Perspectives on cervical cancer screening among educated Muslim women in Dubai (the UAE): a qualitative study

Barriers, facilitators, needs, and preferences in seeking information regarding cervical cancer prevention programs among Turkish, Moroccan, and Syrian immigrant women: a scoping review

BACKGROUND

Cervical cancer (CC) is the fourth most frequently diagnosed cancer in women worldwide. Immigrant women are often disproportionately affected by CC but show low participation in CC screening and human papillomavirus (HPV) vaccination.

METHODS

We conducted a scoping review on immigrant women's information needs regarding CC screening participation and HPV vaccination uptake. A total of 584 articles were found on Embase.com, PsychINFO, and CINAHL, of which 87 articles were included.

RESULTS

This review revealed that immigrant women indicate a need for more personalized information regarding CC screening and HPV vaccination. We identified barriers to obtaining, processing, and understanding the information, which included overall practical, emotional, cultural and religious aspects (e.g., shame, taboo, lack of trust, fatalism, and cultural norms and values regarding sexual activity). Facilitators, such as translation services, receiving information from people with similar cultural and/or religious backgrounds, encouraging other women or family, and using home visits as an outreach strategy, were also identified.

CONCLUSIONS

Our review provides a comprehensive overview of the information needs and preferences of immigrant women, which could be used to tailor interventions, considering the contextual nuances in which these women are situated. The needs and preferences of immigrant women should be taken into account during the development of new information materials or other interventions. This would help immigrant women make informed decisions regarding participation in CC screening and HPV vaccination.

Exploring cervical cancer screening awareness, beliefs, barriers, and practices among indonesian muslim women in Japan: a qualitative study

BACKGROUND

The population of migrant women in Japan is increasing, with a corresponding need for access to health services. Cervical cancer screening (CCS) coverage remains very low within this group. This is an increasingly difficult challenge for Muslim migrant women due to their religious values and beliefs. However, research addressing the awareness, beliefs, barriers, and practices of Muslim migrant women in Japan regarding CCS is lacking. This study aims to fill this gap by exploring CCS awareness, beliefs, barriers, and practices among Indonesian Muslim women in Japan.

METHODS

A qualitative study was conducted in Osaka, Japan, involving in-depth interviews with 12 Indonesian Muslim women. Data were collected between January and April 2023. All participants were between 20 and 50 years old, Muslim, married, had resided in Japan for a minimum of 3 years, and had no cervical cancer diagnosis.

RESULTS

The participants demonstrated awareness regarding cervical cancer and CCS. However, in actual practice, they encountered several obstacles that might have prevented them from undergoing CCS, including language barriers, lack of information, pain, and psychological factors. All participants preferred female doctors for CCS procedures.

CONCLUSIONS

This research provides information regarding factors that influence Indonesian Muslim migrant women seeking CCS. The need for structured and organized efforts is critical to improve the healthcare system and increase Japan's readiness to accept not only Muslim patients but also migrant patients in general.

TRIAL REGISTRATION

Not applicable.

Barriers to cervical cancer screening among immigrant Yemeni women in Malaysia

BACKGROUND

Cervical cancer is preventable cancer through pap test screening. Despite the benefits of cervical cancer screening, immigrant women have markedly lower use of Pap smear testing. Hence, this study aims to determine the barriers to cervical cancer screening among Yemeni female immigrants in Malaysia and the factors related to these barriers.

METHODS

A cross-sectional survey was carried out among immigrant Yemeni women staying in Selangor and Kuala Lumpur, Malaysia. Data were collected using a validated modified Arabic version of the Cervical Cancer Awareness Measure (Cervical CAM). Descriptive and inferential analyses were utilized. Adjusted binary logistic regression was performed to find out the factors that increase the probability of facing barriers to the Pap test.

RESULTS

A total of 370 questionnaires were collected. Cognitive barriers were the highest recognized type of barrier to undertaking the Pap test among study participants (74.9%) followed by emotional barriers (13%). Unemployed women were significantly less likely than employed to report an emotional barrier to the Pap test (OR = 0.17, 95% CI: 0.03-0.95). Higher educated women (OR = 3.11, CI: 1.02-9.48) and those still studying (OR = 3.11, CI: 1.02-9.48) were significantly more likely to report practical barriers. Regarding the cognitive barriers, women with tertiary education were significantly less likely than those with primary education to have cognitive barriers (OR = 0.41, CI: 0.19-0.90).

