RESULTS In the overall sample, sensitivity was the most important attribute, followed by timing, specificity, and pain. Cluster analysis revealed four distinct groups who placed varying importance on each characteristic. The participants in the cluster for which pain was the most important attribute were more likely to be diagnostic patients, non-white, and have low education levels. They also reported more anxiety and pain during the examination than participants in other clusters. CONCLUSIONS To continue to reduce morbidity and mortality from cervical cancer, developers of new testing procedures should take into account test attributes such as these, which may affect adherence to screening and diagnostic follow-up to further minimize morbidity and mortality from cervical cancer.
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Affiliation(s)
- Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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25
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Nene B, Jayant K, Arrossi S, Shastri S, Budukh A, Hingmire S, Muwonge R, Malvi S, Dinshaw K, Sankaranarayanan R. Determinants of womens participation in cervical cancer screening trial, Maharashtra, India. Bull World Health Organ 2007; 85:264-72. [PMID: 17546307 PMCID: PMC2636321 DOI: 10.2471/blt.06.031195] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/25/2006] [Accepted: 07/28/2006] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a randomized controlled trial. The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid, cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra, India. METHODS Between October 1999 and November 2003 women aged 30-59 years were randomized to receive one of the three tests or to a control group. Participation was analysed for all three intervention arms. The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100,800 eligible women invited for screening. Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high-grade lesions. Participation in screening and compliance with treatment were also analysed according to the type of test used. FINDINGS Compared with women who were not tested, screened women were younger (aged 30-39), better educated and had ever used contraception. A higher proportion of screened women were married and a lower proportion had never been pregnant. Of the 932 women diagnosed with high-grade lesions or invasive cancer, 85.3% (795) received treatment. Women with higher levels of education, who had had fewer pregnancies and those who were married were more likely to comply with treatment. There were no differences in rates of screening or compliance with treatment when results were analysed by the test received. CONCLUSIONS Irrespective of the test being used, good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services. Communication methods and delivery strategies aimed at encouraging older, less-educated women, who have less contact with reproductive services, are needed to further increase screening uptake.
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Affiliation(s)
- Bhagwan Nene
- Tata Memorial Centre Rural Cancer Extension Project, Nargis Dutt Memorial Hospital, Barshi, India
| | - Kasturi Jayant
- Tata Memorial Centre Rural Cancer Extension Project, Nargis Dutt Memorial Hospital, Barshi, India
| | - Silvina Arrossi
- International Agency for Research on Cancer–WHO, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | | | - Atul Budukh
- Tata Memorial Centre Rural Cancer Extension Project, Nargis Dutt Memorial Hospital, Barshi, India
| | - Sanjay Hingmire
- Tata Memorial Centre Rural Cancer Extension Project, Nargis Dutt Memorial Hospital, Barshi, India
| | - Richard Muwonge
- International Agency for Research on Cancer–WHO, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
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Whynes DK, Philips Z, Avis M. Why do women participate in the English cervical cancer screening programme? JOURNAL OF HEALTH ECONOMICS 2007; 26:306-25. [PMID: 17010459 DOI: 10.1016/j.jhealeco.2006.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 06/08/2006] [Accepted: 08/25/2006] [Indexed: 05/12/2023]
Abstract
The vast majority of women in England attend for cervical cancer screening. Conventional economic theorising fails to explain why and its predictions are inconsistent with the evidence. Using questionnaire data, we analyse directly motivations for screening attendance. We conclude that regular attendance at screening is driven primarily by a search for reassurance, a sense of duty and herd signalling. It is evident that recognisable sub-groups of attenders exist, in which the configurations of motivational factors differ. Being motivated to attend by physicians is less significant that is widely supposed and is more frequently associated with irregular attendance.
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Affiliation(s)
- David K Whynes
- School of Economics, University of Nottingham, Nottingham NG7 2RD, United Kingdom.
