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Patel H, Sherman SM, Tincello D, Moss EL. Awareness of and attitudes towards cervical cancer prevention among migrant Eastern European women in England. J Med Screen 2019; 27:40-47. [PMID: 31514572 DOI: 10.1177/0969141319869957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives It has been hypothesized that, in England, the rise in incidence of cervical cancer and the fall in screening coverage might be attributable in part to the effect of migration of Eastern European born women. We explored the attitudes and behaviours of these women towards cervical cancer prevention strategies. Methods A mixed methods study using quantitative surveys and in-depth semi-structured qualitative interviews was conducted between April 2015 and December 2016. Results In total, 331 surveys and 46 interviews were completed. Native English women had greater knowledge that a smear test is a screening test for pre-cancerous cervical cells (90% vs. 71% p≤0.01), whereas migrant Eastern European women believed that it was conducted as part of a full gynaecological examination (46% vs. 21% p≤0.01) and that the screen interval was annual (18% vs. 4% p≤0.01). Distrust of the English healthcare system resulted in some Eastern European women returning to their country of birth for screening. Poor awareness of cervical cancer prior to migration and lack of information at registration with a general practitioner in England were associated with failure to participate in screening. Conclusions The views and attitudes expressed by the migrant Eastern European women in this study suggest that they are not fully participating in cervical screening in England. Targeted education at the point of contact with healthcare services in England is needed to increase cervical screening participation among these women.
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Affiliation(s)
- Hersha Patel
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Douglas Tincello
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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So WKW, Law BMH, Choi KC, Chan DNS, Chan CWH. A Mixed-Method Study Examining Cancer Screening Uptake among South Asian Ethnic Minorities in Hong Kong. Asia Pac J Oncol Nurs 2019; 7:12-17. [PMID: 31879679 PMCID: PMC6927150 DOI: 10.4103/apjon.apjon_36_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: Utilization of cancer screening is an effective means of cancer prevention. However, South Asian ethnic minorities in Western countries are reported to face barriers in cancer screening utilization, resulting in a low screening uptake by these individuals. The purpose of this mixed-method study is to assess the uptake rate of cancer screening among South Asian ethnic minorities in the Chinese Society of Hong Kong and to examine the factors affecting their participation in cancer screening. Methods: This study utilized a sequential mixed-method design, involving two phases. Following the implementation of a self-report survey among South Asian participants via an author-developed questionnaire with 1547 participants in Phase 1, a focus group interview was conducted with 34 participants in Phase 2 to assess the barriers to screening utilization. Convenience sampling was adopted to recruit participants at South Asian community centers in Phase 1, whereas purposive sampling was used for recruiting participants in Phase 2. Results: The findings revealed a low (<40%) uptake rate of cancer screening among the participants. Health illiteracy, language barrier, limited access to health information and screening services, and cultural issues were the major barriers to their cancer screening utilization. Conclusions: Our findings provided valuable information for both policymakers and health professionals to better understand the needs of ethnic minorities in Hong Kong. As cancer death rates can be lowered by early detection and primary preventive measures, health professionals should focus on the development of culture-specific interventions. Similarly, training the community health workers can strengthen the primary care system in enhancing knowledge on cancer, its prevention, and access to cancer screening services among local ethnic minorities.
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Affiliation(s)
- Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Bernard M H Law
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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Hendy J, Vandrevala T, Ahmed A, Kelly C, Gray L, Ala A. Feeling misidentified: Understanding migrant's readiness to engage in health care screening. Soc Sci Med 2019; 237:112481. [DOI: 10.1016/j.socscimed.2019.112481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/22/2019] [Accepted: 08/03/2019] [Indexed: 02/07/2023]
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Aasbø G, Solbrække KN, Waller J, Tropé A, Nygård M, Hansen BT. Perspectives of non-attenders for cervical cancer screening in Norway: a qualitative focus group study. BMJ Open 2019; 9:e029505. [PMID: 31471438 PMCID: PMC6719771 DOI: 10.1136/bmjopen-2019-029505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The attendance rate for cervical cancer screening in Norway is currently suboptimal at 69%, and an in-depth understanding of postponement of cervical cancer screening from the perspective of non-attenders is lacking. This study aims to generate knowledge about how non-attenders for cervical cancer screening reflect on booking a screening appointment. METHODS Using the Norwegian cervical cancer screening registry, we identified and recruited women who were non-attenders to screening. Nine focus group interviews were carried out, with 41 women participating in the interviews. RESULTS Four main themes were generated, which provide a comprehensive understanding of how women who are overdue for screening reflect on their hesitancy to book a screening appointment: 'It's easy to forget about it', 'Women have to arrange their own appointment', 'It has to be a 'must'' and 'It's a humiliating situation'. CONCLUSION The degree to which women regard screening as important is affected by the nudging strategies employed in the screening programme and the facilitation of attendance provided by healthcare services. Dependence on one's personal initiative to schedule a screening appointment and perception of a lack of responsibility on the part of healthcare services to attend screening may undermine informed and shared decision-making about screening attendance.