CONCLUSION

access to health services among immigrant women, including screening for cervical cancer, is a complex issue involving a wide range of barriers. Cognitive barriers associated with sexual activity and the absence of symptoms are the main reason for the decision to not undergo cervical cancer screening. To address this, we recommend adopting a comprehensive approach that integrates education, community engagement, accessibility, and cultural sensitivity to promote the uptake of cervical cancer screening within the Yemeni immigrant community.

Cervical cancer screening uptake in Arab countries: a systematic review with meta-analysis

BACKGROUND

Cervical cancer, though one of the most common cancers affecting women globally, holds immense potential for prevention through screening. Therefore, we conducted this meta-analysis to assess the rate of cervical cancer screening in Arab countries and identify barriers among those who did not participate.

METHODS

A comprehensive search was conducted from January 1st to June 1st,2024, including all observational studies that reported cervical cancer screening uptake in any Arab country. A meta-analysis was performed using a random-effects model to estimate the pooled prevalence, and sensitivity analyses were conducted to test the robustness of the findings. The study followed PRISMA guidelines.

RESULTS

This meta-analysis, covering 55 studies and 204,940 Arab women, found an overall cervical cancer screening uptake rate of 18.2% (95% CI: 13.9-23.6), with sensitivity analysis confirming the reliability of this estimate. Country disparities were evident, with Bahrain having the highest uptake at 44.1%, while Somalia had the lowest at 8.9%. Among women who underwent screening, the majority were ever-married (94.7%) and held positive attitudes towards screening (91.0%). Barriers to screening were common among women who did not participate, with the most frequent reasons being a lack of information (25.1%), the misconception of feeling healthy (24.5%), fear of the procedure (19.3%), and feelings of embarrassment (13.2%). Additionally, women who were screened had lower perceived barrier scores (SMD = -0.466) and higher perceived benefits scores (SMD = 0.379) than those who were not (p < 0.05).

CONCLUSION

This meta-analysis reveals a low overall cervical cancer screening uptake (18.2%) among Arab women. Key barriers such as lack of information, fear, the misconception of feeling healthy, and embarrassment hinder uptake. This alarmingly low rate underscores the urgent need for targeted interventions to address these barriers and promote awareness of early detection's life-saving potential.

Barriers and facilitators for adherence to follow-up by HR-HPV-positive women with premalignant cervical lesions: a mixed-design study in Mexico

BACKGROUND

Mexico reports low follow-up completion rates among women with abnormal cervical cancer screenings. This study aimed to identify barriers and facilitators to follow-up adherence among women with human papillomavirus (HPV) infection and premalignant cervical lesions in Mexico.

METHODS

A mixed-methods study was conducted from February to April 2019. Participants included women undergoing follow-up care for high-risk human papillomavirus (HR-HPV) and premalignant lesions, along with health personnel from the Women's Healthcare Center (CAPASAM) in Mexico. Quantitative data were obtained from the Women's Cancer Information System and through a questionnaire about factors affecting follow-up adherence. Additionally, the health personnel involved completed a compliance checklist regarding care regulations. Descriptive statistics were used for analysis. Qualitative data were collected via semi-structured interviews with both groups, followed by a content analysis based on identified categories. The Hazard Analysis and Critical Control Point System confirmed care process risks. Proposals to enhance the Early Detection Program for Prevention and Control of Cervical Cancer were collected from a CAPASAM health personnel nominal group.

RESULTS

Identified barriers to follow-up included low income among CAPASAM users, family provider roles limiting time for appointments, long waits for testing and results delivery, distant facilities, insufficient service hour communication, inadequate health personnel training, and a lack of systematic counseling. Hesitation toward follow-up was also linked to shame, apprehension, uncertainty, test aversion, fear of positive results, and limited cervical cancer and screening knowledge. Patriarchal attitudes of partners and limited access to the now-discontinued PROSPERA government program further discouraged follow-up. Facilitators comprised respectful treatment by CAPASAM staff, no-cost services, health campaigns, and positive user attitudes.

CONCLUSIONS

The study found more barriers than facilitators to follow-up adherence, highlighting the need for strategies to bolster the Early Detection Program. Future strategies must address the comprehensive array of factors and incorporate stakeholder perspectives.

Is there a need for screening of cervical HPV infections and carcinoma?

