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Lemmo D, Martino ML, Vallone F, Donizzetti AR, Freda MF, Palumbo F, Lorenzo E, D'Argenzio A, Caso D. Clinical and psychosocial constructs for breast, cervical, and colorectal cancer screening participation: A systematic review. Int J Clin Health Psychol 2023; 23:100354. [PMID: 36415605 PMCID: PMC9677078 DOI: 10.1016/j.ijchp.2022.100354] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Research has identified a wide range of psychosocial factors associated to choosing to engage in ongoing cancer screenings. Nevertheless, a systematic review of the theoretical frameworks and constructs underpinning studies on breast, cervical, and colorectal cancer screening participation has yet to be conducted. As part of the action-research project “Miriade,” the present study aims to identifying the main theoretical frameworks and constructs adopted in the literature over the past five years to explain cancer screening participation. According to the PRISMA guidelines, a search of the MEDLINE/PubMed and PsycINFO databases was made. Empirical studies conducted from 2017 to 2021 were included. The following keywords were used: breast OR cervical OR colorectal screening AND adhesion OR participation OR engagement AND theoretical framework OR conceptual framework OR theory. Overall, 24 articles met the inclusion criteria. Each theoretical framework highlighted clinical and psychosocial constructs of cancer screening participation, focusing on the individuals (psycho-emotional functioning and skills plan) and/or the health services perspectives. Findings from the present study acknowledge the plurality of the theoretical frameworks and constructs adopted to predict or promote breast, cervical, and colorectal cancer screening adhesion and the need for new research efforts to improve the effectiveness of cancer screening promotion interventions.
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Affiliation(s)
- Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
- Corresponding author.
| | - Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Federica Vallone
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Anna Rosa Donizzetti
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | | | - Francesco Palumbo
- Department of Political Science, University of Naples Federico II, Naples, Italy
| | - Elvira Lorenzo
- Directorate General for Health Protection and Coordination of the Regional Health System, Campania Region, Italy
| | - Angelo D'Argenzio
- Directorate General for Health Protection and Coordination of the Regional Health System, Campania Region, Italy
| | - Daniela Caso
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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Blomberg K, Hälleberg-Nyman M. Experiences of human papillomavirus self-sampling by women >60 years old: A qualitative study. Health Expect 2023; 26:818-826. [PMID: 36633121 PMCID: PMC10010077 DOI: 10.1111/hex.13707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) self-sampling has shown to be acceptable and feasible across cultures and effective in reaching women who do not participate in regular cervical cancer screening. However, most of these studies have included younger women. There is a lack of knowledge of how older women reason about HPV self-sampling. OBJECTIVE The aim of this study was to describe how women (>60 years old) experience the offering of self-sampling of HPV, compared to having a sample collected by a healthcare professional. DESIGN AND PARTICIPANTS The study had a qualitative explorative design. Four focus group discussions were conducted with women 60-69 years old (n = 22). Data were analysed using principles of interpretive description. RESULTS Five themes were identified: self-sampling-convenient and without pain, lack of knowledge, worries related to HPV self-sampling, need for information and taking a societal perspective. CONCLUSION Women aged >60 years found that HPV self-sampling was convenient and easy to perform. Further, they stressed the importance of being able to remain in the screening programme in advanced age and that self-sampling could be a possible solution. This study also revealed a lack of knowledge among women in this age group regarding HPV infection, how the disease is transmitted and its relation to cervical cancer. PUBLIC CONTRIBUTION Women who had performed HPV self-sampling participated in the focus group discussion.
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Affiliation(s)
- Karin Blomberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Hälleberg-Nyman
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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3
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Kirkegaard P, Larsen MB, Andersen B. “It's cancer screening after all”. Barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening. J Med Screen 2022; 30:74-80. [PMID: 36541340 PMCID: PMC10149879 DOI: 10.1177/09691413221137852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives To explore barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening. Methods Interview study with women who had not responded to one or more invitations to cervical or colorectal cancer screening. A semi-structured interview guide was used and interviews were audio recorded and transcribed verbatim. Concepts from Temporal Motivation Theory were used to structure and analyse the data. Results Twenty-two women were interviewed. Screening was highly valued but the women perceived screening for cervical cancer and colorectal cancer as more troublesome to participate in, compared with participation in breast cancer screening. The lack of a pre-booked appointment or a suggested deadline attenuated the perceived value of cervical and colorectal cancer screening and this further increased procrastination. Promotion of self-sampling kits for cervical and colorectal cancer screening upon attendance for breast cancer screening was considered a feasible way to increase salience of both types of screening. Conclusion A high number of micro steps and absence of a deadline in cervical and colorectal cancer screening diverted attention away from screening participation in cervical and colorectal cancer screening. The main facilitator could be reduction of micro actions, proposing a suggested deadline, and promotion of self-sampling kits when attending breast cancer screening to increase salience and a renewed attention to all three screening programmes.
