Development and validation of a cervical cancer screening self-efficacy scale for low-income Mexican American women

Effects of communicating lifetime risks and screening rates of colorectal cancer and breast cancer

Colorectal cancer and breast cancer are among the most common types of cancer in the United States, and cancer screening is an effective way to detect and treat these cancers early. Health news stories, medical websites, and media campaigns regularly highlight the national lifetime risks of specific cancers and their screening rates, but recent research suggests that people tend to overestimate the prevalence of health problems but underestimate the prevalence of disease prevention behaviors in the absence of numerical information. This study featured two online experiments, one focused on breast cancer (N = 632) and one focused on colorectal cancer (N = 671), to examine the effects of communicating national cancer lifetime risks and screening rates among samples of screening-eligible adults in the United States. Findings confirmed prior work in showing that people overestimated colorectal/breast cancer lifetime risks but underestimated colorectal/breast cancer screening rates. Communicating the national lifetime risk of dying from colorectal/breast cancer lowered people's national risk estimates, which in turn was associated with lower perceived cancer risks for themselves. In contrast, communicating the national colorectal/breast cancer screening rate increased people's estimates of the prevalence of cancer screening, which in turn was associated with higher perceived self-efficacy to engage in cancer screening and greater screening intentions. We conclude that efforts to promote cancer screening may benefit from messages that include data on national cancer screening rates but may not benefit from including national rates of lifetime cancer risks.

Comparison of Narrative Video and Flipchart Presentation to Promote Cervical Cancer Screening Among Latinas Along the Border

INTRODUCTION

Cervical cancer incidence and mortality is higher among Latinas compared with non-Hispanic White women and barriers to screening include lack of knowledge, lack of access to health care, and cultural factors. Both video and printed material have been found effective as health education tools in underserved populations. The purpose of this study was to show no difference between a flipchart presentation facilitated by a community health worker and a narrative video with limited in-person interaction in increasing cervical cancer screening rates among Latinas along the U.S.-Mexico border.

METHODS

Study design: Randomized controlled study. Participants: women in a community-based cervical cancer screening program.

OUTCOMES

Primary outcome was screening completion and secondary outcomes were changes in psychosocial variables.

RESULTS

Total sample size was 500. Most participants were born in Mexico, had a low annual income, preferred Spanish, and did not have a regular doctor. Overall, 371 (74.2%) participants completed screening. There was no significant difference in screening completion between educational delivery modes. The only variable significantly associated with screening completion was age, with 51- to 65-year-olds being 44% more likely than 21- to 40-year-olds to have a Pap test. The only psychosocial variable that was significantly different by delivery mode was perceived susceptibility. The majority of all participants found both the video and flipchart presentation to be acceptable.

CONCLUSION

A health promotion program delivered via self-administered video or PowerPoint slides showed no difference in increasing cervical cancer screening rates.

Community-based health literacy focused intervention for cervical cancer control among Black women living with human immunodeficiency virus: A randomized pilot trial

BACKGROUND

Health literacy plays an essential role in how individuals process health information to make decisions about health behaviours including cancer screening. Research is scarce to address health literacy as a strategy to improve cancer screening participation among women living with human immunodeficiency virus (HIV), particularly Black women who, despite the heavy burden of cervical cancer, report consistently low screening rates.

AIM

To assess the feasibility, acceptability and preliminary efficacy of a health literacy-focused intervention called CHECC-uP-Community-based, HEalth literacy focused intervention for Cervical Cancer control-among women living with HIV.

METHODS

We conducted a community-based, single-blinded randomized pilot trial. A total of 123 eligible women were enrolled and randomized to one of two conditions, control (i.e., cervical cancer brochure) or intervention (cervical cancer brochure plus 30-60 min health literacy-focused education followed by monthly phone counselling and navigation assistance for 6 months). Study assessments were done at baseline, 3 and 6 months. The final analysis sample included 58 women who completed all data points and whose Papanicolaou (Pap) test status was confirmed by medical records.

RESULTS

All intervention participants who completed the programme would recommend the CHECC-uP to other women living with HIV. However, adherence in the experimental conditions was low (49.6% attrition rate including 20 women who dropped out before the intervention began) due, in large part, to phone disconnection. Those who had received the intervention had a significantly higher Pap test rate compared to women in the control group at 6 months (50% vs. 21.9%, p = .025). Participation in the intervention programme was associated with improved health literacy and other psychosocial outcomes at 3 months but the trend was attenuated at 6 months.

CONCLUSIONS

The CHECC-uP was highly acceptable and led to improved Pap testing rates among Black women living with HIV. Future research should consider addressing social determinants of health such as phone connectivity as part of designing a retention plan targeting low-income Black women living with HIV.

IMPLICATIONS

The findings should be incorporated into a future intervention framework to fulfil the unmet needs of Black women living with HIV to facilitate their decision-making about Pap test screening.

PATIENT OR PUBLIC CONTRIBUTION

Nineteen community members including women living with HIV along with HIV advocates and care providers participated in four focus groups to develop cervical cancer screening decision-relevant information and the health literacy intervention. Additionally, a community advisory board was involved to provide guidance in the general design and conduct of the study.

Validity of a questionnaire on self-efficacy for Pap test adherence screening

Introduction

Self-efficacy has been related to different health preventive behaviors, included adherence to the Papanicolaou test—also called Pap smear or Pap test. The aim of this study is to test construct and criterion validity and reliability of a questionnaire on self-efficacy and the Pap test in Chilean women.

Method

This study was carried out on a sample of 969 women of ages from 25 to 64, who are users of the public health care system in Santiago, Chile. The validity of the Self-Efficacy Scale for the Pap Smear Screening Participation (SES-PSSP) questionnaire was done by confirmatory factor analysis, external criteria by t-test, and reliability by Cronbach’s alpha.