Antenatal cervical screening aims to detect cervical intraepithelial neoplasms as precancerous lesions and invasive cervical cancer. Whether this screening is performed routinely during pregnancy varies depending on each country's screening participation rates, guidelines, and the risks to the pregnant woman. In some countries with the high rate of routinely implemented cervical screening among the target women, women are recommended to defer cervical screening intentionally to post-delivery, though having screening in consultation with physicians may be possible if routine screening overlaps. However, when cervical screening rate in fertile women is low and the incidence of cervical cancer is high, cervical screening during pregnancy may play an important role in the early detection of cervical cancer. Cervical screening using high-risk human papillomavirus (HPV) testing is accepted worldwide as a highly sensitive and objective test method, and it should replace traditional primary cervical cytology in the future. However, the benefits and disadvantages of using HPV testing in pregnant women is unclear because a false positive rate may be increased due to pregnant women being generally under an immunosuppressed condition.

Understanding cervical cancer awareness in hard-to-reach areas of Bangladesh: A cross-sectional study involving women and household decisionmakers

INTRODUCTION

In Bangladesh, the uptake of cervical cancer screening is low. Lack of knowledge and understanding of symptoms and risk factors contributes to low screening uptake. The purpose of this study was to explore the knowledge of cervical cancer risk factors and symptoms and to measure the association with socio-demographic characteristics among women and household decisionmakers living in hard-to-reach areas of Bangladesh.

METHODS

A cross-sectional survey was conducted in five districts in Bangladesh among women aged between 30 and 60 years, their husbands, and their mothers-in-law from April to September 2022. Data were collected using a modified version of the validated AWACAN questionnaire tool. The significance level was considered at p-value <0.05 and odds ratios with 95% confidence.

RESULTS

Nearly 50% of participating women in hard-to-reach areas of Bangladesh and their family decisionmakers had low levels of knowledge of the risk factors and symptoms of cervical cancer. Only 20% of respondents in our survey knew about HPV, the most important risk factor for developing cervical cancer. Most respondents were familiar with the terminology of cervical cancer as a disease; however, approximately 40% of respondents did not know that not adhering to cervical cancer screening could be seen as a risk factor. Women do not make decisions about participation in cervical cancer screening on their own. Knowledge of cervical cancer risk factors and symptoms among decisionmakers was significantly associated with higher education and higher household monthly expenditure.

CONCLUSION

Women, their husbands, and mothers-in-law in hard-to-reach areas of Bangladesh had limited knowledge about cervical cancer risk factors and symptoms. Engaging these key decision-makers in targeted health education is vital to improve screening uptake. Conduction of future research to identify and address screening barriers is also essential for effective prevention efforts.

Determination of Opinions on HPV Infection and HPV Vaccine among Nursing Students by Focus Group Discussion

Purpose: This study aimed to determine nursing students' opinions about human papillomavirus (HPV) infection and HPV vaccine. Methods: This is a qualitative focus group discussion study, in which a state university in Western Turkey, undergraduate nursing students are recruited through purposive sampling. The research data were collected on an online platform with the focus group interview method by using the Participant Information Form and Semistructured Interview Form. Results: Three main themes (HPV infection/vaccine perception, severity perception, and suggestions and requests/facilitators) and eight subthemes were developed based on the thematic analysis of the research findings. Conclusions: According to the findings, it was concluded that nursing students' opinions on HPV infection and HPV vaccine were affected by factors related to cultural, religious, and sexual behaviors. Based on study results, it is suggested to organize national cervical screening programs to increase public's knowledge and awareness on the subject in accordance with the sociocultural norms of the society with the agreement and cooperation of educated health service providers, policy makers, and educators.

HPV and Cervical Cancer Awareness and Screening Practices among Migrant Women: A Narrative Review