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Affiliation(s)
- Pia Kirkegaard
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Zheng X, Xu S, Wu J. Cervical Cancer Imaging Features Associated With ADRB1 as a Risk Factor for Cerebral Neurovascular Metastases. Front Neurol 2022; 13:905761. [PMID: 35903112 PMCID: PMC9315067 DOI: 10.3389/fneur.2022.905761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Bioinformatics tools are used to create a clinical prediction model for cervical cancer metastasis and to investigate the neurovascular-related genes that are involved in brain metastasis of cervical cancer. One hundred eighteen patients with cervical cancer were divided into two groups based on the presence or absence of metastases, and the clinical data and imaging findings of the two groups were compared retrospectively. The nomogram-based model was successfully constructed by taking into account four clinical characteristics (age, stage, N, and T) as well as one imaging characteristic (original_glszm_GrayLevelVariance Rad-score). In patients with cervical cancer, headaches and vomiting were more often reported in the brain metastasis group than in the other metastasis groups. According to the TCGA data, mRNA differential gene expression analysis of patients with cervical cancer revealed an increase in the expression of neurovascular-related gene Adrenoceptor Beta 1 (ADRB1) in the brain metastasis group. An analysis of the correlation between imaging features and ADRB1 expression revealed that ADRB1 expression was significantly higher in the low Rad-score group compared with the high Rad-score group (P = 0.025). Therefore, ADRB1 expression in cervical cancer was correlated with imaging features and was associated as a risk factor for cerebral neurovascular metastases. This study developed a nomogram prediction model for cervical cancer metastasis using age, stage, N, T and original_glszm_GrayLevelVariance. As a risk factor associated with the development of cerebral neurovascular metastases of cervical cancer, ADRB1 expression was significantly higher in brain metastases from cervical cancer.
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Affiliation(s)
- Xingju Zheng
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Shilin Xu
- Department of Oncology, Xichang People's Hospital, Liangshan High-Tech Tumor Hospital, Xichang, China
| | - JiaYing Wu
- Department of Gynaecology and Obstetrics, Zhejiang Xinda Hospital, Huzhou, China
- *Correspondence: JiaYing Wu
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Sahlgren H, Sparén P, Elfgren K, Miriam Elfström K. Feasibility of sending a direct send HPV self-sampling kit to long-term non-attenders in an organized cervical screening program. Eur J Obstet Gynecol Reprod Biol 2021; 268:68-73. [PMID: 34875556 DOI: 10.1016/j.ejogrb.2021.11.430] [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: 10/04/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Non-participation in screening is a main risk factor for cervical cancer. Human-papillomavirus (HPV) self-sampling may be an alternative to repeated invitations for non-attenders. Several studies have concluded that participation among non-attenders increases significantly when offering self-sampling kits for HPV. However, participation rates are highly variable between settings, and therefore pilots to determine optimal implementation strategy have been recommended before routine roll out. MATERIALS AND METHODS All women who had not participated in the organized screening program for at least 10 years aged 33-62 in one Swedish county were identified through screening registers. HPV self-sampling kits were sent to all eligible women. Participation was defined as returning a self-sample kit or attending routine screening within 6 months. Women who did not submit the kit within 8 weeks were randomized to receive a written reminder. HPV-positive women were referred directly to colposcopy without prior triage. Biopsies for histopathologic confirmation were used as gold standard. RESULTS Among eligible women, 150/741 (20.2%) returned the self-sample kit or attended routine screening. A randomized written reminder was sent out to 319/591 non-responders and another 11 women returned the kit. In total, 23/147 (16.3%) of returned kits were HPV positive. Out of the 23 HPV-positive women, 17 (74%) attended colposcopy; 10/17 (59%) had a histopathological high-grade squamous intraepithelial lesions (HSIL) or cervical cancer. The most common HPV type was HPV 52, and 2 out of 3 women with HPV 16 had a histopathologically confirmed cancer. CONCLUSION The direct send kit strategy and referral of all HPV-positive women to colposcopy without prior triage appears to be feasible if resources are available and should be prioritized given the high prevalence of HSIL lesions and cancer among non-attenders. A written reminder might further increase attendance.