Results

Three models were tested, obtaining a questionnaire with 20 items and 2 dimensions. The criteria validity was confirmed by adherence to the Pap test. The final questionnaire has a reliability of 0.95, measured by Cronbach´s alpha.

Conclusion

A valid and reliable questionnaire to measure self-efficacy in relation to the Pap test is a relevant contribution in cervical cancer prevention, especially related to interventions focused on increasing adherence.

Ensuring a successful transition from Pap to HPV-based primary cervical cancer screening in Canada by investigating the psychosocial correlates of women’s intentions: Protocol for an observational study (Preprint)

Background

Objective

Methods

Results

Conclusions

International Registered Report Identifier (IRRID)

A blended educational intervention program on Pap-test related behavior among Iranian women

OBJECTIVE

To assess the effect of a blended educational program to promote performing the PST among Iranian women.

DESIGN

In a randomized control trial four main variables; knowledge, attitude, self-efficacy, and practice about PST was evaluated using a man-made questionnaire for PST.

SETTING

Women aged 18-49 living in Andimeshk (Khuzestan, Iran), covered by 16 health centers, participated in study from November 2019 till April 2019.

METHOD

The educational intervention conducted to increasing women's performing the PST. The experimental group received an intervention, whereas the control group received usual care. Participants were tested at four-time points: pre-test (baseline), post-test 1 (immediately after the program's completion) post-test 2 (4 weeks after the program's completion) and post-test 3 (12 weeks after the program completion).

RESULTS

A total of 84 women with average aged 32.27 (42 in the experimental group, 42 in the control group) were recruited from 16 health centers in Andimeshk, southern Iran. Significant group differences were found at different times in knowledge, attitude, self-efficacy, and practice about PST.

CONCLUSION

A blended method was effective in sustaining the effects of the educational program in the experimental group. The development of appropriate teaching method on restricted situation such as COVID-19 pandemic to promote participation is suggested.

A Model-Based Meta-Analysis of Willingness to Participate in Cancer Screening

Although early screening tests are beneficial for the detection and treatment of cancers, many people have failed to participate in screening tests. The present study aims to explore the theoretical underpinning of low participation in screening programs using the method of meta-analytic structural equation modeling. It was found that the health belief model is the most adopted theoretical framework. Moreover, the intended uptake of screening was positively predicted only by cues to action, health literacy, and perceived susceptibility. As a result, a health intention model, including the three significant variables, is proposed. The practical implications of the findings are that health communication campaigns should focus on enlightening and engaging the public through all necessary means to raise awareness and transfer knowledge in relation to screening procedures as well as cancers per se.

Knowledge, attitude, practice, and self-efficacy of women regarding cervical cancer screening

Objective

Iran has a low incidence of cervical cancer (CC). The country is introducing an organized screening system, including human papillomavirus screening. Studies show a high dropout rate among eligible women in continuing testing.

Methods

This descriptive-analytic study was part of the first phase of a clinical trial conducted on a random sample of 400 women aged 18–49 in Andimeshk City, Khuzestan Province, in 2020. The data collection tool consisted of a man-made questionnaire that included domains of demographic characteristics, knowledge, attitude, practice, and self-efficacy in the Pap smear test. The data were analyzed with Stata-16 using linear and logistic regression models.

Results

The mean knowledge, attitude, and self-efficacy scores were 6.80±2.33, 34.99±4.32, and 28.67±7.34, respectively. In the multiple models, every unit increase in the knowledge or attitude scores raised the mean self-efficacy score by 1.04 and 0.48, respectively (P<0.001). Every unit increase in the knowledge and self-efficacy scores increased the chance of performing Pap smear 1.61 and 1.41 times, respectively (P<0.001).

Conclusion

Given the association of women’s knowledge and self-efficacy with practice in performing the Pap smear, it seems that an effective program promoting women’s health behavior regarding CC screening would include applied education to raise community awareness and improve women’s attitudes, self-efficacy, and practice.

Attending to the Psychosocial Needs of Older Hispanic, Black and Non-Hispanic White Women and Their Breast Cancer Screening Behaviors

BACKGROUND

Cancer risk increases with age. Despite breast cancer screening guidelines, older minorities are less likely to obtain screenings. Many factors influence cancer screening participation, though the literature rarely examines factors influencing cancer screening in older adult minority populations.

METHODS

Using 2008 and 2012 waves of data from the Health and Retirement study, we examined and compared the relationships between psychosocial factors and breast screening participation among older African American, Hispanic and non-Hispanic White women. We utilized logistic regression to determine the influence of psychosocial factors (satisfaction with aging, religiosity, perceived control, emotions, purpose in life) in 2008 predicting breast cancer screening participation in 2012, given the increasing importance of understanding health behaviors as predicted by prior circumstances. While controlling for other variables, the major findings demonstrated that the odds of having a mammogram among Hispanics decreased as feelings that 'things were getting worse' with age intensified; and screening was more likely among Hispanic religious women. The odds of obtaining a mammogram increased with increasing purpose in life for Hispanics.

CONCLUSIONS AND IMPLICATIONS

These findings suggest the need for comprehensive geriatric assessments to understand the perspectives of older minority women, and provides formative data to inform shared decision-making interventions.

Psychometric Testing of Papanicolaou Testing Barriers and Self-efficacy Scales Among Black Women

BACKGROUND

Black women face cervical cancer disparities with higher rates of morbidity and mortality compared with White women. Identifying predictors of Papanicolaou (Pap) testing is a first step to decrease morbidity and mortality from cervical cancer, with barriers and self-efficacy being constructs that should be related to Pap testing adherence. Although barriers and self-efficacy scales have been developed, they have not been validated in Black women for Pap testing.

