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Sun L, Patel S, Fiorina C, Glass A, Rochaix L, Foss AM, Legood R. A systematic review of the cost-effectiveness of interventions to increase cervical cancer screening among underserved women in Europe. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:829-844. [PMID: 37726429 PMCID: PMC11192698 DOI: 10.1007/s10198-023-01627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND This study aimed to conduct a systematic review of the cost-effectiveness studies of interventions to increase cervical cancer screening uptake rates in underserved women in Europe. METHODS A search of Embase, Medline, Global Health, PsychINFO, and NHS Economic Evaluation Database was conducted for studies published between January 2000 and September 2022. Studies were eligible if they analysed the cost-effectiveness of any interventions to improve participation in cervical cancer screening among underserved women of any age eligible to participate in cervical cancer screening in European countries, in any language. Study characteristics and cost-effectiveness results were summarised. Study quality was assessed using the Drummond Checklist, and methodological choices were further compared. RESULTS The searches yielded 962 unique studies, with 17 of these (from twelve European countries) meeting the eligibility criteria for data extraction. All studies focused on underscreened women as an overarching group, with no identified studies focusing on specific subgroups of underserved women. Generally, self-HPV testing and reminder interventions were shown to be cost-effective to increase the uptake rates. There was also research showing that addressing access issues and adopting different screening modalities could be economically attractive in some settings, but the current evidence is insufficient due to the limited number of studies. CONCLUSION This systematic review has revealed a gap in the literature on the cost-effectiveness of interventions to improve uptake rates of cervical cancer screening through tailored provision for specific groups of underserved women.
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Affiliation(s)
- Li Sun
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Shruti Patel
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Anna M Foss
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosa Legood
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Walker L, Burke S, McGeechan GJ. Understanding perceptions of the public and key stakeholders toward a localised cancer screening promotion campaign. PSYCHOL HEALTH MED 2024; 29:317-333. [PMID: 36907829 DOI: 10.1080/13548506.2023.2188230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
The aim of this study was to explore perceptions of members of the public and key stakeholders of a localised campaign to increase engagement with cervical cancer screening. Whilst numerous interventions have been trialled to increase engagement with cancer screening, the evidence for their effectiveness is somewhat mixed. In addition, few studies have explored the perceptions of members of the public targeted by such campaigns nor the perceptions of healthcare professionals who may be involved in delivering such campaigns in the United Kingdom. Members of the public who had potentially been exposed to the campaign in the North-East of England were approached to take part in individual interviews whilst stakeholders were invited to take part in a focus group. A total of 25 participants (13 members of the public, 12 stakeholders) took part. All interviews were audio recorded, transcribed verbatim and analysed using applied thematic analysis. Four themes were identified, two of which were cross-cutting (barriers to screening and factors promoting screening), with one theme identified as specific to the public interviews (knowledge of and attitudes toward awareness campaigns) and one theme specific to the focus group (keeping campaigns relevant. Awareness of the localised campaign was limited; however, when made aware, participants were mostly positive towards the approach, although mixed responses were noted in relation to financial incentives. Members of the public and stakeholders identified some common barriers to screening although differed in their perceptions of promotional factors. This study highlights the importance of multiple strategies to promote cervical screening as one size fits all approach may limit engagement.
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Affiliation(s)
- Lauren Walker
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Shani Burke
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
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Andrzejczak A, Rucińska M, Żarłok E, Osowiecka K. Health care system and patient-related factors affecting low cancer screening participation in Poland. Prev Med Rep 2023; 36:102442. [PMID: 37822981 PMCID: PMC10562866 DOI: 10.1016/j.pmedr.2023.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
The level of participation in cancer screening is low in the Polish population. The aim of this study was to assess the opinions of centers providing cancer screening as to the reasons for the low frequency of cancer screening in Poland and possible methods to increase participation. In July 2020 433 centers in Poland carried out breast and/or cervical cancer screening. Of these, 136 centers decided to participate in the study. The study was conducted using an original questionnaire. The questions were addressed to opinion of centers about: reasons for the low frequency of cancer screening in Poland, methods to increase the frequency of cancer screening, pricing and motivating factors for providing cancer screening. Among opinions as to possible reasons for the low frequency of cancer screening in Poland related to the care-system, lack of encouragement from general practitioners, lack of invitations for cancer screening and lack of proper social advertising were most prevalent; whereas among reasons related to patients, a low awareness of cancer screening and fear of cancer diagnosis. The main methods that could potentially increase screening participation are considered to be the inclusion of cancer screening in mandatory periodic employee examinations, more activity by general practitioners, better promotion of screening by central institutions, and sending personal invitations. In conclude some interventions should be carried out to motivate people to break down barriers.
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Affiliation(s)
- A. Andrzejczak
- Fundacja Onkologia 2025, Al. gen. Sikorskiego 9B lok 12D, Warszawa, Poland
| | - M. Rucińska
- Department of Oncology, Collegium Medicum University of Warmia and Mazury in Olsztyn, Wojska Polskiego 37, 10-228 Olsztyn, Poland
| | - E. Żarłok
- Fundacja Onkologia 2025, Al. gen. Sikorskiego 9B lok 12D, Warszawa, Poland
| | - K. Osowiecka
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland
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Xiong S, Ghebre R, Kulasingam S, Mason SM, Pratt RJ, Lazovich D. Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially- and ethnically-diverse women in Minnesota: A cross-sectional study. Prev Med Rep 2023; 34:102243. [PMID: 37234567 PMCID: PMC10206196 DOI: 10.1016/j.pmedr.2023.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30-65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options.
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Affiliation(s)
- Serena Xiong
- Department of Surgery, Washington University in St. Louis School of Medicine, 600 S Taylor Avenue, St. Louis, MO 63110, United States
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology and Women’s Health, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, United States
- Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, United States
| | - Shalini Kulasingam
- Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, United States
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454, United States
| | - Susan M. Mason
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454, United States
| | - Rebekah J. Pratt
- Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, United States
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414, United States
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455, United States
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454, United States
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Zhang M, Sit JW, Choi KC, Chan CW. A theory-driven, culture-tailored educational intervention for cervical cancer screening among rural Chinese females: A feasibility and pilot study. Asia Pac J Oncol Nurs 2023; 10:100218. [PMID: 37288349 PMCID: PMC10242496 DOI: 10.1016/j.apjon.2023.100218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 06/09/2023] Open
Abstract
Objective This study aimed to evaluate the feasibility and preliminarily estimate the effects of a theory-driven, culture-tailored, community-based educational intervention promoting cervical cancer screening among rural females. Methods An experimental study with the two-arm parallel, nonrandomized control trial design was implemented, followed by individual semi-structured interviews. Thirty rural females between 26 and 64 were recruited, with 15 in each group. Both groups were exposed to the usual care about cervical cancer screening promotion from the local clinics, while participants in the intervention group additionally received five educational sessions in 5 weeks. Data were collected at baseline and immediately postintervention. Results All participants completed the study, and the retention rate was 100%. Participants in the intervention group had more significant increments in cervical cancer screening-related self-efficacy (P < 0.001), knowledge (P < 0.001), and intention levels (P = 0.003) than those in the control group. Most participants showed acceptance and satisfaction with this educational intervention. Conclusions This study revealed that the theory-driven, culture-tailored, community-based educational intervention was feasible among the rural populations to promote cervical cancer screening. A large-scale interventional study with a prolonged follow-up duration is warranted to explore this educational intervention's effectiveness further.
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Kamanga P, Zhang B, Stones W. Factors associated with low utilisation of cervical cancer screening among urban women in Lilongwe, Malawi: a cross sectional study. BMC Womens Health 2023; 23:183. [PMID: 37069557 PMCID: PMC10111711 DOI: 10.1186/s12905-023-02324-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/01/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND In 2012, more than half a million women (528,000) were diagnosed with cervical cancer around the world. More than 80% of cervical cancer occurs in developing nations, such as Malawi, where estimates of the disease's burden show an incidence of 75.9 per 100,000 women and a mortality rate of 49.8 per 100,000 women (both age-adjusted). Despite its case fatality rate, cervical cancer can be avoided through immunization, early detection and screening. Malawi however, has low immunization and screening rates with coverage as low as 9% and 15%, respectively. Here our aim is to uncover factors that contribute to low utilization of cervical cancer screening services among women in Lilongwe, a large urban center. METHODS This was a qualitative cross-sectional study. Participants were chosen at random from a big metropolitan health center. In-depth interviews and two observations were undertaken by the researchers. Interviews were taped, transcribed verbatim, and content assessed. RESULTS A total of 24 women and 5 health workers, with an average age of 34.8 years, were questioned. 50% of women had completed secondary school, 33.3% had completed primary school, and 4% had completed no formal education. The majority of the women were housewives and entrepreneurs. 62.5% of the respondents had fewer than four children, 25% had four to six children, and 8.3% had more than six children. 91 - 6% of those surveyed were married, with 78% of Christians and 20% of Muslims. The majority of women were unaware of the importance of cervical cancer screening. Some people were concerned about marital troubles, pain during the process, "laziness," and the amount of time necessary. The majority of people would come for a test as a result of signs and symptoms. Male health personnel would be unable to screen Muslim women. All of the medical personnel had at least two years of experience. Women's low involvement in cervical cancer screening has been linked by health workers to a lack of resources and a lack of community awareness. CONCLUSION Cervical cancer can be prevented by early detection and treatment. Women, on the other hand, are uninformed about cervical cancer. Myths, misconceptions, cultural and religious beliefs, as well as service restrictions and community sensitization, influence the use of cervical cancer screening services. Addressing these issues has the potential to boost cervical cancer screening rates.
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Affiliation(s)
- Patricia Kamanga
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre Malawi, Private Bag 360, Blantyre, Malawi.
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, 511505 Shaitanan Road, Guangzhou, Guangdong, China.
- Kamuzu Central Hospital, P.O. Box 149, Lilongwe, Malawi.
| | - Bo Zhang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, 511505 Shaitanan Road, Guangzhou, Guangdong, China
| | - William Stones
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre Malawi, Private Bag 360, Blantyre, Malawi
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Tin KN, Ngamjarus C, Rattanakanokchai S, Sothornwit J, Aue-Aungkul A, Paing AK, Pattanittum P, Jampathong N, Lumbiganon P. Interventions to increase the uptake of cervical cancer screening in low- and middle-income countries: a systematic review and meta-analysis. BMC Womens Health 2023; 23:120. [PMID: 36959632 PMCID: PMC10035175 DOI: 10.1186/s12905-023-02265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND To identify effective interventions to increase the uptake of cervical cancer screening (CCS) for low-and middle-income countries (LMICs). METHODS We searched PubMed, CENTRAL, ISI Web of Sciences, Scopus, OVID (Medline), CINAHL, LILACS, CNKI and OpenGrey for randomized controlled trials (RCTs) and cluster RCTs conducted in LMICs from January 2000 to September 2021. Two reviewers independently screened studies, extracted data, assessed risk of bias and certainty of evidence. Meta-analyses with random-effects models were conducted for data synthesis. RESULTS We included 38 reports of 24 studies involving 318,423 participants from 15 RCTs and nine cluster RCTs. Single interventions may increase uptake of CCS when compared with control (RR 1.47, 95% CI 1.19 to 1.82). Self-sampling of Human Papillomavirus (HPV) testing may increase uptake of CCS relative to routine Visual Inspection with Acetic Acid (RR 1.93, 95% CI 1.66 to 2.25). Reminding with phone call may increase uptake of CCS than letter (RR 1.72, 95% CI 1.27 to 2.32) and SMS (RR 1.59, 95% CI 1.19 to 2.13). Sending 15 health messages may increase uptake of CCS relative to one SMS (RR 2.75, 95% CI 1.46 to 5.19). Free subsidized cost may increase uptake of CCS slightly than $0.66 subsidized cost (RR 1.60, 95% CI 1.10 to 2.33). Community based HPV test may increase uptake of CCS slightly in compared to hospital collected HPV (RR 1.67, 95% CI 1.53 to 1.82). The evidence is very uncertain about the effect of combined interventions on CCS uptake relative to single intervention (RR 2.20, 95% CI 1.54 to 3.14). CONCLUSIONS Single interventions including reminding with phone call, SMS, community self-sampling of HPV test, and free subsidized services may enhance CCS uptake. Combined interventions, including health education interventions and SMS plus e-voucher, may be better than single intervention. Due to low-certainty evidences, these findings should be applied cautiously.