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Affiliation(s)
- Hanna Sahlgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Regional Cancer Center, Uppsala, Sweden.
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Kristina Elfgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Center for Cervical Cancer Prevention, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
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O'Connor M, McSherry LA, Dombrowski SU, Francis JJ, Martin CM, O'Leary JJ, Sharp L. Identifying ways to maximise cervical screening uptake: a qualitative study of GPs' and practice nurses' cervical cancer screening-related behaviours. HRB Open Res 2021; 4:44. [PMID: 34458677 PMCID: PMC8370130 DOI: 10.12688/hrbopenres.13246.1] [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] [Accepted: 04/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Cervical screening uptake is declining in several countries. Primary care practitioners could play a greater role in maximising uptake, but better understanding is needed of practitioners’ cervical screening-related behaviours. Among general practitioners (GPs) and practice nurses, we aimed to identify cervical screening-related clinical behaviours; clarify practitioners’ roles/responsibilities; and determine factors likely to influence clinical behaviours.
Methods: Telephone interviews were conducted with GPs and practice nurses in Ireland. Interview transcripts were analysed using the Theoretical Domains Framework (TDF), a comprehensive psychological framework of factors influencing clinical behaviour. Results: 14 GPs and 19 practice nurses participated. Key clinical behaviours identified were offering smears and encouraging women to attend for smears. Smeartaking responsibility was considered a predominantly female role. Of 12 possible theoretical domains, 11 were identified in relation to these behaviours. Those judged to be the most important were beliefs about capabilities; environmental context and resources; social influences; and behavioural regulation. Difficulties in obtaining smears from certain subgroups of women and inexperience of some GPs in smeartaking arose in relation to beliefs about capabilities. The need for public health education and reluctance of male practitioners to discuss cervical screening with female patients emerged in relation to social influences. Conclusions: We identified - for the first time - primary care practitioners’ cervical-screening related clinical behaviours, their perceived roles and responsibilities, and factors likely to influence behaviours. The results could inform initiatives to enable practitioners to encourage women to have smear tests which in turn, may help increase cervical screening uptake.
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Affiliation(s)
| | - Lisa A McSherry
- National Cancer Registry of Ireland, Kinsale Road, Cork, Ireland, Ireland
| | | | - Jill J Francis
- School of Health Sciences, City University London, London,, UK
| | | | | | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle, UK
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De Pauw H, Donders G, Weyers S, De Sutter P, Doyen J, Tjalma WAA, Vanden Broeck D, Peeters E, Van Keer S, Vorsters A, Arbyn M. Cervical cancer screening using HPV tests on self-samples: attitudes and preferences of women participating in the VALHUDES study. ACTA ACUST UNITED AC 2021; 79:155. [PMID: 34462004 PMCID: PMC8403820 DOI: 10.1186/s13690-021-00667-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
Background Interventions to reach women who do not participate regularly in screening may reduce the risk of cervical cancer. Self-collection of a vaginal specimen has been shown to increase participation. The relative clinical accuracy of human papillomavirus (HPV) testing on first-void urine (with Colli-Pee) and on vaginal self-samples versus on cervical clinician-collected samples is being investigated in the VALHUDES trial. The current study assesses attitudes and experiences regarding self-sampling among women enrolled in VALHUDES. Methods Questionnaires from 515 women (age 25–64 years [N = 498]; < 25 [N = 10], age ≥ 65 [N = 3], enrolled between December 2017 - January 2020) referred to colposcopy because of previous cervical abnormalities and enrolled in VALHUDES (NCT03064087) were analysed. Results Of the 515 participants, nearly all women confirmed that self-sampling may help in reaching under-screened women (93%). Nevertheless, 44% of the participants stated before starting collection that a clinician-collected sample is more effective than a self-collected sample. After self-sampling, the large majority of women (> 95%) declared that instructions for self-collection were clear, that collection was easy, and that they were confident about having performed the procedure correctly, for both urine and vaginal collection. However, a proportion of women found self-sampling unpleasant (9.5% [49/515] for urine collection; 18.6% [96/515] and 15.5% [80/515] for vaginal sampling with cotton swabs or plastic brushes, respectively). For their next screening round, 57% would prefer self-sampling whereas 41% opted for collection by a clinician. Among women preferring self-sampling, 53% would choose for urine collection, 38% for vaginal self-collection and 9% had no preference. Age did not modify preferences. Conclusion We conclude that both urine and vaginal self-sampling are well accepted by women, with a preference for urine sampling. Although the large majority of women are confident in their ability to perform self-sampling, four to five over ten women preferred specimen collection by a clinician. Trial registration The study VALHUDES was registered in ClinicalTrials.gov (identifier: NCT03064087). Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00667-4.