This narrative review explores the barriers and facilitators that migrant women face globally. The review explored a range of studies conducted in various countries, including the United States of America (USA), the United Kingdom (UK), Canada, Australia, and the United Arab Emirates (UAE). It also specialises in the experiences of migrant women living in Sydney, Australia, and women living in Ras Al Khaimah (RAK), UAE. Cervical cancer ranks as the fourth most prevalent form of cancer among women worldwide. It is the fourteenth most common cancer among women in Australia and the fourth most common cancer in the UAE. Despite the availability of vaccinations and cervical screening initiatives in many countries, including the USA, the UK, Canada, Australia, and the UAE, migrant women living in these countries continue to experience considerable health gaps when accessing cervical cancer screening services. Addressing these disparities is crucial to ensuring everyone has equal healthcare access. An electronic search was conducted using three databases to identify articles published between 2011 and 2021. Qualitative, quantitative, and mixed-methods research studies were included in the search. The identified factors were classified into categories of barriers and facilitators of cervical screening uptake, which were then sub-categorized. This narrative review examines the awareness of cervical cancer and screening behaviours, attitudes, barriers, and facilitators associated with cervical cancer screening. According to the study, several factors pose significant obstacles for migrant women worldwide, particularly those living in the USA, the UK, Canada, and Sydney, Australia, and Emirati and non-Emirati women (migrant women) residing in RAK when it comes to undergoing cervical cancer screening. These barriers include inadequate knowledge and emotional, cultural, religious, psychological, and organisational factors. On the other hand, social support, awareness campaigns, and the availability of screening services were found to promote the uptake of cervical cancer screening. The findings from this review suggest that healthcare providers should adopt culturally sensitive approaches to enhance awareness and encourage participation in screening programs among migrant women. Based on the findings of this narrative review, it is strongly suggested that healthcare providers and policymakers prioritise developing culturally sensitive screening initiatives for migrant women. It is essential to address the psychological and emotional barriers that prevent migrant women from accessing screening services. This can be accomplished by offering education and awareness campaigns in their native languages and implementing a community-based approach to encourage social support and increase awareness of cervical cancer and screening services. Furthermore, healthcare providers and organisations should provide educational tools that address common misconceptions based on cultural and religious factors that prevent women from accessing screening services.

Barriers to cervical cancer screening faced by immigrant Muslim women: a systematic scoping review

BACKGROUND

Uptake for cervical cancer screening (CCS) is extremely low among immigrant women, particularly Muslim women, because of barriers related to religious values, beliefs, and fatalism. This scoping review aimed to summarize and analyze the findings of previous studies regarding perceived barriers to CCS among Muslim immigrant women.

METHODS

A search of electronic databases of peer-reviewed articles, including MEDLINE, CINAHL, PubMed, and Scopus was conducted. The following criteria were used for the selection of the articles: (a) the study population consisted of immigrant Muslim women, (b) CCS barriers were the main focus of the study, (c) the articles were original research articles, (d) the research was conducted within the last 10 years, and (d) the study was reported in English language.

RESULTS

Barriers included sociodemographic factors, economic, language, cognitive, and emotional reactions. The healthcare system was classified as a community barrier, whereas culture and religion were categorized as social barriers. Beliefs that becoming ill and dying is the will of Allah and that health problems are a punishment from God were considered to be major barriers to CCS among immigrant Muslim women.

CONCLUSION

Access to health service centers and CCS among Muslim immigrant women is challenging. Information dissemination by health care workers is needed to increase awareness of CCS and access to CCS service points among immigrant Muslim women. Physician recommendations to attend CCS also play an important role.

Exploring Factors Influencing Cervical Cancer Prevention Behaviors: Unveiling Perspectives of Conservative Muslim American Women in Virginia

Understanding the complexities surrounding cervical cancer prevention methods and hesitancy among conservative Muslim American women is crucial in addressing health disparities. This qualitative study aimed to delve into the religious, behavioral, and socio-cultural factors influencing Muslim women's decisions regarding cervical cancer screening (CC-S) and HPV vaccination (HPV-V) in Virginia, USA. Through interviews with 10 Muslim women residing in Virginia, qualitative data were collected as part of a mixed-method cross-sectional study conducted between August and September 2021. Findings revealed that participants had limited knowledge about cervical cancer, CC-S, and HPV-V, with notable themes emerging, such as cultural influences, misconceptions, language barriers, and challenges posed by the intricate US healthcare system. Future research should focus on exploring these barriers to mitigate the impact of cervical cancer within the Muslim population.

Non-adherence to cervical cancer screening recommendations among women in Eswatini: a cross-sectional study

BACKGROUND

In 2018, Eswatini had the world's highest age-standardised cervical cancer incidence rate. Cervical cancer screening reduces women's risk of invasive cervical cancer. Data on adherence to cervical cancer screening recommendations in Eswatini are scarce. The purpose of the current study was to determine Eswatini women's self-reported adherence to cervical cancer screening recommendations, attitudes toward screening, and factors associated with non-adherence.

METHODS

A cross-sectional survey of women (n = 377) aged 25 to 59 accessing primary healthcare clinics (n = 4) in Eswatini assessed screening participation, attitudes and knowledge regarding cervical cancer screening, and socio-demographic variables. Adjusted logistic regression was used to assess factors associated with non-adherence to Eswatini cervical cancer screening recommendations.

