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Lui PSC, Singh K, Nguyen T, Kurth B, Phan T, Nelson A, Danisevska R, De Ambrosis T. Determinants of cancer screenings participation in Queensland: a scoping review. J Prim Health Care 2024; 16:70-77. [PMID: 38546768 DOI: 10.1071/hc23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/29/2023] [Indexed: 04/02/2024] Open
Abstract
Introduction Cancer screening programmes for cervical, breast, and colorectal cancer have successfully reduced mortality rates among target groups. However, a large proportion of women and men are unscreened. Aim This review aims to provide an overview of the literature regarding the determinants of cancer screening participation among target groups in Queensland. Methods Electronic databases were searched for studies on determinants of cancer screening participation in Queensland. Retrieved studies were screened, and eligible articles were selected for data extraction. Both peer-reviewed and grey literature studies were included. The determinants of cancer screening participation were classified according to the I-Change model. Results Sixteen out of 75 articles were selected and analysed. Information factors, such as the lack of tailored strategies, determined cancer screening participation. Age, gender, cultural beliefs, fear and past experiences were the most reported predisposing factors to cancer screening participation. Lack of knowledge, misconceptions, low awareness, timely access to service, privacy and confidentiality were mainly reported awareness and motivation factors. Encouragement from health professionals, providing more information and interactions with communities would result in different effects on cancer screening participation among the target groups. Discussion The I-Change model is a valuable tool in mapping the current determinants of cancer screening participation programs. Further research may be needed to fully understand the barriers and facilitators of cancer screening programs.
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Affiliation(s)
- Paraniala Silas C Lui
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia; and Centre for Health Research, University of Southern Queensland, Springfield Campus, 37 Sinnathambly Boulevard, QLD 4300, Australia
| | - Kamal Singh
- School of Health, Federation University, Brisbane Campus, PO Box 5274, Brisbane, QLD 4000, Australia
| | - Tam Nguyen
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Brian Kurth
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Thuc Phan
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Ashleigh Nelson
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Renata Danisevska
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
| | - Tony De Ambrosis
- Darling Downs and West Moreton Primary Health Network, Level 1, 162 Humes Street, Toowoomba, QLD 4350, Australia; and Darling Downs Health Innovation and Research Collaborative, Level 2 Administration Building, Baillie, Henderson Hospital, Toowoomba, QLD 4350, Australia
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Moxham R, Moylan P, Duniec L, Fisher T, Furestad E, Manolas P, Scott N, OAM DK, Finlay S. Knowledge, attitudes, beliefs, intentions and behaviours of Australian Indigenous women from NSW in response to the National Cervical Screening Program changes: a qualitative study. Lancet Reg Health West Pac 2021; 13:100195. [PMID: 34527986 PMCID: PMC8403896 DOI: 10.1016/j.lanwpc.2021.100195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 10/25/2022]
Abstract
Background: Indigenous women in New South Wales Australia are nearly four times more likely to die from cervical cancer than non-Indigenous women due to lower screening rates. We aimed to understand Indigenous women's cervical screening awareness, behaviours, knowledge, perceptions, motivators and barriers since the December 2017 National Cervical Screening Program changed to HPV testing, new screening age and screening interval, and introduced the new self-collection test. Methods: A qualitative study was conducted with 94 Indigenous women 25 to 74 years of age across metropolitan, regional and remote New South Wales. A team of six specialist researchers conducted the fieldwork, analysis and reporting. All data were coded thematically. Findings: Participants showed limited awareness of the renewed cervical screening program and the role of cervical screening in cervical cancer prevention, with most having a strong negative attitude towards cervical screening. Several motivators and behavioural barriers to screening were identified into four audience segments based on key characteristics. Most participants eligible to self-collect were unwilling to, due to concerns they would administer it incorrectly, injure themselves or have to return for a more invasive test. Interpretation: This study demonstrates the complex and heterogenous nature of attitudes and behaviours, among Indigenous women and highlights the intrinsic negative attitudes and social norms that are currently shaping community discourse and ultimately limiting screening. Our findings support the need for enhancing positive sentiment and community advocacy. Funding: Cancer Institute NSW Cervical Screening Program.