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Affiliation(s)
- Hélène De Pauw
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J. Wytsmanstreet 14, B1050, Brussels, Belgium
| | - Gilbert Donders
- Department of Obstetrics and Gynaecology of the General Regional Hospital Heilig Hart (RZ Tienen), Tienen, Belgium.,Femicare vzw, Clinical Research for Women, Tienen, Belgium.,Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital (UZ Ghent), Ghent, Belgium.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Philippe De Sutter
- Department of Gynaecology & Oncology, Universitair Ziekenhuis Brussel (UZ Brussel) - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jean Doyen
- Department Gynaecology-Obstetrics, Liège University Hospital (CHU Liège), Liège, Belgium
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Edegem, Belgium.,Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Davy Vanden Broeck
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Antwerp, Belgium.,National Reference Centre for HPV, Brussels, Belgium.,AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium.,International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Eliana Peeters
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J. Wytsmanstreet 14, B1050, Brussels, Belgium.,Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Severien Van Keer
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J. Wytsmanstreet 14, B1050, Brussels, Belgium. .,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
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Stuart G, D'Lima D. Perceived barriers and facilitators to attendance for cervical cancer screening in EU member states: a systematic review and synthesis using the Theoretical Domains Framework. Psychol Health 2021; 37:279-330. [PMID: 34121540 DOI: 10.1080/08870446.2021.1918690] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To identify and synthesise peer-reviewed, published literature reporting perceived barriers and facilitators associated with cervical cancer screening attendance in EU member states with organised population-based screening programmes. METHODS Quantitative and qualitative studies reporting perceived barriers/facilitators to attendance for cervical cancer screening were searched for in databases Embase, HMIC, Medline and PsycInfo. Data were extracted and deductively coded to the Theoretical Domains Framework domains and inductive thematic analysis within domains was employed to identify specific barriers or facilitators to attendance for cervical cancer screening. RESULTS 38 studies were included for data extraction. Five theoretical domains ['Emotion' (89% of the included studies), 'Social influences' (79%), 'Knowledge' (76%), 'Environmental Context and Resources' (74%) and 'Beliefs about Consequences' (68%)] were identified as key domains influencing cervical cancer screening attendance. CONCLUSION Five theoretical domains were identified as prominent influences on cervical cancer screening attendance in EU member states with organised population-based screening programmes. Further research is needed to identify the relative importance of different influences for different sub-populations and to identify the influences that are most appropriate and feasible to address in future interventions.
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Affiliation(s)
- Gabriella Stuart
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Schröer-Günther M, Fechtelpeter D, Zschorlich B, Wegmann M, Keller S, Schürmann C, Lampert U, Seidl A, Janßen I, Koch K. [Development of Decision Aids for Organized Cervical Carcinoma Screening in Germany]. DAS GESUNDHEITSWESEN 2019; 83:128-134. [PMID: 31830768 DOI: 10.1055/a-1028-7283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM OF THE STUDY The Federal Joint Committee has decided to introduce organized cervical carcinoma screening in 2020. The present work describes the development of decision aids that will be sent to women in this program. METHODS A systematic search for qualitative studies and surveys was conducted to gather information on experiences, attitudes and information needs. Furthermore, we searched for systematic reviews on advantages and disadvantages of screening. An existing decision analysis for cervical carcinoma screening in Germany was used. The designs were subjected to a qualitative test (focus groups with 26 women and 8 expert interviews), to a quantitative user test (online survey n=2,014 women) and to a public hearing. RESULTS Most women found the decision aids informative and helpful. The majority would recommend the use of these materials to others. For many women, part of the information was new, although they had been involved in cervical cancer screening for some time. The presentation of the advantages and disadvantages was judged to be balanced. However, 10% changed their attitude towards participation and 70% of women would attend screening. CONCLUSION The decision aids found a high acceptance among the users. They can help to reduce knowledge deficits on cervical carcinoma screening and support a informed decision making.
