Effectiveness of nursing interventions to increase pap smear test screening

Educational interventions for cervical cancer prevention: a scoping review

OBJECTIVES

to identify, map and describe characteristics of educational interventions for cervical cancer prevention in adult women.

METHODS

a scoping review conducted on eleven databases and the gray literature, including studies that described educational interventions aimed at preventing cervical cancer in adult women.

RESULTS

thirty-three articles with 151,457 participants were analyzed. The most used educational strategies were participatory discussions and educational leaflets. Most of the interventions took place in a single session, ranging from 40 to 60 minutes. The most used theoretical model in interventions to improve women's compliance with Pap smear was the Health Belief Model.

CONCLUSIONS

group discussions, lectures and educational brochures can increase knowledge and reduce barriers to cervical cancer prevention. Theory-based and culturally sensitive interventions can have a positive impact on women's health.

Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review

OBJECTIVES

Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions.

DESIGN

This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model.

SETTING

We included studies conducted in LMICs published in English between 2010 and 2020.

PARTICIPANTS

We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening.

RESULTS

Seventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women.

CONCLUSION

A wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women's health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.

The effect of multiple ınterventions for women at risk for cervical cancer on their health responsibility, beliefs regarding cervical cancer and having screening: a randomized controlled trial

This study was intended to analyze the effect of multiple initiations on beliefs about cervical cancer, health responsibility, and screening participation. In total, 134 women aged 40-55 years, who were at risk of cervical cancer and had never had a Pap smear before, were randomly assigned to the experimental (n = 67) and control (n = 67) groups. The 14 weeks of sessions involving the experimental group included group training on cervical cancer, counselling, reminder phone calls and delivery materials, all aimed to increase motivation to be screened regularly for cervical cancer. The control group received the usual care. The study data were collected using an information form, the Health Belief Model Scale, the Healthy Lifestyle Behaviors Scale II and the Assessment Form for Undergoing Pap-Smear Test. After the multiple interventions, there was a significant difference between the experimental and control group's Health Responsibility, Pap smear benefit and motivation, obstacle and health motivation scores (P < 0,05). The participation rate of women in the experimental group to cervical cancer screening was found to be 93%. Multiple nursing interventions (group training, counselling, reminder phone calls and delivery materials) were effective in increasing participation in cervical cancer screening programs.

The application of health behavior theories to promote cervical cancer screening uptake

BACKGROUND

While cervical cancer is a major cause of mortality, its progress and survival rate can be improved through screening. Yet despite their wide availability, women's participation in cervical cancer screening (CCS) programs is often suboptimal, especially in low- and middle-income countries. Besides demographic and organizational characteristics, screening uptake is influenced by psychological factors, most of which are included in health behavior theories. This systematic review compared different health behavior theories in terms of their capacity to explain CCS uptake and inform CCS promotion campaigns.

METHODS

A comprehensive search and analysis of published intervention and non-intervention (observational) studies that applied at least one health behavior theory to CCS participation.

RESULTS

After quality screening, 48 observational and 21 intervention studies were identified that applied the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Transtheoretical model (TTM), Social-ecological Model (SEM), and/or Theory of Triadic Influence (TTI) to CCS. The HBM was most frequently used to explain behavior, whereas the TPB was better at explaining screening intentions. Tailored intervention studies focusing on all theoretical constructs were most effective in modifying perceptions and increasing CCS uptake.

CONCLUSIONS

Despite their inconsistent use, health behavior theories can explain CCS intentions and behavior and contribute to the development of targeted interventions to promote screening uptake.

Effectiveness of Mass and Small Media Campaigns to Improve Cancer Awareness and Screening Rates in Asia: A Systematic Review

PURPOSE

The main objective of this systematic review was to identify whether mass and small media interventions improve knowledge and attitudes about cancer, cancer screening rates, and early detection of cancer in Asia.

METHODS

The review was conducted according to a predefined protocol. Medline, EMBASE, CINAHL, Web of Science, Cochrane Library, and Google Scholar were searched in September 2017, and data extraction and rating of methodologic study quality (according to Joanna Briggs Institute rating procedures) were performed independently by reviewers.