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Affiliation(s)
- Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Jo Waller
- Department of Behavioural Science and Health, Institute of Epidemiology and Public Health, University College London, London, UK
| | - Ameli Tropé
- Cervical Cancer Screening Programme, Cancer Registry of Norway, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Ryan M, Marlow L, Waller J. Socio-demographic correlates of cervical cancer risk factor knowledge among screening non-participants in Great Britain. Prev Med 2019; 125:1-4. [PMID: 31085204 PMCID: PMC6590931 DOI: 10.1016/j.ypmed.2019.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/22/2019] [Accepted: 04/28/2019] [Indexed: 11/05/2022]
Abstract
This study explored knowledge of cervical cancer risk factors among cervical screening non-participants in Great Britain. The aim was to identify knowledge gaps that could be targeted in screening information materials or public education campaigns. We used a cross-sectional design to survey women aged 25 to 64 years living in Great Britain, identified as cervical screening non-participants through self-report questions. Data were collected via a household survey. Survey questions measured awareness of risk factors for cervical cancer and socio-demographic factors. Screening non-participants were included in the study (n = 793) and classified into non-participant groups based on the Precaution Adoption Process Model. Across the sample, 57% of participants identified 'not going for regular smear tests' as a risk factor for cervical cancer. Women who intended to be screened were more likely to identify this risk factor than other non-participant groups (OR = 2.13, 95% CI: 1.51-2.99). Women age 55-64 years (OR = 0.60, 95% CI: 0.39-0.93) and women from non-white ethnic backgrounds (OR = 0.70, 95% CI: 0.52-0.94) were less likely to recognise this risk factor. Recognition was lower for 'infection with human papillomavirus' (41%). Just over half the sample were aware that screening non-attendance is associated with increased cervical cancer risk, suggesting that non-attendance at screening is not always based on an accurate understanding of the offer. Overall, non-participants are poorly informed about cervical cancer risk factors and further work is needed to ensure that women are making informed choices about (non-) participation.
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Affiliation(s)
- Mairead Ryan
- UCL, Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, London, WC1E 6BT, United Kingdom
| | - Laura Marlow
- UCL, Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, London, WC1E 6BT, United Kingdom
| | - Jo Waller
- UCL, Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, London, WC1E 6BT, United Kingdom.
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Mustari S, Hossain B, Diah NM, Kar S. Opinions of the Urban Women on Pap test: Evidence from Bangladesh. Asian Pac J Cancer Prev 2019; 20:1613-1620. [PMID: 31244279 PMCID: PMC7021619 DOI: 10.31557/apjcp.2019.20.6.1613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 11/17/2022] Open
Abstract
Each year, many countries from developed world publishes reports on early cancer detection; which is absolutely absent in most developing countries like Bangladesh.Very limited evidence is found on the role and acceptance of Pap test among the women of Bangladesh in determining cervical cancer. More research and updates are needed relating Pap test in early detection of cervical cancer. Thus the purpose of this study is set to assess the opinions of Bangladeshiurban womentowardsthe Pap test. A questionnaire-based survey of 400 Bangladeshi urban women was evaluated by on their socio-demographic characteristics, knowledgeand attitudes towards Pap testing. In general, the findings reveal that respondents havea good understanding of thepurpose of Pap test screening with 3.92 (Mean score). With 3.54 Mean score,the respondents believed that Pap tests are recommended to women who are married and with 3.45 mean score women believed that Pap tests arerecommended only to those who have children. Generally, respondents possess good knowledge of Pap test and its purpose. These findings can be used in identifying prospect cervical cancer screening significance populations and trend for future intrusion.
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Affiliation(s)
- Sohela Mustari
- Department of Sociology Begum Rokeya University, Rangpur, Bangladesh.
| | - Belal Hossain
- Directorate General of Health Services (DGHS) Mohakhali, Dhaka, Bangladesh
| | - Nurazzura Mohamad Diah
- Department of Sociology and Anthropology Kulliyyah of Islamic Revealed Knowledge and Human Sciences (KIRKHS) International Islamic University Malaysia Kuala Lumpur, Malaysia
| | - Susmita Kar
- Department of Public Health, Faculty of Allied Health Science Daffodil International University, Dhaka, Bangladesh
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Hertzum-Larsen R, Kjær SK, Frederiksen K, Thomsen LT. Participation in cervical cancer screening among immigrants and Danish-born women in Denmark. Prev Med 2019; 123:55-64. [PMID: 30796926 DOI: 10.1016/j.ypmed.2019.02.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/29/2019] [Accepted: 02/17/2019] [Indexed: 01/08/2023]
Abstract
In this nationwide register-based cohort study, we examined cervical cancer screening participation among immigrants in Denmark by country and region of origin. Furthermore, we assessed whether differences in screening participation between immigrants and Danish-born women were explained by sociodemographic or health-related characteristics, and examined predictors of participation among immigrants. Using high-quality registries, we identified women invited for cervical cancer screening during 2008-2009 and retrieved individual-level data on sociodemographic-, health- and immigration-related characteristics. A total of 610,907 women were followed for up to 2.9 years after screening invitation. We estimated the probability of participation using the Aalen-Johansen estimator and the hazard ratios (HRs) of participation using Cox regression. The probability of participation within follow-up was 74.5% (95% CI, 74.4%-74.6%) in Danish-born women; 61.2% (95% CI, 60.4%-62.1%) in Western immigrants; and 61.3% (95% CI, 60.9%-61.8%) in non-Western immigrants. Participation in immigrants varied by region of origin from 44.3% (95% CI, 41.4%-47.4%) in immigrants from North America, New Zealand and Australia to 67.8% (95% CI, 65.4%-70.3%) in immigrants from South- and Central America. Substantial variation was seen between specific countries of origin. Differences in participation between immigrants and Danish-born women were not explained by sociodemographic or health-related characteristics. Predictors of low participation in immigrants included lower income, unemployment, being unmarried, having a history of schizophrenia or other psychoses, and ≤5 years' stay in Denmark. In conclusion, cervical cancer screening participation in immigrants varied by region and country of origin, but all immigrant groups had lower participation than Danish-born women.
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Affiliation(s)
- Rasmus Hertzum-Larsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark; Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Juliane Maries Vej 10, 2100 Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark.