OBJECTIVE

The purpose of this study was to modify and psychometrically test barriers and self-efficacy to Pap testing in a Black population.

INTERVENTION/METHODS

Data were collected from a minority health fair. Internal consistency reliability testing was conducted using item analysis and Cronbach's α. Construct validity was assessed by exploratory factor analysis and logistic regression. Papanicolaou testing adherence was regressed on each scale (barriers and self-efficacy) while controlling for antecedents.

RESULTS

Data demonstrated 2 reliable scales: (1) barriers (Cronbach's α = .79), item-total correlation = 0.479 to 0.628; and (2) self-efficacy (Cronbach's α = .85), item-total correlation = 0.560 to 0.697. Exploratory factor analysis supported 2 unidimensional scales. The regression models supported a relationship between each scale and Pap testing adherence.

CONCLUSIONS

The data suggested barriers and self-efficacy scales were reliable and valid among Black women. Barriers and self-efficacy could be tailored in future interventions to increase Pap testing adherence.

IMPLICATIONS FOR PRACTICE

Nurses could use responses to these scales for framing discussions about Pap testing.

Group Versus Individual Culturally Tailored and Theory-Based Education to Promote Cervical Cancer Screening Among the Underserved Hispanics: A Cluster Randomized Trial

Purpose:

To determine whether group education is as effective as individual education in improving cervical cancer screening uptake along the US–Mexico border.

Design:

Cluster randomized controlled study.

Setting:

El Paso and Hudspeth Counties, Texas.

Participants:

Three hundred women aged 21 to 65 years, uninsured, due for a Pap test, no prior history of cervical cancer or hysterectomy.

Intervention:

Theory-based, culturally appropriate program comprised of outreach, educational session, navigation services, and no-cost cervical cancer testing.

Measures:

Baseline, immediate postintervention, and 4-month follow-up surveys measured knowledge and theoretical constructs from the Health Belief Model, Theory of Reasoned Action, and the Social Cognitive Theory.

Analysis:

Relative risk regression analyses to assess the effects of educational delivery mode on the uptake of screening. Mixed effect models to analyze changes in psychosocial variables.

Results:

One hundred and fifty women assigned to each educational group; 99% Hispanic. Of all, 85.7% completed the follow-up survey. Differences in screening rate at follow-up were analyzed by education type. Overall screening rate at follow-up was 73.2%, no significant difference by education type (individual: 77.6%, group: 68.9% P = .124). Significant increases among group education at follow-up for knowledge, perceived susceptibility, perceived seriousness, and subjective norms and significant decrease for perceived benefits.

Conclusion:

This study provides evidence to support the effectiveness of group education to promote cervical cancer screening among vulnerable Hispanic women and offers an additional method to address cervical cancer disparities.

Cervical Cancer Knowledge, Self-Efficacy, and Health Literacy Levels of Married Women

The purpose of this descriptive and relational study is to investigate the relationship between cervical cancer knowledge and self-efficacy and health literacy levels of married women aged 18-65 years. The study sample consisted of 400 married women (18-65 years old) who presented to a family health center. Independent variables were sociodemographic characteristics; dependent variables were cancer knowledge, self-efficacy, and health literacy level. Of the participants, 67% had a Pap smear. The participants' median knowledge score was 13 (min-max = 1-21). As the age increased, so did the knowledge score (p = 0.001). The secondary school graduates had the lowest knowledge level (p = 0.009). The participants' self-efficacy level was moderate (83.18 ± 7.70). As the educational status increased, so did their self-efficacy. Of the participants, 55.2% had a health literacy level of 7th-8th grade. The health literacy level was lower among the literate, primary school graduate, and advanced-age participants (p = 0.000). Increases in the self-efficacy and health literacy levels of the participants positively affected their knowledge status. The participants' cervical cancer and Pap smear screening knowledge levels increased as their self-efficacy levels increased. The literate or primary school graduate participants had the self-efficacy and health literacy levels.

Parental predictors of HPV vaccine initiation among low-income Hispanic females aged 11-17 years

PURPOSE

Hispanic women experience a disproportionate burden of cervical cancer morbidity and mortality compared to non-Hispanic women. Increasing HPV vaccination among Hispanic adolescents can help alleviate disparities. This study aimed to identify parental psychosocial predictors associated with HPV vaccine initiation and correlates of parental intentions to obtain the vaccine for their Hispanic adolescent daughters aged 11-17 years.

METHODS

This study is part of a larger three-arm randomized controlled trial testing the effectiveness of interventions to increase HPV vaccination. Parents of adolescent females were recruited in community clinics where we conducted baseline surveys. We obtained electronic medical records six months after baseline to assess vaccination status. Multilevel logistic regression was used to identify correlates of parental intentions to vaccinate and predictors of HPV vaccine initiation. Analyses with initiation as the outcome also controlled for intervention study arm. The Integrated Behavioral Model guided selection of psychosocial and outcome variables.

RESULTS

Our sample (n = 765) consisted mostly of mothers with less than a high school education born outside of the U.S. Forty-one percent had a household income less than $15,000. Most daughters had public or private insurance. Twenty-one percent initiated the HPV vaccine series. Correlates of intention to vaccinate intention included subjective norms related to daughter's doctor (AOR = 1.04; 95% CI 1.01-1.07), belief that the vaccine is safe (AOR = 1.38; 95% CI 1.06-1.78), self-efficacy to obtain the vaccine for their daughter (AOR = 2.39; 95% CI 1.52-3.77), and parental concern about vaccine side effects (AOR = 0.73; 95% CI 0.60-0.89). Intentions predicted initiation (AOR = 2.01; 95% CI 1.10-5.26); concern about sexual disinhibition decreased the odds of having a vaccinated daughter at follow-up (AOR = 0.66; 95% CI 0.47-0.92).