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Affiliation(s)
- Rosalind Moxham
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Penny Moylan
- ORIMA Research Pty Ltd, PO Box 7543 Melbourne VIC 3004, Australia
| | - Liz Duniec
- ORIMA Research Pty Ltd, PO Box 7543 Melbourne VIC 3004, Australia
| | - Teresa Fisher
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Erin Furestad
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Pene Manolas
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Nicola Scott
- Cancer Institute NSW, NSW Health, NSW Government, Locked Bag 2030 St Leonards NSW 1590, Australia
| | - Deborah Kenna OAM
- Molong Health Service, Western NSW Local Health District, NSW Government, King Street, Molong NSW, Australia
| | - Summer Finlay
- School of Population Health, University of South Australia, Adelaide SA, Australia
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Dasgupta P, Condon JR, Whop LJ, Aitken JF, Garvey G, Wenitong M, Baade PD. Access to Aboriginal Community-Controlled Primary Health Organizations Can Explain Some of the Higher Pap Test Participation Among Aboriginal and Torres Strait Islander Women in North Queensland, Australia. Front Oncol 2021; 11:725145. [PMID: 34395296 PMCID: PMC8355598 DOI: 10.3389/fonc.2021.725145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander Community-Controlled Health Organisations (ACCHOs) provides culturally appropriate primary care for Aboriginal and Torres Strait Islander people in Australia. The population of North Queensland has a higher proportion of Aboriginal and Torres Strait Islander people, a greater population coverage of ACCHOs, and higher cervical screening participation than the Rest of Queensland. The association between regional differences in the use of ACCHOs for cervical screening and variations in screening participation among Aboriginal and Torres Strait Islander women is currently unknown. Methods This is a population-based study of 1,107,233 women, aged 20–69 years who underwent cervical screening between 2013 and 2017. Of these women, 132,972 (12%) were from North Queensland, of which 9% were identified as Aboriginal and Torres Strait Islander women (2% Rest of Queensland) through linkage to hospital records. Regional differentials in screening by Aboriginal and Torres Strait Islander status were quantified using participation rate ratios (PRRs) with 95% confidence intervals (CIs) from negative binomial regression models. Logistic regression was used to identify factors associated with Aboriginal and Torres Strait Islander women being screened at ACCHOs. Results Aboriginal and Torres Strait Islander women from North Queensland (versus) Rest of Queensland had higher odds of screening at ACCHOs after adjusting for age and area-level variables. After adjustment for non-ACCHO variables, the regional differential in screening among Aboriginal and Torres Strait Islander women was significantly higher (PRR 1.28, 95% CI 1.20–1.37) than that among other Australian women [PRR = 1.11 (1.02–1.18)], but was attenuated on further adjustment for ACCHO variables, [PRR = 1.15, (1.03–1.28)] to become similar to the corresponding point estimate for other Australian women [PRR = 1.09, (1.01–1.20)]. However, the significant interaction between Aboriginal and Torres Strait Islander status and region (p < 0.001) remained, possibly reflecting the large cohort size. Screening participation increased with better access to health services for all women. Conclusions Improving access to primary health care for Aboriginal and Torres Strait Islander women, especially through ACCHOs, may reduce existing disparities in cervical screening participation. Further gains will require greater levels of local community engagement and understanding of the experiences of screened Aboriginal and Torres Strait Islander women to inform effective interventions.
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Affiliation(s)
| | - John R Condon
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Lisa J Whop
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Mark Wenitong
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD, Australia
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Ju X, Canfell K, Howard K, Garvey G, Hedges J, Smith M, Jamieson L. Population-based utility scores for HPV infection and cervical squamous cell carcinoma among Australian Indigenous women. PLoS One 2021; 16:e0254575. [PMID: 34292987 PMCID: PMC8298063 DOI: 10.1371/journal.pone.0254575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Working in partnership with Indigenous communities in South Australia, we aimed to develop, pilot test and estimate utility scores for health states relating to cervical cancer screening, precancer, and invasive cervical cancer and precancer/cancer treatment among Indigenous women. Methods Development and pilot testing of hypothetical cervical cancer health states, specifically through the lens of being an Indigenous Australian woman, was done with an Indigenous Reference Group in conjunction with five female Indigenous community members. Six health states were developed. These included: (1) Screened: cytology normal; (2) human papillomaviruses (HPV) positive with cytology normal; (3) low grade cytology (LSIL);(4) high grade cytology (HSIL); (5) early stage cervical cancer and; (6) later stage cervical cancer. Utility scores were calculated using a two-stage standard gamble approach among a large cohort of Indigenous Australian women taking part in a broader study involving oral HPV infection. The mean and standard deviation (SD) of the rank, percentage of respondents with a utility = 1 (perfect health) and utility score of each health state was summarised. Mean (SD) and medians and inter-quartile range (IQR) over 12 months and lifetime duration were calculated. Potential differences by age and residential location were assessed using the Wilcox Sum Rank test. Results Data was obtained from 513 Indigenous women aged 19+ years. Mean utility scores were higher for the four non-cancer health states than for invasive cervical cancer states (p-values <0.05). Lower mean utility scores were observed for late stage cervical cancer, with 0.69 at 12 months and 0.70 for lifetime duration (Intra-class correlation coefficients = 0.425). Higher utility scores were observed for the four non-cancer health states among non-metropolitan participants (ranged from 0.93 to 0.98) compared with metropolitan participants (ranged from 0.86 to 0.93) (p-values<0.05). Conclusion Among a large cohort of Indigenous Australian women, the reduction in quality of life (which utilities reflect) was perceived to be greater with increasing severity of cervical cancer health states. There were differences observed by geographic location, with positive cervical screening and precursor cancer-related quality of life being much higher among non-metropolitan-dwelling participants. These utility values, from one of the largest such studies ever performed in any population will be uniquely able to inform modelled evaluations of the benefits and costs of cervical cancer prevention interventions in Indigenous women.