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Hvidberg L, Virgilsen LF, Pedersen AF, Vedsted P. Cancer beliefs and participation in screening for colorectal cancer: A Danish cohort study based on data from the International Cancer Benchmarking Partnership and national registers. Prev Med 2019; 121:11-17. [PMID: 30690041 DOI: 10.1016/j.ypmed.2019.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/28/2018] [Accepted: 01/24/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Line Hvidberg
- Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Line Flytkjær Virgilsen
- Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Anette Fischer Pedersen
- Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
| | - Peter Vedsted
- Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
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Chan DNS, So WKW, Choi KC, Gurung S. Development of an explanatory model to explore cervical cancer screening behaviour among South Asian women: The influence of multilevel factors. Eur J Oncol Nurs 2019; 40:2-9. [PMID: 31229203 DOI: 10.1016/j.ejon.2019.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To develop an explanatory model, built on an ecological basis, and examine the relational effects of multilevel factors on screening behaviour among South Asian immigrant women. METHODS This is a cross-sectional, exploratory correlational study using path analysis. 776 South Asian immigrant women were recruited from community in Hong Kong. A self-administered survey with eight sections covering socio-demographics, recommendations received from others, previous screening experience, knowledge of the disease and screening, attitudes and perceptions, level of acculturation, cultural barriers to screening and perception of cancer fatalism was used to collect data. Path analysis was done to test the hypothesised model. FINDINGS The final model obtained an acceptable model fit with x2/df = 2.52, RMSEA = 0.044, CFI = 0.95 and TLI = 0.93. A total of 15 factors, ranging from intra-personal to community level, were identified as being associated with South Asian immigrant women's cervical cancer screening behaviour. Three factors at the community level (language use, modesty and crisis orientation) had an inter-relationship with three intra-personal factors (perceived barriers to screening, cancer fatalism and perceived benefits of screening) and hence affected screening uptake. CONCLUSIONS South Asian women's cervical cancer screening behaviour is affected by multi-level factors. Efforts should be made to change the current health-promoting strategies and attract more involvement from appropriate stakeholders, incorporating cultural and socio-environmental components in future interventions.
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Affiliation(s)
- Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, New Territories, Hong Kong, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, New Territories, Hong Kong, China
| | - Kai C Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, New Territories, Hong Kong, China
| | - Sharmila Gurung
- United Christian Nethersole Community Health Service, Unit 26-33, G/F, Kui On House, Wo Lok Estate, Kwun Tong, Kowloon, Hong Kong, China
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Marlow L, McBride E, Varnes L, Waller J. Barriers to cervical screening among older women from hard-to-reach groups: a qualitative study in England. BMC Womens Health 2019; 19:38. [PMID: 30808349 PMCID: PMC6390581 DOI: 10.1186/s12905-019-0736-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical screening attendance among 50-64 year-olds is suboptimal. Understanding attitudes to screening and reasons for non-attendance in older women will help to identify the content of interventions for this age group. This study aimed to explore barriers to cervical screening among women aged 50-64 years from hard-to-reach groups whose perspectives are often absent from research on cervical screening but are critical to developing appropriate interventions to increase engagement with the screening offer. METHODS Qualitative methodology was used. Six focus groups were carried out with women aged 50-64 years from lower socio-economic and ethnic minority backgrounds (n = 38). Focus group discussions were recorded, transcribed verbatim and translated where necessary. Data were analysed using the Framework Approach, a type of thematic analysis. RESULTS All women had heard of cervical screening, but many felt they had poor knowledge. Women's reasons for non-attendance were wide-ranging and included discomfort and embarrassment, negative perceptions of health professionals, worry and trust in the results, concern about the procedure, idiosyncratic beliefs, and extreme negative experiences. Some women reported not receiving letters or prompts to be screened. CONCLUSIONS Information designed specifically for older women should ensure they understand the purpose of screening and its relevance to them. Emphasising changes to the programme that have made the experience less uncomfortable, and improved sample taker awareness of how women feel, may help to allay concerns related to previous negative experiences.
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Affiliation(s)
- Laura Marlow
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Emily McBride
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Laura Varnes
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Jo Waller
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
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Bennett KF, Waller J, Chorley AJ, Ferrer RA, Haddrell JB, Marlow LAV. Barriers to cervical screening and interest in self-sampling among women who actively decline screening. J Med Screen 2018; 25:211-217. [PMID: 29649936 PMCID: PMC6262593 DOI: 10.1177/0969141318767471] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/07/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Understanding why some women actively decline cervical screening could contribute to tailored intervention development. We explored reasons for non-participation in cervical screening among women who had made an active decision not to attend in the future. We also explored interest in human papillomavirus self-sampling. METHODS In a population-based survey of women in Great Britain, home-based computer-assisted interviews were carried out with screening eligible women. Women reported their intention to attend for screening when next invited. They endorsed predefined barriers to screening and indicated their interest in human papillomavirus self-sampling. RESULTS Women who had actively declined screening and those who intended to go but were currently overdue (n=543) were included in this analysis. Women who had made an active decision not to be screened in the future were more likely to endorse the barriers 'I have other more important things to worry about' and to perceive screening to be of low relevance based on their sexual behaviour. Most participants (70%) indicated that they would be interested in human papillomavirus self-sampling. Interest in self-sampling was greater among those who reported having had a bad experience of screening in the past, were too busy or embarrassed to attend, or would not want a man to carry out the test. CONCLUSIONS Women who had made an active decision not to attend screening felt it was of low relevance to them and that they had more important things to worry about. Shifting the perceived cost-benefit ratio for these women by offering human papillomavirus self-sampling might increase screening participation in this group.