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Nygård M, Daltveit AK, Thoresen SØ, Nygård JF. Effect of an antepartum Pap smear on the coverage of a cervical cancer screening programme: a population-based prospective study. BMC Health Serv Res 2007; 7:10. [PMID: 17244348 PMCID: PMC1790705 DOI: 10.1186/1472-6963-7-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 01/23/2007] [Indexed: 11/29/2022] Open
Abstract
Background Almost one-third of Norwegian women aged 25–69 years invited to have a Pap smear do not attend during the recommended period, and thus constitute a population with high-risk of cervical cancer (CC). Since the incidence of precancerous lesions of the cervix peak with occurrence of pregnancies within the same decade in women aged 25 to 35 years of age, antepartum care presents an opportunity to offer a Pap smear thereby increasing the coverage of the programme. The study objective was to describe the effect of the antepartum Pap smear on the coverage of a cytological CC screening programme. Methods Among 2 175 762 women resident in Norway in 31.12.1996, all women who gave birth in 1996–7 were identified from the Medical Birth Registry of Norway. Attendance to the cervical cancer screening was assessed by linkage to the Cytology Registry separately for the pregnant and non-pregnant women cohorts. The results were stratified by age, history of previous Pap smear and history of invitation to the CC screening programme. Logistic regression was used to estimate the relative probabilities of having a Pap smear adjusted for age, screening history, and time since invitation, for pregnant and non-pregnant women, respectively. Results 69% of the pregnant women had a Pap smear during one year of follow-up since beginning of the pregnancy with the majority taken during the antepartum period. Irrespectively of age or history of having a Pap smear, pregnant women were 4.3 times more likely to have a Pap smear during follow-up compared to non-pregnant women. 63.2% of the pregnant women had a smear as response to the invitation letter compared to 28.7% of the non-pregnant women, OR = 2.1 (95% CI 1.9 to 2.4). As an indication of "over-screening", 5397 pregnant women (57.8%) with a smear shortly before the start of follow-up also had a new Papsmear, compared to 83 023 (32.3%) in non-pregnant. Conclusion Pap smear screening during pregnancy increases the coverage of the CC screening programme. The contribution of the antepartum Pap smear to "over-screening" exists but its effect is modest in countries where women on average become pregnant after the start of recommended age of screening.
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Affiliation(s)
- Mari Nygård
- Department of Screening-based Research, The Cancer Registry of Norway, Oslo, Norway
| | - Anne-Kjersti Daltveit
- Department of Public Health and Primary Health Care, Section for Epidemiology and Medical Statistics, University of Bergen, Bergen, Norway
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - Steinar Ø Thoresen
- Department of Screening-based Research, The Cancer Registry of Norway, Oslo, Norway
| | - Jan F Nygård
- Department of Screening-based Research, The Cancer Registry of Norway, Oslo, Norway
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Lindqvist PG, Hellsten C, Rippe A. Screening history of women in Malmö with invasive cervical cancer. Eur J Obstet Gynecol Reprod Biol 2007; 137:77-83. [PMID: 17210219 DOI: 10.1016/j.ejogrb.2006.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Revised: 11/23/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Cervical cancer is one of the most common forms of cancer among women. Cytological screening and follow-up are potentially effective procedures for preventing the development of - and mortality from - cervical cancer. The purpose of this study was to investigate the screening history of women diagnosed with cervical cancer with the aim of improving the screening programme. STUDY DESIGN All of the 187 women diagnosed with invasive cervical cancer in Malmö between 1991 and 2000 were identified, and those below 61 years of age (n=130) were included in the analysis. The cytological and histological screening history of these women prior to their diagnosis was scrutinized. We analyzed shortcomings related to the cervical screening with special attention to participation defined as having had a cervical smear within 1 year of the scheduled time. RESULTS Of the non-participants who developed cervical cancer (n=70), roughly one-third "never participated," half were "sub-optimal participants," and one-sixth were "decliners," i.e., women who declined the recommended measures. Among participants (n=60), 80% were either "unexplained" (n=35) or "misread as normal" (n=13). The 9.5% subgroup of non-participants was at an 11-fold increased risk of being diagnosed with invasive cervical cancer. CONCLUSION The greatest reduction in cervical cancer would be realized if non-participants could be brought into the screening program.
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Affiliation(s)
- Pelle G Lindqvist
- Department of Obstetrics and Gynaecology, Clinical Science Malmö, University Hospital MAS, Lund University, Ingång 74, Se-205 02 Malmö, Sweden.