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Affiliation(s)
- Khaing Nwe Tin
- Maternal and Reproductive Health Division, Department of Public Health, Ministry of Health, Naypyidaw, Myanmar
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Chetta Ngamjarus
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
| | - Siwanon Rattanakanokchai
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Jen Sothornwit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Apiwat Aue-Aungkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Porjai Pattanittum
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | | | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Xiong S, Lazovich DA, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study. Implement Sci Commun 2022; 3:130. [PMID: 36514133 PMCID: PMC9745769 DOI: 10.1186/s43058-022-00382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Persistent infection with high-risk human papillomavirus (hrHPV) types is a well-documented cause of cervical cancer. Since the implementation of cervical cancer screening methods (e.g., Pap tests), cervical cancer rates have declined. However, Pap tests are still unacceptable to many women and require complex infrastructure and training. Self-sampling techniques for collecting HPV specimens (or "HPV self-sampling") have been proposed as a possible alternative to overcome these barriers. The objective of this study was to capture perspectives from health care personnel (providers, leaders, and clinic staff) across primary care systems on the potential implementation of an HPV self-sampling practice. METHODS Between May and July 2021, a study invitation was emailed to various health care professional networks across the Midwest, including a snowball sampling of these networks. Eligible participants were invited to a 45-60-min Zoom-recorded interview session and asked to complete a pre-interview survey. The survey collected sociodemographics on age, occupation, level of educational attainment, race/ethnicity, gender, and awareness of HPV self-sampling. The semi-structured interview was guided by the Consolidated Framework for Implementation Research and asked participants about their views on HPV self-sampling and its potential implementation. All interviews were audio-recorded, transcribed, and analyzed using NVivo 12. RESULTS Key informant interviews were conducted with thirty health care personnel-13 health care providers, 6 clinic staff, and 11 health care leaders-from various health care systems. Most participants had not heard of HPV self-sampling but reported a general enthusiasm for wanting to implement it as an alternative cervical cancer screening tool. Possible barriers to implementation were knowledge of clinical evidence and ease of integration into existing clinic workflows. Potential facilitators included the previous adoption of similar self-sampling tools (e.g., stool-based testing kits) and key decision-makers. CONCLUSION Although support for HPV self-sampling is growing, its intervention's characteristics (e.g., advantages, adaptability) and the evidence of its clinical efficacy and feasibility need to be better disseminated across US primary care settings and its potential adopters. Future research is also needed to support the integration of HPV self-sampling within various delivery modalities (mail-based vs. clinic-based).
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Affiliation(s)
- Serena Xiong
- grid.4367.60000 0001 2355 7002Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, St. Louis, MO 63110 USA
| | - De Ann Lazovich
- grid.17635.360000000419368657Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454 USA ,grid.17635.360000000419368657Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455 USA
| | - Faiza Hassan
- grid.17635.360000000419368657Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414 USA
| | - Nafisa Ambo
- grid.17635.360000000419368657Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414 USA
| | - Rahel Ghebre
- grid.17635.360000000419368657Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455 USA ,grid.17635.360000000419368657Department of Obstetrics, Gynecology and Women’s Health, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455 USA
| | - Shalini Kulasingam
- grid.17635.360000000419368657Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454 USA ,grid.17635.360000000419368657Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455 USA
| | - Susan M. Mason
- grid.17635.360000000419368657Department of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd Suite 300, Minneapolis, MN 55454 USA
| | - Rebekah J. Pratt
- grid.17635.360000000419368657Masonic Cancer Center, University of Minnesota, 425 East River Parkway, Minneapolis, MN 55455 USA ,grid.17635.360000000419368657Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414 USA
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Tsedenbal B, Enebish G, Tserensodnom B, Saio M. Results of Self-Sampling Methodology Impression for Cervical Cancer Screening in Mongolia. Asian Pac J Cancer Prev 2022; 23:4099-4107. [PMID: 36579991 PMCID: PMC9971469 DOI: 10.31557/apjcp.2022.23.12.4099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Mongolia is a sparsely populated country; however, almost fifty percent of the population lives in the capital city. Medical care services and exceptionally well-organized cervical cancer screening tests are limited in remote areas. To improve cervical cancer screening test coverage, we compared the interest between physicians taking samples and self-sampling among the attendees in this study. METHODS A total of 175 women participated in this study. The hundred twelve women visited the Gynecology ward, and the sixty-three women were provided with the cervical self-sampling test kit and filled out a questionnaire. Subsequently, the acceptability of physician taking and self-sampling were evaluated using a questionnaire. All specimens were processed using the TACAS LBC system, and the quality of samples was tested by cytology. RESULTS Regarding the acceptability of self-sampling, the selections for subsequent screening were 36% self-sampling and 64% gynecologist-sampling methods. The acceptability rates were higher in the remote areas than the urban areas. However, 64% of the participants lacked knowledge that the causative agent of cervical cancer is the human papillomavirus, and 66.9% mainly were sexually transmitted. In addition, 82.3% of the women surveyed were unaware that there was a vaccine to prevent cervical cancer, but 88.6% wanted to be vaccinated. Of most women, 44.4% chose self-sampling due to no embarrassment in the gynecological examination. The self-sampling preferences were dominant in the old age group (61.6%). The cytology satisfaction rate in physician-sampling (99.1%) was higher than in the self-sampling group (69.8%). CONCLUSION The Implementation of the self-sampling tool may be considered a primary screening. The self-sampling test can adopt into the early screening program and may increase the coverage of the screening program and improve the quality.
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Affiliation(s)
- Batchimeg Tsedenbal
- Mongolian National University of Medical Sciences, Mongolia. ,National Center for Pathology, Mongolia. ,For Correspondence:
| | | | | | - Masanao Saio
- Gunma University, Graduate School of Health Sciences, Japan.
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Chueiri PS, Gonçalves MR, Hauser L, Mengue S, Agostinho M, Roman R, Wollmann L, Dilda A, da Silva RAM, Harzheim E. Brazilian Survey on Preventive Actions for the Population With Access to Primary Healthcare: Inefficient Spending in a Country in Economic Crisis. Int J Health Policy Manag 2022; 11:1905-1912. [PMID: 34523857 PMCID: PMC9808240 DOI: 10.34172/ijhpm.2021.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/24/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cancer ranks second as a cause of death in Brazil. Although preventive practices are part of the daily routine of primary healthcare (PHC) teams, organized screening programs are lacking. This study aimed to evaluate the adequacy of preventive interventions in the main cancer types, as defined by the Brazilian government. METHODS We analyzed cross-sectional data from a larger project conducted in 2016 with PHC service users and physicians from all over Brazil, interviewed by trained research staff. The sample was stratified by the number of PHC physicians per geographic region, who were eligible for inclusion if they had been working in the same PHC unit for at least one year. Twelve adult patients with at least two encounters were included per participating physician. Only the data from service users were analyzed in this study. We evaluated the questions about preventive practices and calculated the following indicators: coverage, focus, screening errors, and screening ratio. National guidelines and international evidence were used as a comparison parameter. RESULTS The study population consisted of 6160 service users. The data indicate that the recommendations for cervical, breast, and prostate cancer screening and for treatment of tobacco dependence are not adequately followed. Coverage for breast and cervical cancer screening presented an overutilization bias, with rates 50% and 9% above the expected, respectively. The screening focus was also inadequate: 24%, 47%, and 54% of the screening tests for the three cancer types were performed in individuals outside the recommended age range. 31% of smokers were not approached for treatment. CONCLUSION These findings indicate that the Brazilian population has been subjected to inadequate and potentially iatrogenic interventions in PHC. New policies based on stricter criteria of adequacy and increased use of the concept of quaternary prevention may improve the effectiveness and equity of the health system.
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Affiliation(s)
| | - Marcelo Rodrigues Gonçalves
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lisiane Hauser
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Sotero Mengue
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Rudi Roman
- Graduate Program in Epidemiology, TelehealthRS Project, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas Wollmann
- Community Health Services, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Anna Dilda
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Erno Harzheim
- School of Medicine, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
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11
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Malekzadeh E, Nourizadeh R, Farshbaf-Khalili A, Mehrabi E, Hakimi S. The effect of decision-aid-based counseling on cervical cancer screening behavior among women: An interventional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:205. [PMID: 36003249 PMCID: PMC9393954 DOI: 10.4103/jehp.jehp_714_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/29/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Performing appropriate and regular screening can effectively reduce cervical cancer and mortality rate, however, the available evidence suggests that women's participation in cervical cancer screening remains low in middle- and low-income countries, and that it is necessary to identify appropriate intervention methods to change behavior. The present study was designed to determine the effect of decision-aid-based counseling on cervical cancer screening behavior among women. MATERIALS AND METHODS This trial study was conducted on 154 women with no history of Pap smear during the past 3 years and refers to Tabriz health care centers. The participants were assigned to the intervention (decision aid based counseling) and control (routine health education) groups through randomized block design with block sizes of 4 and 6 and a 1:1 allocation ratio. The data were collected using the sociodemographic and fertility characteristics, stages of change checklist, and shared decision-making (SDM) and decisional conflict (DC) questionnaire before and 6 months after the intervention by interview and then, analyzed by SPSS24 software. The independent t-test, ANCOVA tests were used. RESULTS A significant difference was observed between the two groups in terms of changing the stages of cervical cancer screening behavior 6 months after the intervention. As after the intervention, the frequency of individuals entered the preparation or action stage was more than the control group (P = 0.001). The mean score of SDM in the intervention group was significantly higher than the control group after intervention ([45.49 ± 1.18] vs. [27.56 ± 1.18] [Mean Difference (MD): 17.92; 95% confidence interval [CI]: 14.59-21.25; P < 0.001]). The mean score of DC in the intervention group was significantly lower than the control group after intervention ([29.16 ± 1.09] vs. [34.14 ± 1.09] [MD: -4.97; 95% CI: 1.09-8.04; P < 0.002]). CONCLUSIONS This study revealed that evidence-based information communicated between clients and clinicians has very important role in clients' health-related behavior. It is recommended, health care providers apply decision-aid-based counseling for promoting the cervical cancer screening behavior among women.
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Affiliation(s)
- Elnaz Malekzadeh
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roghaiyeh Nourizadeh
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azizeh Farshbaf-Khalili
- Physical Medicine and Rehabilitation Research Centre, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmat Mehrabi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sevil Hakimi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Zhang M, Sit JWH, Chan DNS, Akingbade O, Chan CWH. Educational Interventions to Promote Cervical Cancer Screening among Rural Populations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116874. [PMID: 35682457 PMCID: PMC9180749 DOI: 10.3390/ijerph19116874] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023]
Abstract
The urban-rural gap in cervical cancer screening uptake is a significant public health consideration. Educational interventions are commonly adopted to promote cervical cancer screening among females in rural areas; however, the characteristics and effectiveness of these educational interventions remain unclear. In this review, we aimed to identify the characteristics of educational interventions used in rural populations and to evaluate the effects of these interventions on cervical cancer screening-related outcomes. Seven English databases were searched in January 2022. Randomized controlled trials (RCTs) and quasi-experimental studies were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Quasi-Experimental Studies were used for quality appraisal. RevMan 5.4 software was used for the meta-analysis. A narrative synthesis was conducted in instances where a meta-analysis was inappropriate. Three RCTs and seven quasi-experimental studies conducted in six countries were included. A social cognitive theory-based framework, the community setting, group sessions, healthcare professional-led approaches, and culture-tailored materials were implemented in the educational interventions for cervical cancer screening. The educational content mainly included basic information on cervical cancer screening, psychological issues, barriers and strategies to overcome them, and locally available resources. Educational interventions increased the knowledge and uptake of cervical cancer screening in the rural population. However, the studies only evaluated the short-term effects of these educational interventions, with the cervical screening behavior only being assessed in one instance for each participant. Educational interventions promote cervical cancer screening among females in rural areas. Theory-driven, community-involved, group-based, and healthcare professional-led approaches should be prioritized in the application of educational interventions in rural populations. Both the short- and long-term, influences of educational interventions on the cervical cancer screening behavior of females in rural areas need to be recognized.
