1
|
Staley H, Shiraz A, Shreeve N, Bryant A, Martin-Hirsch PP, Gajjar K. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2021; 9:CD002834. [PMID: 34694000 PMCID: PMC8543674 DOI: 10.1002/14651858.cd002834.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND This is an update of the Cochrane review published in Issue 5, 2011. Worldwide, cervical cancer is the fourth commonest cancer affecting women. High-risk human papillomavirus (HPV) infection is causative in 99.7% of cases. Other risk factors include smoking, multiple sexual partners, the presence of other sexually transmitted diseases and immunosuppression. Primary prevention strategies for cervical cancer focus on reducing HPV infection via vaccination and data suggest that this has the potential to prevent nearly 90% of cases in those vaccinated prior to HPV exposure. However, not all countries can afford vaccination programmes and, worryingly, uptake in many countries has been extremely poor. Secondary prevention, through screening programmes, will remain critical to reducing cervical cancer, especially in unvaccinated women or those vaccinated later in adolescence. This includes screening for the detection of pre-cancerous cells, as well as high-risk HPV. In the UK, since the introduction of the Cervical Screening Programme in 1988, the associated mortality rate from cervical cancer has fallen. However, worldwide, there is great variation between countries in both coverage and uptake of screening. In some countries, national screening programmes are available whereas in others, screening is provided on an opportunistic basis. Additionally, there are differences within countries in uptake dependent on ethnic origin, age, education and socioeconomic status. Thus, understanding and incorporating these factors in screening programmes can increase the uptake of screening. This, together with vaccination, can lead to cervical cancer becoming a rare disease. OBJECTIVES To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical screening. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 6, 2020. MEDLINE, Embase and LILACS databases up to June 2020. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical screening. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. Where possible, the data were synthesised in a meta-analysis using standard Cochrane methodology. MAIN RESULTS Comprehensive literature searches identified 2597 records; of these, 70 met our inclusion criteria, of which 69 trials (257,899 participants) were entered into a meta-analysis. The studies assessed the effectiveness of invitational and educational interventions, lay health worker involvement, counselling and risk factor assessment. Clinical and statistical heterogeneity between trials limited statistical pooling of data. Overall, there was moderate-certainty evidence to suggest that invitations appear to be an effective method of increasing uptake compared to control (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.49 to 1.96; 141,391 participants; 24 studies). Additional analyses, ranging from low to moderate-certainty evidence, suggested that invitations that were personalised, i.e. personal invitation, GP invitation letter or letter with a fixed appointment, appeared to be more successful. More specifically, there was very low-certainty evidence to support the use of GP invitation letters as compared to other authority sources' invitation letters within two RCTs, one RCT assessing 86 participants (RR 1.69 95% CI 0.75 to 3.82) and another, showing a modest benefit, included over 4000 participants (RR 1.13, 95 % CI 1.05 to 1.21). Low-certainty evidence favoured personalised invitations (telephone call, face-to-face or targeted letters) as compared to standard invitation letters (RR 1.32, 95 % CI 1.11 to 1.21; 27,663 participants; 5 studies). There was moderate-certainty evidence to support a letter with a fixed appointment to attend, as compared to a letter with an open invitation to make an appointment (RR 1.61, 95 % CI 1.48 to 1.75; 5742 participants; 5 studies). Low-certainty evidence supported the use of educational materials (RR 1.35, 95% CI 1.18 to 1.54; 63,415 participants; 13 studies) and lay health worker involvement (RR 2.30, 95% CI 1.44 to 3.65; 4330 participants; 11 studies). Other less widely reported interventions included counselling, risk factor assessment, access to a health promotion nurse, photo comic book, intensive recruitment and message framing. It was difficult to deduce any meaningful conclusions from these interventions due to sparse data and low-certainty evidence. However, having access to a health promotion nurse and attempts at intensive recruitment may have increased uptake. One trial reported an economic outcome and randomised 3124 participants within a national screening programme to either receive the standard screening