RESULTS

One hundred and sixty-six (44%) women were classified as adherent to cervical cancer screening recommendations. Attitudinal barriers endorsed by over one-third of participants included a perceived low risk of cervical cancer (n = 161, 43%) and a view that screening is likely to be painful (n = 146, 38%). Participants had higher odds of being classified as non-adherent if they: were single compared with married (OR = 1.78, 95% CI: 1.05, 3.01, p = 0.03), perceived screening as likely painful (OR = 4.43, 95% CI: 2.62, 7.46, p < 0.001); and had not been advised by a doctor/ nurse to screen (OR = 2.82, 95% CI: 1.71, 4.64, p < 0.001). Also, a 1-year increase in age was associated with an increase in the odds of being classified as non-adherent (OR = 1.42, 95% CI: 1.39, 1.45, p = 0.01).

CONCLUSIONS

Self-reported adherence was moderate among this group of women. Tailored interventions are needed to increase participation in cervical cancer screening, especially for those women with characteristics associated with being classified as non-adherent. Primary healthcare clinic nurses (and other health providers) may contribute toward improving participation in cervical cancer screening by advising eligible women to screen and providing health education addressing negative attitudes toward screening.

The State of Cancer Care in the United Arab Emirates in 2022

Cancer is the third-leading cause of death in the United Arab Emirates (UAE); cancer care in the UAE has evolved dramatically over the last 40 years, from a single center in Al Ain in 1981 to more than 30 cancer centers and clinics across the UAE, with at least four comprehensive cancer centers in the UAE nowadays. Despite the significant progress in medical care, cancer quality control across the UAE is still lacking, with significant variations in cancer care across the cancer centers. Access to clinical trials is still hampered by a lack of expertise and research infrastructure and a small population, which renders patient accrual for trials a major challenge. Education and training are other areas for improvement that require immediate attention, and, in this review, we try to address these critical aspects for stakeholders to consider better cancer care in the UAE. Early cancer detection and screening are still evolving in the UAE, and a national screening program is lacking. There is also a need to address barriers to screening and to consider less invasive screening methods such as approved blood-based screening, which is likely to be more acceptable to the UAE population. In this review, we also address new topics that have not been addressed previously, including oncology medical tourism, psycho-oncology, onco-fertility, precision oncology, survivorship, oncology nursing, cancer support programs, and the oncology sector's response to the COVID-19 pandemic, all in the context of the UAE cancer landscape. Finally, we provide recommendations for policymakers, regulators, payers, patient advocacy groups, and the UAE oncology community regarding the delivery and future planning of high-quality cancer care. These recommendations are aligned with the UAE government's vision to reduce cancer mortality and provide high-quality healthcare for its citizens and residents.

Qualitative factors influencing breast and cervical cancer screening in women: A scoping review

Breast and cervical are top cancers for women globally, but few studies have summarised how gender norms influence screening uptake, given sexual connotations and physical exposure. These beliefs may play a central role in decision-making, and understanding them is crucial to improving screening rates and services. This review scopes international literature for gender-based qualitative factors influencing women's screening uptake. A systematic search of peer-reviewed English articles in PubMed, Scopus, and CINAHL was conducted from inception until December 2019. Articles were included if they were about breast or cervical cancer screening, had mixed or qualitative methodology, and sampled women from the general population. 72 studies spanning 34 countries were analysed. Eight studies also included healthcare providers' views. Our narrative thematic analysis summarised primary themes extracted from each study into first-level subthemes, then synthesising second-level and third-level themes: (I) gender socialisation of women, (II) gender inequality in society, and (III) lack of empowerment to women in making screening decisions. Women tended to face sociocultural/role-based constraints, were expected to prioritise family, and keep bodily exposure to their husbands. Women showed low awareness and had fewer opportunities for health education compared to men. Male relations were often gatekeepers to financial resources needed to pay for screening tests. Screening risked community norms about women's or husbands' perceived embarrassing sexual behaviours. These findings suggest that interventions targeting unhelpful stigmatising beliefs about women's cancer screening must concurrently address community general norms, familial role-based beliefs, as well as at male relations who hold the purse-strings.

Role of cervical cancer screening during prenatal checkups for infectious diseases: A retrospective, descriptive study

Objective

This study was conducted to evaluate the status and role of cervical cytology affected by human papillomavirus infection and other infectious diseases screened during routine prenatal checkups.

Methods

We retrospectively examined medical records containing the screening results for infectious diseases and cervical cancer in women who delivered neonates in our hospital from 2014 to 2017.