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Ideström M, Milsom I, Andersson-Ellström A, Athlin E. Cervical cancer screening--"For better or worse...": women's experience of screening. Cancer Nurs 2006; 29:453-60. [PMID: 17135818 DOI: 10.1097/00002820-200611000-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In Sweden, the population-based cervical cancer screening program has been in progress since the 1970s and is directed toward women between 23 and 60 years of age. The aim of this study was to explore women's experience of cervical screening after being diagnosed with cancer. A qualitative study inspired by Grounded Theory was used. Eleven women were interviewed. The interviews were analyzed using the constant comparative method. "Screening-For Better or Worse..." was identified as the core category, around which the categories "Unawareness," "Trust," "Search for Understanding," and "Making the Invisible Visible" were integrated and on which the conceptual model was built. The experience of screening had both a positive and a negative dimension for the women stricken by cervical cancer. The women had a positive experience of screening as such and they believed in its benefits. However, many women felt deceived and, because of their unawareness, questions arose for which they searched for understanding. The women requested adequate and understandable information. Their trust remained because the contact with healthcare professionals involved in screening and in the follow-up program had been reassuring.
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Affiliation(s)
- Monica Ideström
- Department of Obstetrics and Gynaecology, Central Hospital, SE-651 85 Karlstad, Sweden.
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Shah S, Montgomery H, Smith C, Madge S, Walker P, Evans H, Johnson M, Sabin C. Cervical screening in HIV-positive women: characteristics of those who default and attitudes towards screening. HIV Med 2006; 7:46-52. [PMID: 16313292 DOI: 10.1111/j.1468-1293.2005.00331.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the characteristics of HIV-positive women who undergo cervical screening and to identify negative attitudes and experiences of these women to screening and the factors associated with these. METHODS We compared the Royal Free Cohort data from 59 newly diagnosed HIV-infected women, 31 of whom did and 28 of whom did not attend for cervical screening in 2001, and from 227 women under active cervical screening follow-up (at least one cervical screen since June 2001) and 88 HIV-infected women lost to follow-up (not screened since January 2001). Attitudes to screening were investigated with the aid of a questionnaire given to all women attending clinic who had had a previous colposcopy. RESULTS Of the 59 newly HIV diagnosed women, 31 (53%) underwent cervical screening. These 31 women were more likely to be heterosexual (100 vs 89%, P=0.05), to have lower median viral loads (< 50 vs 3210 HIV-1 RNA copies/mL) and to be receiving antiretrovirals (ARVs) (74 vs 54%, P=0.1) than those not screened. Of the 315 women who had at least one screen, 72% returned for further follow-up. There were no differences in age or ethnicity between these groups. Those under active follow-up had a higher CD4 count (P=0.04) and lower viral load (P=0.0001) at their last visit. They were also more likely to be on highly active antiretroviral therapy (HAART) (68 vs 52%, P=0.006). A total of 78 of 104 questionnaires (75%) were returned. Women participating in the questionnaire study were mainly of back ethnicity (68%), did not speak English as their first language (59%) and were taking ARVs (76%). Most agreed that regular smears and colposcopy were valuable. Women of white ethnicity, and those speaking English as a first language, were more likely to dislike colposcopy compared with those of nonwhite ethnicity (87 vs 25%, respectively, P=0.0007) and not speaking English as a first language (74 vs 26%, respectively, P=0.002). Those of white ethnicity were more likely to find smears and colposcopy painful (60 and 73%) compared with those of black ethnicity (46 and 51%, P=0.47 and 0.28, respectively). CONCLUSIONS Our results suggest that women on HAART with better disease control, older women, and those of black African ethnicity are more likely to take up cervical screening. Cervical screening experience varies by ethnicity and language.
