Latin America and the Caribbean Code Against Cancer 1st edition: Formative research on the comprehension and persuasiveness of the recommendations by the general population

BACKGROUND

Cancer prevention is the most efficient and cost-effective strategy in cancer control. One prevention strategy is giving credible, clear, and evidence-based recommendations to the individual; however, it is key that these messages are accepted and understood properly by the public. This study aimed to pilot the draft recommendations developed as part of the Latin America and the Caribbean (LAC) Code Against Cancer 1st edition, in terms of comprehension and persuasion of each message.

METHODS

A mixed method two-wave study, in which two versions of the messages were presented to the general population in five LAC countries. We used an ad-hoc questionnaire and interviews that followed the cognitive-pretesting methodology.

RESULTS

Findings suggest that the messages were generally well understood, especially in Spanish speaking countries, and that the messages were generally more understandable than persuasive. We adapted and revised the recommendations based on the findings of the first Wave and held a second iteration in the Spanish speaking countries. We observed a better understanding of most messages in Wave 2.

CONCLUSION

The LAC Code Against Cancer is a valuable tool of well understood messages for the public, with concrete actions everyone can take to prevent cancer. Further research should assess particularities of the region for further efficient dissemination of these important health messages, identify key messages for certain population groups and future interventions that strengthen health literacy in rural and less educated populations to increase behavior change.

Health Beliefs Associated with the Follow-Up of Pap Smear Abnormalities Among Low-Income Women in Medellín, Colombia

The purpose of the study was to explore variables of the health belief model in relation to the follow-up of abnormal Pap smear among low-income women in Medellín, Colombia. Eight focus groups (62 women) were conducted according to age groups (25-45 and 46-69 years). The data were analyzed using content analysis. The participants perceived themselves as vulnerable, recognized the severity of the disease in terms of both its emotional and physical consequences, perceived the benefits of the follow-up, and mentioned cues to action, such as social support and the support of health entities. Perceived self-efficacy was compromised by health system barriers and by personal barriers, such as placing the needs of their children ahead of their own, fear, neglect, and the pain caused by the diagnostic and therapeutic procedures. Health education activities aimed at increasing the follow-up of abnormal Pap smears should consider psychological factors.

The effect of misclassification error on risk estimation in case-control studies

INTRODUCTION

In epidemiological studies, misclassification error, especially differential misclassification, has serious implications.

OBJECTIVE

To illustrate how differential misclassification error (DME) and non-differential misclassification error (NDME) occur in a case-control design and to describe the trends in DME and NDME.

METHODS

Different sensitivity levels, specificity levels, prevalence rates and odds ratios were simulated. Interaction graphics were constructed to study bias in the different settings, and the effect of the different factors on bias was described using linear models.

RESULTS

One hundred per cent of the biases caused by NDME were negative. DME biased the association positively more often than it did negatively (70 versus 30%), increasing or decreasing the OR estimate towards the null hypothesis.

CONCLUSIONS

The effect of the sensitivity and specificity in classifying exposure, the prevalence of exposure in controls and true OR differed between positive and negative biases. The use of valid exposure classification instruments with high sensitivity and high specificity is recommended to mitigate this type of bias.