invitation, which would incur a fee, or an invitation offering screening free of charge. No difference in the uptake at 90 days was found (574/1562 intervention versus 612/1562 control, (RR 0.94, 95% CI: 0.86 to 1.03). The use of HPV self-testing as an alternative to conventional screening may also be effective at increasing uptake and this will be covered in a subsequent review. Secondary outcomes, including cost data, were incompletely documented. The majority of cluster-RCTs did not account for clustering or adequately report the number of clusters in the trial in order to estimate the design effect, so we did not selectively adjust the trials. It is unlikely that reporting of these trials would impact the overall conclusions and robustness of the results. Of the meta-analyses that could be performed, there was considerable statistical heterogeneity, and this should be borne in mind when interpreting these findings. Given this and the low to moderate evidence, further research may change these findings. The risk of bias in the majority of trials was unclear, and a number of trials suffered from methodological problems and inadequate reporting. We downgraded the certainty of evidence because of an unclear or high risk of bias with regards to allocation concealment, blinding, incomplete outcome data and other biases. AUTHORS' CONCLUSIONS There is moderate-certainty evidence to support the use of invitation letters to increase the uptake of cervical screening. Low-certainty evidence showed lay health worker involvement amongst ethnic minority populations may increase screening coverage, and there was also support for educational interventions, but it is unclear what format is most effective. The majority of the studies were from developed countries and so the relevance of low- and middle-income countries (LMICs), is unclear. Overall, the low-certainty evidence that was identified makes it difficult to infer as to which interventions were best, with exception of invitational interventions, where there appeared to be more reliable evidence.
Collapse
Affiliation(s)
- Helen Staley
- Obstetrics & Gynaecology, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Norman Shreeve
- Obstetrics & Gynaecology, University of Cambridge Clinical School, Cambridge, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Pierre Pl Martin-Hirsch
- Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Preston, UK
| | - Ketankumar Gajjar
- Department of Gynaecological Oncology, 1st Floor Maternity Unit, City Hospital Campus, Nottingham, UK
| |
Collapse
|
2
|
Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health 2013; 36:146-57. [DOI: 10.1002/nur.21526] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 11/10/2022]
|
3
|
Bailey JV, Murray E, Rait G, Mercer CH, Morris RW, Peacock R, Cassell J, Nazareth I. Cochrane Review: Interactive computer-based interventions for sexual health promotion. ACTA ACUST UNITED AC 2011. [DOI: 10.1002/ebch.885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
4
|
Merzouk MD, Courtney P, Garrett-Albaugh S, Janoo J, Hobbs G, Vernon M. Knowledge of HPV in West Virginia high school health students and the effects of an educational tool. J Pediatr Adolesc Gynecol 2011; 24:278-81. [PMID: 21600809 DOI: 10.1016/j.jpag.2011.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 03/18/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To assess the knowledge of human papillomavirus (HPV) in West Virginia high school students, create an educational DVD that could be used as a supplement to health class, and evaluate whether our intervention increases student knowledge of HPV. DESIGN Prospective, randomized experimental design with analysis of questionnaire data. SETTING West Virginia high school health class. PARTICIPANTS A total of 626 students participated. INTERVENTIONS HPV educational DVD designed by health care providers. MAIN OUTCOME MEASURES Three WV counties were chosen for study participation. The study took place in health class during the sexually transmitted infection curriculum. Students were randomized to 2 arms: (1) HPV DVD educational intervention plus health class and (2) health class only. Participants completed a pretest and posttest that involved 11 true and false questions. The changes in test scores were compared between the 2 groups. RESULTS Overall, posttest scores of those students in the HPV DVD plus health class arm improved significantly more than the posttest scores in the health class only arm (P < .0001). CONCLUSION The educational HPV DVD we created was shown to be an effective learning tool. This is the first reported study to look at the effects of an educational program created by health care providers on the topic of HPV that would be used in the school setting. We believe this tool can be used to supplement the current health education curriculum in the school system.