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Affiliation(s)
- S Shah
- Department of Thoracic Medicine, Royal Free Centre for HIV Medicine, London, UK
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Rydström C, Törnberg S. Cervical cancer incidence and mortality in the best and worst of worlds. Scand J Public Health 2006; 34:295-303. [PMID: 16754588 DOI: 10.1080/14034940500241979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Globally speaking, cervical cancer is a common cause of death. The cancer is caused by a human papillomavirus (HPV) infection, and hence is preventable. Pap smear screening allows for the early detection of precancerous lesions that are easily treated in a pre-invasive phase of the disease. New tests and treatment methods have the overall aim of lowering cervix cancer incidence and death. However, whether a woman will or will not develop cervix cancer depends on a complex number of interacting variables. AIM The aim of the present study was to identify factors that might have an impact on cervix cancer incidence and mortality, and rank them according to the weight of their relative influence. METHODS By using a forecasting model called the scenario method, factors were identified that could have an impact on cervix cancer development, and their relative importance was ranked by using a special matrix. The figures given for each factor were summed and presented in a System Grid, which made it possible to determine the most important variable. RESULTS The cultural structure of the female population, as well as women's habits and behaviour, all seem to be more important factors than the Pap smear test or the treatment in relation to cervical cancer incidence and mortality. CONCLUSION In the endeavour to prevent cervical cancer one must consider the whole chain of events, i.e. population-tests-treatment-outcome. New and improved test methods and treatment procedures are of little use if women refrain from coming for a test when called.
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Affiliation(s)
- Catrine Rydström
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Women's perceptions and social barriers determine compliance to cervical screening: Results from a population based study in India. ACTA ACUST UNITED AC 2006; 30:369-74. [DOI: 10.1016/j.cdp.2006.07.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2006] [Indexed: 11/19/2022]
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Markovic M, Kesic V, Topic L, Matejic B. Barriers to cervical cancer screening: a qualitative study with women in Serbia. Soc Sci Med 2005; 61:2528-35. [PMID: 15953668 DOI: 10.1016/j.socscimed.2005.05.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Indexed: 11/22/2022]
Abstract
Serbia employs opportunistic approaches to cervical cancer screening, leading to inequitable health care access. To better understand the health care needs of women, we investigated their knowledge of and perceived barriers to cervical cancer screening. Data reported in the paper arise from nine focus group discussions with 62 women from diverse socio-economic backgrounds. They were recruited in two cities with contrasting social settings, Belgrade, the Serbian capital, and a regional town, Smederevo. Thematic analysis identified that the interplay of social and personal barriers influenced women's poor presentation for screening. Inadequate public health education, lack of patient-friendly health services, socio-cultural health beliefs, gender roles, and personal difficulties were the most salient barriers to screening. We suggest how within the context of opportunistic screening patient education may be employed. The introduction of compulsory cervical cancer screening, suggested by some participants, is also discussed.
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Affiliation(s)
- Milica Markovic
- Department of Public Health, Key Centre for Women's Health in Society, School of Population Health, The University of Melbourne, Victoria 3010, Australia.
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Abstract
BACKGROUND Differences exist between defined groups of women in their attendance to screening programs for cervical carcinoma. Data from the screening organization in the southwest Netherlands were used to evaluate differences between subpopulations to get information to improve the screening procedure. METHODS Between 1998 and 2001, a total of 251,446 women had been invited to participate in the screening program. The ethnic background of all invited women was documented. Both the results of Papanicolaou tests and the reason women did not participate were stored in a data base that was matched with the invitation data base. The resulting data set was analyzed with regard to participation rates and results of screening in relation to age, ethnic background, and socioeconomic status. RESULTS Overall participation was 55.7%. Women who were born in The Netherlands participated at a rate of 56.8%, whereas women who were born in other Western countries participated at a rate of 45.3%. The participation rate for women who had a Moroccan background was as low as 35.9%. The prevalence of high-grade squamous intraepithelial lesion was 6.2 times higher among women in the younger age groups compared with women in the oldest age group. Women with low socioeconomic status were 1.5 times more likely to have high-grade squamous intraepithelial lesions. Women from The Netherlands Antilles had greater percentages of both low-grade and high-grade squamous intraepithelial lesions (1.6 and 3.0 times more frequent, respectively) compared with women who were born in The Netherlands. CONCLUSIONS Although cervical screening is free of charge in The Netherlands, participation rates differed greatly between ethnic groups and between women from different socioeconomic strata. Abnormalities were found more often in women who were not born in The Netherlands and in women with lower socioeconomic status. In these groups, attendance at the screening program was lower compared with the attendance of women who were born in The Netherlands.
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Affiliation(s)
- Antoine W F M van Leeuwen
- Reinier de Graaf Gasthuis, Diagnostisch Center Stichting Samenwerkende Delftse Ziekenhuizen (SSDZ), Department of Pathology, Delft, The Netherlands.