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Affiliation(s)
- Mengyue Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Janet W H Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Oluwadamilare Akingbade
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
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13
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Coleridge SL, Wiggans A, Nelissen E, Bethune R, Blackwell R, Bryant A, Morrison J. Improving the uptake of cervical screening in pregnant and recently postnatal women: a quality improvement project. BMJ Open Qual 2022; 11:e001709. [PMID: 35613829 PMCID: PMC9134207 DOI: 10.1136/bmjoq-2021-001709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 05/11/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In 2018, cervical screening uptake was at its lowest level since screening began, particularly in those aged 25-35, coinciding with the peak incidence of cervical cancer and average age at first delivery. PROBLEM Retrospective baseline data of pregnant women found 47.3% (n=123/260) were overdue for screening by delivery, of whom 74% (n=91/123) remained overdue by 6 months postnatal. METHODS We undertook a quality improvement project from April 2018 to April 2019 to improve cervical screening uptake in pregnant and postnatal women. We mapped out the screening process and canvassed stakeholders. The main theme was inconsistency of advice received by women. From February 2018 to May 2020, we undertook a prospective audit of 10 women per week who gave birth in our maternity department, recording screening status at delivery and 6 months postnatal.Interventions included introducing evidence-based guidelines about cervical screening in pregnancy and the postnatal period, flow charts for maternity staff, multiprofessional teaching for all maternity staff and information dissemination to women (via the HANDiApp platform, a social media campaign and adapting results letters following colposcopy, highlighting dates when screening would be due). Primary care opening hours were extended for screening and women received a letter from their midwives, if they required cervical screening in pregnancy. RESULTS Locally, the percentage of women overdue for cervical screening by 6 months postnatal improved by 8.0% during this project, compared with a 1.6% change in national screening rates in women aged 25-49. CONCLUSIONS We increased the percentage of local pregnant and postnatal women attending cervical screening by introduction of a package of information, targeted education and widening access to screening appointments.
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Affiliation(s)
| | - Alison Wiggans
- Gynaecological Oncology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Ellen Nelissen
- Gynaecological Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Rob Bethune
- South West Academic Health Science Network, Exeter, UK
- Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Andrew Bryant
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jo Morrison
- Gynaecological Oncology, Somerset NHS Foundation Trust, Taunton, UK
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14
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Moradi S, Taherinezhad Ledari A. Encouraging women to do cervical cancer screening: a secondary preventive intervention with a multitude of behavioural dimensions. Evid Based Nurs 2022; 25:ebnurs-2021-103510. [PMID: 35393296 DOI: 10.1136/ebnurs-2021-103510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Saivash Moradi
- Medical Education Development Centre, Mazandaran University of Medical Sciences Faculty of Medicine, Sari, Iran
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15
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Ouanhnon L, Rougé Bugat ME, Lamy S, Druel V, Delpierre C, Grosclaude P. Social and territorial inequalities in breast and cervical cancers screening uptake: a cross-sectional study in France. BMJ Open 2022; 12:e055363. [PMID: 35193917 PMCID: PMC8867371 DOI: 10.1136/bmjopen-2021-055363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this cross-sectional study was to investigate the impact of socio-territorial characteristics on mammography and pap smear uptake according to the place of residence in the recommended age groups, and second outside the recommended age groups. SETTING AND PARTICIPANTS We used an existing dataset of 1 027 039 women which combines data from the Health Insurance information systems, with census data from Midi-Pyrénées, France. PRIMARY AND SECONDARY OUTCOME MEASURES Our outcome was, for each woman, the uptake of the pap smear and the uptake of the mammography during the year. RESULTS A social gradient of screening uptake was found in the recommended age groups. This gradient was stronger in large urban areas:(1) For mammography: decile 10 (the most deprived) vs 1 (the least deprived), adjusted OR 0.777, 95% CI (0.748 to 0.808) in large urban area; adjusted OR= 0.808 for decile 1 to 0.726 for decile 10 in other areas vs decile 1 in urban areas;(2) For pap smear: decile 10 vs 1 adjusted OR 0.66, 95%CI (0.642 to 0.679) in large urban areas; adjusted OR= 0.747 for decile 1 to 0.562 for decile 10 in other areas vs decile 1 in urban areas).Screening rates were globally higher in large urban areas.For mammography, the social and territorial disparities were higher outside the recommended age group. CONCLUSIONS Offering a universal approach to every woman, as it is often the case in nationally organised screening programmes, is likely to be insufficient to ensure real equity in access. Developing global dataset combining health data and diverse socioeconomic data, at individual and contextual levels, could enable a better understanding of the mechanisms involved in this social gradient, and therefore, the development of targeted territorial actions to improve equity of access to healthcare.
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Affiliation(s)
- Lisa Ouanhnon
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Marie-Eve Rougé Bugat
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Sebastien Lamy
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- Registre des cancers du Tarn, Institute Claudius Regaud, Toulouse, France
| | - Vladimir Druel
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Cyrille Delpierre
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- LEASP, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pascale Grosclaude
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- Registre des cancers du Tarn, Institute Claudius Regaud, Toulouse, France
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16
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Landy R, Hollingworth T, Waller J, Marlow LA, Rigney J, Round T, Sasieni PD, Lim AW. Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial. Br J Gen Pract 2022; 72:e26-e33. [PMID: 34972808 PMCID: PMC8714504 DOI: 10.3399/bjgp.2021.0350] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cervical cancer disproportionately affects women ≥65 years, especially those not screened regularly. Speculum use is a key barrier. AIM To assess if offering non-speculum clinician-taken sampling and self-sampling increases uptake for lapsed attenders aged 50-64 years. DESIGN AND SETTING Pragmatic randomised control trial conducted at 10 general practices in East London, UK. METHOD Participants were 784 women aged 50-64 years, last screened 6-15 years before randomisation. Intervention participants received a letter offering the choice of non-speculum clinician- or self-sampling. Control participants received usual care. The main outcome measure was uptake within 4 months. RESULTS Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4% (n = 80/393) versus 4.9% in the control arm (n = 19/391, absolute difference 15.5%, 95% confidence interval [CI] = 11.0% to 20.0%, P<0.001). This was maintained at 12 months: intervention 30.5% (n = 120/393) versus control 13.6% (n = 53/391) (absolute difference 17.0%, 95% CI = 11.3% to 22.7%, P<0.001). Conventional screening attendance within 12 months was very similar for both intervention 12.7% (n = 50/393) and control 13.6% (n = 53/391) arms. Ethnic differences were seen in screening modality preference. More White women opted for self-sampling (50.7%, n = 38/75), whereas most Asian and Black women and those from other ethnic backgrounds opted for conventional screening. CONCLUSION Offering non-speculum clinician-taken sampling and self-sampling substantially increases uptake in older lapsed attendee women. Non-speculum clinician sampling appeals to women who dislike the speculum but still prefer a clinician to take their sample. Providing a choice of screening modality may be important for optimising cervical screening uptake.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, US
| | | | - Jo Waller
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Laura Av Marlow
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Jane Rigney
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London and National Cancer Analysis and Registration Service, Public Health England
| | - Peter D Sasieni
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Anita Ww Lim
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
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17
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Acuti Martellucci C, Morettini M, Flacco ME, Manzoli L, Palmer M, Giacomini G, Pasqualini F. Delivering cervical cancer screening during the COVID-19 emergency. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:296-299. [PMID: 33926910 DOI: 10.1136/bmjsrh-2021-201099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Affiliation(s)
| | - Margherita Morettini
- Department of Prevention, Oncologic Screening Unit, Health Agency of the Marche Region, Ancona, Italy
| | | | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Matthew Palmer
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Giusi Giacomini
- Department of Prevention, Oncologic Screening Unit, Health Agency of the Marche Region, Ancona, Italy
| | - Francesca Pasqualini
- Department of Prevention, Oncologic Screening Unit, Health Agency of the Marche Region, Ancona, Italy
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18
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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.
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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
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19
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Heidemann DL, Adhami A, Nair A, Haftka-George A, Zaidan M, Seshadri V, Tang A, Willens DE. Using a Frontline Staff Intervention to Improve Cervical Cancer Screening in a Large Academic Internal Medicine Clinic. J Gen Intern Med 2021; 36:2608-2614. [PMID: 33987788 PMCID: PMC8390589 DOI: 10.1007/s11606-021-06865-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cervical cancer is the third most common malignancy affecting women. Screening with Papanicolaou (Pap) tests effectively identifies precancerous lesions and early-stage cervical cancer. While the nationwide rate of cervical cancer screening (CCS) is 84%, our urban general internal medicine (GIM) clinic population had a CCS rate of 70% in 2016. OBJECTIVE To improve our clinic's CCS rate to match or exceed the national average within 18 months by identifying barriers and testing solutions. DESIGN A quality improvement project led by a multidisciplinary group of healthcare providers. PARTICIPANTS Our GIM clinic includes 16 attending physicians, 116 resident physicians, and 20 medical assistants (MAs) with an insured and underserved patient population. INTERVENTION Phase 1 lasted 9 months and implemented CCS patient outreach, patient financial incentives, and clinic staff education. Phase 2 lasted 9 months and involved a workflow change in which MAs identified candidates for CCS during patient check-in. Feedback spanned the entire study period. MAIN MEASURES Our primary outcome was the number of Pap tests completed per month during the 2 study phases. Our secondary outcome was the clinic population's CCS rate for all eligible clinic patients. KEY RESULTS After interventions, the average number of monthly Pap tests increased from 35 to 56 in phase 1 and to 75 in phase 2. Of 385 patients contacted in phase 1, 283 scheduled a Pap test and 115 (41%) completed it. Compared to baseline, both interventions improved cervical cancer screening (phase 1 relative risk, 1.86; 95% CI, 1.64-2.10; P < 0.001; phase 2 relative risk, 2.70; 95% CI, 2.40-3.02; P < 0.001). Our clinic's CCS rate improved from 70% to 75% after the 18-month intervention. CONCLUSIONS The rate of CCS increased by 5% after a systematic 2-phase organizational intervention that empowered MAs to remind, identify, and prepare candidates during check-in for CCS.
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Affiliation(s)
- Danielle L Heidemann
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA.
| | - Angie Adhami
- Department of Primary Care, Dedicated Senior Medical Center, St. Petersburg, FL, USA
| | - Anupama Nair
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Alexis Haftka-George
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Mariam Zaidan
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Vaidehi Seshadri
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Amy Tang
- Department of Public Health Sciences, Detroit, MI, USA
| | - David E Willens
- Department of Internal Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
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20
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Nelson M, Patton A, Robb K, Weller D, Sheikh A, Ragupathy K, Morrison D, Campbell C. Experiences of cervical screening participation and non-participation in women from minority ethnic populations in Scotland. Health Expect 2021; 24:1459-1472. [PMID: 34137135 PMCID: PMC8369098 DOI: 10.1111/hex.13287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/21/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background The introduction of screening in the UK and other high‐income countries led to a significant decrease in the incidence of cervical cancer and increase in survival rates. Minority ethnic groups are often underrepresented in screening participation for reasons that are poorly understood. Objective To explore experiences of cervical screening participation and non‐participation of women from minority ethnic populations in Scotland and gain insights to support the development of interventions that could potentially support screening participation and thereby reduce inequalities. Design Qualitative comparison group study using in‐depth, semi‐structured individual interviews that were thematically analysed. Setting and participants This study took place in Scotland. Fifty women were purposively sampled from four ethnic minority groups: South Asian; East European; Chinese; and Black African or Caribbean. White Scottish women were also interviewed. Results Many experiences described were common regardless of ethnicity, such as difficulties managing competing priorities, including work and care responsibilities. However, important differences existed across the groups. These included going abroad for more frequent screening, delayed introduction to screening and not accessing primary care services, language difficulties in health‐care settings despite proficiency in English and not being sexually active at screening commencement. Experiences of racism, ignorance and feeling shamed were also reported. Conclusions Key differences exist in the experience of minority ethnic groups in Scotland. These offer potential opportunities to reduce disparity and support screening participation including maximizing co‐incidental interactions and developing outreach work.
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Affiliation(s)
- Mia Nelson
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Andrea Patton
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Katie Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David Weller
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - David Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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21
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O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 PMCID: PMC8201571 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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22
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Van Keer S, van Splunter AP, Pattyn J, De Smet A, Herzog SA, Van Ostade X, Tjalma WAA, Ieven M, Van Damme P, Steenbergen RDM, Vorsters A. Triage of human papillomavirus infected women by methylation analysis in first-void urine. Sci Rep 2021; 11:7862. [PMID: 33846517 PMCID: PMC8042010 DOI: 10.1038/s41598-021-87329-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/26/2021] [Indexed: 11/28/2022] Open
Abstract
Host cell DNA methylation analysis in urine provides promising triage markers for women diagnosed with a high-risk (HR) human papillomavirus (HPV) infection. In this study, we have investigated a panel of six host cell methylation markers (GHSR, SST, ZIC1, ASCL1, LHX8, ST6GALNAC5) in cervicovaginal secretions collected within the first part of the urine void (FVU) from a referral population. Cytology, histology, and HPV DNA genotyping results on paired FVU and cervical samples were available. Urinary median methylation levels from HR-HPV (n = 93) positive women were found to increase for all markers with severity of underlying disease. Significantly elevated levels were observed for GHSR and LHX8 in relation to high-grade cervical intraepithelial neoplasia (CIN2 +; n = 33), with area under de curve values of 0.80 (95% Confidence Interval (CI) 0.59–0.92) and 0.76 (95% CI 0.58–0.89), respectively. These findings are the first to support the assertion that methylation analysis of host cell genes is feasible in FVU and holds promise as molecular, triage strategy to discern low- from high-grade cervical disease in HR-HPV positive women. Molecular testing on FVU may serve to increase cervical cancer screening attendance in hard-to-reach populations whilst reducing loss to follow-up and await further optimization and validation studies.