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Affiliation(s)
| | | | - Beate Zschorlich
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | | | - Sabine Keller
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | | | - Ulrike Lampert
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | - Astrid Seidl
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | - Inger Janßen
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | - Klaus Koch
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
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Elfström KM, Sundström K, Andersson S, Bzhalava Z, Carlsten Thor A, Gzoul Z, Öhman D, Lamin H, Eklund C, Dillner J, Törnberg S. Increasing participation in cervical screening by targeting long‐term nonattenders: Randomized health services study. Int J Cancer 2019; 145:3033-3039. [DOI: 10.1002/ijc.32374] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Klara Miriam Elfström
- Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Regional Cancer Center Stockholm Gotland Stockholm Sweden
| | - Karin Sundström
- Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health, Division of Obstetrics and GynecologyKarolinska University Hospital Solna, Karolinska Institutet Stockholm Sweden
| | - Zurab Bzhalava
- Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
| | | | - Zohra Gzoul
- Regional Cancer Center Stockholm Gotland Stockholm Sweden
| | - Daniel Öhman
- Regional Cancer Center Stockholm Gotland Stockholm Sweden
| | - Helena Lamin
- Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Carina Eklund
- Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
| | - Joakim Dillner
- Department of Laboratory MedicineKarolinska Institutet Stockholm Sweden
- Karolinska University LaboratoryKarolinska University Hospital Stockholm Sweden
| | - Sven Törnberg
- Regional Cancer Center Stockholm Gotland Stockholm Sweden
- Department of Oncology and PathologyKarolinska Institutet Stockholm Sweden
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11
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Eriksson EM, Lau M, Jönsson C, Zhang C, Risö Bergerlind LL, Jonasson JM, Strander B. Participation in a Swedish cervical cancer screening program among women with psychiatric diagnoses: a population-based cohort study. BMC Public Health 2019; 19:313. [PMID: 30885177 PMCID: PMC6421650 DOI: 10.1186/s12889-019-6626-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/05/2019] [Indexed: 11/12/2022] Open
Abstract
Background In Sweden, organized screening programs have significantly reduced the incidence of cervical cancer. For cancers overall, however, women with psychiatric diagnoses have lower survival rates than other women. This study explores whether women with psychiatric diagnoses participate in cervical cancer screening programs to a lesser extent than women on average, and whether there are disparities between psychiatric diagnostic groups based on grades of severity. Methods Between 2000 and 2010, 65,292 women within screening ages of 23–60 had at least two ICD-10 (International Statistical Classification of Diseases and Related Health Problems – Tenth Revision) codes F20*–F40* registered at visits in primary care or psychiatric care in Region Västra Götaland, Sweden. Participation in the cervical cancer screening program during 2010–2014 was compared with the general female population using logistic regression adjusted for age. Results Relative risk for participation (RR) for women diagnosed within psychiatric specialist care RR was 0.94 compared with the general population, adjusted for age. RR for diagnoses outside specialist care was 0.99. RR for psychoses (F20*) was 0.81. Conclusions Women with less-severe psychiatric diagnoses participate in the screening program to the same extent as women overall. Women who have received psychiatric specialist care participate to a lesser extent than women overall. The lowest participation rates were found among women diagnosed with psychoses.
