Correlates of cervical cancer screening participation, intention and self-efficacy among Muslim women in southern Ghana

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.

Cervical cancer screening uptake and its predictors among women aged 30-49 in Ghana: Providing evidence to support the World Health Organization's cervical cancer elimination initiative

INTRODUCTION

Cervical cancer remains a global health challenge, disproportionately affecting women in low- and middle-income countries, including Ghana. Hence, this study examined the regional variations and predictors of cervical cancer screening uptake among women aged 30-49 in Ghana.

METHODS

Data for this study was obtained from the 2022 Ghana Demographic and Health Survey, comprising 7,124 women aged 30-49. The regional variations in women's uptake of cervical cancer screening was presented using spatial map. A mixed-effect multilevel binary logistic regression was used to examine the factors associated with cervical cancer screening uptake. The results were presented using adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

RESULTS

The uptake of cervical cancer screening was 7.27% [6.33, 8.35] in Ghana. Significant variations in cervical cancer screening existed across regions, with the lowest uptake in Western, Oti, Savannah, and North East regions. Women in rural areas had lower odds of being screened for cervical cancer [aOR = 0.46; 95% CI = 0.28, 0.76] compared to those in urban areas. Women living in the Central, Greater Accra, Volta, Eastern, Ashanti, Ahafo, Bono East, Oti, Northern, North East, Upper East, and Upper West regions all had higher odds of undergoing cervical cancer screening compared to those in the Western region. Women with higher education [aOR = 2.71; 95% CI = 1.23, 5.94] were more likely to be screened for cervical cancer compared to those with no formal education. Women who visited a health facility in the past year had higher odds of being screened for cervical cancer [aOR = 1.48; 95% CI = 1.02, 2.15] relative to those who did not. Reading newspapers or magazines increased the odds of cervical cancer screening uptake [aOR = 1.80; 95% CI = 1.10, 2.92] . Women who belonged to the middle [aOR = 2.19; 95% CI = 1.07, 4.49], richer [aOR = 2.85; 95% CI = 1.28, 6.38], and richest [aOR = 3.08; 95% CI: 1.25, 7.59] wealth indices were more likely to be screened for cervical cancer compared to those in the poorest wealth index.

CONCLUSIONS

Our findings highlight critical disparities in cervical cancer screening uptake in Ghana, particularly emphasizing the need for targeted interventions to address the lower screening rates among women in the Western, Oti, Savannah, and North East regions. The significant association between cervical cancer screening uptake and healthcare access, media exposure, and wealth underscores the importance of enhancing healthcare infrastructure and outreach in underserved regions. To improve screening rates, it is recommended that public health initiatives focus on increasing awareness through community education programs, promoting health facility visits, and leveraging media platforms to disseminate information about cervical cancer screening. Additionally, policies should aim to reduce geographical and socioeconomic barriers, ensuring equitable access to screening services across all regions, especially for women in lower wealth quintiles.

Factors Influencing Cervical Cancer Screening: A Cross-Sectional Study Among Ethnically Diverse Women in the Kumasi Metropolis of Ghana

Background

Globally, Ghana is one of the countries with the greatest cervical cancer (CC) burdens and mortality rates. Available research has focused primarily on women's experiences in the general population neglecting factors that influence cervical cancer screening (CCS) among ethnically diverse populations in Ghana.

Aim

This study explored the factors influencing CCS among ethnically diverse women in the Kumasi Metropolis of Ghana.

Method

From April to June 2023, a community-based cross-sectional study was carried out in the Aboabo and Asawase communities of the Ashanti Region. Binary and multivariable logistic regressions were employed to determine the relationships between the dependent and independent variables. Outcome variables with p-values < 0.05 were considered statistically significant.

Results

Habits, knowledge, perceived benefits, and facilitating factors influenced CCS among ethnically diverse women. An overall self-reported CCS rate of 7.2% (n = 32) with an early age of sexual initiation of 15-20 years was recorded. While habits (OR = 0.23, 95% CI 0.09, 0.58; p = 0.002), affect (OR = 0.00, 95% CI 0.00, 0.03; p < 0.001), and the perceived benefits of screening (OR = 3.07, 95% Cl 1.01, 10.8; p = 0.059) were associated with CCS. Norms (OR = 0.00, 95% CI 0.00, 20,948,726,859,075; p > 0.9), knowledge (OR = 1.27, 95% CI 0.61, 2.53; p = 0.5), and facilitating factors (OR = 1.02, 95% CI 0.51, 2.01; p > 0.9) were not statistically significant with CCS.