DISCUSSION

Parental intention and concerns about sexual disinhibition predict vaccine initiation. Further research is needed to explore the role of intention as a potential mediator between psychosocial variables and vaccination status.

Educating Hispanic Women about Cervical Cancer Prevention: Feasibility of a Promotora-Led Charla Intervention in a Farmworker Community

Hispanic women suffer disproportionately from cervical cancer incidence and mortality compared with non-Hispanic Whites in the United States. Peer-led health education and coaching via charlas (talking circles) may improve cervical cancer screening and early detection rates among specific sub-groups such as farmworker communities. This pilot study sought to collect preliminary evaluation data about the feasibility of implementing a promotora-led cervical cancer education intervention among women from a farmworker community. The study took place between April 2014 and November 2014. Created based on an established network (Tampa Bay Community Cancer Network, TBCCN), in partnership with a local farmworker organization (Farmworkers Self-Help, Inc.), the project entailed refinement of a curriculum guide including Spanish-language educational resources (teaching cards). Social Cognitive Theory and the Health Belief Model provided the conceptual framework for the study. Six women from the farmworker community helped to refine the intervention and were trained as promotoras. They successfully delivered the program via charlas to a total of 60 participants who completed baseline and post-intervention measures on knowledge (cervical cancer/HPV), beliefs, self-efficacy, and intentions. Findings demonstrated gains in knowledge and self-efficacy among charla participants (P<.0001), and support the promise of a community-driven intervention that is delivered by promotoras who use their cultural knowledge and trustworthiness to educate women about cancer screening practices. Results also add to the literature on the use of a charla approach for cancer prevention education within a farmworker community to prompt discussions about health. Future research should evaluate peer-led programs on a larger scale and among other at-risk groups in other community settings.

The Impact of Perceived Barriers on Self-Efficacy for HPV Preventive Behavior

Background: Cervical cancer is one of the most common cancers found among women. Many studies have focused on factors associated with human papilloma virus (HPV) preventive behavior and early detection using models such as the health belief model (HBM). Despite a growing body of knowledge regarding HPV preventive behavior, few studies have examined how self-efficacy affects this behavior in foreign women living in South Korea. This study identified factors affecting the self-efficacy of foreign women living in South Korea and the impact on HPV preventive behavior. Methods: A total of 171 participants consisting of international school parents who voluntarily participated in HPV preventive behavior were selected. A multivariate regression analysis included key variables such as demographics, cervical cancer knowledge, perceived susceptibility, and perceived barriers. Results: Self-efficacy for HPV preventive behavior was significantly associated with perceived barriers. That is, women with lower perceived barriers were likely to have higher self-efficacy scores. However, demographics, cervical cancer knowledge, and perceived susceptibility did not show any association with self-efficacy. The final model was significant and accounted for 14.4% of the variance in self-efficacy. Conclusion: This study showed the importance of considering perceived barriers of HPV preventive behavior related to self-efficacy. However, different from HBM, modifying factors, such as knowledge, perceived susceptibility, and individual demographics were not related to self-efficacy. Based on these findings, future research should investigate self-efficacy and HPV preventive behavior among individuals who do not participate in HPV preventive behavior.

Decisional balance and self-efficacy mediate the association among provider advice, health literacy and cervical cancer screening

PURPOSE

Health literacy has emerged as a potential determinant of cancer screening, yet limited literature has investigated the pathways which health literacy influences Pap tests among immigrant women who experience a higher incidence of cervical cancer. This study aimed to test a health literacy-focused sociocognitive model which proposes motivational (knowledge, decisional balance) and volitional (self-efficacy) factors mediating the association between health literacy and triennial Pap tests.

METHODS

Using structural equation modeling, we conducted a secondary analysis of baseline data obtained from a randomized controlled trial to promote breast and cervical cancer screenings among 560 Korean American women 21-65 years of age. They were interviewed on demographics such as education and English proficiency, provider advice, health literacy, knowledge of cervical cancer, decisional balance for Pap tests, self-efficacy, and Pap test use.

RESULTS

Higher health literacy predicted high level of knowledge and high decisional balance score, and greater self-efficacy and then only decisional balance and self-efficacy affected Pap tests. High level of knowledge predicted Pap tests through its impact on the decisional balance score. Receiving provider advice both directly and indirectly predicted Pap tests through high level of health literacy, high level of decisional balance and greater self-efficacy.

CONCLUSIONS

Findings from this study suggest possible pathways through which provider advice and health literacy affect Pap tests. Interventions targeting immigrant women with limited English proficiency should consider skill-based approaches such as health literacy training, promoting patient-provider communications and emphasizing decisional balance and self-efficacy as potentially sustainable ways of promoting Pap tests.

Salud es Vida: a Cervical Cancer Screening Intervention for Rural Latina Immigrant Women

This study examined the feasibility and efficacy of Salud es Vida-a promotora-led, Spanish language educational group session on cervical cancer screening (Pap tests)-self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds. These women are disproportionately burdened with cervical cancer, with mortality rates significantly higher than non-Hispanic whites. The two-arm, quasi-experimental study was conducted in four rural counties of Southeast Georgia in 2014-2015. Hispanic/Latina immigrant women aged 21-65 years and overdue for a Pap test were included as intervention (N = 38) and control (N = 52) group participants. The intervention was developed in partnership with a group of promotoras to create the toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Twelve (32 %) intervention group participants received the Pap test compared to 10 (19 %) control group participants (p = 0.178). The intervention group scored significantly higher on both cervical cancer knowledge recall and retention than the control group (p < 0.001). While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores. The group intervention approach was associated with increased cervical cancer knowledge but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.