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Affiliation(s)
- Erik M Eriksson
- Service Management and Logistics/Centre for Health Care Improvement, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden.
| | - Malena Lau
- Centre for Equity in Healthcare, Gothenburg, Region Västra Götaland, Sweden
| | - Claes Jönsson
- Department of Healthcare, Gothenburg, Region Västra Götaland, Sweden.,Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden
| | | | | | | | - Björn Strander
- Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden.,Regional Cancer Centre West Sweden, Gothenburg, Sweden
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12
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Bennett KF, Waller J, Chorley AJ, Ferrer RA, Haddrell JB, Marlow LAV. Barriers to cervical screening and interest in self-sampling among women who actively decline screening. J Med Screen 2018; 25:211-217. [PMID: 29649936 PMCID: PMC6262593 DOI: 10.1177/0969141318767471] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/07/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Understanding why some women actively decline cervical screening could contribute to tailored intervention development. We explored reasons for non-participation in cervical screening among women who had made an active decision not to attend in the future. We also explored interest in human papillomavirus self-sampling. METHODS In a population-based survey of women in Great Britain, home-based computer-assisted interviews were carried out with screening eligible women. Women reported their intention to attend for screening when next invited. They endorsed predefined barriers to screening and indicated their interest in human papillomavirus self-sampling. RESULTS Women who had actively declined screening and those who intended to go but were currently overdue (n=543) were included in this analysis. Women who had made an active decision not to be screened in the future were more likely to endorse the barriers 'I have other more important things to worry about' and to perceive screening to be of low relevance based on their sexual behaviour. Most participants (70%) indicated that they would be interested in human papillomavirus self-sampling. Interest in self-sampling was greater among those who reported having had a bad experience of screening in the past, were too busy or embarrassed to attend, or would not want a man to carry out the test. CONCLUSIONS Women who had made an active decision not to attend screening felt it was of low relevance to them and that they had more important things to worry about. Shifting the perceived cost-benefit ratio for these women by offering human papillomavirus self-sampling might increase screening participation in this group.
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Affiliation(s)
- Kirsty F Bennett
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Amanda J Chorley
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - Jessica B Haddrell
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Laura AV Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
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Barriers and facilitators of cervical cancer screening practices among African immigrant women living in Brisbane, Australia. Eur J Oncol Nurs 2017; 31:22-29. [PMID: 29173823 DOI: 10.1016/j.ejon.2017.09.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/27/2017] [Accepted: 09/26/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe barriers and facilitators of cervical screening practices among African immigrant women living in Brisbane, Australia. METHOD Nineteen African immigrant women (10 refugee and 9 non-refugee) were recruited using convenience sampling. The interviews were conducted with a semi-structured and open-ended questionnaire guide. All the interviews were audio recorded and transcribed verbatim. The data was manually analysed using interpretative thematic analysis. Thematic categories were identified and organised into coherent broader areas. RESULTS Lack of knowledge about cervical cancer and Pap smear, the absence of warning signs, embarrassment, fear, concern about the gender of the service provider, lack of privacy, cultural and religious beliefs, and healthcare system factors were identified as barriers to screening. The results did not show any major differences between refugee and non-refugee women. Recommendation of the test by health professionals, provision of standardised information on the test, and preferences for female service providers were identified as facilitators of cervical screening. CONCLUSION There is a need to provide culturally appropriate approaches to cervical screening practices and to enhance cultural competence among health professionals to apply service delivery models that honour group cultures.
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Williams D, Davies M, Fiander A, Farewell D, Hillier S, Brain K. Women's perspectives on human papillomavirus self-sampling in the context of the UK cervical screening programme. Health Expect 2017; 20:1031-1040. [PMID: 28186384 PMCID: PMC5600225 DOI: 10.1111/hex.12544] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Testing for human papillomavirus (HPV) is being incorporated into the cervical screening programme, with the probable future introduction of HPV as a primary test and a possibility of HPV self-sampling. In anticipation of this development, we sought to inform future policy and practice by identifying potential barriers to HPV self-sampling. METHODS A cross-sectional survey of 194 women aged 20-64 years was conducted. Logistic regression analysis was used to identify determinants of self-sampling intentions. A purposive subsample of 19 women who reported low self-sampling intentions were interviewed. Interviews were framework-analysed. RESULTS Most survey participants (N=133, 69.3%) intended to HPV self-sample. Lower intention was associated with lower self-efficacy (OR=24.96, P≤.001), lower education (OR=6.06, P≤.05) and lower perceived importance of HPV as a cause of cervical cancer (OR=2.33, P≤.05). Interviews revealed personal and system-related barriers. Personal barriers included a lack of knowledge about HPV self-sampling, women's low confidence in their ability to self-sample correctly and low confidence in the subsequent results. System-related factors included a lack of confidence in the rationale for modifying the current cervical screening programme, and concerns about sample contamination and identity theft. CONCLUSIONS Insights gained from this research can be used to guide further enquiry into the possibility of HPV self-sampling and to help inform future policy and practice. Personal and system-related barriers including low confidence in the reasons for changing current cervical screening provision need to be addressed, should HPV self-sampling be incorporated into the cervical screening programme.