Conclusion

Poor knowledge, lower perceived benefits of CCS, and weak facilitating factors were identified as barriers to CCS. Implementing national CCS and vaccination campaigns to improve awareness, and screening to reduce women's risk is encouraged.

Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review

BACKGROUND

Cervical cancer (CC) results in around 604,00 new cancer cases yearly and is caused by the human papillomavirus (HPV). Uptake rates for both the HPV vaccination and screening have been decreasing over recent years, particularly in young women, whilst CC remains a concern for both low- and high-income countries.

OBJECTIVES

To highlight the key barriers and facilitators of CC screening attendance in young women and to identify the factors associated with their CC screening behaviour, to inform interventions to increase screening rates.

DESIGN

Systematic review.

DATA SOURCES AND METHODS

A systematic review was conducted using Scopus, Web of Science, MEDLINE, PsycINFO/PyscARTICLES and CINAHL. The review included primary qualitative, quantitative and mixed-method studies that reported barriers, facilitators and factors associated with current CC screening behaviours in women aged 30 or below. Outcomes were summarised narratively. Risk of bias was conducted for individual studies using the Mixed-Method Appraisal Tool.

RESULTS

Among the 106 studies included in the review, the most frequently reported barriers were financial constraints (n = 36), embarrassment (n = 35) and low accessibility to obtaining screening (n = 34). The most frequently reported facilitators were knowledge of CC (n = 12), healthcare provider recommendations (n = 11) and communication with friends (n = 11). Age (older), marital status (in a relationship) and sexual activity (active) were key factors associated with attendance at screening. Studies also highlighted that those vaccinated were more likely to have screened than those not vaccinated against HPV.

CONCLUSION

These unique factors represent potential targets for interventions to increase CC screening attendance in young women. Future research could benefit from employing strong theoretical frameworks, such as the COM-B model of behavioural change, to categorise and gain further insight into the contributing factors affecting CC screening attendance.

REGISTRATION

PROSPERO CRD42022324948.

Factors associated with cervical cancer screening among women of reproductive age in Ghana

BACKGROUND

Cervical cancer remains a leading cause of cancer-related deaths among women in Ghana and other Sub-Sahara African (SSA) countries. Despite the importance of early diagnosis for timely treatment and death prevention, cervical cancer screening among women in developing countries remain very low. Nonetheless, there is a paucity of research examining the factors associated with screening uptake among women of reproductive age in Ghana. Thus, this study fills the scholarly void and contributes to the existing literature by examining the determinants of cervical cancer screening in Ghana.

METHODS

Utilizing data from the 2022 Ghana Demographic and Health Survey (GDHS) (N = 15,014 women), and by employing logistic regression models for a cross-sectional analysis, this study evaluated the factors associated with cervical cancer screening in Ghana.

RESULTS

Women with tertiary educational attainment (OR = 4.140; 95%CI: 2.960 5.789; p < 0.001), from the richer (OR = 1.968; p < 0.001) and richest households (OR = 2.492; p < 0.001), the married/living with partner (OR = 1.773; 95%CI:1.372 2.290; p < 0.001), the widowed/divorced/separated (OR = 1.888; 95%CI:1.320 2.701; p < 0.001), owners of valid health insurance card (OR = 1.356; 95%CI:1.086 1.693; p < 0.01), visitation to health facility in the past 12 months (OR = 1.312; 95%CI: 1.082 1.590; p < 0.001), those who watched television at least once in a week (OR = 1.395; 95%CI: 1.055 1.846; p < 0.001), as well as those who listened to radio at least once in a week (OR = 1.509; 95%CI: 1.228 1.853; p < 0.001), were all significantly more associated with cervical cancer screening in the study context. Also, ethnicity, religion, and the region of residence significantly predicted cervical cancer screening in the study context.