Results

Among 3393 deliveries, 18.8% of women underwent a regular cervical cancer screening within 1 year of becoming pregnant, and 2641 women underwent a cervical cytology screening during this pregnancy. The cytological diagnostic results showed that 2562 women (97.0%) were negative for intraepithelial lesions or malignancy, whereas 79 (3.0%) had abnormal results. Of those with abnormal cytology results, 70 had abnormal cytology that was newly detected in this pregnancy, and 42 had grade ≥1 cervical intraepithelial neoplasia lesions. Spatulas were the most frequently used cytological sampling instruments, followed by cotton swabs. Cervical cytology revealed no major adverse reactions during these pregnancies.

Conclusions

Our results confirm the importance of screening for infectious diseases during pregnancy. Only 20% of the women underwent a regular pre-pregnancy cervical cytology screening. Cervical cytology screening during pregnancy may currently be playing a crucial role in preventing cervical cancer in Japan.

Promoting Colorectal Cancer Screening in South Asian Muslims Living in the USA

Colorectal cancer is one of the more common forms of cancer in South Asian men and women. Despite the rates of colorectal cancer (CRC) in South Asians, the CRC screening rates remain low in South Asians and Muslims compared with those in Whites and other ethnic minorities in the USA. Religious and cultural barriers have been examined in relation to other types of cancer such as breast and cervical cancers. However, few data are available about CRC screening among Muslims, particularly South Asian American Muslims. A community-based participatory research approach was used to assess attitudes toward CRC screening and various cultural, religious, and gender barriers that prevent CRC screening expressed by Muslim South Asian men and women in the larger San Francisco Bay Area. Six focus groups were conducted (three males and three females) with South Asian American Muslims. The focus groups consisted of a total sample size of n = 32, with 15 men and 17 women, with the average age of participants being 57 years old. This study highlighted key religious, cultural, and gender barriers to CRC screening including lack of awareness of CRC, the notion of fatalism as it relates to screening, lack of emphasis on preventive health, the need to preserve modesty, and stigma around certain CRC screening practices. Religiously tailored interventions and culturally sensitive healthcare providers are needed to better promote CRC screening in South Asian Muslim communities and to help inform the design of health interventions and outreach strategies.

Paclitaxel-loaded lignin particle encapsulated into electrospun PVA/PVP composite nanofiber for effective cervical cancer cell inhibition

Electrospun composite nanofibrous scaffolds have been regarded as a potential carrier for local drug delivery to prevent tumor recurrence. Herein, a model drug (paclitaxel) was creatively loaded into lignin nanoparticles (PLNPs) and then encapsulated into the polymer of poly (vinyl alcohol)/polyvinyl pyrrolidone which has been fabricated into a composite nanofibrous membrane (PVA/PVP-PLNPs) for use as a drug carrier using the electrospinning technique. The fabricated PVA/PVP-PLNPs membranes exhibited good particle distribution, mechanical properties, thermal stability and biocompatibility. In vitro experiments showed that combining lignin nanoparticles by electrospinning not only improved the drug release profile, but also enhanced the hydrophilicity of nanofibrous membranes which was beneficial to cell adhesion and proliferation. Cellular experiments demonstrated that PVA/PVP-2%PLNPs membrane showed good cell inhibition ability, and the cell survival rate was only 21% at day 7. It indicates that the as-prepared PVA/PVP-PLNPs composite nanofibers are promising candidates for local anticancer therapy.

Gender of Provider-Barrier to Immigrant Women's Obstetrical Care: A Narrative Review

OBJECTIVE

To explore the preference for female obstetrician/gynaecologists among immigrant women, and providers' understandings of these preferences, to identify challenges and potential solutions.

METHODS

Five databases (Medline, Embase, CINAHL, Global Health, and Scopus) were searched using combinations of search terms related to immigrant, refugee, or Muslim women and obstetrics or gynaecological provider gender preference.

STUDY SELECTION

Peer reviewed, English-language articles were included if they discussed either patient or provider perspectives of women's preference for female obstetrics or gynaecological care provider among immigrant women in Western and non-western settings. After screening, 54 met inclusion criteria and were reviewed.

DATA EXTRACTION

Studies were divided first into those specifically focusing on gender of provider, and those in which it was one variable addressed. Each category was then divided into those describing immigrant women, and those conducted in a non-Western settings. The research question, study population, methods, results, and reasons given for preferences in each article were then examined and recorded.