RESULTS

Twenty-two studies (reported across 24 papers) met the inclusion criteria. Most studies (n = 21) were conducted in high or upper-middle income countries; targeted breast (n = 11), cervical (n = 7), colorectal (n = 3), or oral (n = 2) cancer; and used small media either alone (n = 15) or in combination with mass media and other components (n = 5). Studies regarding cancer screening uptake were of medium to high quality and mainly reported positive outcomes for cervical cancer and mixed results for breast and colorectal cancer. The methodologic strength of research that investigated change in cancer-related knowledge and the cost effectiveness of interventions, respectively, were weak and inconclusive.

CONCLUSION

Evidence indicated that small media campaigns seemed to be effective in terms of increasing screening uptake in Asia, in particular cervical cancer screening. Because of the limited number of studies in Asia, it was not possible to be certain about the effectiveness of mass media in improving screening uptake and the effectiveness of campaigns in improving cancer-related knowledge.

Evaluating the Effectiveness of Interventions on Increasing Participation in Cervical Cancer Screening

Background:

Although cervical cancer is highly preventable through regular screenings using Pap smear or human papillomavirus–deoxyribonucleic acid tests, cervical cancer remains a prevalent women's health issue across the world. Therefore, encouraging women to screen for cervical cancer is very important for the early detection of cervical cancer.

Purpose:

The purposes of this study were to (1) assess the effectiveness of three interventions that are typically used to increase the uptake of cervical cancer screening during home visits and (2) determine the participation rate in cervical cancer screenings after invitation, the health promotion perceptions, and the cervical cancer and screening-related knowledge of women. The three interventions noted in Purpose 1 were one-on-one training accompanied by an educational brochure, providing the educational brochure only, and giving an invitation without any relevant information.

Methods:

This interventional study was conducted on women who were between the ages of 30 and 65 years in three Turkish provinces (Ankara, Malatya, and Trabzon). Five hundred twenty home visits were made, and 356 women who did not have a Pap smear test within the previous year were invited for cervical cancer screening. Women were randomized into one of three intervention groups, and the participants in each group were invited to attend a national cervical cancer screening program and to undergo a cervical cancer screening using the related intervention type.

Results:

The results showed that the interventions used during home visits and knowledge were effective in encouraging women to participate in cervical cancer screening. It was determined that the participants who had received one-on-one training accompanied by an educational brochure had a higher cervical cancer screening rate than their peers who were offered a brochure only or a verbal invitation only.

Conclusions:

Invitations to screenings that are made by providing training accompanied with a brochure were found to be effective in increasing the participation of women in cervical cancer screening.

Cervical cancer: knowledge, attitude and practice on the prevention examination

OBJECTIVE

to evaluate the knowledge, attitude and practice of women on the cervical-uterine cancer screening and to investigate their association with sociodemographic variables.

METHOD

a cross-sectional study, carried out from July to September 2015, with 500 women enrolled in the Basic Health Units of the Health District V, of the city of Recife-PE. For data collection, a semi-structured form was used. In statistical analysis, the Chi-square test and Fisher's Exact Test were applied and, in the multivariate analysis, the Poisson model and Wald statistic.

RESULTS

the prevalence of adequate knowledge, attitude and practice was 35.2%, 98% and 70.6%, respectively. Adequate knowledge was associated with having no children, having a family income of two minimum wages and Spiritist/Afro-Brazilian religion.

CONCLUSION

women carry out the examination, deem it necessary, but do not have adequate knowledge, which demonstrates the need for educational actions by nurses and other health professionals.