Collapse
Affiliation(s)
- Maria D Merzouk
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, WV, USA.
| | | | | | | | | | | |
Collapse
|
5
|
Everett T, Bryant A, Griffin MF, Martin‐Hirsch PPL, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2011; 2011:CD002834. [PMID: 21563135 PMCID: PMC4163962 DOI: 10.1002/14651858.cd002834.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND World-wide, cervical cancer is the second most common cancer in women. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection. OBJECTIVES To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical cancer screening. SEARCH STRATEGY We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 1, 2009. MEDLINE, EMBASE and LILACS databases up to March 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical cancer screening. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Where possible the data were synthesised in a meta-analysis. MAIN RESULTS Thirty-eight trials met our inclusion criteria. These trials assessed the effectiveness of invitational and educational interventions, counselling, risk factor assessment and procedural interventions. Heterogeneity between trials limited statistical pooling of data. Overall, however, invitations appear to be effective methods of increasing uptake. In addition, there is limited evidence to support the use of educational materials. Secondary outcomes including cost data were incompletely documented so evidence was limited. Most trials were at moderate risk of bias. Informed uptake of cervical screening was not reported in any trials. AUTHORS' CONCLUSIONS There is evidence to support the use of invitation letters to increase the uptake of cervical screening. There is limited evidence to support educational interventions but it is unclear what format is most effective. The majority of the studies are from developed countries and so the relevance to developing countries is unclear.
Collapse
Affiliation(s)
- Thomas Everett
- Addenbrooke's Hospital NHS Foundation TrustDepartment of Gynaecological OncologyBOX 242, Addenbrooke's HospitalHills RoadCambridgeUKCB2 0QQ
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Michelle F Griffin
- Addenbrooke's Hospital NHS Foundation TrustDepartment of Gynaecological OncologyBOX 242, Addenbrooke's HospitalHills RoadCambridgeUKCB2 0QQ
| | - Pierre PL Martin‐Hirsch
- Royal Preston Hospital, Lancashire Teaching Hospital NHS TrustGynaecological Oncology UnitSharoe Green LaneFullwoodPrestonLancashireUKPR2 9HT
| | - Carol A Forbes
- University of YorkNHS Centre for Reviews & DisseminationHeslingtonYorkNorth YorkshireUKYO10 5DD
| | - Ruth G Jepson
- Scottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghScotlandUKEH8 9DX
| | | |
Collapse
|
6
|
Shepherd JP, Frampton GK, Harris P. Interventions for encouraging sexual behaviours intended to prevent cervical cancer. Cochrane Database Syst Rev 2011; 2011:CD001035. [PMID: 21491379 PMCID: PMC4040418 DOI: 10.1002/14651858.cd001035.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is the key risk factor for cervical cancer. Continuing high rates of HPV and other sexually transmitted infections (STIs) in young people demonstrate the need for effective behavioural interventions. OBJECTIVES To assess the effectiveness of behavioural interventions for young women to encourage safer sexual behaviours to prevent transmission of STIs (including HPV) and cervical cancer. SEARCH STRATEGY Systematic literature searches were performed on the following databases: Cochrane Central Register of Controlled Trials (CENTRAL Issue 4, 2009) Cochrane Gynaecological Cancer Review Group (CGCRG) Specialised Register, MEDLINE, EMBASE, CINAHL, PsychINFO, Social Science Citation Index and Trials Register of Promoting Health Interventions (TRoPHI) up to the end of 2009. All references were screened for inclusion against selection criteria. SELECTION CRITERIA Randomised controlled trials (RCTs) of behavioural interventions for young women up to the age of 25 years that included, amongst other things, information provision about the transmission and prevention of STIs. Trials had to measure behavioural outcomes (e.g. condom use) and/or biological outcomes (e.g. incidence of STIs, cervical cancer). DATA COLLECTION AND ANALYSIS A narrative synthesis was conducted. Meta-analysis was not considered appropriate due to heterogeneity between the interventions and trial populations. MAIN RESULTS A total of 5271 references were screened and of these 23 RCTs met the inclusion criteria. Most were conducted in the USA and in health-care clinics (e.g. family planning).The majority of interventions provided information about STIs and taught safer sex skills (e.g. communication), occasionally supplemented with provision of resources (e.g. free sexual health services). They were heterogeneous in duration, contact time, provider, behavioural aims and outcomes. A variety of STIs were addressed including HIV and chlamydia. None of the trials explicitly mentioned HPV or cervical cancer prevention.Statistically significant effects for behavioural outcomes (e.g. increasing condom use) were common, though not universal and varied according to the type of outcome. There were no statistically significant effects of abstaining from or reducing sexual activity. There were few statistically significant effects on biological (STI) outcomes. Considerable uncertainty exists in the risk of bias due to incomplete or ambiguous reporting. AUTHORS' CONCLUSIONS Behavioural interventions for young women which aim to promote sexual behaviours protective of STI transmission can be effective, primarily at encouraging condom use. Future evaluations should include a greater focus on HPV and its link to cervical cancer, with long-term follow-up to assess impact on behaviour change, rates of HPV infection and progression to cervical cancer. Studies should use an RCT design where possible with integral process evaluation and cost-effectiveness analysis where appropriate. Given the predominance of USA studies in this systematic review evaluations conducted in other countries would be particularly useful.