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Affiliation(s)
- Kirsty F Bennett
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Amanda J Chorley
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - Jessica B Haddrell
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Laura AV Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
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Anderson de Cuevas RM, Saini P, Roberts D, Beaver K, Chandrashekar M, Jain A, Kotas E, Tahir N, Ahmed S, Brown SL. A systematic review of barriers and enablers to South Asian women's attendance for asymptomatic screening of breast and cervical cancers in emigrant countries. BMJ Open 2018; 8:e020892. [PMID: 29982210 PMCID: PMC6042536 DOI: 10.1136/bmjopen-2017-020892] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aim of this review was to identify the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance in South Asian populations, in order to improve uptake and propose priorities for further research. DESIGN A systematic review of the literature for inductive, comparative, prospective and intervention studies. We searched the following databases: MEDLINE/In-Process, Web of Science, EMBASE, SCOPUS, CENTRAL, CDSR, CINAHL, PsycINFO and PsycARTICLES from database inception to 23 January 2018. The review included studies on the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance and cervical smear testing (Papanicolaou test) in South Asian populations and those published in the English language. The framework analysis method was used and themes were drawn out following the thematic analysis method. SETTINGS Asymptomatic breast or cervical screening. PARTICIPANTS South Asian women, including Bangladeshi, Indian, Pakistani, Sri Lankan, Bhutanese, Maldivian and Nepali populations. RESULTS 51 included studies were published between 1991 and 2018. Sample sizes ranged from 25 to 38 733 and participants had a mean age of 18 to 83 years. Our review showed that South Asian women generally had lower screening rates than host country women. South Asian women had poorer knowledge of cancer and cancer prevention and experienced more barriers to screening. Cultural practices and assumptions influenced understandings of cancer and prevention, emphasising the importance of host country cultures and healthcare systems. CONCLUSIONS High-quality research on screening attendance is required using prospective designs, where objectively validated attendance is predicted from cultural understandings, beliefs, norms and practices, thus informing policy on targeting relevant public health messages to the South Asian communities about screening for cancer. PROSPERO REGISTRATION NUMBER CSD 42015025284.
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Affiliation(s)
| | - Pooja Saini
- NIHR Collaboration for Leadership in Applied Health Research and Care, University of Liverpool, Liverpool, UK
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | - Deborah Roberts
- Royal Liverpool and Broadgreen Hospital NHS Trust, Liverpool, UK
| | - Kinta Beaver
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | | | - Anil Jain
- The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Stevens C, Vrinten C, Smith SG, Waller J, Beeken RJ. Determinants of willingness to receive healthy lifestyle advice in the context of cancer screening. Br J Cancer 2018; 119:251-257. [PMID: 29991698 PMCID: PMC6048170 DOI: 10.1038/s41416-018-0160-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Providing lifestyle advice at cancer screening may help reduce the cancer burden attributable to health-related behaviour. We examined determinants of willingness to receive advice about several behavioural cancer risk factors. METHODS A population-based sample of English adults eligible for cancer screening (n = 1221) completed items on willingness to receive lifestyle advice. Sociodemographic, psychological (risk perceptions, cancer risk factor awareness) and behavioural factors were used to predict interest in advice about diet, weight, physical activity, smoking and alcohol consumption. RESULTS Two thirds (62-67%) reported interest in advice about diet, weight, and physical activity; 17% were willing to receive advice about smoking, and 32% about alcohol consumption. Willingness to receive advice was higher in those not adhering to guidelines for weight, physical activity, smoking and alcohol consumption (all p < 0.01). Non-White ethnicity was associated with interest in advice about diet, physical activity and smoking (all p < 0.01). Willingness to receive advice about diet, weight, physical activity and alcohol consumption increased with greater recognition of cancer risk factors (all p < 0.01). CONCLUSIONS Willingness to receive lifestyle advice at cancer screening was high, suggesting this context may provide an opportunity to support behaviour change. Increasing awareness of cancer risk factors may facilitate interest in lifestyle advice.
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Affiliation(s)
- Claire Stevens
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Samuel G Smith
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK.
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK.
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Leinonen MK, Campbell S, Ursin G, Tropé A, Nygård M. Barriers to cervical cancer screening faced by immigrants: a registry-based study of 1.4 million women in Norway. Eur J Public Health 2018; 27:873-879. [PMID: 28957477 PMCID: PMC5881680 DOI: 10.1093/eurpub/ckx093] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Immigrants from certain low- and middle-income countries are more prone to cancers attributed to viral infections in early life. Cervical cancer is caused by human papillomavirus but is highly preventable by regular screening. We assessed participation among immigrants in a population-based cervical screening programme and identified factors that predicted non-adherence within different immigrant groups. Methods We used data from several nationwide registries. The study population consisted of 208 626 (15%) immigrants and 1 157 223 (85%) native Norwegians. Non-adherence was defined as no eligible screening test in 2008–12. We estimated prevalence ratios with 95% confidence intervals (CIs) for factors associated with non-adherence by modified Poisson regression. Results In total, 52% of immigrants were not screened. All immigrants showed 1.72 times higher non-adherence rates (95% CI 1.71–1.73) compared with native Norwegian women when adjusted for age and parity. The proportion of non-adherent immigrants varied substantially by region of origin and country of origin. Being unemployed or not in the workforce, being unmarried, having low income and having a male general practitioner was associated with non-adherence regardless of region of origin. Living <10 years in Norway was an evident determinant of non-adherence among most but not all immigrant groups. Conclusions An increasing proportion of immigrants and low screening participation among them pose new public health challenges in Europe. Immigrants are diverse in terms of their sociodemographic attributes and screening participation. Tailored information and service delivery may be necessary to increase cancer screening among immigrants.
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Affiliation(s)
| | | | - Giske Ursin
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ameli Tropé
- Department of Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Andersson S, Belkić K, Mints M, Östensson E. Is self-sampling to test for high-risk papillomavirus an acceptable option among women who have been treated for high-grade cervical intraepithelial neoplasia? PLoS One 2018; 13:e0199038. [PMID: 29912903 PMCID: PMC6005489 DOI: 10.1371/journal.pone.0199038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Self-sampling to test for high risk human papilloma virus (HPV) is becoming an increasingly important component of cervical cancer screening. The aim of this observational study is to examine how women treated for high-grade cervical intraepithelial neoplasia (CIN) view HPV self-sampling. Methods Invited to participate in the present study were patients who had undergone treatment of high-grade CIN (grade 2 or higher) and were followed-up at 6-months at the Karolinska University Hospital, Stockholm. The participants were instructed as to how to perform HPV self-sampling. Thereafter, the participants completed a questionnaire about HPV self-sampling and other cervical cancer screening methods, as well as about self-perceived risk of cervical cancer without regular gynecologic follow-up and about specific knowledge regarding HPV, CIN and cervical cancer. Results Altogether 479 women enrolled in this study. The participation rate was 96.6%. Nearly 75% of the participants stated they would consider performing the HPV self-sampling prior to their next gynecologic follow-up. Confidence in HPV self-sampling was a significant independent predictor of willingness to perform HPV self-sampling. However, confidence in HPV self-sampling was significantly lower than confidence in Papanicolaou smears and in HPV testing with samples collected by health professionals. Higher specific knowledge about HPV, CIN and cervical cancer was also a significant independent predictor of willingness to perform HPV self-sampling, as was having travelled longer distance to attend gynecologic follow-up. Participants with lower income and without completed university education expressed significantly higher confidence in HPV self-sampling and lower confidence in Papanicolaou smears than the other women. Conclusions To the best of our knowledge, this is the first study to examine the views of women treated for high-grade CIN vis-à-vis HPV self-sampling. The latter is an acceptable option for the vast majority of this cohort of women.