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Affiliation(s)
- Severien Van Keer
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Annina P van Splunter
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jade Pattyn
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Annemie De Smet
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Sereina A Herzog
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Xaveer Van Ostade
- Laboratory of Proteinscience, Proteomics & Epigenetic Signalling (PPES), Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Wilrijkstraat 10, 2650, Edegem, Belgium.,Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology (LMM), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Renske D M Steenbergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium
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23
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Mc Cord KA, Ewald H, Agarwal A, Glinz D, Aghlmandi S, Ioannidis JPA, Hemkens LG. Treatment effects in randomised trials using routinely collected data for outcome assessment versus traditional trials: meta-research study. BMJ 2021; 372:n450. [PMID: 33658187 PMCID: PMC7926294 DOI: 10.1136/bmj.n450] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare effect estimates of randomised clinical trials that use routinely collected data (RCD-RCT) for outcome ascertainment with traditional trials not using routinely collected data. DESIGN Meta-research study. DATA SOURCE Studies included in the same meta-analysis in a Cochrane review. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised clinical trials using any type of routinely collected data for outcome ascertainment, including from registries, electronic health records, and administrative databases, that were included in a meta-analysis of a Cochrane review on any clinical question and any health outcome together with traditional trials not using routinely collected data for outcome measurement. REVIEW METHODS Effect estimates from trials using or not using routinely collected data were summarised in random effects meta-analyses. Agreement of (summary) treatment effect estimates from trials using routinely collected data and those not using such data was expressed as the ratio of odds ratios. Subgroup analyses explored effects in trials based on different types of routinely collected data. Two investigators independently assessed the quality of each data source. RESULTS 84 RCD-RCTs and 463 traditional trials on 22 clinical questions were included. Trials using routinely collected data for outcome ascertainment showed 20% less favourable treatment effect estimates than traditional trials (ratio of odds ratios 0.80, 95% confidence interval 0.70 to 0.91, I2=14%). Results were similar across various types of outcomes (mortality outcomes: 0.92, 0.74 to 1.15, I2=12%; non-mortality outcomes: 0.71, 0.60 to 0.84, I2=8%), data sources (electronic health records: 0.81, 0.59 to 1.11, I2=28%; registries: 0.86, 0.75 to 0.99, I2=20%; administrative data: 0.84, 0.72 to 0.99, I2=0%), and data quality (high data quality: 0.82, 0.72 to 0.93, I2=0%). CONCLUSIONS Randomised clinical trials using routinely collected data for outcome ascertainment show smaller treatment benefits than traditional trials not using routinely collected data. These differences could have implications for healthcare decision making and the application of real world evidence.
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Affiliation(s)
- Kimberly A Mc Cord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Hannah Ewald
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
- University Medical Library, University of Basel, Basel, Switzerland
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dominik Glinz
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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24
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Gates A, Pillay J, Reynolds D, Stirling R, Traversy G, Korownyk C, Moore A, Thériault G, Thombs BD, Little J, Popadiuk C, van Niekerk D, Keto-Lambert D, Vandermeer B, Hartling L. Screening for the prevention and early detection of cervical cancer: protocol for systematic reviews to inform Canadian recommendations. Syst Rev 2021; 10:2. [PMID: 33388083 PMCID: PMC7777363 DOI: 10.1186/s13643-020-01538-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To inform recommendations by the Canadian Task Force on Preventive Health Care on screening in primary care for the prevention and early detection of cervical cancer by systematically reviewing evidence of (a) effectiveness; (b) test accuracy; (c) individuals' values and preferences; and (d) strategies aimed at improving screening rates. METHODS De novo reviews will be conducted to evaluate effectiveness and to assess values and preferences. For test accuracy and strategies to improve screening rates, we will integrate studies from existing systematic reviews with search updates to the present. Two Cochrane reviews will provide evidence of adverse pregnancy outcomes from the conservative management of cervical intraepithelial neoplasia. We will search Medline, Embase, and Cochrane Central (except for individuals' values and preferences, where Medline, Scopus, and EconLit will be searched) via peer-reviewed search strategies and the reference lists of included studies and reviews. We will search ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. Two reviewers will screen potentially eligible studies and agree on those to include. Data will be extracted by one reviewer with verification by another. Two reviewers will independently assess risk of bias and reach consensus. Where possible and suitable, we will pool studies via meta-analysis. We will compare accuracy data per outcome and per comparison using the Rutter and Gatsonis hierarchical summary receiver operating characteristic model and report relative sensitivities and specificities. Findings on values and preferences will be synthesized using a narrative synthesis approach and thematic analysis, depending on study designs. Two reviewers will appraise the certainty of evidence for all outcomes using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and come to consensus. DISCUSSION The publication of guidance on screening in primary care for the prevention and early detection of cervical cancer by the Task Force in 2013 focused on cytology. Since 2013, new studies using human papillomavirus tests for cervical screening have been published that will improve our understanding of screening in primary care settings. This review will inform updated recommendations based on currently available studies and address key evidence gaps noted in our previous review.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Jennifer Pillay
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Donna Reynolds
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rob Stirling
- Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada, Ottawa, Canada
| | - Gregory Traversy
- Centre for Chronic Disease Prevention and Health Equity, Public Health Agency of Canada, Ottawa, Canada
| | | | - Ainsley Moore
- Family Medicine, McMaster University, Hamilton, Canada
| | | | - Brett D. Thombs
- Faculty of Medicine, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Dirk van Niekerk
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada
| | - Diana Keto-Lambert
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9 Canada
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25
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Crosbie PA, Gabe R, Simmonds I, Kennedy M, Rogerson S, Ahmed N, Baldwin DR, Booton R, Cochrane A, Darby M, Franks K, Hinde S, Janes SM, Macleod U, Messenger M, Moller H, Murray RL, Neal RD, Quaife SL, Sculpher M, Tharmanathan P, Torgerson D, Callister ME. Yorkshire Lung Screening Trial (YLST): protocol for a randomised controlled trial to evaluate invitation to community-based low-dose CT screening for lung cancer versus usual care in a targeted population at risk. BMJ Open 2020; 10:e037075. [PMID: 32912947 PMCID: PMC7485242 DOI: 10.1136/bmjopen-2020-037075] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/24/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Lung cancer is the world's leading cause of cancer death. Low-dose computed tomography (LDCT) screening reduced lung cancer mortality by 20% in the US National Lung Screening Trial. Here, we present the Yorkshire Lung Screening Trial (YLST), which will address key questions of relevance for screening implementation. METHODS AND ANALYSIS Using a single-consent Zelen's design, ever-smokers aged 55-80 years registered with a general practice in Leeds will be randomised (1:1) to invitation to a telephone-based risk-assessment for a Lung Health Check or to usual care. The anticipated number randomised by household is 62 980 individuals. Responders at high risk will be invited for LDCT scanning for lung cancer on a mobile van in the community. There will be two rounds of screening at an interval of 2 years. Primary objectives are (1) measure participation rates, (2) compare the performance of PLCOM2012 (threshold ≥1.51%), Liverpool Lung Project (V.2) (threshold ≥5%) and US Preventive Services Task Force eligibility criteria for screening population selection and (3) assess lung cancer outcomes in the intervention and usual care arms. Secondary evaluations include health economics, quality of life, smoking rates according to intervention arm, screening programme performance with ancillary biomarker and smoking cessation studies. ETHICS AND DISSEMINATION The study has been approved by the Greater Manchester West research ethics committee (18-NW-0012) and the Health Research Authority following review by the Confidentiality Advisory Group. The results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and on the YLST website. TRIAL REGISTRATION NUMBERS ISRCTN42704678 and NCT03750110.
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Affiliation(s)
- Philip Aj Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Irene Simmonds
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Martyn Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nazia Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David R Baldwin
- Department of Respiratory Medicine, City Campus, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Heart and Lung Division, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Michael Darby
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin Franks
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sam M Janes
- Department of Respiratory Medicine, University College London, London, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Mike Messenger
- Leeds Centre for Personalised Medicine and Health, University of Leeds, Leeds, UK
| | - Henrik Moller
- Thames Cancer Registry, Kings College London, London, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Samantha L Quaife
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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26
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Raginel T, Grandazzi G, Launoy G, Trocmé M, Christophe V, Berchi C, Guittet L. Social inequalities in cervical cancer screening: a discrete choice experiment among French general practitioners and gynaecologists. BMC Health Serv Res 2020; 20:693. [PMID: 32718319 PMCID: PMC7385880 DOI: 10.1186/s12913-020-05479-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/28/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Cervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners' (GPs) and gynaecologists' preferences for actions designed to reduce screening inequalities. METHODS French physicians' preferences to UCC screening modalities was assessed using a discrete choice experiment. A national cross-sectional questionnaire was sent between September and October 2014 to 500 randomly selected physicians, and numerically to all targeted physicians working in the French region Midi-Pyrénées. Practitioners were offered 11 binary choices of organized screening scenarios in order to reduce inequalities in UCC screening participation. Each scenario was based on five attributes corresponding to five ways to enhance participation in UCC screening while reducing screening inequalities. RESULTS Among the 123 respondents included, practitioners voted for additional interventions targeting non-screened women overall (p < 0.05), including centralized invitations sent from a central authority and involving the mentioned attending physician, or providing attending physicians with the lists of unscreened women among their patients. However, they rejected the specific targeting of women over 50 years old (p < 0.01) or living in deprived areas (p < 0.05). Only GPs were in favour of allowing nurses to perform Pap smears, but both GPs and gynaecologists rejected self-collected oncogenic papillomavirus testing. CONCLUSIONS French practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.
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Affiliation(s)
- Thibaut Raginel
- NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- NORMANDIE UNIV, UNICAEN, UFR Sante, Department of General Practice, 14000 Caen, France
| | | | - Guy Launoy
- NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
| | - Mélanie Trocmé
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Véronique Christophe
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Célia Berchi
- NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
| | - Lydia Guittet
- NORMANDIE UNIV, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Caen University Hospital, Département d’Information Médicale, Avenue de la Côte de Nacre, 14033 Caen, France
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Ryan M, Marlow L, Forster A, Ruwende J, Waller J. Offering an app to book cervical screening appointments: A service evaluation. J Med Screen 2020; 27:85-89. [PMID: 31500520 PMCID: PMC7222961 DOI: 10.1177/0969141319871312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the feasibility of offering women who are overdue for cervical screening the use of a smartphone app to book their appointment. METHODS Women who were at least six months overdue for cervical screening in three general practice surgeries in a deprived East London borough were identified from practice records. Staff sent batches of text messages informing women that they were overdue for screening, and inviting them to download an app to book their appointment. RESULTS Across the three practices, 2632 eligible women were identified. Valid mobile phone numbers were available for 1465 women. One woman had opted out of receiving text messages, so messages were sent to 1464 women. Of these, 158 (11%) booked a screening appointment within five months. The majority of these women booked without using the app (72%; 113/158); just over a quarter booked via the app (28%; 45/158). CONCLUSIONS Just over 10% of cervical screening non-attenders booked an appointment in response to a text message with a link to a downloadable app; however, only one in four of these women booked using the app. This suggests that the text message reminder was likely to have been the key 'active ingredient' for most women, rather than the app itself. Future research could explore the optimal message for a text reminder in this context and evaluate the inclusion of a link to existing online booking systems.