Collapse
Affiliation(s)
- Jonathan P Shepherd
- University of SouthamptonSouthampton Health Technology Assessments Centre (SHTAC)1st Floor Epsilon HouseEnterprise Road, Southampton Science ParkChilworth, SouthamptonHampshireUKSO16 7NS
| | - Geoff K Frampton
- University of SouthamptonSouthampton Health Technology Assessments CentreFirst Floor, Epsilon House, Enterprise Road, Southampton Science Park, ChilworthSouthamptonHampshireUKSO16 7NS
| | - Petra Harris
- University of SouthamptonSouthampton Health Technology Assessments Centre (SHTAC)1st Floor Epsilon HouseEnterprise Road, Southampton Science ParkChilworth, SouthamptonHampshireUKSO16 7NS
| | | |
Collapse
|
7
|
Vardas E, Giuliano AR, Goldstone S, Palefsky JM, Moreira ED, Penny ME, Aranda C, Jessen H, Moi H, Ferris DG, Liaw KL, Marshall JB, Vuocolo S, Barr E, Haupt RM, Garner EIO, Guris D. External genital human papillomavirus prevalence and associated factors among heterosexual men on 5 continents. J Infect Dis 2011; 203:58-65. [PMID: 21148497 PMCID: PMC3086430 DOI: 10.1093/infdis/jiq015] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 08/10/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We examined the baseline prevalence of penile, scrotal, and perineal/perianal human papillomavirus (HPV) in heterosexual men (HM). We also evaluated baseline characteristics of HM to assess factors associated with prevalent HPV detection. METHODS We tested serum samples from 3463 HM aged 16-24 years with 1-5 lifetime female sexual partners for antibodies to HPV 6, 11, 16, and 18. We collected baseline swab specimens for the detection of DNA of HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 from 3 areas: penile, scrotal, and perineal/perianal. Risk factors for prevalent HPV DNA detection were evaluated. RESULTS The prevalence of any tested HPV type was 18.7% at the penis, 13.1% at the scrotum, 7.9% at the perineal/perianal region, and 21.0% at any site. Having >3 lifetime female sexual partners had the greatest impact on HPV prevalence: odds ratio (OR) 3.2 (95% confidence interval (CI) 2.1-4.9) for HPV 6, 11, 16, and 18; and OR 4.5 (95% CI 3.3-6.1) for all HPV types tested. HPV DNA detection was highest in Africa. Neither condom usage nor circumcision was associated with HPV DNA prevalence. CONCLUSION Genital-HPV DNA detection is common in young, sexually active HM. We found HPV to be most prevalent in African men and least prevalent in men from the Asia-Pacific region. Increased numbers of sexual partners was an important risk factor for HPV DNA prevalence.