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Affiliation(s)
- Sonia Andersson
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Karen Belkić
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- School of Community and Global Health, Claremont Graduate University, Claremont, California, United States of America
- Institute for Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, California, United States of America
| | - Miriam Mints
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Ellinor Östensson
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- * E-mail:
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Ajenifuja OK, Ikeri NZ, Adeteye OV, Banjo AA. Comparison between self sampling and provider collected samples for Human Papillomavirus (HPV) Deoxyribonucleic acid (DNA) testing in a Nigerian facility. Pan Afr Med J 2018; 30:110. [PMID: 30364362 PMCID: PMC6195243 DOI: 10.11604/pamj.2018.30.110.14321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction The multiple visits required for an effective Pap smear screening program is difficult to replicate in many developing countries. This precludes early diagnosis and care for patients with cervical cancer and contributes to its high mortality in these countries. HPV screening has higher specificity and high negative predictive value and has the advantage that materials can be self-collected, which permits the screening of women who for various cultural and religious reasons would be reluctant to come to the clinic to expose themselves for screening. The aim of the study was to assess the degree of agreement between self sampling for HPV DNA with samples collected by a health provider. Methods Each respondent selected from women presenting for cervical cancer screening underwent both self- and provider sampling for HPV DNA testing using Hybribio GenoArray. Results Of the 194 women screened, 12 (6.2%) and 19 (9.8%) had HPV on self sampling and provider col-lected samples respectively. The commonest HPV type seen using both techniques was HPV 58 (2.6%). Multiple HPV genotypes were seen in 1 (0.5%) and 5 cases (2.6%) of provider and self-collected samples respectively. The high risk-HPV detection rate was 7.2% when self sampled and 6.8% when sampled by the provider. There was moderate correlation between both sampling techniques (κ = 0.47, 95% CI: 21.3 - 72.3%, P < 0.05). Conclusion Our study shows moderate correlation between both sampling techniques. Larger multicentre studies will be needed to provide results generalisable to the Nigerian population. Keywords: Pap smear, HPV screening, cervical cancer, sample collection, self-sampling, provider collected, PCR, HPV DNA, Ile-Ife Nigeria.
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Affiliation(s)
| | | | | | - Adekunbiola Aina Banjo
- Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital.,Department of Anatomic and Molecular Pathology, College of Medicine University of Lagos
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Idehen EE, Koponen P, Härkänen T, Kangasniemi M, Pietilä AM, Korhonen T. Disparities in cervical screening participation: a comparison of Russian, Somali and Kurdish immigrants with the general Finnish population. Int J Equity Health 2018; 17:56. [PMID: 29728104 PMCID: PMC5935973 DOI: 10.1186/s12939-018-0768-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is currently ranked as the fourth commonly diagnosed cancer in women globally. A higher incidence has been reported in low- and-middle-income countries, and the disease poses significant public health challenges. Evidence suggests that this disease is preventable by means of regular screening using the Papanicolaou (Pap) test. However, limited knowledge exists about disparities in cervical screening participation among immigrants compared with non-immigrants, in countries with universal cervical screening programmes. We aimed to examine disparities in cervical screening participation among women of Russian, Somali, and Kurdish, origin in Finland, comparing them with the general Finnish population (Finns). We controlled for differences in several socio-demographic and health-related variables as potential confounders. Methods We employed data from the Finnish Migrant Health and Well-being Study 2010–2012 and the National Health 2011 Survey. Data collection involved face-to-face interviews. Data on screening participation in the previous five years from women aged 29–60 were available from 537 immigrants (257 Russians, 113 Somalis, 167 Kurds) and from 436 Finns. For statistical analyses, we used multiple logistic regression. Results Age-adjusted screening participation rates were as follows: Russians 79% (95% CI 72.9–84.4), Somalis 41% (95% CI 31.4–50.1), and Kurds 64% (95% CI 57.2–70.8), compared with 94% (95% CI 91.4–95.9) among Finns. After additionally adjusting for socio-demographic and health-related confounders, all the immigrant groups showed a significantly lower likelihood of screening participation when compared with Finns. The Odds Ratios were as follows: Russians 0.32 (95% CI 0.18–0.58), Somalis 0.10 (95% CI 0.04–0.23), and Kurds 0.17 (95% CI 0.09–0.35). However, when additionally accounting for country of origin-confounder interactions, such differences were attenuated. Conclusions Our results indicate disparities in screening participation among these immigrants and a lower likelihood of screening participation compared with the general Finnish population. To improve equity in cervical cancer screening participation, appropriate culturally tailored intervention programmes for each immigrant group might be beneficial.