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Affiliation(s)
- Mairead Ryan
- Department of Behavioural Science and Health, UCL, London, UK
| | - Laura Marlow
- Department of Behavioural Science and Health, UCL, London, UK
| | - Alice Forster
- Department of Behavioural Science and Health, UCL, London, UK
| | | | - Jo Waller
- Department of Behavioural Science and Health, UCL, London, UK
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28
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Lott BE, Trejo MJ, Baum C, McClelland DJ, Adsul P, Madhivanan P, Carvajal S, Ernst K, Ehiri J. Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC Public Health 2020; 20:654. [PMID: 32393218 PMCID: PMC7216595 DOI: 10.1186/s12889-020-08777-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work. METHODS A systematic search of literature was conducted in PubMed, Web of Science, Embase, and CINAHL databases through May 2019. Screening and data charting were performed by two independent reviewers. Intervention studies measuring changes to uptake in screening among women in SSA were included, with no restriction to intervention type, study setting or date, or participant characteristics. Intervention type and implementation strategies were described using behavioral constructs from the IBM. RESULTS Of the 3704 citations the search produced, 19 studies were selected for inclusion. Most studies were published between 2014 and 2019 (78.9%) and were set in Nigeria (47.4%) and South Africa (26.3%). Studies most often assessed screening with Pap smears (31.6%) and measured uptake as ever screened (42.1%) or screened during the study period (36.8%). Education-based interventions were most common (57.9%) and the IBM construct of knowledge/skills to perform screening was targeted most frequently (68.4%). Willingness to screen was high, before and after intervention. Screening coverage ranged from 1.7 to 99.2% post-intervention, with six studies (31.6%) reporting a significant improvement in screening that achieved ≥60% coverage. CONCLUSIONS Educational interventions were largely ineffective, except those that utilized peer or community health educators and mHealth implementation strategies. Two economic incentivization interventions were moderately effective, by acting on participants' instrumental attitudes, but resulted in screening coverage less than 20%. Innovative service delivery, including community-based self-sampling, acted on environmental constraints, striving to make services more available, accessible, and appropriate to women, and were the most effective. This review demonstrates that intent to perform screening may not be the major determinant of screening behavior, suggesting other theoretical frameworks may be needed to more fully understand uptake of cervical screening in sub-Saharan Africa, particularly for health systems change interventions.
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Affiliation(s)
- Breanne E Lott
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
| | - Mario J Trejo
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Christina Baum
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - D Jean McClelland
- Health Sciences Library, University of Arizona, 1501 N Campbell Ave Ward 6, Tucson, AZ, 85724, USA
| | - Prajakta Adsul
- School of Medicine and Cancer Center, University of New Mexico, MSC08 4720, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Purnima Madhivanan
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.,College of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.,Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore, 560021, India
| | - Scott Carvajal
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Kacey Ernst
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - John Ehiri
- Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
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Ampofo AG, Adumatta AD, Owusu E, Awuviry-Newton K. A cross-sectional study of barriers to cervical cancer screening uptake in Ghana: An application of the health belief model. PLoS One 2020; 15:e0231459. [PMID: 32352983 PMCID: PMC7192489 DOI: 10.1371/journal.pone.0231459] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/24/2020] [Indexed: 02/02/2023] Open
Abstract
Background The high incidence (32.9, age-standardized per 100,000) and mortality (23.0, age-standardized per 100,000) of cervical cancer (CC) in Ghana have been largely attributed to low screening uptake (0.8%). Although the low cost (Visual inspection with acetic acid) screening services available at various local health facilities screening uptake is meager. Objective The purpose of the study is to determine the barriers influencing CC screening among women in the Ashanti Region of Ghana using the health belief model. Methods A analytical cross-sectional study design was conducted between January and March 2019 at Kenyase, the Ashanti Region of Ghana. The study employed self-administered questionnaires were used to collect data from 200 women. Descriptive statistics were used to examine the differences in interest and non-interest in participating in CC screening on barriers affecting CC screening. Multivariable logistic regression was used to determine factors affecting CC screening at a significance level of p<0.05. Results Unemployed women were less likely to have an interest in CC screening than those who were employed (adjustes odds ratio (aOR) = 0.005, 95%CI:0.001–0.041, p = 0.005). Women who were highly educated were 122 times very likely to be interested in CC screening than those with no or low formal education (aOR = 121.915 95%CI: 14.096–1054.469, p<0.001) and those who were unmarried were less likely to be interested in CC screening than those with those who were married (aOR = 0.124, 95%CI: 0.024–0.647, p = 0.013). Also, perceived threat, perceived benefits, perceived barriers and cues for action showed significant differences with interest in participating in screening with a P-values <0.003. The association was different for long waiting time, prioritizing early morning and late evening screening which showed no significant difference (P-value > 0.003). Conclusions Married women, unemployed and those with no formal education are less likely to participate in CC screening. The study details significant barriers to cervical cancer screening uptake in Ghana. It is recommended that the Ghana health services should develop appropriate, culturally tailored educational materials to inform individuals with no formal education through health campaigns in schools, churches and communities to enhance CC screening uptake.
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Affiliation(s)
- Ama G. Ampofo
- Department of Nursing, Garden City University College, Kumasi, Ghana
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- * E-mail:
| | - Afia D. Adumatta
- Department of Nursing, Garden City University College, Kumasi, Ghana
| | - Esther Owusu
- Department of Nursing, Garden City University College, Kumasi, Ghana
| | - Kofi Awuviry-Newton
- Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Bunten A, Porter L, Gold N, Bogle V. A systematic review of factors influencing NHS health check uptake: invitation methods, patient characteristics, and the impact of interventions. BMC Public Health 2020; 20:93. [PMID: 31964366 PMCID: PMC6975079 DOI: 10.1186/s12889-019-7889-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background The NHS Health Check (NHSHC) is a risk assessment for those aged 40–74 without a pre-existing condition in England, with the aim of preventing stroke, kidney disease, heart disease, type 2 diabetes and dementia. Uptake has been lower than anticipated. Ensuring that a high percentage of eligible patients receive a NHSHC is key to optimising the clinical and cost effectiveness of the programme. The aim of this systematic review is to highlight interventions and invitation methods that increase the uptake of NHSHCs, and to identify whether the effectiveness of these interact with broader patient and contextual factors. Method A systematic review was conducted according to the PRISMA checklist. Papers were eligible if they explored the impact of at least one of (i) interventions, (ii) invitation methods or (iii) broader factors on NHSHC uptake. Ten databases were searched in January 2016 and seven were searched in March 2018. Nine-hundred-and-forty-five papers were identified, 238 were screened and 64 full texts were assessed for eligibility. Nine studies were included in the review. Results The nine studies were all from peer reviewed journals. They included two randomised controlled trials, one observational cohort and six cross-sectional studies. Different invitation methods may be more effective for different groups of patients based on their ethnicity and gender. One intervention to enhance invitation letters effectively increased uptake but another did not. In addition, individual patient characteristics (such as age, gender, ethnicity and risk level) were found to influence uptake. This review also finds that uptake varies significantly by GP practice, which could be due either to unidentified practice-level factors or deprivation. Conclusions Further research is needed to assess the effectiveness of different invitation methods for different population groups. Research should examine how existing invitation methods can be enhanced to drive uptake whilst reducing health inequalities. Trial registration This systematic review was registered with PROSPERO on 22.02.2016. Registration number CRD42016035626.
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Affiliation(s)
- Amanda Bunten
- Public Health England, PHE Behavioural Insights Team (PHEBI), Research, Translation & Innovation Division, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.
| | - Lucy Porter
- Public Health England, PHE Behavioural Insights Team (PHEBI), Research, Translation & Innovation Division, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.,University of Exeter, Exeter, UK
| | - Natalie Gold
- Public Health England, PHE Behavioural Insights Team (PHEBI), Research, Translation & Innovation Division, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
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Spees LP, Des Marais AC, Wheeler SB, Hudgens MG, Doughty S, Brewer NT, Smith JS. Impact of human papillomavirus (HPV) self-collection on subsequent cervical cancer screening completion among under-screened US women: MyBodyMyTest-3 protocol for a randomized controlled trial. Trials 2019; 20:788. [PMID: 31881928 PMCID: PMC6935089 DOI: 10.1186/s13063-019-3959-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/04/2019] [Indexed: 12/29/2022] Open
Abstract
Background Screening substantially reduces cervical cancer incidence and mortality. More than half of invasive cervical cancers are attributable to infrequent screening or not screening at all. The current study, My Body My Test (MBMT), evaluates the impact of mailed kits for self-collection of samples for human papillomavirus (HPV) testing on completion of cervical cancer screening in low-income, North Carolina women overdue for cervical cancer screening. Methods/design The study will enroll at least 510 US women aged 25–64 years who report no Pap test in the last 4 years and no HPV test in the last 6 years. We will randomize participants to an intervention or control arm. The intervention arm will receive kits to self-collect a sample at home and mail it for HPV testing. In both the intervention and control arms, participants will receive assistance in scheduling an appointment for screening in clinic. Study staff will deliver HPV self-collection results by phone and assist in scheduling participants for screening in clinic. The primary outcome is completion of cervical cancer screening. Specifically, completion of screening will be defined as screening in clinic or receipt of negative HPV self-collection results. Women with HPV-negative self-collection results will be considered screening-complete. All other participants will be considered screening-complete if they obtain co-testing or Pap test screening at a study-affiliated institution or other clinic. We will assess whether the self-collection intervention influences participants’ perceived risk of cervical cancer and whether perceived risk mediates the relationship between HPV self-collection results and subsequent screening in clinic. We also will estimate the incremental cost per woman screened of offering at-home HPV self-collection kits with scheduling assistance as compared to offering scheduling assistance alone. Discussion If mailed self-collection of samples for HPV testing is an effective strategy for increasing cervical cancer screening among women overdue for screening, this method has the potential to reduce cervical cancer incidence and mortality in medically underserved women at higher risk of developing cervical cancer. Trial registration ClinicalTrials.gov NCT02651883, Registered on 11 January 2016.
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Affiliation(s)
- Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1102-G McGavran-Greenberg, CB7411, Chapel Hill, NC, 27599-7411, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Andrea C Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 2103 McGavran-Greenberg, CB7435, Chapel Hill, NC, 27599-7435, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1102-G McGavran-Greenberg, CB7411, Chapel Hill, NC, 27599-7411, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah Doughty
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 2103 McGavran-Greenberg, CB7435, Chapel Hill, NC, 27599-7435, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer S Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA. .,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 2103 McGavran-Greenberg, CB7435, Chapel Hill, NC, 27599-7435, USA.
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Shokar NK, Calderon-Mora J, Molokwu J, Byrd T, Alomari A, Mallawaarachchi I, Dwivedi A. Outcomes of a Multicomponent Culturally Tailored Cervical Cancer Screening Intervention Among Underserved Hispanic Women (De Casa en Casa). Health Promot Pract 2019; 22:112-121. [DOI: 10.1177/1524839919893309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hispanic women have almost double the cervical cancer incidence and are twice as likely to die from cervical cancer compared with non-Hispanic White women. Cervical cancer is preventable with screening, and based on available data, multiple component screening interventions have been proposed as a strategy to maximize screening, but such studies are lacking. We sought to test the effectiveness of a multicomponent screening intervention for primary prevention and early detection of cervical cancer among underserved Hispanic women. We conducted a prospective community-based cervical cancer screening intervention utilizing a quasi-experimental design. The intervention was theory based, delivered by bilingual community health workers, combined education and reduction of noneconomic barriers, and addressed economic barriers. Components included outreach, education, provision of no-cost Papanicolaou and human papillomavirus screening, on-site diagnostic and treatment colposcopy, and patient navigation with tracking to facilitate screening, diagnosis, and treatment. The main outcome was self-reported screening. We recruited 300 intervention group and 299 control group participants. Mean age of the sample was 44.7 years. The majority were Hispanic (98%), born in Mexico (79%), and had a Spanish-language preference (86%). In intention-to-treat analyses, the intervention group had a relative risk of screening of 14.58 (95% confidence interval = 8.57-24.80, p < .001) compared with the control group. A multilevel, multiple component culturally tailored bilingual cervical cancer screening intervention combining education, navigation, and no-cost screening can significantly increase cervical cancer screening uptake in a high-risk, underscreened population and has the potential to affect cervical cancer health disparities.