Collapse
Affiliation(s)
- Eftyhia Vardas
- Division of Medical Virology, University of Stellenbosch, South Africa and Lancet Laboratories, Johannesburg, South Africa.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Bailey JV, Murray E, Rait G, Mercer CH, Morris RW, Peacock R, Cassell J, Nazareth I. Interactive computer-based interventions for sexual health promotion. Cochrane Database Syst Rev 2010:CD006483. [PMID: 20824850 DOI: 10.1002/14651858.cd006483.pub2] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sexual health promotion is a major public health challenge; there is huge potential for health promotion via technology such as the Internet. OBJECTIVES To determine effects of interactive computer-based interventions (ICBI) for sexual health promotion, considering cognitive, behavioural, biological and economic outcomes. SEARCH STRATEGY We searched more than thirty databases for randomised controlled trials (RCTs) on ICBI and sexual health, including CENTRAL, DARE, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsycINFO. We also searched reference lists of published studies and contacted authors. All databases were searched from start date to November 2007, with no language restriction. SELECTION CRITERIA RCTs of interactive computer-based interventions for sexual health promotion, involving participants of any age, gender, sexual orientation, ethnicity or nationality. 'Interactive' was defined as packages that require contributions from users to produce tailored material and feedback that is personally relevant. DATA COLLECTION AND ANALYSIS Two review authors screened abstracts, applied eligibility and quality criteria and extracted data. Results of RCTs were pooled using a random-effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes. We assessed heterogeneity using the I(2) statistic. Separate meta-analyses were conducted by type of comparator: 1) minimal intervention such as usual practice or leaflet, 2) face-to-face intervention or 3) a different design of ICBI; and by type of outcome (cognitive, behavioural, biological outcomes). MAIN RESULTS We identified 15 RCTs of ICBI conducted in various settings and populations (3917 participants). Comparing ICBI to 'minimal interventions' such as usual practice, meta-analyses showed statistically significant effects as follows: moderate effect on sexual health knowledge (SMD 0.72, 95% CI 0.27 to 1.18); small effect on safer sex self-efficacy (SMD 0.17, 95% CI 0.05 to 0.29); small effect on safer-sex intentions (SMD 0.16, 95% CI 0.02 to 0.30); and also an effect on sexual behaviour (OR 1.75, 95% CI 1.18 to 2.59). Data were insufficient for meta-analysis of biological outcomes and analysis of cost-effectiveness.In comparison with face-to-face sexual health interventions, meta-analysis was only possible for sexual health knowledge, showing that ICBI were more effective (SMD 0.36, 95% CI 0.13 to 0.58). Two further trials reported no difference in knowledge between ICBI and face-to-face intervention, but data were not available for pooling. There were insufficient data to analyse other types of outcome.No studies measured potential harms (apart from reporting any deterioration in measured outcomes). AUTHORS' CONCLUSIONS ICBI are effective tools for learning about sexual health, and they also show positive effects on self-efficacy, intention and sexual behaviour. More research is needed to establish whether ICBI can impact on biological outcomes, to understand how interventions might work, and whether they are cost-effective.
Collapse
Affiliation(s)
- Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Hospital, Rowland Hill Street, London, UK, NW3 2PF
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Free C, Roberts IG, Abramsky T, Fitzgerald M, Wensley F. A systematic review of randomised controlled trials of interventions promoting effective condom use. J Epidemiol Community Health 2009; 65:100-10. [PMID: 19822557 PMCID: PMC3009845 DOI: 10.1136/jech.2008.085456] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Effective condom use can prevent sexually transmitted infections (STIs) and unwanted pregnancy. We conducted a systematic review and methodological appraisal of randomised controlled trials (RCTs) of interventions to promote effective condom use. Methods We searched for all RCTs of interventions to promote effective condom use using the Cochrane Infectious Diseases Group's trials register (Oct 2006), CENTRAL (Issue 4, 2006), MEDLINE (1966 to Oct 2006), EMBASE (1974 to Oct 2006), LILACS (1982 to Oct 2006), IBSS (1951 to Oct 2006) and Psychinfo (1996 to Oct 2006). We extracted data on allocation sequence, allocation concealment, blinding, loss to follow-up and measures of effect. Effect estimates were calculated. Results We identified 139 trials. Seven out of ten trials reported reductions in ‘any STI’ with five statistically significant results. Three out of four trials reported reductions in pregnancy, although none was statistically significant. Only four trials met all the quality criteria. Trials reported a median of 11 (IQR 7–17) outcome measures. Few trials used the same outcome measure. Altogether, 10 trials (7%) used the outcome ‘any STI’, 4 (3%) self-reported pregnancy and 22 (16%) used ‘condom use at last sex’. Conclusions The results are generally consistent with modest benefits but there is considerable potential for bias due to poor trial quality. Because of the low proportion of trials using the same outcome the potential for bias from selective reporting of outcomes is considerable. Despite the public health importance of increasing condom use there is little reliable evidence on the effectiveness of condom promotion interventions.