Latina Women and Cervical Cancer Screening: Decisional Balance and Self-Efficacy

BACKGROUND

Latina women in the United States have greater cervical cancer mortality rates than non-Latina women because of their low rates of Papanicolau (Pap) smear screening.

OBJECTIVES

The purpose of this article is to assess differences in perceived benefits, perceived barriers, and self-efficacy among Latina women to obtain Pap smears using the framework of the Transtheoretical Model.

METHODS

A descriptive design with a snowball sample was used. The researchers assessed demographics, three perceived benefits, 12 barriers, and seven self-efficacy measures for 121 Latina women in northern Nevada.

FINDINGS

Participants in precontemplation and relapse perceived greater barriers than those in action and maintenance for three items.

Utilization of Cervical Cancer Screening Among Hispanic Immigrant Women in Coastal South Carolina

OBJECTIVES

This study aims to examine prevalence and correlates of cervical cancer screening utilization and adherence among a growing population of Hispanic immigrant women in coastal South Carolina.

METHODS

We conducted a cross-sectional survey of 196 women to assess recency of screening and hypothesized study predictors (health status, beliefs, self-efficacy, having a regular provider, barriers to screening, and trust in providers). Multiple ordinal logistic regressions identified final covariates which would predict recency of screening.

RESULTS

Approximately 84% of women were up-to-date with their Pap tests and 47% had received a Pap test in the previous year. In the adjusted analyses, having a regular provider and having a chronic medical condition were significantly associated with recency of Pap test.

CONCLUSIONS

Differences in cervical cancer screening for participants were partially explained by psychosocial factors, health status, and individual and structural barriers to healthcare.

Using Health Belief Model Constructs to Examine Differences in Adherence to Pap Test Recommendations among Iranian Women

Despite documented successful Pap tests in routine care of women, screening levels are unfortunately often lower than recommended. This study aimed to assess differences in adherence to Pap test guidelines among a sample of Iranian women using the Health Belief Model (HBM). In this descriptive and analytical study, information was collected from a total of 305 women, (age range of 15-49) from Zarandieh health centers in Iran using a random multistage sampling method. The questionnaire covered demographic characteristics; health belief model constructs were gathered by a self-report method. The results were analyzed using the independent samples t test and logistic regression in SPSS-20. A total 32% of the subjects had a history of a Pap test and the score mean of the whole constructs model (knowledge, susceptibility, severity, benefits, barriers and self-efficacy) in these individuals was higher than those without a positive history. Among the predictive variables of HBM constructs, the highest weights were observed for perceived benefits ß)=0.36), perceived susceptibility =ß) 0.35) and self-efficacy ß)=0.29). Based on our finding of positive relationships for health belief model structures with performance of a pap smear test, designing educational interventions for changing the knowledge levels and beliefs of women is recommended.

Women's perspectives on human papillomavirus self-sampling in the context of the UK cervical screening programme

BACKGROUND

Testing for human papillomavirus (HPV) is being incorporated into the cervical screening programme, with the probable future introduction of HPV as a primary test and a possibility of HPV self-sampling. In anticipation of this development, we sought to inform future policy and practice by identifying potential barriers to HPV self-sampling.

METHODS

A cross-sectional survey of 194 women aged 20-64 years was conducted. Logistic regression analysis was used to identify determinants of self-sampling intentions. A purposive subsample of 19 women who reported low self-sampling intentions were interviewed. Interviews were framework-analysed.

RESULTS

Most survey participants (N=133, 69.3%) intended to HPV self-sample. Lower intention was associated with lower self-efficacy (OR=24.96, P≤.001), lower education (OR=6.06, P≤.05) and lower perceived importance of HPV as a cause of cervical cancer (OR=2.33, P≤.05). Interviews revealed personal and system-related barriers. Personal barriers included a lack of knowledge about HPV self-sampling, women's low confidence in their ability to self-sample correctly and low confidence in the subsequent results. System-related factors included a lack of confidence in the rationale for modifying the current cervical screening programme, and concerns about sample contamination and identity theft.

CONCLUSIONS

Insights gained from this research can be used to guide further enquiry into the possibility of HPV self-sampling and to help inform future policy and practice. Personal and system-related barriers including low confidence in the reasons for changing current cervical screening provision need to be addressed, should HPV self-sampling be incorporated into the cervical screening programme.

Psychosocial correlates of cervical cancer screening among older Hispanic women

Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women's participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

Predictors of Human Papillomavirus Vaccine Initiation and Completion Among Latino Mothers of 11- to 17-Year-Old Daughters Living Along the Texas-Mexico Border

Few Texas Latino girls initiate and complete the human papillomavirus (HPV) vaccine series, but few studies have examined predictors of initiation and completion in this group. Mothers are crucial to vaccine uptake. Using self-reported data from mothers of unvaccinated girls (n = 317), we examined the association between predictors (HPV and HPV vaccine knowledge, vaccine self-efficacy) and outcomes (initiation and completion). Despite an increase in HPV and HPV vaccine knowledge from baseline to follow-up (n = 195), we found no association between the predictors and the outcomes. Findings showed that health insurance status and study group participation (Entre Madre e Hija program or brochure only) were associated with initiation and completion.