Knowledge and perception of female nursing students about human papillomavirus (HPV), cervical cancer, and attitudes toward HPV vaccination

Objective: The researchers aimed to evaluate the knowledge and perceptions of first-year female nursing students about human papillomavirus (HPV), cervical cancer (CC), and HPV vaccination. Participants: The sample included 690 female nursing students from sampled universities between April and June 2015. Methods: Students were surveyed by using a pretested HPV and CC awareness questionnaire. Results: More than half of the students (65.1%) answered questions incorrectly with a mean HPV knowledge score of 6.085 ± 3.38. The majority of students (82.6%) did not hear HPV vaccine. Only, 2.8% of the students had been vaccinated. A statistically significant relationship was found between HPV knowledge score and hearing about HPV vaccine (U = 28280.500, p = .015), and believing HPV vaccine protectiveness (χ² = 14.153, p = .001). Conclusions: This study highlights the lack of knowledge and low level of awareness about HPV, CC, and HPV vaccination among first-year nursing college students.

Barriers affecting uptake of cervical cancer screening in low and middle income countries: A systematic review

BACKGROUND

Cervical cancer is the second-most common cancer among women in the developing world and approximately 500,000 cases are diagnosed each year. In developed countries, cervical cancer (CCa) accounts for only 3.6% of newly diagnosed cancers.

OBJECTIVE

The present study aims to identify the most effective barriers associated with CCa screening uptake in low and middle-income countries (L and MICs) and aid to adopt effective measures to overcome prevailing barriers to the attainment of CCa uptake in the community.

MATERIALS AND METHODS

Health sciences electronic databases like MEDLINE, PubMed, Cochrane library, and Google Scholar were searched for studies published until August 2017. Keywords used for the search were ("cervical cancer screening"), ("barriers"), AND ("low income countries" OR "Middle income countries"). Articles were reviewed and data were extracted by using Mendeley Desktop Software (V-1.17.10). Income-level classification of countries was done as per the World Bank 2017 report. Statistical software like SPSS-V.23 and Medical-V.14 were used for the statistical application.

RESULTS

A total of 31 studies met the inclusion criteria with a total of 25,650 participants. The sample size of the included studies ranged from 97 to 5929 participants. Articles majorly reported data on participants from African region (51.6%) and minimally in the Western Pacific region (3.2%). Sampling methods among studies varied from convenience sampling-12 (39.7%) to consecutive sampling-1 (3.2%). Besides, two studies (6.5%) did not discuss their sampling procedures. It was observed that "Lack of information about CCa and its treatment" (Barrier of lack of knowledge and Awareness); "Embracement or shy" (Psychological Barrier); "Lack of time" (structural Barrier); and "Lack of family support" (Sociocultural and religious barrier) were the most commonly reported among all 22 barriers.

CONCLUSION

There is a need of policies advancement of CCa screening programs by focusing on aspects of accessibility, affordability, CCa education, and the necessity of screening to improve screening uptake to control the CCa morbidity and mortality rate in L and MIC's.

Breast and cervical cancer screening for women with physical disabilities: A qualitative study of experiences and barriers

AIM

To determine the experiences of women with physical disabilities regarding the barriers to their participation in breast and cervical cancer screening.

DESIGN

Qualitative descriptive study.

METHOD

Sixteen women who use wheelchairs were recruited. Data were collected via semi-structured face-to-face interviews between January - March 2017. Interviews were transcribed and data were analysed thematically.

RESULTS

Three main themes were uncovered: (a) Personal factors; such as lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others; (b) Environmental and structural factors; and (c) expectations and suggestions of women with disabilities to enable their participation in screening.

CONCLUSION

The participation rate of women with physical disabilities in screening is low. The participation of women with disabilities in breast and cervical cancer screening may increase if physical barriers to accessing healthcare services are removed, appropriate and less time-consuming examination conditions are met, and healthcare personnel are informed about the needs of persons with disabilities.

IMPACT

Knowing the barriers for women with physical disabilities to participate in cancer screening can help health professionals develop new procedures to increase their participation to cancer screening. Women with physical disabilities encountered various barriers such as; lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others, access to the healthcare services, environmental, physical limitations, and inadequate knowledge of healthcare professional about their disability. This study will guide healthcare professionals in developing strategies to increase the participation of women with physical disabilities in screening.

Educational Interventions for Cervical Cancer Screening Behavior of Women: A Systematic Review

Background:

Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective of this study was to systematically assess the effects of educational interventions on cervical cancer screening (CCS) behavior of women.