CONCLUSION

Cervical cancer screening in Ghana can be improved by addressing socioeconomic and geographical disparities in the country's healthcare system. To ensure early detection, timely treatment or care and prevention of cervical cancer-related deaths in the country, there must be coordinated efforts by the government of Ghana to improve healthcare access and surveillance systems for cervical cancer cases, particularly, in geographically disadvantage areas.

Drivers of breast cancer and cervical cancer screening among women of reproductive age: insights from the Ghana Demographic and Health Survey

BACKGROUND

The two major causes of cancer-related deaths among women in Ghana are breast cancer (BC) and cervical cancer (CC). These types of cancers typically do not show any symptoms until they have progressed. Therefore, it is important to screen for early detection. This research aimed to investigate the rate of breast cancer and cervical cancer screening, as well as the factors associated with it, among women of reproductive age in Ghana.

METHODS

This study analysed data from the 2022 Ghana Demographic and Health Survey. A total of 15,014 women aged 15 to 49 years were included in the analysis. Descriptive statistics and binary logistic regression were employed to analyse the data with the aid of STATA/SE, version 17.

RESULTS

It was found that 18.4% and 5.0% of the women had screened for BC and CC, respectively. Women aged 45-49 years were about three times more likely (aOR = 2.83, 95% CI: 1.88-4.24) to screen for BC compared to those aged 15-19 years. Women who had tested for HIV had increased odds (aOR = 1.88, 95% CI: 1.56-2.25) of screening for BC compared to their counterparts. Women within the richest wealth index (aOR = 1.95, 95% CI: 1.40-2.72) had increased odds of screening for BC compared to those in the poorest wealth index. Regarding CC screening, women with higher education (aOR = 2.56, 95% CI: 1.53-4.29) were two times more likely to screen for CC compared to those with no formal education. Women who did not use tobacco (aOR = 0.45, 95% CI: 0.21-0.96) had decreased odds of CC screening compared to their counterparts.

CONCLUSIONS

This study showed that the uptake of BC and CC screening services among women in Ghana was very low. The drivers of BC and CC screening included enabling, predisposing, and need factors. Stakeholders can leverage the mass media to raise awareness and educate women in reproductive age about the importance of BC and CC screening. This study provides relevant information that can inform BC and CC policies and programmes in Ghana.

Video based educational intervention in waiting area to improve awareness about health screening among patients visiting family medicine clinics

BACKGROUND

Multiple educational modalities have been utilized including leaflet, face-to-face counseling and watching videos in waiting areas for engaging patients. Considering the two challenges of waiting time frustration and lack of health screening awareness, Family Physicians' waiting area are an ideal place to bridge this gap. The objective of this study is to evaluate the effectiveness of video-based health education intervention in improving knowledge about health screening among patients and their families sitting in waiting area of Family Medicine clinics.

METHODS

It was a pre and post quasi-experimental study that was conducted in family medicine clinics located at main campus and Outreach centers of a tertiary care hospital. A total of 300 participants were approached during the six month period. The intervention consisted of an educational video on health screening. The content of the video was taken from the recommended preventive care guidelines from CDC and USPSTF. The pre-and post-intervention knowledge of the participants was assessed through a semi-structured coded questionnaire by an interviewer who was trained in data collection. Data was analyzed using SPSS version 26. Pre and post intervention knowledge adequacy was determined using MacNemar's Chi-square test.

RESULTS

Total 300 participants voluntarily participated into the study. Median age of the participants was 28 (IQR = 23.25-36.75) years. Majority of participants were males (56%). Following the intervention, there was significant increase in the proportion of participants (51.3% versus 68%) who had understanding of health screening check-up (p < 0.001). Following the study intervention, there was significant increase in proportion of participants who had adequate knowledge related to diabetes (p = 0.045), hypertension (p < 0.001), cholesterol (p < 0.001), cervical cancer (p < 0.001), colon cancer (p < 0.001) and hepatitis B & C (p < 0.001). No significant improvement in breast cancer related knowledge was observed (p = 0.074). Highest post-intervention increase in knowledge from baseline was observed for hypertension (13.3% versus 63.3%) followed by colon cancer (24.3% versus 59.3%), cholesterol (67 versus 96.7%), hepatitis b & C (56.7% versus 77.3%), diabetes (29.7% versus 48%), cervical cancer (1.7% versus 19%), and breast cancer (7.7% versus 18.3%).