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Affiliation(s)
- Esther E Idehen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tellervo Korhonen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Perceived cervical cancer risk among women treated for high-grade cervical intraepithelial neoplasia: The importance of specific knowledge. PLoS One 2017; 12:e0190156. [PMID: 29272293 PMCID: PMC5741232 DOI: 10.1371/journal.pone.0190156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022] Open
Abstract
Objective Women with high-grade cervical intraepithelial neoplasia (CIN) are at increased risk for developing cervical cancer. We examine how women with high-grade CIN perceive their own risk, and about pertinent knowledge concerning human high-risk papillomavirus (HPV), CIN and cervical cancer. Methods All patients who underwent first-time treatment of high-grade CIN (grade 2+) were followed-up at 6-months at the Karolinska University Hospital, Stockholm, Sweden and were invited to participate in the present study. This included completion of a questionnaire examining sociodemographic characteristics, self-perceived risk of cervical cancer without regular gynecologic follow-up, and 14 queries about HPV, CIN and cervical cancer knowledge, inter alia. Results The participation rate was 96.6%, with 479 women enrolled in this study. Over 75% were age 40 or younger, over half had completed university education. Most were married or co-living with their partner and were gainfully employed. On a scale scored from 10 (highest self-perceived risk of cervical cancer without regular gynecologic follow-up) to 1 (lowest self-perceived risk), 64% rated their risk ≥ 7; almost 30% viewed their risk ≤ 6 and 7.5% did not rate their risk. A Specific Knowledge Scale with six of the queries explained 58.3% of the total variance. Nearly 30% of the women answered four or fewer of the six queries correctly. The Specific Knowledge Scale predicted self-perceived cervical cancer risk (Odds ratio = 11.3, 95% Confidence Interval 5.6 − 22.6) after adjusting for age, income and education. Most of the women with low self-perceived cervical cancer risk did not rate their HPV-related knowledge as good. However, 32 predominantly university-educated women, with low self-perceived cervical cancer risk, considered their HPV-related knowledge good. Conclusion It is vital to effectively convey accurate information about these patients’ cervical cancer risk, needed preventive and follow-up measures, together with the relevant specific knowledge, for these women at increased risk for developing cervical cancer. Tailored programming to address these knowledge gaps is needed.
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A Systematic Review of the Factors Influencing Ethnic Minority Women's Cervical Cancer Screening Behavior: From Intrapersonal to Policy Level. Cancer Nurs 2017; 40:E1-E30. [PMID: 28081032 DOI: 10.1097/ncc.0000000000000436] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical cancer can be prevented by effective screening using Papanicolaou tests, but the utilization rate is lower among ethnic minorities than in the general population. Understanding the factors influencing minorities' use of such screening can aid the design of an appropriate intervention to increase their uptake rate. OBJECTIVE The aims of this study were to examine the factors that influence ethnic minority women in using cervical cancer screening and the similarities and differences in associated factors across different groups and to explore the interrelationships between the factors identified. METHODS A literature search was conducted using Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, PsycINFO, and PubMed. Furthermore, 1390 articles were retrieved, of which 24 met the inclusion criteria. Critical appraisal was performed by means of a quality assessment tool. The findings were summarized in tabular and narrative forms. RESULTS The findings showed that certain factors commonly affected ethnic minority women's screening behavior, including knowledge, attitude and perceptions, physician's recommendation, quality of care and service, language, and acculturation. Culture-related factors, religion, and acculturation exhibited close interrelationships with the attitude and perceptions factor, resulting in behavioral change. CONCLUSIONS The review sheds light on how common or unique are the factors across ethnic minorities and how these factors interact to influence behavior. Further studies are warranted to develop and test empirically a comprehensive model leading to a better understanding of the interrelationships between multiple factors. IMPLICATIONS FOR PRACTICE The model should be useful in informing policy makers about appropriate resource allocation and in guiding the development of culturally relevant programs to increase screening uptake.
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Lenoir P, Moulahi B, Azé J, Bringay S, Mercier G, Carbonnel F. Raising Awareness About Cervical Cancer Using Twitter: Content Analysis of the 2015 #SmearForSmear Campaign. J Med Internet Res 2017; 19:e344. [PMID: 29038096 PMCID: PMC5662788 DOI: 10.2196/jmir.8421] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023] Open
Abstract
Background Cervical cancer is the second most common cancer among women under 45 years of age. To deal with the decrease of smear test coverage in the United Kingdom, a Twitter campaign called #SmearForSmear has been launched in 2015 for the European Cervical Cancer Prevention Week. Its aim was to encourage women to take a selfie showing their lipstick going over the edge and post it on Twitter with a raising awareness message promoting cervical cancer screening. The estimated audience was 500 million people. Other public health campaigns have been launched on social media such as Movember to encourage participation and self-engagement. Their result was unsatisfactory as their aim had been diluted to become mainly a social buzz. Objective The objectives of this study were to identify the tweets delivering a raising awareness message promoting cervical cancer screening (sensitizing tweets) and to understand the characteristics of Twitter users posting about this campaign. Methods We conducted a 3-step content analysis of the English tweets tagged #SmearForSmear posted on Twitter for the 2015 European Cervical Cancer Prevention Week. Data were collected using the Twitter application programming interface. Their extraction was based on an analysis grid generated by 2 independent researchers using a thematic analysis, validated by a strong Cohen kappa coefficient. A total of 7 themes were coded for sensitizing tweets and 14 for Twitter users’ status. Verbatims were thematically and then statistically analyzed. Results A total of 3019 tweets were collected and 1881 were analyzed. Moreover, 69.96% of tweets had been posted by people living in the United Kingdom. A total of 57.36% of users were women, and sex was unknown in 35.99% of cases. In addition, 54.44% of the users had posted at least one selfie with smeared lipstick. Furthermore, 32.32% of tweets were sensitizing. Independent factors associated with posting sensitizing tweets were women who experienced an abnormal smear test (OR [odds ratio] 13.456, 95% CI 3.101-58.378, P<.001), female gender (OR 3.752, 95% CI 2.133-6.598, P<.001), and people who live in the United Kingdom (OR 2.097, 95% CI 1.447-3.038, P<.001). Nonsensitizing tweets were statistically more posted by a nonhealth or nonmedia company (OR 0.558, 95% CI 0.383-0.814, P<.001). Conclusions This study demonstrates that the success of a public health campaign using a social media platform depends on its ability to get its targets involved. It also suggests the need to use social marketing to help its dissemination. The clinical impact of this Twitter campaign to increase cervical cancer screening is yet to be evaluated.