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Affiliation(s)
| | | | | | - Theresa Byrd
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Adam Alomari
- Texas Tech University Health Sciences Center, El Paso, TX, USA
| | | | - Alok Dwivedi
- Texas Tech University Health Sciences Center, El Paso, TX, USA
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Paulauskiene J, Ivanauskiene R, Skrodeniene E, Petkeviciene J. Organised Versus Opportunistic Cervical Cancer Screening in Urban and Rural Regions of Lithuania. ACTA ACUST UNITED AC 2019; 55:medicina55090570. [PMID: 31500116 PMCID: PMC6780374 DOI: 10.3390/medicina55090570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 01/12/2023]
Abstract
Background and Objectives: In 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. However, screening is more opportunistic than population-wide and the programme’s coverage is insufficient. The aim of this study was to assess the effect of systematic personal invitation on coverage of cervical cancer (CC) screening in urban and rural regions of Lithuania. Materials and Methods: The study was conducted in an urban primary healthcare centre (PHCC) and in a rural PHCC, where prevailing CC screening practice was highly opportunistic. Over the first year, all women aged 25–60 who had not received a Pap smear test within the last three years in urban (n = 1591) and rural (n = 1843) PHCCs received a personal invitation letter to participate in the screening. Over the second year, the reminder letter was sent to the non-attendees (n = 1042 in urban and n = 929 in rural PHCCs). A random sample of women (n = 93), who did not attend for screening after two letters, was contacted by phone in order to identify the barriers of non-attendance. Results: Before the study, only 9.6% of the target population in urban and 14.7% in rural PHCCs participated in CC screening. After the first invitation letter, the participation in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p < 0.001). After the reminder letter, the attendance was 16.4% in urban and 22.2% in rural PHCCs (p < 0.001). The most common barriers for the non-attendance were lack of time, long waiting time for family doctor’s appointment, worries that a Pap test might be unpleasant and preventive gynaecological examination outside of the screening program. Conclusions: A systematic personal invitation with one reminder letter significantly increased the coverage of CC screening and was more effective in rural regions than in urban regions. The assessed barriers for non-attendance can be used to improve the coverage of screening.
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Affiliation(s)
- Justina Paulauskiene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT 47181 Kaunas, Lithuania.
| | - Rugile Ivanauskiene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT 47181 Kaunas, Lithuania.
| | - Erika Skrodeniene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, LT 44307 Kaunas, Lithuania.
| | - Janina Petkeviciene
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT 47181 Kaunas, Lithuania
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Sallis A, Sherlock J, Bonus A, Saei A, Gold N, Vlaev I, Chadborn T. Pre-notification and reminder SMS text messages with behaviourally informed invitation letters to improve uptake of NHS Health Checks: a factorial randomised controlled trial. BMC Public Health 2019; 19:1162. [PMID: 31438908 PMCID: PMC6706889 DOI: 10.1186/s12889-019-7476-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake. METHODS We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMS - yes or no) × 4 (letter - national template control, open-ended, time-limited, social norm) × 2 (reminder SMS - yes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC. RESULTS Data for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder (Uptake 30%; Adjusted Odds Ratio AOR 1.86; 95% CI 1.45-2.83; p < 0.00); 10 percentage points for the open-ended letter with reminder (Uptake 27%; AOR 1.68; 95% CI 1.31-2.17; p < 0.00) and a 9 percentage point increase using the time-limited letter with reminder (Uptake 27%; AOR 1.61; 95% CI 1.25-2.10; p < 0.00). The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect. CONCLUSIONS This large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance. TRIAL REGISTRATION Retrospectively Registered (24/01/2014) ISRCTN36027094 .
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Affiliation(s)
- Anna Sallis
- PHE Behavioural Insights, Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG UK
| | - Joseph Sherlock
- Center for Advanced Hindsight, Social Science Research Institute, Duke University, 334 Blackwell Street, Suite 320, Durham, North Carolina 27701 USA
- HMRC, 100 Parliament Street, London, SW1A 2BQ England
| | | | - Ayoub Saei
- PHE Statistics, Modelling and Economics Department, Public Health England, Colindale Avenue Site, 61 Colindale Avenue, London, NW9 5EQ UK
| | - Natalie Gold
- PHE Behavioural Insights, Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG UK
- Faculty of Philosophy, Radcliffe Observatory Quarter 555, Woodstock Road, Oxford, OX2 6GG England
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, CV4 7AL UK
| | - Tim Chadborn
- PHE Behavioural Insights, Public Health England, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG UK
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Ryan M, Waller J, Marlow LA. Could changing invitation and booking processes help women translate their cervical screening intentions into action? A population-based survey of women's preferences in Great Britain. BMJ Open 2019; 9:e028134. [PMID: 31300499 PMCID: PMC6629419 DOI: 10.1136/bmjopen-2018-028134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/28/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Many women who do not attend screening intend to go, but do not get around to booking an appointment. Qualitative work suggests that these 'intenders' face more practical barriers to screening than women who are up-to-date ('maintainers'). This study explored practical barriers to booking a screening appointment and preferences for alternative invitation and booking methods that might overcome these barriers. DESIGN A cross-sectional survey was employed. SETTING Great Britain. PARTICIPANTS Women aged 25-64, living in Great Britain who intended to be screened but were overdue ('intenders', n=255) and women who were up-to-date with screening ('maintainers', n=359). RESULTS 'Intenders' reported slightly more barriers than 'maintainers' overall (mean=1.36 vs 1.06, t=3.03, p<0.01) and were more likely to think they might forget to book an appointment (OR=2.87, 95% CI: 2.01 to 4.09). Over half of women said they would book on a website using a smartphone (62%), a computer (58%) or via an app (52%). Older women and women from lower social grades were less likely to say they would use online booking methods (all ps <0.05). Women who reported two or more barriers were more likely to say they would use online booking than women who reported none (ps <0.01). CONCLUSIONS Women who are overdue for screening face practical barriers to booking appointments. Future interventions may assess the efficacy of changing the architecture of the invitation and booking system. This may help women overcome logistical barriers to participation and increase coverage for cervical screening.
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Affiliation(s)
- Mairead Ryan
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Laura Av Marlow
- Department of Behavioural Science and Health, University College London, London, UK
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How does information on the harms and benefits of cervical cancer screening alter the intention to be screened?: a randomized survey of Norwegian women. Eur J Cancer Prev 2019; 28:87-95. [PMID: 29595751 DOI: 10.1097/cej.0000000000000436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cervical cancer (CC) is the 13th most frequent cancer among women in Norway, but the third most common among women aged 25-49 years. The national screening program sends information letters to promote screening participation. We aimed to evaluate how women's stated intention to participate in screening and pursue treatment changed with the provision of additional information on harms associated with screening, and to assess women's preferences on the timing and source of such information. We administered a web-based questionnaire to a panel of Norwegian women aged 25-69 years and randomized into three groups on the basis of when in the screening process additional information was introduced: (i) invited for routine screening, (ii) recommended an additional test following detection of cellular abnormalities, and (iii) recommended precancer treatment. A fourth (control) group did not receive any additional information. Results show that among 1060 respondents, additional information did not significantly alter women's stated intentions to screen. However, it created decision uncertainty on when treatment was recommended (8.76-9.09 vs. 9.40; 10-point Likert scale; P=0.004). Over 80% of women favored receiving information on harms and 59% preferred that information come from a qualified public health authority. Nearly 90% of women in all groups overestimated women's lifetime risk of CC. In conclusion, additional information on harms did not alter Norwegian women's stated intention to screen for CC; yet, it resulted in greater decision uncertainty to undergo precancer treatment. Incorporating information on harms into invitation letters is warranted as it would increase women's ability to make informed choices.
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Rippinger N, Heinzler J, Bruckner T, Brucker J, Dinkic C, Hoffmann J, Dornhöfer N, Seitz S, Rom J, Sohn C, Schott TC, Schott S. The impact of a cervical dysplasia diagnosis on individual cancer prevention habits over time: a bicentric case-control study. Arch Gynecol Obstet 2019; 299:847-855. [PMID: 30607592 DOI: 10.1007/s00404-018-5029-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/14/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women's adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event. METHODS Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1. RESULTS 132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 - 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1-S1/T2-S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study. CONCLUSION This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.
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Affiliation(s)
- N Rippinger
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Heinzler
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany
| | - J Brucker
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Dinkic
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Hoffmann
- Department of Gynaecology and Obstetrics, Leipzig University Hospital, Leipzig, Germany
| | - N Dornhöfer
- Department of Gynaecology and Obstetrics, Leipzig University Hospital, Leipzig, Germany
| | - S Seitz
- Department of Gynaecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - J Rom
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Sohn
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - T C Schott
- Department of Orthodontics and Orofacial Orthopedics, University Hospital Tubingen, Tubingen, Germany
| | - Sarah Schott
- Department of Gynaecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. .,German Cancer Consortium (DKTK), Heidelberg and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
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Kaneko N. Factors associated with cervical cancer screening among young unmarried Japanese women: results from an internet-based survey. BMC Womens Health 2018; 18:132. [PMID: 30064505 PMCID: PMC6069882 DOI: 10.1186/s12905-018-0623-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 07/20/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The prevalence of cervical cancer among women aged 20-30 years has been increasing. A better understanding of the factors correlated with cervical cancer screening is vital to better identify suitable candidates and develop effective interventions. However, few studies have examined factors correlated with cervical cancer screening using a quantitative research design. Thus, this study aimed to assess the prevalence of and factors correlated with cervical cancer screening among unmarried and sexually active Japanese women aged 20-29 years. METHODS Seven hundred Japanese women who responded to an internet-based cross-sectional survey conducted by a marketing research company in 2015 were enrolled. Associations between lifetime cervical cancer screening and demographic profile, sexual behavior, and psychosocial factors were assessed via univariate analysis. Variables indicating significance (P < 0.05) were used in the univariate analysis to determine adjusted odds ratios (AOR). RESULTS Overall, 383 (54.7%) respondents underwent cervical cancer screening during their lifetime. Multiple regression analysis indicated that age, employment status, income, lifetime number of sex partners, human papillomavirus (HPV) vaccination, receipt of a free coupon for cervical cancer screening from the local government, perceived susceptibility and logistical barriers (cost/time), and confidence of receiving Pap testing from a male physician were significantly correlated with lifetime cervical cancer screening. Individuals aged 28-29 years (AOR = 1.86) and those with full-time employment (AOR = 3.30), income ≥ ¥ 4,000,000($35,000) (AOR = 1.60), > 5 lifetime sex partners (AOR = 1.97), HPV vaccination (AOR = 4.88), coupon from the local government (AOR = 3.14), higher perceived level of cervical cancer susceptibility (middle, AOR = 1.77; high, AOR = 3.23), lower perceived logistical barriers (middle, AOR = 0.55; high, AOR = 0.31), and higher confidence of receiving pap testing from a male physician (AOR = 2.66) were more likely to undergo cervical cancer screening. CONCLUSIONS Women who were younger and unemployed and those with lower perceived cervical cancer susceptibility, higher perceived logistical barriers, and lower confidence of receiving Pap testing from a male physician were less likely to undergo lifetime cervical cancer screening. Thus, to increase the cervical cancer screening rate among young women, it may be effective to target younger unemployed women, provide interventions to increase perceived susceptibility, and recommend tests while considering psychosocial barriers.
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Affiliation(s)
- Noriyo Kaneko
- Department of Global and Community Health, School of Nursing, Kawasumi 1, Aza, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.
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Maia MN, Silva RPDOD, Santos LPRD. A organização do rastreamento do câncer do colo uterino por uma equipe de Saúde da Família no Rio de Janeiro, Brasil. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2018. [DOI: 10.5712/rbmfc13(40)1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: O rastreamento organizado do câncer do colo do útero ainda é um desafio a ser vencido em todo o Brasil. Objetivo: Descrever a intervenção de uma equipe de Saúde da Família para a melhoria da qualidade das ações de rastreamento desta condição. Métodos: A intervenção foi estruturada a partir das recomendações nacionais para o rastreamento do câncer do colo do útero e das evidências disponíveis na literatura para aumento da participação popular em programas de rastreamento. Funcionalidades do sistema de prontuário eletrônico local foram fundamentais para a viabilização da proposta. A partir da reorientação de práticas assistenciais e administrativas, foi estabelecido e mantido por 15 meses um programa organizado de rastreamento do câncer do colo do útero nesta equipe de Saúde da Família. Resultados: No mês anterior ao início da intervenção, as equipes da unidade de saúde e da área programática apresentavam uma cobertura média de 10% da população alvo rastreada. Ao final de 15 meses, a equipe-intervenção atingiu uma cobertura de 44%, em contraste com a média de 22% das demais equipes da unidade, e 25% da área programática. Conclusões: Quando uma equipe de Saúde da Família empreende esforços para a organização do rastreamento do câncer do colo do útero, bons resultados podem ser alcançados no aumento da cobertura populacional. Esperamos que outras equipes possam se beneficiar da divulgação desta experiência e tomem para si a responsabilidade de organizar o rastreamento do câncer do colo do útero, impactando positivamente sobre a saúde de suas comunidades.