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Chan Chee C, Begassat M, Kovess V. Les facteurs associés au dépistage des cancers du col utérin dans une population mutualiste. Rev Epidemiol Sante Publique 2005; 53:69-75. [PMID: 15888991 DOI: 10.1016/s0398-7620(05)84573-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aims of our study were to examine the factors associated with cervical screening in women whose tests are supported by a national health insurance scheme, the Mutuelle Générale de l'Education Nationale. METHODS A self-administered postal questionnaire was sent to a random sample of 10,000 adults aged 20 to 60 years old living in France and insured with the Mutuelle Générale de l'Education Nationale. Response rate was 66.5% (N=6,518). RESULTS Of the 3,741 women aged 20 to 60 years old, 88.5% have had at least one cervical smear. Mean age for the first cervical smear was 29.3 years (95% CI: 29.0-29.6). Preventive practices (mammogram, cervical smear and fecal occult-blood testing) were strongly related. The predictive factors for cervical smear during the past three years included: age between 30 and 49 years, marital status (married, separated or divorced), the socioeconomic status (unskilled workers reported cervical smears less often than women from other socioeconomic status). Consulting a gynaecologist in the past twelve months increased 9-fold the probability of having a cervical smear and 2-fold when consulting a general practitioner compared to women who consulted neither a gynecologist nor a general practitioner. CONCLUSIONS In a population whose tests were supported by a national health scheme, the socioeconomic status was one of the determinants of Pap smear.
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García M, Fernández E, Borràs JM, Nieto FJ, Schiaffino A, Peris M, Pérez G, La Vecchia C. Cancer risk perceptions in an urban Mediterranean population. Int J Cancer 2005; 117:132-6. [PMID: 15880362 DOI: 10.1002/ijc.21091] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objective of our study was to analyze the perceived (belief) or adopted (behavior) measures to reduce cancer risk in a Spanish population. We used cross-sectional data from the Cornella Health Interview Survey Follow-up Study (CHIS.FU). We analyzed 1,438 subjects who in 2002 answered questions about risk perceptions on cancer and related behavior (668 males and 770 females). The benefits of avoiding cigarette smoking (95.8%), sunlight exposure (94.9%) and alcohol (81.0%) were widely recognized. On the other hand, electromagnetic fields (92.1%), food coloring and other food additives (78.4%) or pesticides (69.4%), whose role in cancer occurrence, if any, remain unproven, were clearly considered as cancer risk factors in this population. Compared to men, women more frequently reported healthy behaviors, and the role of exogenous factors (i.e., environmental risk factors) were widely popular. There was a socioeconomic gradient on cancer risk perception with respect to several lifestyle or dietary factors. Individuals with higher educational level scored lower in several risk factors than those with primary or less than primary school education. Smokers reported adopting fewer healthy behaviors than former or never smokers. How people perceive health issues and risk or make choices about their own behavior does not always follow a predictable or rational pattern.
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Affiliation(s)
- Montse García
- Cancer Prevention and Control Unit, Institut d' Investigació Biomédica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.
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Miles A, Cockburn J, Smith RA, Wardle J. A perspective from countries using organized screening programs. Cancer 2004; 101:1201-13. [PMID: 15316915 DOI: 10.1002/cncr.20505] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cancer screening may be offered to a population opportunistically, as part of an organized program, or as some combination of the preceding two options. Organized screening is distinguished from opportunistic screening primarily on the basis of how invitations to screening are extended. In organized screening, invitations are issued from centralized population registers. In opportunistic screening, however, due to the lack of central registers, invitations to screening depend on the individual's decision or on encounters with health care providers. The current article outlines key differences between organized and opportunistic screening. In the current study, literature searches were performed using PubMed and MEDLINE. Additional data were assembled from interviews with health officials in the five countries investigated and from the authors' personal files. Opportunistic screening was found to be distinguishable from organized screening on the basis of whether screening invitations were issued from centralized population registers. Organized screening programs also assumed centralized responsibility for other key elements of screening, such as eligibility requirements, quality assurance, follow-up, and evaluation. Organized programs focused on reducing mortality and morbidity at the level of the population rather than at the level of the individual. Thus, programs did not necessarily offer the most sensitive screening test for a particular cancer, and tests sometimes were offered at suboptimal intervals with respect to individual-level protection. Nonetheless, organized systems paid greater attention to the quality of screening, as measured by factors such as cancer detection rates, tumor characteristics, and false-positive biopsy rates. As a result, participants in organized screening programs received greater protection from the harmful effects associated with screening. In addition, organized programs worked more systematically toward providing value for money in an inevitably resource-limited environment. Although organized and opportunistic models of screening can yield similar uptake rates, organized programs exhibited greater potential ability to reduce cancer incidence and mortality, because of the higher levels of population coverage and centralized commitment to quality and monitoring; were more likely to be cost-effective; and offered greater protection against the harmful effects associated with poor quality or overly frequent screening.