CONCLUSION

Preference for female obstetricians/gynaecologists was demonstrated. Although many will accept a male provider, psychological stress, delays, or avoidance in seeking care may result. Providers' views were captured in only eight articles, with conflicting perspectives on responding to preferences and the health system impact.

Histopathological Patterns and Characteristics of Abnormal Cervical Smear in Madinah Region of Saudi Arabia

Cervical cancer is a major public health problem that continues to be one of the leading female genital cancers worldwide. In the kingdom of Saudi Arabia (KSA), cervical cancer ranks the fifteenth most frequent cancer among females. This study is the first published research study addressing the screening of cervical cancer in Madinah region of KSA. Aim: To evaluate the abnormal cytological entities detected by cervical Pap smear in Madinah region of KSA and to compare the results with other national and international studies. Methods: This retrospective case-control study was conducted in the Departments of Obstetrics and Gynecology, and Histopathology at the Maternity and Children Hospital (MCH), Madinah, KSA from January 2013 to December 2015. Results: Of the 1594 cases reviewed, only 38 cases (2.4%) had epithelial cell abnormalities. High grade squamous intraepithelial lesions (HSIL) and low grade squamous intraepithelial lesions (LSIL) were the most common diagnosis categories, and cervical cancer accounted for 36.8% of the total cases for each, followed by atypical squamous cells of uncertain significance (ASCUS) found in (15.9%). Squamous cell carcinoma (SCC ) was found in (5.3%) of the cases. Patients with abnormal epithelial changes had higher parity (P=0.021) and presented more with a complaint of postcoital bleeding (P<0.0001), tend to have abnormal cervical appearance (P=0.004), more likely bleeding on touch (P=0.001) and associated with cervical erosion (P=0.014). Conclusion: The study showed a relatively low prevalence of epithelial cell lesions. These lesions were mainly squamous cell lesions harbored by females who have an abnormal cervical appearance, and those with high parity who were lacking cervical screening program.

Factors affecting Pap smear uptake in a maternity hospital: A descriptive cross-sectional study

AIM

To understand factors that influence women's decisions to go for Pap smears.

BACKGROUND

Globally, cervical cancer is the fourth most common cancer among women. In Singapore, cervical cancer is on the rise and has been found to be the eighth highest cause of death among women. Research has shown that regular screening for cervical cancer with Pap smear reduces cervical cancer-related mortality. However, Pap smear awareness is still limited and its uptake in Singapore is highly opportunistic, requiring the need for a deeper understanding of the factors that influence Pap smear uptake among women in Singapore.

DESIGN

A descriptive cross-sectional study design was used.

METHODS

Convenience sampling was used to recruit 350 participants (postnatal women of at least 21 years old) from a local maternity hospital. Data were collected using validated questionnaires. Logistic regression was used to analyse the data.

RESULTS

Demographic factors, such as age, ethnicity and religion, as well as women's beliefs about the effectiveness of Pap smear in detecting cervical cancer, the desire to discover health problems early and considering Pap smear to be painful, were found to be factors significantly influencing Pap smear uptake. Healthcare professionals need to be mindful of these factors to address women's needs to encourage women to go for Pap smears.

CONCLUSION

Various factors were found to influence Pap smear uptake. Future interventions can take these factors into account for increasing Pap smear awareness.

Socio-demographic characteristics influencing cervical cancer screening intention of HIV-positive women in the central region of Ghana

Background

The burden of HIV and cervical cancer is concentrated in sub-Saharan Africa. Women with HIV are more likely to have persistent HPV infection leading to cervical abnormalities and cancer. Cervical cancer screening seems to be the single most critical intervention in any efforts to prevent cervical cancer. The purpose of this study was to determine the socio-demographic factors influencing intention to seek cervical cancer screening by HIV-positive women in the Central Region of Ghana.

Methods

A descriptive cross-sectional study involving a convenience sample of 660 HIV-positive women aged 20 to 65 years receiving antiretroviral therapy in HIV care centres in the Central Region of Ghana was conducted using an interviewer-administered questionnaire. The data were summarised and analysed using frequencies, percentages and binary logistic regression.

Results

The study revealed that 82.0% of HIV-positive women intended to obtain cervical cancer screening. Level of education was a determinant of cervical cancer screening intention. HIV-positive women with low levels of education were 2.67 times (95% CI, 1.61–4.42) more likely to have intention to screen than those with no formal education. Those with high levels of education were 3.16 times (95% CI, 1.42–7.02) more likely to have intention to screen than those with no formal education. However, age, religion, marital status, employment status, and ability to afford the cost of cervical cancer screening were not determinants of intention to screen.