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Affiliation(s)
- Philippe Lenoir
- Department of General Practice, Montpellier University, Montpellier, France
| | - Bilel Moulahi
- Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier, UMR 5506, Montpellier University/Centre National de la Recherche Scientifique, Montpellier, France
| | - Jérôme Azé
- Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier, UMR 5506, Montpellier University/Centre National de la Recherche Scientifique, Montpellier, France
| | - Sandra Bringay
- Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier, UMR 5506, Montpellier University/Centre National de la Recherche Scientifique, Montpellier, France.,Application des Mathématiques, Informatique et Statistique Group, Paul Valéry University, Montpellier, France
| | - Gregoire Mercier
- Public Health Department, Montpellier University Hospital, Montpellier, France.,Centre d'Etudes Politiques de l'Europe Latine UMR 5112, Montpellier University/Centre National de la Recherche Scientifique, Montpellier, France.,Centre d'Evaluation des programmes de Prévention Santé Platform, Paul Valéry University Montpellier 3, Montpellier University, Montpellier, France
| | - François Carbonnel
- Department of General Practice, Montpellier University, Montpellier, France.,Centre d'Evaluation des programmes de Prévention Santé Platform, Paul Valéry University Montpellier 3, Montpellier University, Montpellier, France.,Avicenne Multiprofessional Health Center, Cabestany, France.,Institut du Cancer Montpellier, Montpellier, France.,Epsylon EA4556, Paul Valéry University Montpellier 3, Montpellier University, Montpellier, France
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Marlow LAV, Chorley AJ, Haddrell J, Ferrer R, Waller J. Understanding the heterogeneity of cervical cancer screening non-participants: Data from a national sample of British women. Eur J Cancer 2017; 80:30-38. [PMID: 28535495 PMCID: PMC5489076 DOI: 10.1016/j.ejca.2017.04.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Uptake of cervical cancer screening in the United Kingdom (UK) is falling year on year, and a more sophisticated understanding of non-participation may help design interventions to reverse this trend. This study ascertained the prevalence of different non-participant types using the Precaution Adoption Process Model (PAPM). METHODS Home-based computer-assisted interviews were carried out with 3113 screening-eligible women in Britain. Survey items assessed self-reported screening uptake and intention to attend in future. Responses to these items were used to classify women into one of five different types of non-participants. RESULTS Of 793 non-participants, 28% were unaware of screening, 15% had decided not to attend and 51% were intending to have screening but were currently overdue. Younger women were more likely to be unaware of screening or to intend to be screened, while older women were more likely to have decided not to be screened. Women from ethnic minority backgrounds were more likely to be unaware of screening than white women. Being in a lower social grade was associated with increased odds of all three types of non-participation. CONCLUSION The majority of cervical cancer screening non-participants are not making an active decision not to attend but rather are either unaware or unable to act. There are clear sociodemographic differences between non-participant types, which could be used to identify where tailored interventions may be best targeted.
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Affiliation(s)
- Laura A V Marlow
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Amanda J Chorley
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jessica Haddrell
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Rebecca Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jo Waller
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
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Lim AW, Hollingworth A, Kalwij S, Curran G, Sasieni P. Offering self-sampling to cervical screening non-attenders in primary care. J Med Screen 2017; 24:43-49. [PMID: 27235844 DOI: 10.1177/0969141316639346] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objectives To assess the feasibility and acceptability of offering self-sampling for Human Papillomavirus (HPV) testing to cervical screening non-attenders when they consult primary care for any reason. Methods In a pilot implementation study, six general practices in London, UK, offered self-sampling kits during consultation to women aged 25-64 who were at least six months overdue for cervical screening (no cytology test recorded in the past 3.5 years if aged 25-49, or 5.5 years if aged 50-64). Eligible women were identified using an automated real-time search (during consultation) of the general practice electronic medical record system. Women collected samples either in clinic or at home (dry flocked swabs analysed using Roche Cobas®4800). Results Of approximately 5000 eligible women, 3131 consulted primary care between January and December 2014 (mean recruitment period 9.5 months). Of these, 21% (652) were offered kits, 14% (443) accepted, and 9% (292) returned a self-sample. The proportion of eligible women offered kits varied considerably among practices (11-36%). Sample return rates increased with kit offered rates ( r = 0.8, p = 0.04). Of 39 HPV positive women 85% (33) attended follow-up, including two with invasive cancers (stage 2A1 and 1A1). Conclusions Offering self-sampling to cervical screening non-attenders opportunistically in primary care is feasible. Return rates could be increased if more women were offered kits. A large trial is needed to identify how self-sampling is best integrated into the national screening programme, and to identify determinants of uptake.
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Affiliation(s)
- Anita Ww Lim
- 1 Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, London, UK
| | | | - Sebastian Kalwij
- 3 Amersham Vale Training Practice, Waldron Health Centre, London, UK
| | - Geoffrey Curran
- 4 Division of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Peter Sasieni
- 1 Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, London, UK
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Magnani B, Harubin B, Katz JF, Zuckerman AL, Strohsnitter WC. See, Test & Treat: A 5-Year Experience of Pathologists Driving Cervical and Breast Cancer Screening to Underserved and Underinsured Populations. Arch Pathol Lab Med 2017; 140:1411-1422. [PMID: 27922769 DOI: 10.5858/arpa.2016-0094-sa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - See, Test & Treat is a pathologist-driven program to provide cervical and breast cancer screening to underserved and underinsured patient populations. This program is largely funded by the CAP Foundation (College of American Pathologists, Northfield, Illinois) and is a collaborative effort among several medical specialties united to address gaps in the current health care system. OBJECTIVE - To provide an outline for administering a See, Test & Treat program, using an academic medical center as a model for providing care and collating the results of 5 years of data on the See, Test & Treat program's findings. DESIGN - Sources include data from patients seen at Tufts Medical Center (Boston, Massachusetts) who presented to the See, Test & Treat program and institutional data between 2010 and 2014 detailing the outline of how to organize and operationalize a volunteer cancer-screening program. RESULTS - During the 5-year course of the program, 203 women were provided free cervical and breast cancer screening. Of the 169 patients who obtained Papanicolaou screening, 36 (21.3%) had abnormal Papanicolaou tests. In addition, 16 of 130 patients (12.3%) who underwent mammography had abnormal findings. CONCLUSIONS - In general, women from ethnic populations have barriers that prevent them from participating in cancer screening. However, the CAP Foundation's See, Test & Treat program is designed to reduce those barriers for these women by providing care that addresses cultural, financial, and practical issues. Although screening programs are helpful in identifying those who need further treatment, obtaining further treatment for these patients continues to be a challenge.