Cues to Cervical Cancer Screening Among U.S. Hispanic Women

Introduction:

Hispanic women’s cervical cancer rates are disproportionately high. Cues to cervical cancer screening (Cues to Action) are strategies to activate the decision-making process to get screened for cervical cancer. This study used the health belief model to examine which cues prompt Hispanic women to undergo cervical cancer screening and how perceptions could be potentiated by cues to cervical cancer screening.

Method:

A cross-sectional survey was conducted among Hispanic women 18 to 65 years old ( n = 220). Generalized linear modeling was used.

Results:

Spanish media and reminders by mother and doctors were relevant cues. Generalized linear modeling showed cues to action modified significantly the predictive effect of Perceived Threats (i.e., Susceptibility, Severity), benefits, barriers, and self-efficacy on Hispanic women’s cervical cancer screening behavior. “Mother told me” and Spanish media messages were significant covariates.

Conclusion:

Cues to Action influenced Hispanic’s women participation in cervical cancer screening. Cues to Action increased the strength of the health belief model as an explanatory model, and must be considered in designing culturally appropriate cervical cancer screening interventions.

Cultural beliefs and understandings of cervical cancer among Mexican immigrant women in Southeast Georgia

Rural Mexican immigrant women in the U.S. are infrequently screened and experience health disparities from cervical cancer. We explored cancer-related cultural beliefs in this population. We administered a cross-sectional survey to 39 Mexican immigrant women due for screening. We conducted univariate and bivariate analyses of participants' characteristics, Pap test history, cancer-related knowledge and beliefs, and cultural consensus analysis about causes of cervical cancer and barriers to screening. For all the cultural consensus tasks, there was consensus (Eigenratios >3:1) among survey participants. Comparing the rankings of risk factor clusters, clusters related to sexual behaviors were ranked more severely than clusters related to genetic or other behavioral factors. There was agreement on ideas of cervical cancer causation and barriers to screening among these women. Hence, improved methods of disseminating important health information and greater access to care are needed, particularly in relationship to stigma about sex and birth control practices.

Correlates of Receipt of Colorectal Cancer Screening among American Indians in the Northern Plains

Research has consistently documented lower colorectal cancer (CRC) screening rates for racial and ethnic minority populations, with the lowest screening rates among American Indians (AIs). Given the low CRC screening rates among AIs residing in the Northern Plains region, the objective of this research was to identify CRC screening correlates for Northern Plains AIs. With a sample of 181 AIs age 50 years or older, the authors used Andersen's behavioral model to examine the following factors related to receipt of CRC screening: (a) predisposing factors-age, education, marital status, and gender; (b) need factors-personal and family history of cancer; and (c) enabling factors-having a particular place to receive medical care, annual health checkup, awareness of the availability of CRC screening, knowledge of CRC, and self-efficacy of CRC. Nested logistic regression identified the following correlates of receipt of CRC screening: (a) predisposing factors-older age; (b) need factors-having a personal history of cancer; and (c) enabling factors-having an annual health checkup, greater awareness of CRC screening, and greater self-efficacy of CRC. Given the findings, prevention and intervention strategies, including public awareness and education about CRC screening, are promising avenues to reduce cancer screening disparities among AIs.

mHealth Pilot Study: Text Messaging Intervention to Promote HPV Vaccination

OBJECTIVES

To test the feasibility and efficacy of a culturally-tailored mobile health intervention designed to increase knowledge about, intent to obtain, and receipt of the HPV vaccine.

METHODS

A 7-day text message HPV intervention was developed using a quasi-experimental research design for 30 Korean-American women.

RESULTS

Participants demonstrated significant increases in knowledge of HPV with an intent to get vaccinated within one year, and 30% of participants received the first dose of the HPV vaccine.

CONCLUSIONS

Mobile health technology could be a promising tool in reducing the cancer burden for underserved populations.

Beliefs About Anal Cancer among HIV-Infected Women: Barriers and Motivators to Participation in Research

BACKGROUND

Infection with the human immunodeficiency virus (HIV) remains associated with a greater risk of anal cancer, despite widespread use of combination antiretroviral therapy. Evidence concerning the acceptability of anal cancer screening gives little attention to women. Because HIV-infected women have a high prevalence of depression and history of sexual trauma, understanding acceptability among this group is critical.

PURPOSE

We sought to assess barriers and motivators to participation in anal cancer screening research among a racial/ethnically diverse HIV-infected female population.

METHODS

We conducted a survey based on the Health Belief Model to identify characteristics of women willing to participate in anal cancer screening research (n = 200). Bivariate analyses examined associations between willingness to participate and sociodemographics, clinical characteristics, and health beliefs. Logistic regression modeled willingness to participate in research.

MAIN FINDINGS

Of the women who participated, 37% screened positive for depression, 43% reported a high trauma history, and 36% screened positive for posttraumatic stress disorder. Overall, 65% reported willingness to participate in research. Those likely to participate were older, reported intravenous drug use as their HIV risk factor, and had a history of prior high-resolution anoscopy (HRA) compared with those unwilling to participate. The most commonly reported barrier to anal Pap testing was fear of pain. In adjusted analyses, a lack of fear of pain and prior experience with HRA significantly predicted willingness to participate.

CONCLUSIONS

Findings suggest that, to increase participation in anal Pap and HRA-related research for HIV-infected women, a single approach may not be adequate. Rather, we must harness patients' previous experiences and address psychosocial and financial concerns to overcome barriers to participation.

Colorectal cancer screening among Latinos in three communities on the Texas-Mexico border

OBJECTIVE

To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas.

METHOD

Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older).

RESULTS

In this socioeconomically disadvantaged population, 40% had never heard of any CRCS test, only 34% reported ever completing any type of CRCS, and only 25% were adherent to CRCS guidelines. Insurance status, gender, perceived cons, CRCS self-efficacy, and CRCS norms were significantly associated with CRCS.