CONCLUSION

This study highlighted a pivotal role of an educational video intervention in clinic waiting area to improve awareness regarding health screening among patients and their families. Further interventional community based or multicenter studies are warranted to assess the long-term impact of these educational videos on knowledge and utilization of health screening among adult population.

The edutainment program on knowledge, perception, and uptake of cervical cancer screening among Muslim women in Southern Thailand: a quasi experimental study

INTRODUCTION

Cervical cancer is a significant global health concern and is the third most common cancer in women. Owing to their religious beliefs, Muslim women in Thailand are less likely to be screened for cervical cancer.

OBJECTIVE

This study aimed to explore how a Health Belief Model (HBM) (HBM = Health Belief Model)-Based Edutainment Program affects the knowledge, perception, and uptake of cervical cancer screening among Muslim women in Thailand.

METHODS

A quasi-experimental study was conducted in two rural districts of Southern Thailand with 83 Muslim women (intervention = 42, control = 41). The assessment was conducted through face-to-face interviews at baseline, post-intervention, and at 3-month follow-up. The intervention included four sessions involving video clips, folk songs, and short films. Data analysis was performed using repeated-measures ANOVA (ANOVA = Analysis of Variance) at a significance level of 0.05.

RESULTS

There were significant differences in the mean score of knowledge and perception between the intervention and control groups post-intervention and at 3-month follow-up (p < 0.001). The mean scores of knowledge and perception in the intervention group significantly increased post-intervention and at 3-month follow-up (p < 0.001). The uptake of cervical cancer screening tests in the intervention group was approximately twice as high as that in the control group (90.47% vs. 51.21%).

CONCLUSION

The findings revealed that the Edutainment Program could improve the knowledge, perception, and uptake of cervical cancer screening among Muslim women in Thailand. In future studies, the intervention suggests testing different population groups to improve access to primary care for everyone.

HIV status and knowledge of cervical cancer among women in Ghana

BACKGROUND

Cervical cancer remains a disease of significant concern to women's health. The aim of this study was to identify predictors of knowledge of cervical cancer among women living with HIV and those with negative or unknown HIV status at the Cape Coast Teaching Hospital (CCTH).

METHODS

This study was based on a larger hospital-based analytical cross-sectional study conducted at the antiretroviral therapy (ART) and gynaecology clinics of the Cape Coast Teaching Hospital in Ghana. Participants were women living with HIV (WLHIV) and women without HIV or whose status was unknown, aged 25 to 65 years, seeking healthcare. Data were collected with a questionnaire and analysed using frequencies, percentages, Chi-square test, binary logistic regression and multivariate analysis.

RESULTS

The mean age was 39.5 years (± 9.8) and 47.2 years (± 10.7) for women without or unknown HIV and WLHIV, respectively. HIV-negative/unknown women were mostly nulligravida (76%) and nullipara (69%), while WLHIV mostly had pregnancies (76%) and children (84%) in excess of seven. Knowledge of cervical cancer was statistically significantly associated with HIV status (X2 = 75.65; P-value = 0.001). The odds of having knowledge of cervical cancer for women considered to be negative/unknown for HIV were about three times (AOR = 3.07; 95% CI = 1.47, 6.41) higher than their compatriots with HIV. Women with post-secondary/tertiary (AOR = 4.45; 95% CI = 2.11, 9.35) education had significantly higher odds of having knowledge of cervical cancer than those with no education or those with just primary education.

CONCLUSIONS

To improve knowledge of cervical cancer among women, an intentionally structured health education programme is needed, particularly for WLHIV, those with lower levels of education and the unemployed.

A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana

BACKGROUND

Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer.

CONCLUSION

The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.