Methods:

In this review the Cochrane library, Web of Science, Science Direct, PubMed, Scopus and search engine of Google scholar were searched for all interventional studies (trails, pre- and post-test or quasi-experimental) published in 2000-2017 for a systematic review, The search was based on the following keywords: cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papanicolaou Test, pap test, pap smear, education, intervention, systematic review. Due to the heterogeneity of the data, a qualitative analysis was performed.

Results:

Thirty seven articles with 15,658 female participants in different parts of world were included in the review. About three quarters of the articles covered behavior change interventions. About one fourth of the articles were based on health education methods. The heath belief model is the most popular used framework for cervical cancer screening interventions. The results of our study showed that different health education methods (such as calls, mailed postcards, mother/daughter education. consultation sessions, picture books, videos, PowerPoint slides, small group discussions, educational brochures, radio broadcast education, lecture presentations, tailored counseling and a fact sheet, Self-learning package, face-to- face interviews and etc) are effective in modifying cervical cancer screening behavior of women.

Conclusions:

Our results showed that the different interventions and health behavior change frameworks provide an effective base for cervical cancer prevention. Heath providers can chose educational methods based on the particular client situations.

Differences in Dementia Beliefs between Non-Demented Public Screeners and In-Home Screeners and Their Potential Impact on Future Dementia Screening Intention: The Nakajima Study

In many cohort studies of dementia, while differences in sociodemographic characters between responders and non-responders of dementia screening have been reported, differences in dementia beliefs have been relatively less known. The aims of this study were to clarify dementia beliefs and to explore potential impacts on an intention to attend a future dementia screening in public screeners and in-home screeners, respectively. We performed a cross-sectional population-based study using a question about an intention to attend a future dementia screening and a questionnaire on dementia beliefs. Subjects were all residents aged 65 years or older in the north area of Nakajima, Japan (n = 385). All subjects were asked to attend a public dementia screening first. An in-home dementia screening was subsequently conducted in subjects with non-responders to a public screening. The questionnaire consisted of four dementia beliefs: "perceived susceptibility," "perceived severity," "perceived barriers," and "perceived benefits." Public screeners significantly expressed an intention to attend a future dementia screening more than in-home screeners (p = 0.002). In in-home screeners, low "perceived severity" were significantly associated with an intention to attend a future dementia screening [adjusted OR (95% CI) = 0.51 (0.32-0.80)]. In both public and in-home screeners, high "perceived benefits" were significantly associated with an intention to attend a future dementia screening [adjusted OR (95% CI) = 2.13 (1.46-3.10); adjusted OR (95% CI) = 2.56 (1.22-5.35), respectively]. It is necessary to reduce "perceived severity" among in-home screeners to increase dementia screening participants.

Contributions and Limitations of National Cervical Cancer Screening Program in Korea: A Retrospective Observational Study

PURPOSE

The purpose of this study was to evaluate the contributions and limitations of the cervical cancer screening test with accuracy in Korea.

METHODS

This was a retrospective observational study. The study population consisted of all participants who underwent cervical cancer screening test from 2009 to 2014. The data were obtained from National Health Information Database (NHID) which represents medical use records of most Koreans. As the indices for contributions and limitations of the screening test, crude detection rate, incidence rate of interval cancer, sensitivity, specificity, and positive predictive value were used.

RESULTS

The crude detection rate of screening test per 100,000 participants increased from 100.7 in 2009 to 102.1 in 2014. The incidence rate of interval cancer per 100,000 negatives decreased from 13.0 in 2009 to 10.2 in 2014. The sensitivities of screening test were 88.7% in 2009 and 91.2% in 2014, and the specificities were 98.5% in 2009 and 97.7% in 2014. The positive predictive value of screening decreased from 6.2% in 2009 to 4.3% in 2014.

CONCLUSION

The Korean national cervical cancer screening program has improved in accuracy and has contributed to detection of early stage of cervical cancer over the years. Along with efforts to promote participation in cancer screening programs, quality control over the screening program should be enhanced.