CONCLUSION

CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS.

The relationship between psychosocial factors and breast cancer screening behaviors of older Hispanic women

Guided by the theory of planned behavior, this study utilized data from the 2008 wave of the Health and Retirement Study to investigate psychosocial factors associated with older Hispanic women's participation in breast cancer screening services. Hierarchical logistic regression models were used to assess the odds of breast cancer screening participation. Findings indicate that satisfaction with aging and constraints were associated with a reduced likelihood of participating in breast cancer screening. These findings suggest the continued importance to assess older women's attitudes when discussing preventive services.

Individual and community effectiveness of a cervical cancer screening program for semi-urban Mexican women

The effectiveness at the individual and community level of an educational intervention to increase cervical cancer screening self-efficacy among semi-urban Mexican women was evaluated and changes in reported community barriers were measured after the intervention was implemented. The educational intervention was evaluated with a quasi-experimental pre-test/post-test design and a control group, based on the Integrative Model of Behavior Prediction and AMIGAS project materials. For the intervention group, increased self-efficacy increased requests to obtain a Pap (p < 0.05). Barriers to obtaining a Pap were embarrassment and lack of time at the individual level, and lack of time, test conditions and fear of social rejection in the community's cultural domain. At both the individual and community levels, having more information about the test and knowing it would be performed by a woman were primary facilitators. Few women used medically precise information when referring to the Pap and cervical uterine cancer. Although the level of self-efficacy of the participants increased, barriers in the health system affect the women's perceived ability to get a Pap. Better care for users is needed to increase consistent use of the test. The study shows the importance of using culturally adapted, multilevel, comprehensive interventions to achieve successful results in target populations.

Creating a patient navigation model to address cervical cancer disparities in a rural Hispanic farmworker community

This report describes the implementation of a pilot patient navigation (PN) program created to address cervical cancer disparities in a predominantly Hispanic agricultural community. Since November 2009, a patient navigator has provided services to patients of Catholic Mobile Medical Services (CMMS). The PN program has resulted in the need for additional clinic sessions to accommodate the demand for preventive care at CMMS.

Increasing cervical cancer screening in the United States-Mexico border region

PURPOSE

Hispanic women living on the United States-México border experience health disparities, are less likely to access cervical cancer screening services, and have a higher rate of cervical cancer incidence compared to women living in nonborder areas. Here we investigate the effects of an intervention delivered by community health workers (CHWs, known as lay health educators or Promotores de Salud in Spanish) on rates of cervical cancer screening in Hispanic women who were out of compliance with recommended screening guidelines.

METHODS

Hispanic women out of compliance with screening guidelines, attending clinics in southern New Mexico, were identified using medical record review. All eligible women were offered the intervention. The study was conducted between 2009 and 2011, and data were analyzed in 2012. Setting/participants--162 Hispanic women, resident in New Mexico border counties, aged 29-80 years, who had not had a Pap test within the past 3 years. Intervention--a CHW-led, culturally appropriate, computerized education intervention. Main outcome measures--the percentage of women who underwent cervical cancer screening within 12 months of receiving the intervention. Change in knowledge of, and attitudes toward cervical cancer and screening as assessed by a baseline and follow-up questionnaire.

RESULTS

76.5% of women had a Pap test after the intervention. Women displayed increased knowledge about cervical cancer screening and about HPV.

CONCLUSIONS

A culturally appropriate promotora-led intervention is successful in increasing cervical cancer screening in at-risk Hispanic women on the United States-México border.

Parental Human Papillomavirus Vaccine Survey (PHPVS): nurse-led instrument development and psychometric testing for use in research and primary care screening

BACKGROUND AND PURPOSE

Human papillomavirus (HPV) vaccine was approved for girls aged 9-24 years in 2006 to prevent HPV infection and cervical cancer. The Parental Human Papillomavirus Survey (PHPVS) was framed on theoretical constructs of the health belief model (HBM) and developed to survey parents regarding their HPV knowledge, attitudes, and intent to vaccinate.

METHODS

We evaluated the psychometric properties of the PHPVS using classical item analysis and exploratory factor analysis (EFA) among a sample of 200 parents/caregivers.

RESULTS

The EFA yielded a 4-factor unidimensional model that explained between 62% and 68% of the total variance depending on the extraction method used. The estimated Cronbach's alpha for the PHPVS was .96.

CONCLUSIONS

The PHPVS is a reliable measure of HPV knowledge, attitudes, and intent to vaccinate.

Development of a theory-based (PEN-3 and Health Belief Model), culturally relevant intervention on cervical cancer prevention among Latina immigrants using intervention mapping

The development of efficacious theory-based, culturally relevant interventions to promote cervical cancer prevention among underserved populations is crucial to the elimination of cancer disparities. The purpose of this article is to describe the development of a theory-based, culturally relevant intervention focusing on primary (sexual risk reduction) and secondary (Pap smear) prevention of cervical cancer among Latina immigrants using intervention mapping (IM). The PEN-3 and Health Belief Model provided theoretical guidance for the intervention development and implementation. IM provides a logical five-step framework in intervention development: delineating proximal program objectives, selecting theory-based intervention methods and strategies, developing a program plan, planning for adoption in implementation, and creating evaluation plans and instruments. We first conducted an extensive literature review and qualitatively examined the sociocultural factors associated with primary and secondary prevention of cervical cancer. We then proceeded to quantitatively validate the qualitative findings, which led to development matrices linking the theoretical constructs with intervention objectives and strategies as well as evaluation. IM was a helpful tool in the development of a theory-based, culturally relevant intervention addressing primary and secondary prevention among Latina immigrants.