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Affiliation(s)
- Anne Miles
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Forss A, Tishelman C, Widmark C, Sachs L. Women's experiences of cervical cellular changes: an unintentional transition from health to liminality? SOCIOLOGY OF HEALTH & ILLNESS 2004; 26:306-25. [PMID: 15043601 DOI: 10.1111/j.1467-9566.2004.00392.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Cervical cancer screening is a preventive intervention directed towards women to both detect cervical cancer and identify those at risk for developing this disease. It has been argued that participation in screening programmes and early detection situations may lead to new kinds of sickness experiences. This article is based on qualitative phenomenological hermeneutical analysis of interviews with women who have received abnormal Pap smear test results through a population-based outreach screening programme in urban Sweden. The aim of this article is to illuminate the meaning, for the participating women, of the lived experience of receiving notification about an abnormal Pap smear result. The data are presented in terms of two themes: Pap smear for routine and recurrent confirmation of health and unexpected and ambiguous communication about Pap smear results. The findings are discussed as an unintentional transition from confirmation of health to liminality. Whereas medical diagnosis has been discussed as structuring the inchoate, an abnormal Pap smear did not create order for the interviewed women. On the contrary, the notification of an abnormal Pap smear created disorder as the women had expected to be confirmed as healthy but instead neither health nor disease were confirmed or excluded. Even 'simple' technology is shown to have an ontological dimension, with the ability to transform daily taken-for-grantedness of ourselves as primarily healthy to (potentially) unhealthy.
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Affiliation(s)
- Anette Forss
- Department of Nursing, Karolinska Institutet, Sweden.
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Eaker S, Adami HO, Granath F, Wilander E, Sparén P. A Large Population-Based Randomized Controlled Trial to Increase Attendance at Screening for Cervical Cancer. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.346.13.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Objective: Although cervical cancer is one of the potentially most preventable malignancies, it is still fairly common. In settings with established screening programs, increased compliance is important for future reduction in cervical cancer incidence, but it is presently unclear how this can be effectively achieved. Methods: We conducted a randomized controlled trial including all 12,240 women invited to organized screening in Sweden. To increase compliance, three successive interventions were tested: (a) modified invitation versus the standard invitation letter, (b) reminder letter to nonattenders after the first intervention versus no reminder letter, and (c) phone reminder to nonattenders after the reminder letter versus no phone reminder. We analyzed the proportion of women attending screening after each intervention and the cumulative proportion after the interventions as well as the cumulative proportions of cytologic abnormalities. Results: The modified invitation did not increase attendance compared with the standard invitation letter [difference 1.3% 95% confidence interval (CI) −0.3 to 2.9]. In contrast, a reminder letter increased the proportion of women attending with 9.2% (95% CI 7.9–10.5) compared with women who did not receive a reminder letter, and a phone reminder increased the proportion of women attending with 31.4% (95% CI 26.9–35.9). Combinations of modified invitation, written reminder, and phone reminder almost doubled attendance within 12 months, and the number of detected cytologic abnormalities was more than tripled. Conclusion: Simple reminders by mail and phone can drastically increase women's participation in Papanicolaou smear screening and increase the number of detected precursor lesions and thereby save lives.
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Affiliation(s)
- Sonja Eaker
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Olov Adami
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- 2Department of Epidemiology, Harvard University, Boston, MA; and
| | - Fredrik Granath
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik Wilander
- 3Department of Genetics and Pathology, University Hospital, Uppsala, Sweden Sweden
| | - Pär Sparén
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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