Conclusions

Education of women of all ages needs to be a priority, as it could enable them to adopt appropriate health behaviours and engage in cervical cancer screening. Additionally, interventions to improve understanding of cervical cancer screening among HIV-positive women are highly recommended. These include health education about the disease and availability of screening options in HIV/AIDS care centres.

Limited Understanding of Pap Smear Testing among Women, a Barrier to Cervical Cancer Screening in the United Arab Emirates

Global data indicate that cervical cancer is the fourth most common cancer among women worldwide. Important factors that affect interventions for early diagnosis of cervical cancer include social beliefs and values and poor knowledge. These may contribute to women’s participation in screening for cervical cancer and have a significant impact on decisions to take preventive action. The present study was conducted with 599 women in the UAE between September 2016 and March 2017. A cross-sectional survey was conducted to determine knowledge about cervical cancer and screening, demographic characteristics and perceived barriers. Knowledge about the Pap smear test was limited, and awareness that they should undergo the Pap smear test every three years even with an initial negative/normal Pap smear result was abysmal. In spite of the positive attitude of the women towards the Pap smear test, almost 80% of the women surveyed had no knowledge of precancerous lesions. Having higher income (21/29, 72%, p=0.027) and more miscarriages were associated with better practice of Pap smears (19/26, 73%, p=0.010). Knowledge levels were significantly higher (66.3±22.2,) that values for attitude (60.5±20.9, p= 0.03, 95% CI {0.22-11.3}, Chi-square 4.38) and practice (53.7 24.1, p= 0.001, 95% CI {6.9-18.1}, Chi-square 19.7). A well-designed health education programme on cervical cancer and benefits of screening should increase the awareness among women in UAE. One point to stress is that better communication with health professionals and improvement of access to health care services should increase the rate of cervical cancer screening.

Integrative review of cervical cancer screening in Western Asian and Middle Eastern Arab countries

Population-based screening programs have resulted in minimizing mortality and morbidity from cervical cancer. The aim of this integrative review was to explore the factors influencing access of women from Western Asian and Middle Eastern Arab countries to cervical cancer screening. A systematic search for studies conducted in Arab countries in those regions, and published in English between January 2002 and January 2017, was undertaken. Thirteen papers were selected and subjected to quality appraisal. A three step analysis was used, which involved a summary of the evidence, analysis of both quantitative and qualitative data, and integration of the results in narrative form. Few population-based cervical cancer screening programs had been implemented in the relevant countries, with low knowledge of, and perceptions about, cervical screening among Arab women, the majority of whom are Muslim. Factors affecting the uptake of cervical cancer screening practices were the absence of organized, systematic programs, low screening knowledge among women, healthcare professionals' attitudes toward screening, pain and embarrassment, stigma, and sociocultural beliefs. Policy changes are urgently needed to promote population-based screening programs. Future research should address the promotion of culturally-sensitive strategies to enable better access of Arab Muslim women to cervical cancer screening.

Hearing the Silenced Voices of Underserved Women: The Role of Qualitative Research in Gynecologic and Reproductive Care

In order to provide effective evidence-based health care to women, rigorous research that examines women's lived experiences in their own voices is needed. However, clinical health research has often excluded the experiences of women and minority patient populations. Further, clinical research has often relied on quantitative research strategies; this provides an interesting but limited understanding of women's health experiences and hinders the provision of effective patient-centered care. This article defines qualitative research and its unique contributions to research, and provides examples of how qualitative research has given insights into the reproductive health perspectives and behaviors of underserved women.

Ramadan Fasting and Patients with Cancer: State-of-the-Art and Future Prospects

Ramadan fasting represents one of the five pillars of the Islam creed. Even though some subjects (among which patients) are exempted from observing this religious duty, they may be eager to share this particular moment of the year with their family and peers. However, there are no guidelines or standardized protocols that can help physicians to properly address the issue of patients with cancer fasting in Ramadan and correctly advising them. Moreover, in a more interconnected and globalized society, in which more and more Muslim patients live in the Western countries, this topic is of high interest also for the general practitioner. For this purpose, we carried out a systematic review on the subject. Our main findings are that (1) very few studies have been carried out, addressing this issue, (2) evidence concerning quality of life and compliance to treatment is contrasting and scarce, and (3) generally speaking, few patients ask their physicians whether they can safely fast or not. For these reasons, further research should be performed, given the relevance and importance of this topic.