Integrative review of cervical cancer screening in Western Asian and Middle Eastern Arab countries

Population-based screening programs have resulted in minimizing mortality and morbidity from cervical cancer. The aim of this integrative review was to explore the factors influencing access of women from Western Asian and Middle Eastern Arab countries to cervical cancer screening. A systematic search for studies conducted in Arab countries in those regions, and published in English between January 2002 and January 2017, was undertaken. Thirteen papers were selected and subjected to quality appraisal. A three step analysis was used, which involved a summary of the evidence, analysis of both quantitative and qualitative data, and integration of the results in narrative form. Few population-based cervical cancer screening programs had been implemented in the relevant countries, with low knowledge of, and perceptions about, cervical screening among Arab women, the majority of whom are Muslim. Factors affecting the uptake of cervical cancer screening practices were the absence of organized, systematic programs, low screening knowledge among women, healthcare professionals' attitudes toward screening, pain and embarrassment, stigma, and sociocultural beliefs. Policy changes are urgently needed to promote population-based screening programs. Future research should address the promotion of culturally-sensitive strategies to enable better access of Arab Muslim women to cervical cancer screening.

Interventions that facilitate adherence to Pap smear exam: integrative review

RESUMO Objetivo: identificar produções científicas que apresentem intervenções relevantes para implementar o Programa de Prevenção do Câncer Cérvico-Uterino, aumentando a adesão à realização do exame. Método: revisão integrativa da literatura, realizada por busca on-line, nas bases de dados: LILACS, SciELO e Pubmed®, abrangendo artigos publicados de 2009 a 2014. Resultados: trinta e oito artigos compuseram a amostra final do estudo. Estes indicaram as seguintes intervenções: utilização de gerente de caso, contato telefônico, carta-convite, atividades educativas, divulgação na mídia, agentes de saúde da comunidade, parcerias, rastreamento de base populacional e múltiplas intervenções. Conclusão: as pesquisas concentram-se entre mulheres provenientes de países em desenvolvimento, e estas intervenções são eficazes no aumento da adesão e do conhecimento destas mulheres em relação à prevenção do câncer cérvico-uterino.

The Effects of an Educational Intervention on Preventing Cervical Cancer Among Vietnamese Women in Southern Taiwan

This paper aims to conduct and evaluate an educational intervention on preventing cervical cancer among married immigrant women of Vietnamese origin. The study design was a quasi-experimental method with two groups. In total, 260 married immigrant women of Vietnamese origin with national health insurance at least 30 years of age were recruited from November 2013 to January 2015 in southern Taiwan. The effects of the educational intervention, including cervical cancer and Papanicolaou test knowledge, attitudes towards cervical cancer, fatalism, barriers to receiving Papanicolaou tests, intention for receiving Papanicolaou tests within the next year, and intention for receiving Papanicolaou tests within the next 3 years, were evaluated. Repeated measures analyses of variance showed significant interactions between the intervention group and time for cervical cancer knowledge, knowledge of Papanicolaou test, attitudes towards cervical cancer, and intention for receiving a Papanicolaou test within the next 3 years; in addition, 71.4 % reported being satisfied or very satisfied with the intervention. The results of this study can provide information for governments to make appropriate health policies for screening behavior of cervical cancer, increase healthcare professionals' competencies towards Vietnamese women, and increase Papanicolaou test screening rates to decrease cervical cancer mortality. Effective interventions may require particular consideration of married immigrant women.

Interventional Education Methods for Increasing Women's Participation in Breast Cancer Screening Program

The purpose of this study was to evaluate the impact of the three methods of education-individual, individual with an educational brochure for spouses, and group-on participation on breast cancer screening in Turkey. A total of 550 home visits were made and 446 women were interviewed to accrue 327 women for the study, 26.7% of whom reported receiving a screening mammogram within the past 2 years. Participants were divided into one of the three educational groups, and following the educational session, they were invited to attend a breast cancer screening program. The results indicated that the decision to have a screening mammogram was influenced by the method of education and the knowledge score. Women, who were educated, within a group scored the highest. These results demonstrate that group education is an effective method of increasing breast cancer knowledge and screening awareness.