Coping resources and self-rated health among Latina breast cancer survivors

PURPOSE/OBJECTIVES

To examine relationships between coping resources and self-rated health among Latina breast cancer survivors.

DESIGN

Cross-sectional telephone survey.

SETTING

Four northern California counties.

SAMPLE

330 Latina breast cancer survivors within one to five years of diagnosis.

METHODS

Telephone survey conducted by bilingual and bicultural interviewers.

MAIN RESEARCH VARIABLES

Predictors were sociodemographic and clinical factors, cancer self-efficacy, spirituality, and social support from family, friends, and oncologists. Outcomes were functional limitations and self-rated health.

FINDINGS

Twenty-two percent of women reported functional limitations (n = 73) and 27% reported poor or fair self-rated health (n = 89). Unemployment (adjusted odds ratio [AOR] = 7.06; 95% confidence interval [CI] [2.04, 24.46]), mastectomy (AOR = 2.67; 95% CI [1.06, 6.77]), and comorbidity (AOR = 4.09; 95% CI [1.69, 9.89]) were associated with higher risk of functional limitations; cancer self-efficacy had a protective effect (AOR = 0.4, 95% CI [0.18, 0.9]). Comorbidity was associated with higher risk of poor or fair self-rated health (AOR = 4.95; 95% CI [2.13, 11.47]); cancer self-efficacy had a protective effect (AOR = 0.3; 95% CI [0.13, 0.66]).

CONCLUSIONS

Comorbidities place Latina breast cancer survivors at increased risk for poor health. Cancer self-efficacy deserves more attention as a potentially modifiable protective factor.

IMPLICATIONS FOR NURSING

Nurses need to assess the impact of comorbidity on functioning and can reinforce patients' sense of control over cancer and clinician support.

Psychosocial determinants of socioeconomic inequalities in cancer screening participation: a conceptual framework

Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.

Evaluating an intervention to increase cancer knowledge in racially diverse communities in South Carolina

OBJECTIVE

To conduct a cancer education intervention with racially diverse communities in South Carolina.

METHODS

The study was conducted at eight different sites in six counties in SC. The intervention included a 3-h general cancer knowledge and 30-min prostate cancer knowledge component. Pre- and post-intervention surveys were administered. Maximum scores were 31, 10 and 5 for the general cancer knowledge, prostate cancer knowledge and perceived self-efficacy in patient-physician interaction instruments, respectively. Analyses were completed using SPSS 16.0, SAS 9.1.3, and R v2.6.1.

RESULTS

The study sample consisted of 164 predominantly African American participants. Most of the participants who reported age were 50+ years (62.5%). Among those who reported income, 46.1% had an annual household income <$40,000. The mean general cancer knowledge pre-test score was 26.2 (standard deviation (SD) 3.7) with a mean post-intervention increase of 2.15 points (p<0.01). The mean pre-test prostate cancer knowledge score was 7.3 (SD 2.0) with a post-intervention increase of 0.48 points (p<0.01). Perceived self-efficacy in patient-physician interaction scores had a ceiling effect.

CONCLUSION

General cancer knowledge and prostate cancer knowledge scores increased following the intervention.

PRACTICE IMPLICATIONS

The intervention was successful in the short-term. It could be continued by community members.

The role of self-efficacy in inflammatory bowel disease management: preliminary validation of a disease-specific measure

BACKGROUND

Inflammatory bowel diseases (IBDs) require self-management skills that may be influenced by self-efficacy (SE). Self-efficacy represents an individual's perception of his or her ability to organize and execute the behaviors necessary to manage disease. The goal of this study was to develop a valid and reliable measure of IBD-specific SE that can be used in clinical and research contexts.

METHODS

One hundred and twenty-two adults with a verified IBD diagnosis participated in the study. Data were pooled from 2 sources: patients from an outpatient university gastroenterology clinic (n=42) and a sample of online respondents (n=80). All participants (N=122) completed the IBD Self-Efficacy Scale (IBD-SES) and the Inflammatory Bowel Disease Questionnaire. Additionally, online participants completed the Brief Symptom Inventory-18 and the Rosenberg Self-Esteem Scale, whereas those in the clinic sample completed the Perceived Health Competence Scale, the Perceived Stress Questionnaire, and the Short Form Version 2 Health Survey.

RESULTS

The IBD-SES was initially constructed to identify 4 distinct theoretical domains of self-efficacy: (1) managing stress and emotions, (2) managing medical care, (3) managing symptoms and disease, and (4) maintaining remission. The 29-item IBD-SES has high internal consistency (r=0.96), high test-retest reliability (r=0.90), and demonstrates strong construct and concurrent validity with established measures.

CONCLUSIONS

The IBD-SES is a critical first step toward addressing an important psychological construct that could influence treatment outcomes in IBD.

Using intervention mapping to promote the receipt of clinical preventive services among women with physical disabilities

This article describes the development of Promoting Access to Health Services (PATHS), an intervention to promote regular use of clinical preventive services by women with physical disabilities. The intervention was developed using intervention mapping (IM), a theory-based logical process that incorporates the six steps of assessment of need, preparation of matrices, selection of theoretical methods and strategies, program design, program implementation, and evaluation. The development process used methods and strategies aligned with the social cognitive theory and the health belief model. PATHS was adapted from the workbook Making Preventive Health Care Work for You, developed by a disability advocate, and was informed by participant input at five points: at inception through consultation by the workbook author, in conceptualization through a town hall meeting, in pilot testing with feedback, in revision of the curriculum through an advisory group, and in implementation by trainers with disabilities. The resulting PATHS program is a 90-min participatory small-group workshop, followed by structured telephone support for 6 months.