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Marlow LAV, Ferrer RA, Chorley AJ, Haddrell JB, Waller J. Variation in health beliefs across different types of cervical screening non-participants. Prev Med 2018; 111:204-209. [PMID: 29550302 PMCID: PMC5945192 DOI: 10.1016/j.ypmed.2018.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/24/2022]
Abstract
Understanding factors associated with different types of cancer screening non-participation will help with the development of more targeted approaches for improving informed uptake. This study explored patterns of general health beliefs and behaviour, and cancer-specific beliefs across different types of cervical screening non-participants using the Precaution Adoption Process Model (PAPM). A population-representative sample of women in Britain completed a home-based survey in 2016. Women classified as non-participants (n = 839) completed additional questions about health beliefs. Some general health beliefs and behaviours, as well as cancer-specific beliefs, were associated with particular types of non-participation. For example, those who scored higher on fatalism were more likely to be unaware of screening (OR = 1.74, 95%CI: 1.45-2.08) or unengaged with screening (OR = 1.57, CI: 1.11-2.21). Women with greater deliberative risk perceptions were less likely to be unengaged with screening (OR = 0.74 CI: 02.55-0.99) and less likely to have decided against screening (OR = 0.71, CI: 0.59-0.86). Women who had seen a general practitioner in the last 12 months were less likely to be unaware (OR = 0.49, CI: 0.35-0.69), and those reporting cancer information avoidance were more likely to be unengaged with screening (OR = 2.25, CI: 1.15-4.39). Not wanting to know whether one has cancer was the only factor associated with all types of non-participation. Interventions to raise awareness of screening should include messages that address fatalistic and negative beliefs about cancer. Interventions for women who have decided not to be screened could usefully include messages to ensure the risk of cervical cancer and the relevance and benefits of screening are well communicated.
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Affiliation(s)
- Laura A V Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, United Kingdom.
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, United States
| | - Amanda J Chorley
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, United Kingdom
| | - Jessica B Haddrell
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, United Kingdom
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, United Kingdom
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Gupta S, Palmer C, Bik EM, Cardenas JP, Nuñez H, Kraal L, Bird SW, Bowers J, Smith A, Walton NA, Goddard AD, Almonacid DE, Zneimer S, Richman J, Apte ZS. Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs. Front Public Health 2018; 6:77. [PMID: 29686981 PMCID: PMC5900042 DOI: 10.3389/fpubh.2018.00077] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/01/2018] [Indexed: 12/23/2022] Open
Abstract
In most industrialized countries, screening programs for cervical cancer have shifted from cytology (Pap smear or ThinPrep) alone on clinician-obtained samples to the addition of screening for human papillomavirus (HPV), its main causative agent. For HPV testing, self-sampling instead of clinician-sampling has proven to be equally accurate, in particular for assays that use nucleic acid amplification techniques. In addition, HPV testing of self-collected samples in combination with a follow-up Pap smear in case of a positive result is more effective in detecting precancerous lesions than a Pap smear alone. Self-sampling for HPV testing has already been adopted by some countries, while others have started trials to evaluate its incorporation into national cervical cancer screening programs. Self-sampling may result in more individuals willing to participate in cervical cancer screening, because it removes many of the barriers that prevent women, especially those in low socioeconomic and minority populations, from participating in regular screening programs. Several studies have shown that the majority of women who have been underscreened but who tested HPV-positive in a self-obtained sample will visit a clinic for follow-up diagnosis and management. In addition, a self-collected sample can also be used for vaginal microbiome analysis, which can provide additional information about HPV infection persistence as well as vaginal health in general.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zachary S Apte
- uBiome, San Francisco, CA, United States.,University of California San Francisco, San Francisco, CA, United States
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Ebu NI, Ogah JK. Predictors of cervical cancer screening intention of HIV-positive women in the central region of Ghana. BMC WOMENS HEALTH 2018; 18:43. [PMID: 29482523 PMCID: PMC5828486 DOI: 10.1186/s12905-018-0534-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/15/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cervical cancer affects women, especially those with HIV-positive status. This study hypothesised that more HIV-positive women with high cues about cervical cancer screening, high perceived susceptibility to cervical cancer, high perceived seriousness of cervical cancer, high perceived benefits of cervical cancer screening, and low perceived barriers about cervical cancer screening have intention to seek cervical cancer screening than HIV-positive women with low cues, low perceived susceptibility, low perceived seriousness, low perceived benefits, and high perceived barriers. METHODS A descriptive cross-sectional study was conducted with 660 HIV-positive women aged 20 to 65 years using an interviewer administered questionnaire. Data were summarised using frequencies, percentages and binary logistic regression analysis. RESULTS The findings showed that 82% (n = 540) of the respondents had intention to seek cervical cancer screening. The determinants of cervical cancer screening intention by HIV-positive women were cues, perceived seriousness and perceived benefits. Specifically, HIV-positive women with high cues were 3.48 times more likely to have intention to screen than those with low cues (95% CI, 1.43-8.49). Those with high perceived seriousness were 2.02 times more likely to have intention to screen than those with low perceived seriousness (95% CI, 1.24-3.30). Similarly, those with high perceived benefits were 1.7 times more likely to have intention to screen than those with low perceived benefits (95% CI, 1.05-2.71). However, perceived susceptibility (p = 0.063, OR 2.57, [95% CI, 0.95-6.93]) and perceived barriers (p = 0.969, OR = 1.01, [95% CI, 0.54-1.88]) were not statistically significant predictors of intention to seek cervical cancer screening in the sample studied. CONCLUSIONS Cervical cancer screening interventions for HIV-positive women need to have a strong focus on explaining the seriousness of the disease, benefits of screening, and increase cues about screening, as these factors could improve attitude towards cervical cancer screening and promote the health of high risk women.
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Affiliation(s)
- Nancy Innocentia Ebu
- Department of Public Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
| | - Joseph Kwesi Ogah
- Department of Health, Physical Education and Recreation, Faculty of Science and Technology Education, University of Cape Coast, Cape Coast, Ghana
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Ravikumar KE, MacLaughlin KL, Scheitel MR, Kessler M, Wagholikar KB, Liu H, Chaudhry R. Improving the Accuracy of a Clinical Decision Support System for Cervical Cancer Screening and Surveillance. Appl Clin Inform 2018; 9:62-71. [PMID: 29365341 PMCID: PMC5801884 DOI: 10.1055/s-0037-1617451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background
Clinical decision support systems (CDSS) for cervical cancer prevention are generally limited to identifying patients who are overdue for their next routine/next screening, and they do not provide recommendations for follow-up of abnormal results. We previously developed a CDSS to automatically provide follow-up recommendations based on the American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines for women with both previously normal and abnormal test results leveraging information available in the electronic medical record (EMR).
Objective
Enhance the CDSS by improving its accuracy and incorporating changes to reflect the latest revision of the guidelines.
Methods
After making enhancements to the CDSS, we evaluated the performance of the clinical recommendations on 393 patients selected through stratified sampling from a set of 3,704 patients in a nonclinical setting. We performed chart review of individual patient's record to evaluate the performance of the system. An expert clinician assisted by a resident manually reviewed the recommendation made by the system and verified whether the recommendations were as per the ASCCP guidelines.
Results
The recommendation accuracy of the enhanced CDSS improved to 93%, which is a substantial improvement over the 84% reported previously. A detailed analysis of errors is presented in this article. We fixed the errors identified in this evaluation that were amenable to correction to further improve the accuracy of the system. The source code of the updated CDSS is available at
https://github.com/ohnlp/MayoNlpPapCdss
.
Conclusion
We made substantial enhancements to our earlier prototype CDSS with the updated ASCCP guidelines and performed a thorough evaluation in a nonclinical setting to improve the accuracy of the CDSS. The CDSS will be further refined as it is utilized in the practice.
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Lawrenson JG, Graham‐Rowe E, Lorencatto F, Burr J, Bunce C, Francis JJ, Aluko P, Rice S, Vale L, Peto T, Presseau J, Ivers N, Grimshaw JM. Interventions to increase attendance for diabetic retinopathy screening. Cochrane Database Syst Rev 2018; 1:CD012054. [PMID: 29333660 PMCID: PMC6491139 DOI: 10.1002/14651858.cd012054.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite evidence supporting the effectiveness of diabetic retinopathy screening (DRS) in reducing the risk of sight loss, attendance for screening is consistently below recommended levels. OBJECTIVES The primary objective of the review was to assess the effectiveness of quality improvement (QI) interventions that seek to increase attendance for DRS in people with type 1 and type 2 diabetes.Secondary objectives were:To use validated taxonomies of QI intervention strategies and behaviour change techniques (BCTs) to code the description of interventions in the included studies and determine whether interventions that include particular QI strategies or component BCTs are more effective in increasing screening attendance;To explore heterogeneity in effect size within and between studies to identify potential explanatory factors for variability in effect size;To explore differential effects in subgroups to provide information on how equity of screening attendance could be improved;To critically appraise and summarise current evidence on the resource use, costs and cost effectiveness. SEARCH METHODS We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, Web of Science, ProQuest Family Health, OpenGrey, the ISRCTN, ClinicalTrials.gov, and the WHO ICTRP to identify randomised controlled trials (RCTs) that were designed to improve attendance for DRS or were evaluating general quality improvement (QI) strategies for diabetes care and reported the effect of the intervention on DRS attendance. We searched the resources on 13 February 2017. We did not use any date or language restrictions in the searches. SELECTION CRITERIA We included RCTs that compared any QI intervention to usual care or a more intensive (stepped) intervention versus a less intensive intervention. DATA COLLECTION AND ANALYSIS We coded the QI strategy using a modification of the taxonomy developed by Cochrane Effective Practice and Organisation of Care (EPOC) and BCTs using the BCT Taxonomy version 1 (BCTTv1). We used Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital (PROGRESS) elements to describe the characteristics of participants in the included studies that could have an impact on equity of access to health services.Two review authors independently extracted data. One review author entered the data into Review Manager 5 and a second review author checked them. Two review authors independently assessed risks of bias in the included studies and extracted data. We rated certainty of evidence using GRADE. MAIN RESULTS We included 66 RCTs conducted predominantly (62%) in the USA. Overall we judged the trials to be at low or unclear risk of bias. QI strategies were multifaceted and targeted patients, healthcare professionals or healthcare systems. Fifty-six studies (329,164 participants) compared intervention versus usual care (median duration of follow-up 12 months). Overall, DRS attendance increased by 12% (risk difference (RD) 0.12, 95% confidence interval (CI) 0.10 to 0.14; low-certainty evidence) compared with usual care, with substantial heterogeneity in effect size. Both DRS-targeted (RD 0.17, 95% CI 0.11 to 0.22) and general QI interventions (RD 0.12, 95% CI 0.09 to 0.15) were effective, particularly where baseline DRS attendance was low. All BCT combinations were associated with significant improvements, particularly in those with poor attendance. We found higher effect estimates in subgroup analyses for the BCTs 'goal setting (outcome)' (RD 0.26, 95% CI 0.16 to 0.36) and 'feedback on outcomes of behaviour' (RD 0.22, 95% CI 0.15 to 0.29) in interventions targeting patients, and 'restructuring the social environment' (RD 0.19, 95% CI 0.12 to 0.26) and 'credible source' (RD 0.16, 95% CI 0.08 to 0.24) in interventions targeting healthcare professionals.Ten studies (23,715 participants) compared a more intensive (stepped) intervention versus a less intensive intervention. In these studies DRS attendance increased by 5% (RD 0.05, 95% CI 0.02 to 0.09; moderate-certainty evidence).Fourteen studies reporting any QI intervention compared to usual care included economic outcomes. However, only five of these were full economic evaluations. Overall, we found that there is insufficient evidence to draw robust conclusions about the relative cost effectiveness of the interventions compared to each other or against usual care.With the exception of gender and ethnicity, the characteristics of participants were poorly described in terms of PROGRESS elements. Seventeen studies (25.8%) were conducted in disadvantaged populations. No studies were carried out in low- or middle-income countries. AUTHORS' CONCLUSIONS The results of this review provide evidence that QI interventions targeting patients, healthcare professionals or the healthcare system are associated with meaningful improvements in DRS attendance compared to usual care. There was no statistically significant difference between interventions specifically aimed at DRS and those which were part of a general QI strategy for improving diabetes care. This is a significant finding, due to the additional benefits of general QI interventions in terms of improving glycaemic control, vascular risk management and screening for other microvascular complications. It is likely that further (but smaller) improvements in DRS attendance can also be achieved by increasing the intensity of a particular QI component or adding further components.