Collapse
Affiliation(s)
- Caroline Free
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | | | |
Collapse
|
10
|
O'Connor C, Myles H, O'Connor MB, Clancy J, Ryan A, Traynor M, McGrath D, O'Sullivan K. An audit of Colposcopy referrals from a GU/STD clinic. BMC Res Notes 2008; 1:24. [PMID: 18710481 PMCID: PMC2518287 DOI: 10.1186/1756-0500-1-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 06/12/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is increasing at 1.5% per year in Ireland with 50% mortality giving 2.2% of all cancer deaths. In the Mid-West region a pilot screening programme has begun to screen all women 25-60 years. 66% of Genitourinary/Sexually transmitted disease (GU/STD) clinics' abnormal smears are <25 years. Requests to abandon "opportunistic" screening prompted this GU/STD clinic audit. METHODS 221(8.4%) patients referred to colposcopy over 4 years were audited. Retrospective analysis was carried out on GU/STD clinic files, hospital files and computer records for biopsy reports. Ethical approval was prospectively granted. RESULTS 2637 smears were carried out from November 1999 - September 2003.221 patients referred to colposcopy were audited.1%, 3%, 5% had severe, moderate and, mild dyskaryosis, respectively, on cervical screening while 0.8%, 1.2%, 1.5% had CIN3, CIN2, CIN1 abnormalities, respectively, on biopsy with 3.5% having no abnormality (Cervical Intraepithelial Neoplasia = CIN).53% referred to colposcopy were <25 years. CONCLUSION 2% had high grade lesions. 37% of high grade lesions are <25 years.Of the high grade lesions 13% had Chlamydia trachomatis (27% of CIN3) and 44% had HPV despite Relative Risks (RR) being 0.75 and 1.09 respectively. Older women had higher grade changes. No statistical difference was found for progression, regression and persistence in those over and under 25.
Collapse
Affiliation(s)
- Catherine O'Connor
- Dept. of GU/STD Medicine, Mid-Western Regional Hospital, Limerick, Ireland.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Shemilt I, Mugford M, Drummond M, Eisenstein E, Mallender J, McDaid D, Vale L, Walker D. Economics methods in Cochrane systematic reviews of health promotion and public health related interventions. BMC Med Res Methodol 2006; 6:55. [PMID: 17107612 PMCID: PMC1660547 DOI: 10.1186/1471-2288-6-55] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 11/15/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provision of evidence on costs alongside evidence on the effects of interventions can enhance the relevance of systematic reviews to decision-making. However, patterns of use of economics methods alongside systematic review remain unclear. Reviews of evidence on the effects of interventions are published by both the Cochrane and Campbell Collaborations. Although it is not a requirement that Cochrane or Campbell Reviews should consider economic aspects of interventions, many do. This study aims to explore and describe approaches to incorporating economics methods in a selection of Cochrane systematic reviews in the area of health promotion and public health, to help inform development of methodological guidance on economics for reviewers. METHODS The Cochrane Database of Systematic Reviews was searched using a search strategy for potential economic evaluation studies. We included current Cochrane reviews and review protocols retrieved using the search that are also identified as relevant to health promotion or public health topics. A reviewer extracted data which describe the economics components of included reviews. Extracted data were summarised in tables and analysed qualitatively. RESULTS Twenty-one completed Cochrane reviews and seven review protocols met inclusion criteria. None incorporate formal economic evaluation methods. Ten completed reviews explicitly aim to incorporate economics studies and data. There is a lack of transparent reporting of methods underpinning the incorporation of economics studies and data. Some reviews are likely to exclude useful economics studies and data due to a failure to incorporate search strategies tailored to the retrieval of such data or use of key specialist databases, and application of inclusion criteria designed for effectiveness studies. CONCLUSION There is a need for consistency and transparency in the reporting and conduct of the economics components of Cochrane reviews, as well as regular dialogue between Cochrane reviewers and economists to develop increased capacity for economic analyses alongside such reviews. Use of applicable economics methods in Cochrane reviews can help provide the international context within which economics data can be interpreted and assessed as a preliminary to full economic evaluation.