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Affiliation(s)
- Xiangqun Ju
- Adelaide Dental School, Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Karen Canfell
- Cancer Council of NSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Gail Garvey
- Menzies School of Health Research, Tiwi, Australia
| | - Joanne Hedges
- Adelaide Dental School, Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Megan Smith
- Cancer Council of NSW, Sydney, Australia.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Lisa Jamieson
- Adelaide Dental School, Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
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Jaenke R, Butler TL, Condon J, Garvey G, Brotherton JML, Cunningham J, Anderson K, Tong A, Moore SP, Whop LJ. Health care provider perspectives on cervical screening for Aboriginal and Torres Strait Islander women: a qualitative study. Aust N Z J Public Health 2021; 45:150-157. [PMID: 33683744 DOI: 10.1111/1753-6405.13084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate perspectives of primary health care providers (HCPs) on providing cervical screening for Aboriginal and Torres Strait Islander women, who experience a higher burden of cervical cancer than other Australian women. METHODS Semi-structured interviews with 13 HCPs from four Australian Indigenous primary health care centres (PHCCs). Transcripts were thematically analysed. RESULTS HCPs discussed the need to approach cervical screening with sensitivity to women's emotional and cultural needs and sustaining relationships built on trust and respect. HCPs reported challenges in promoting screening to Aboriginal and Torres Strait Islander women due to cumbersome systems, competing clinical priorities, workforce capacity limitations and specific challenges associated with implementing the renewed National Cervical Screening Program. CONCLUSIONS In practice, HCPs experience several challenges to delivering cervical screening. Understanding HCPs' perspectives on their approach to cervical screening delivery, and the systems in which this occurs, can help to ensure that they receive adequate support and resources to deliver cervical screening to Aboriginal and Torres Strait Islander women. Implications for public health: It is important that HCPs adopt a multi-faceted, person-centred approach to cervical screening that is responsive to women's needs and that works synchronously with supportive PHCC services and systems and the National Cancer Screening Register.
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Affiliation(s)
- Rachael Jaenke
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Tamara L Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - John Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | | | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales
| | - Suzanne P Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Lisa J Whop
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory
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Dasgupta P, Aitken JF, Condon J, Garvey G, Whop LJ, DeBats C, Baade PD. Spatial and temporal variations in cervical cancer screening participation among indigenous and non-indigenous women, Queensland, Australia, 2008-2017. Cancer Epidemiol 2020; 69:101849. [PMID: 33157511 DOI: 10.1016/j.canep.2020.101849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/01/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cervical cancer incidence and mortality have declined in Australia since the implementation of a national cervical screening program in 1991, however, disparities in both measures between Indigenous and non-Indigenous women remain. We describe spatial and temporal changes in Pap test participation rates by Indigenous status for Queensland (Australia). Analyses were done in the context of renewed screening program in December 2017. METHODS Population-based study 2,132,925 Queensland female residents, aged 20-69 years who underwent cervical screening from 2008 to December 2017; 47,136 were identified as Indigenous through linkage to hospital records. Bayesian spatial models were used to generate smoothed estimates of participation across 528 small areas during 2008-2012 and 2013-2017 compared to the overall state average (2008-2017). Results are presented as thematic maps and graphs showing the associated uncertainty of the estimates. RESULTS Overall screening participation decreased over time for both Indigenous and non-Indigenous women. Strong spatial patterns were evident in five-year participation for both groups. Indigenous women had significantly lower participation than the Queensland average for ≥ 88 % of areas during both reporting periods whereas corresponding estimates were lower than average for <30 % of areas among non-Indigenous women. Disparities by Indigenous status persisted over time and remained across broader geographical groups of accessibility and area disadvantage. CONCLUSIONS Cervical cancer burden in Australia can only be reduced through concentrated efforts on identifying and addressing key drivers of the continuing disparities in screening participation. Achieving equitable screening participation for all women especially Indigenous women requires community engagement and localised interventions.
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Affiliation(s)
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, 4006, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, 4059, Australia; Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4222, Australia.
| | - John Condon
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Lisa J Whop
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, ACT, 2601, Australia.
| | - Claire DeBats
- Cancer Screening Unit, Prevention Division, Queensland Health, Brisbane, QLD, Australia.
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, QLD, 4006, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4222, Australia; School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD, 4000, Australia.
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