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Affiliation(s)
- Barbarajean Magnani
- From the Departments of Pathology and Laboratory Medicine (Dr Magnani and Ms Harubin), Radiology (Dr Katz), and Women's Care (Dr Zuckerman), Tufts Medical Center, Boston, Massachusetts; and the Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester (Dr Strohsnitter)
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Chorley AJ, Marlow LAV, Forster AS, Haddrell JB, Waller J. Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis. Psychooncology 2017; 26:161-172. [PMID: 27072589 PMCID: PMC5324630 DOI: 10.1002/pon.4126] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/04/2016] [Accepted: 03/07/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call-recall programme, in order to understand the barriers to informed uptake. METHODS We searched nine databases for English language peer-reviewed publications reporting on qualitative data from screening-eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call-recall programme. Evidence was integrated using thematic synthesis. RESULTS Thirty-nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action. CONCLUSIONS The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Amanda J. Chorley
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
| | - Laura A. V. Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
| | - Alice S. Forster
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
| | - Jessica B. Haddrell
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
| | - Jo Waller
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
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Hanley SJ, Fujita H, Yokoyama S, Kunisawa S, Tamakoshi A, Dong P, Kobayashi N, Watari H, Kudo M, Sakuragi N. HPV self-sampling in Japanese women: A feasibility study in a population with limited experience of tampon use. J Med Screen 2016; 23:164-70. [PMID: 26919866 DOI: 10.1177/0969141315625702] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/15/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Cervical cancer incidence and mortality is increasing in Japanese women under age 50. Screening uptake is low and proactive recommendations for human papillomavirus vaccination have been suspended. Other cervical cancer prevention initiatives are urgently needed. We assessed whether human papillomavirus self-sampling might be an acceptable alternative to physician-led screening, particularly in women with limited experience of tampon use. We also sought to identify any practical, logistical, or safety issues in women already attending for screening, before carrying out further large-scale studies in non-responders. METHODS In total, 203 women aged 20-49 attending their annual workplace healthcheck in Sapporo, northern Japan, performed unsupervised human papillomavirus self-sampling before undergoing a physician-led cervical smear and human papillomavirus test, and completing a measure of acceptability for both tests. RESULTS Ninety per cent of participants stated they would use self-sampling again. They found instructions easy to follow and reported no issues with the usability of the self-sampling device. Compared with physician-led testing, women found self-sampling significantly less painful, less embarrassing and could relax more (p < 0.001), regardless of history of tampon use, which was associated with negative experiences in physician sampling (p = 0.034). Women lacked confidence the test had been performed correctly, despite no unsatisfactory samples. No safety issues were reported. CONCLUSIONS Self-sampling was highly acceptable in this population of women. They could perform the test safely unsupervised, but lacked confidence the test has been carried out correctly. Japanese women need to be educated about the accuracy of human papillomavirus self-sampling and further large-scale studies are necessary in non-responders.
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Affiliation(s)
- Sharon Jb Hanley
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Susumu Yokoyama
- Sapporo Industrial Health Management Screening Center, Sapporo, Japan
| | - Shiori Kunisawa
- Sapporo Industrial Health Management Screening Center, Sapporo, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Peixin Dong
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Noriko Kobayashi
- Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidemichi Watari
- Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masataka Kudo
- Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Noriaki Sakuragi
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Vrinten C, Wardle J, Marlow LA. Cancer fear and fatalism among ethnic minority women in the United Kingdom. Br J Cancer 2016; 114:597-604. [PMID: 26867159 PMCID: PMC4782206 DOI: 10.1038/bjc.2016.15] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/14/2015] [Accepted: 12/26/2015] [Indexed: 11/13/2022] Open
Abstract
Background: Cancer fear and fatalism are believed to be higher in ethnic minorities and may contribute to lower engagement with cancer prevention and early detection. We explored the levels of cancer fear and fatalism in six ethnic groups in the United Kingdom and examined the contribution of acculturation and general fatalism. Methods: A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women (120 of each) was conducted. Three items assessed cancer fear and two cancer fatalism. Acculturation was assessed using (self-reported) migration status, ability to speak English, and understanding of health leaflets; general fatalism with a standard measure. Results: Relative to White British women, African and Indian women were more fearful of cancer, Bangladeshi women less fearful, and Pakistani and Caribbean women were similar to White British women. Cancer fatalism was higher in all the ethnic minority groups compared with White British women. Less acculturated women were less likely to worry (ORs 0.21–0.45, all P<0.05) or feel particularly afraid (ORs 0.11–0.31, all P<0.05) but more likely to feel uncomfortable about cancer (ORs 1.97–3.03, all P<0.05). Lower acculturation (ORs 4.30–17.27, P<0.05) and general fatalism (OR 2.29, P<0.05) were associated with the belief that cancer is predetermined. Conclusions: In general, cancer fear and fatalism are more prevalent among ethnic minority than White British women and even more so in less acculturated ethnic minorities. This may affect their participation in cancer prevention and early detection.
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Affiliation(s)
- Charlotte Vrinten
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Laura Av Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London WC1E 6BT, UK
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