Collapse
Affiliation(s)
- Ian Shemilt
- School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, UK
| | - Miranda Mugford
- School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, UK
| | | | | | | | - David McDaid
- LSE Health and Social Care, London School of Economics, UK
| | - Luke Vale
- Health Economics Research Unit, University of Aberdeen, UK
| | - Damian Walker
- John Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - The Campbell & Cochrane Economics Methods Group (CCEMG)
- Centre for Health Economics, University of York, UK
- Duke University Medical Center, North Carolina, USA
- Matrix Research & Consultancy Ltd, London, UK
- LSE Health and Social Care, London School of Economics, UK
- Health Economics Research Unit, University of Aberdeen, UK
- John Hopkins Bloomberg School of Public Health, Baltimore, USA
| |
Collapse
|
12
|
Waller J, McCaffery KJ, Forrest S, Wardle J. Human papillomavirus and cervical cancer: issues for biobehavioral and psychosocial research. Ann Behav Med 2004; 27:68-79. [PMID: 14979865 DOI: 10.1207/s15324796abm2701_9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
There is now overwhelming evidence that high-risk, sexually transmitted types of human papillomavirus (HPV) are the main causal agent in cervical cancer. Biobehavioral and psychosocial research is uniquely capable of addressing many of the issues raised by HPV and its link with cervical cancer. In this article we review current findings in this area and identify issues for future research. The first of the three sections explores issues associated with the introduction of HPV testing for the detection and management of cervical abnormalities and the impact of growing public awareness of the sexually transmitted nature of cervical cancer. The implications for public understanding of cervical cancer, psychosocial issues associated with screening, and the potential impact on screening uptake are discussed. The second section addresses the role of biobehavioral factors in the persistence and progression of HPV infection as well as possible interventions to minimize the risk of persistence. Finally, primary prevention of HPV is discussed.
Collapse
Affiliation(s)
- Jo Waller
- Cancer Research UK Health Behaviour Unit, University College London, UK.
| | | | | | | |
Collapse
|
13
|
Traeen B. Effect of an intervention to prevent unwanted pregnancy in adolescents. A randomized, prospective study from Nordland County, Norway, 1999-2001. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2003. [DOI: 10.1002/casp.712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
14
|
Forbes C, Jepson R, Martin-Hirsch P. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2002:CD002834. [PMID: 12137660 DOI: 10.1002/14651858.cd002834] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cervical cancer is the third most common cancer world-wide. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection. OBJECTIVES To assess the effectiveness of interventions aimed at increasing uptake, and informed uptake of cervical cancer screening. SEARCH STRATEGY Twenty-three electronic databases (to March 2000) were searched with no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs), or quasi-RCTs of interventions to increase uptake/informed uptake of cervical cancer screening. DATA COLLECTION AND ANALYSIS Data on study characteristics and quality were extracted independently by two reviewers. Where data were available, relative risks and 95% CI were calculated and a chi-squared test for heterogeneity was performed. MAIN RESULTS Thirty-five studies were included (27 RCTs and eight quasi-RCTs). Heterogeneity between studies limited statistical pooling of data. Overall, however, invitations appear to be effective methods of increasing uptake. In addition, there is limited evidence to support the use of educational materials. The number and quality of included studies limited evidence regarding effectiveness of other interventions. Informed uptake of cervical screening was not considered by any studies. REVIEWER'S CONCLUSIONS There was some evidence to support the use of invitation letters to increase the uptake of cervical screening. There was limited evidence to support educational interventions but it was unclear what format was most effective. The majority of the studies were from developed countries and so the relevance to developing countries is unclear.
Collapse
Affiliation(s)
- C Forbes
- NHS Centre for Reviews & Dissemination, University of York, Heslington, York, North Yorkshire, UK, YO10 5DD.
| | | | | |
Collapse
|