High-risk human papillomavirus genotype distribution among women living with HIV; implication for cervical cancer prevention in a resource limited setting

BACKGROUND

For women living with HIV (WLHIV), the burden of persistent HPV infection, cervical pre-cancerous lesions and cancer have been demonstrated to be higher than among HIV-negative women. As Ghana and other lower-middle-income countries (LMIC) work toward developing national cervical cancer programmes, it is essential that local scientific evidence be provided to guide policy decisions, especially for such special populations. The objective of this study was to determine the distribution of high-risk HPV genotype and related factors among WLHIV and its implication for the prevention of cervical cancer prevention efforts.

METHODS

A cross-sectional study was conducted at the Cape Coast Teaching Hospital in Ghana. WLHIV, aged 25-65 years, who met the eligibility criteria were recruited through a simple random sampling method. An interviewer-administered questionnaire was used to gather socio-demographic, behavioural, clinical and other pertinent information. The AmpFire HPV detection system (Atila BioSystem, Mointain View, CA was used to detect 15 high-risk HPV genotypes from self-collected cervico-vaginal samples. The data collected were exported to STATA 16.0 for statistical analysis.

RESULTS

In all, 330 study participants, with mean age of 47.2 years (SD ± 10.7), were involved. Most (69.1%, n = 188/272) had HIV viral loads < 1000 copies/ml and 41.2% (n = 136) had ever heard of cervical screening. The overall hr-HPV prevalence was 42.7% (n = 141, 95% CI 37.4-48.1) and the five commonest hr-HPV types among screen positives were HPV59 (50.4%), HPV18 (30.5%), HPV35 (26.2%), HPV58 (17%) and HPV45 (14.9%). Most infected women (60.3%, n = 85) had multiple hr-HPV infections, with about 57.4% (n = 81) having 2-5 h-HPV types, while 2.8% (n = 4) had more than five hr-HPV types. A total of 37.6% (n = 53) had HPV16 and/or18, while 66.0% (n = 93) had the hr-HPV genotypes covered by the nonavalent vaccine. Women with HIV viral load ≥ 1000copies/ml (AOR = 5.58, 95% CI 2.89-10.78, p < 0.001) had a higher likelihood of being co-infected.

CONCLUSION

This study found out that the prevalence of hr-HPV still remains high in women with HIV, with a notable occurrence of multiple infections and infection with genotypes 16 and/or18. Additionally, an association was established between hr-HPV and infection HIV viral load.. Therefore, comprehensive HIV care for these women should include awareness of cervical cancer, consideration of vaccination and implementation of screening and follow-up protocols. National programmes in LMIC, such as Ghana, should consider using HPV-based screen-triage-treat approach with partial genotyping.

Effectiveness and feasibility of self-sampling for human papillomavirus testing for internet-based cervical cancer screening

Objectives

Worldwide, around 18.2% of cervical cancer occurred in China, mainly because of lower screening coverage and screening quality in regional disparities. To assess self-sampling for human papillomavirus (HPV) testing, combined with the internet, as a primary cervical cancer screening (CCS) method in low-resource settings, and to establish an internet-based self-sampling CCS-management model.

Methods

The women who participated registered on a CCS website. We recruited 20,136 women, aged 30-59 years, from 13 provinces in China, to perform vaginal self-sampling for HPV testing as a primary CCS, based on the internet. A questionnaire was subsequently used to investigate the acceptability of self-sampling.

Results

Of the 20,103 women with qualified samples, 35.80% lived in remote areas, 37.69% had never undergone CCS, 59.96% were under-screened, and the overall prevalence of a high-risk of HPV was 13.86%. Of 8,136 respondents, 95.97% of women felt that self-sampling was easy to perform, 84.61% had no discomfort when using a self-sampling brush, 62.37% women were more likely to choose self-sampling for CCS in future, and 92.53% were willing to introduce the concept to others around them. The reliability and ease of self-sampling were independent factors influencing selection of self-sampling (p < 0.05).

Conclusions

The Internet-facilitated self-sampling for HPV testing and management model for cervical cancer prevention is feasible and effective. It can be used as a supplement to the conventional screening, particularly in outlying areas with few medical resources, to improve the coverage of CCS.

Clinical trial registration

https://www.chictr.org.cn, identifier: ChiCTR2000032331.

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.