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Affiliation(s)
- John G Lawrenson
- City University of LondonCentre for Applied Vision Research, School of Health SciencesNorthampton SquareLondonUKEC1V 0HB
| | - Ella Graham‐Rowe
- City University LondonSchool of Health Sciences, Centre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Fabiana Lorencatto
- City University LondonSchool of Health Sciences, Centre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Jennifer Burr
- University of St AndrewsSchool of Medicine, Medical and Biological Sciences BuildingFifeUKKY16 9TF
| | - Catey Bunce
- Kings College LondonDepartment of Primary Care & Public Health Sciences4th Floor, Addison HouseGuy's CampusLondonUKSE1 1UL
| | - Jillian J Francis
- City University LondonSchool of Health Sciences, Centre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Patricia Aluko
- Newcastle UniversityNational Institute for Health Research (NIHR) Innovation ObservatoryTimes Central offices, 4th Floor, GallowgateNewcastle upon TyneUKNE1 4BF
| | - Stephen Rice
- Newcastle UniversityInstitute of Health & SocietyNewcastle upon TyneUKNE2 4AX
| | - Luke Vale
- Newcastle UniversityInstitute of Health & SocietyNewcastle upon TyneUKNE2 4AX
| | - Tunde Peto
- Queen's University BelfastCentre for Public HealthBelfastUKBT12 6BA
| | - Justin Presseau
- Ottawa Hospital Research InstituteClinical Epidemiology Program501 Smyth RoadOttawaOntarioCanadaK1H 8L6
| | - Noah Ivers
- Women's College HospitalDepartment of Family and Community Medicine76 Grenville StreetTorontoONCanadaM5S 1B2
| | - Jeremy M Grimshaw
- Ottawa Hospital Research InstituteClinical Epidemiology Program501 Smyth RoadOttawaOntarioCanadaK1H 8L6
- University of OttawaDepartment of MedicineOttawaONCanada
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MacLaughlin KL, Kessler ME, Komandur Elayavilli R, Hickey BC, Scheitel MR, Wagholikar KB, Liu H, Kremers WK, Chaudhry R. Impact of Patient Reminders on Papanicolaou Test Completion for High-Risk Patients Identified by a Clinical Decision Support System. J Womens Health (Larchmt) 2018; 27:569-574. [PMID: 29297754 PMCID: PMC5953769 DOI: 10.1089/jwh.2017.6667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: A clinical decision support system (CDSS) for cervical cancer screening identifies patients due for routine cervical cancer screening. Yet, high-risk patients who require more frequent screening or earlier follow-up to address past abnormal results are not identified. We aimed to assess the effect of a complex CDSS, incorporating national guidelines for high-risk patient screening and abnormal result management, its implementation to identify patients overdue for testing, and the outcome of sending a targeted recommendation for follow-up. Materials and Methods: At three primary care clinics affiliated with an academic medical center, a reminder recommending an appointment for Papanicolaou (Pap) testing or Pap and human papillomavirus cotesting was sent to high-risk women aged 18 through 65 years (intervention group) identified by CDSS as overdue for testing. Historical control patients, who did not receive a reminder, were identified by CDSS 1 year before the date when reminders were sent to the intervention group. Test completion rates were compared between the intervention and control groups through a generalized estimating equation extension. Results: Across the three sites, the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7% (61/257) than the completion rate at 3.3% (17/516) in the control group (p < 0.001). Conclusions: A CDSS with enhanced capabilities to identify high-risk women due for cervical cancer testing beyond routine screening intervals, with subsequent patient notification, has the potential to decrease cervical precancer and cancer by improving adherence to guideline-compliant follow-up and needed treatment.
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Affiliation(s)
| | - Maya E Kessler
- 2 Division of Primary Care Internal Medicine, Mayo Clinic , Rochester, Minnesota
| | | | - Branden C Hickey
- 4 Knowledge and Delivery Center, Mayo Clinic , Rochester, Minnesota
| | | | | | - Hongfang Liu
- 3 Division of Biomedical Statistics and Informatics, Mayo Clinic , Rochester, Minnesota
| | - Walter K Kremers
- 3 Division of Biomedical Statistics and Informatics, Mayo Clinic , Rochester, Minnesota
| | - Rajeev Chaudhry
- 2 Division of Primary Care Internal Medicine, Mayo Clinic , Rochester, Minnesota
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Vorsters A, Arbyn M, Baay M, Bosch X, de Sanjosé S, Hanley S, Karafillakis E, Lopalco PL, Pollock KG, Yarwood J, Van Damme P. Overcoming barriers in HPV vaccination and screening programs. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 4:45-53. [PMID: 29179869 PMCID: PMC7268103 DOI: 10.1016/j.pvr.2017.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/17/2023]
Abstract
The Human Papillomavirus Prevention and Control Board brought together experts to discuss optimizing HPV vaccination and screening programs. Board members reviewed the safety profile of licensed HPV vaccines based on clinical and post-marketing data, reaching a consensus that current safety data is reassuring. Successful vaccination programs used well-coordinated communication campaigns, integrating (social) media to spread awareness. Communication of evidence supporting vaccine effectiveness had beneficial effects on the perception of the vaccine. However, anti-vaccination campaigns have threatened existing programs in many countries. Measurement and monitoring of HPV vaccine confidence over time could help understand the nature and scale of waning confidence, define issues and intervene appropriately using context-specific evidence-based strategies. Finally, a broad group of stakeholders, such as teachers, health care providers and the media should also be provided with accurate information and training to help support prevention efforts through enhanced understanding of the risks and benefits of vaccination. Similarly, while cervical cancer screening through population-based programs is highly effective, barriers to screening exist: awareness in countries with population-based screening programs, access for vulnerable populations, and access and affordability in low- and middle-income countries. Integration of primary and secondary prevention has the potential to accelerate the decrease in cervical cancer incidence.
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Affiliation(s)
- Alex Vorsters
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Marc Baay
- P95, Epidemiology and Pharmacovigilance Consulting and Services, Leuven, Belgium
| | - Xavier Bosch
- Cancer Research Epidemiology Program, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Research Epidemiology Program, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain
| | - Sharon Hanley
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Kita Ku, Sapporo, Japan
| | - Emilie Karafillakis
- Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, London, UK
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | | | - Joanne Yarwood
- Immunisation, Hepatitis & Blood Safety Department, Public Health England, London, UK
| | - Pierre Van Damme
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
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Bianco A, Larosa E, Pileggi C, Nobile CGA, Pavia M. Cervical and breast cancer screening participation and utilisation of maternal health services: a cross-sectional study among immigrant women in Southern Italy. BMJ Open 2017; 7:e016306. [PMID: 29038177 PMCID: PMC5652469 DOI: 10.1136/bmjopen-2017-016306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Women make up approximately half of the world's one billion migrants. Immigrant women tend to be one of the most vulnerable population groups with respect to healthcare. Cancer screening (CS) and maternal and reproductive health have been included among the 10 main issues pertinent to women's health. The aim of this study is to explore breast and cervical CS participation and to acquire information regarding access to healthcare services during pregnancy, childbirth and the postpartum period among age eligible immigrant women in Southern Italy. METHODS A structured questionnaire was used to collect data from each participant. Women aged 25-64 years who had not had a hysterectomy and women aged 50-69 years without history of breast cancer were considered eligible for the evaluation of cervical and breast CS participation, respectively. Moreover, women who had delivered at least once in Italy were enrolled to describe antenatal and postpartum care services use. All women were recruited through the third sector and non-profit organisations (NPOs). RESULTS Rate of cervical CS among the 419 eligible women was low (39.1%), and about one-third had had a Pap test for screening purposes within a 3-year period from interview (32.8%). Regarding breast CS practices, of the 125 eligible women 45.6% had had a mammography for control purposes and less than a quarter (26, 20.8%) had their mammography within the recommended time interval of 2 years. About 80% of the respondents did not report difficulties of access and use of antenatal and postpartum services. CONCLUSION This study provides currently unavailable information about adherence to CS and maternal and child health that could encourage future research to develop and test culturally appropriate, women-centred strategies for promoting timely and regular CS among immigrant women in Italy.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
| | - Elisabetta Larosa
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
| | - Carmelo G A Nobile
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
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Pantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS, Herrera CA, Rada G, Peñaloza B, Dudley L, Gagnon M, Garcia Marti S, Oxman AD. Implementation strategies for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9:CD011086. [PMID: 28895659 PMCID: PMC5621088 DOI: 10.1002/14651858.cd011086.pub2] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. OBJECTIVES To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview. METHODS We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. MAIN RESULTS We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.Implementation strategies addressed in the reviews were grouped into four categories - strategies targeting:1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);4. healthcare recipients (e.g. medication adherence; 15 reviews).Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions.2.Strategies targeted at healthcare workers for specific types of problems: training healthcare workers to be more patient-centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in-service neonatal emergency care training.3. Strategies targeted at healthcare recipients: mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community-based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support. AUTHORS' CONCLUSIONS Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.
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Affiliation(s)
- Tomas Pantoja
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | | | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Cristian A Herrera
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
| | - Gabriel Rada
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicineLira 44, Decanato Primer pisoSantiagoChile
| | - Blanca Peñaloza
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Lilian Dudley
- Stellenbosch UniversityDivision of Community Health, Faculty of Medicine and Health SciencesFransie Van Zyl DriveTygerbergCape TownSouth Africa7505
| | - Marie‐Pierre Gagnon
- CHU de Québec ‐ Université Laval Research CentrePopulation Health and Optimal Health Practices Research Unit10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Sebastian Garcia Marti
- Institute for Clinical Effectiveness and Health PolicyBuenos AiresCapital FederalArgentinaC1056ABH
| | - Andrew D Oxman
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
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Musa J, Achenbach CJ, O’Dwyer LC, Evans CT, McHugh M, Hou L, Simon MA, Murphy RL, Jordan N. Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS One 2017; 12:e0183924. [PMID: 28873092 PMCID: PMC5584806 DOI: 10.1371/journal.pone.0183924] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Although cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of cancer-related morbidity and mortality globally. Objectives The objective of this systematic review is to understand the evidence of the effect of cervical cancer education compared to control conditions on cervical cancer screening rates in eligible women population at risk of cervical cancer. We also sought to understand the effect of provider recommendations for screening to eligible women on cervical cancer screening (CCS) rates compared to control conditions in eligible women population at risk of cervical cancer. Methods We used the PICO (Problem or Population, Interventions, Comparison and Outcome) framework as described in the Cochrane Collaboration Handbook to develop our search strategy. The details of our search strategy has been described in our systematic review protocol published in the International Prospective Register of systematic reviews (PROSPERO). The protocol registration number is CRD42016045605 available at: http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016045605. The search string was used in Pubmed, Embase, Cochrane Systematic Reviews and Cochrane CENTRAL register of controlled trials to retrieve study reports that were screened for inclusion in this review. Our data synthesis and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We did a qualitative synthesis of evidence and, where appropriate, individual study effects were pooled in meta-analyses using RevMan 5.3 Review Manager. The Higgins I2 was used to assess for heterogeneity in studies pooled together for overall summary effects. We did assessment of risk of bias of individual studies included and assessed risk of publication bias across studies pooled together in meta-analysis by Funnel plot. Results Out of 3072 study reports screened, 28 articles were found to be eligible for inclusion in qualitative synthesis (5 of which were included in meta-analysis of educational interventions and 8 combined in meta-analysis of HPV self-sampling interventions), while 45 were excluded for various reasons. The use of theory-based educational interventions significantly increased CCS rates by more than double (OR, 2.46, 95% CI: 1.88, 3.21). Additionally, offering women the option of self-sampling for Human Papillomavirus (HPV) testing increased CCS rates by nearly 2-fold (OR = 1.71, 95% CI: 1.32, 2.22). We also found that invitation letters alone (or with a follow up phone contact), making an appointment, and sending reminders to patients who are due or overdue for screening had a significant effect on improving participation and CCS rates in populations at risk. Conclusion Our findings supports the implementation of theory-based cervical cancer educational interventions to increase women’s participation in cervical cancer screening programs, particularly when targeting communities with low literacy levels. Additionally, cervical cancer screening programs should consider the option of offering women the opportunity for self-sample collection particularly when such women have not responded to previous screening invitation or reminder letters for Pap smear collection as a method of screening.
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Affiliation(s)
- Jonah Musa
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- * E-mail: , ,
| | - Chad J. Achenbach
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Linda C. O’Dwyer
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Charlesnika T. Evans
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, United States of America
| | - Megan McHugh
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Lifang Hou
- Division of Cancer Epidemiology, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Robert L. Murphy
- Center for Global Health, Institute of Public Health and Medicine, Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
| | - Neil Jordan
- Health Sciences Integrated PhD Program, Center for Healthcare Studies, Institute of Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
- Department of Preventive Medicine, Center for Health Care Studies, Global Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Psychiatry & Behavioral Science, Feinberg School of Medicine, Northwestern University, Chicago, United States of America
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Towards sustainable cancer care: Reducing inefficiencies, improving outcomes—A policy report from the All.Can initiative. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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