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Affiliation(s)
- Denitza Williams
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Myfanwy Davies
- School of Social Sciences, Bangor University, Bangor, UK
| | - Alison Fiander
- Leading Safe Choices programme, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Chorley AJ, Marlow LAV, Forster AS, Haddrell JB, Waller J. Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis. Psychooncology 2017; 26:161-172. [PMID: 27072589 PMCID: PMC5324630 DOI: 10.1002/pon.4126] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/04/2016] [Accepted: 03/07/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call-recall programme, in order to understand the barriers to informed uptake. METHODS We searched nine databases for English language peer-reviewed publications reporting on qualitative data from screening-eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call-recall programme. Evidence was integrated using thematic synthesis. RESULTS Thirty-nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action. CONCLUSIONS The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Amanda J. Chorley
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
| | - Laura A. V. Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
| | - Alice S. Forster
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
| | - Jessica B. Haddrell
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
| | - Jo Waller
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public HealthUCLLondonUK
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Urrutia MT, Araya A, Jaque MF. Why Do Chilean Women Choose to Have or Not Have Pap Tests? J Obstet Gynecol Neonatal Nurs 2016; 46:e3-e12. [PMID: 27886949 DOI: 10.1016/j.jogn.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the perceptions of Chilean women about why women choose to have or not have Pap test screening. DESIGN Qualitative research using content analysis according to Krippendorf. SETTING Four urban health clinics in Santiago, Chile. PARTICIPANTS Fifty-seven Chilean women. METHODS Audiotaped focus groups. RESULTS Six themes emerged: Reasons that make it difficult for women to schedule appointments, Characteristics of health professionals that make it difficult to have a Pap test, Characteristics of the test that are barriers to having a Pap test, The relationship of the test with cancer, Family context, and Each woman's personal characteristics. CONCLUSION Primary health care providers play an important role in promoting adherence to cervical cancer screening. Nurses should proactively address women's perceptions and knowledge about screening and openly and uniformly discuss the importance and benefits of Pap test screening.
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Dorrington MS, Herceg A, Douglas K, Tongs J, Bookallil M. Increasing Pap smear rates at an urban Aboriginal Community Controlled Health Service through translational research and continuous quality improvement. Aust J Prim Health 2016; 21:417-22. [PMID: 25703868 DOI: 10.1071/py14088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/19/2014] [Indexed: 01/18/2023]
Abstract
This article describes translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS). Rapid Plan-Do-Study-Act (PDSA) cycles were conducted, informed by client surveys, a data collection tool, focus groups and internal research. There was a statistically significant increase in Pap smear numbers during PDSA cycles, continuing at 10 months follow up. The use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. Community and service collaboration should be at the core of research in Aboriginal and Torres Strait Islander health settings. This model is transferrable to other settings and other health issues.
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Ward PR, Coffey C, Meyer S. Trust, choice and obligation: a qualitative study of enablers of colorectal cancer screening in South Australia. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:988-1006. [PMID: 25912247 DOI: 10.1111/1467-9566.12280] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Colorectal cancer (CRC) has the second highest cancer prevalence and mortality rates in Australia. The Australian National Bowel Cancer Screening Program (NBCSP) aims to increase early detection of CRC by offering free faecal occult blood testing. The NBCSP aims to offer choice to consumers about whether or not to participate in screening. This article presents data on trust, choice and perceived obligation to participate in the NBCSP by population groups with low uptake. A qualitative study was undertaken in South Australia. We interviewed 94 people from four culturally distinct groups: Greek, Iranian, Anglo-Australian and Indigenous peoples. This article demonstrates the complexity of factors shaping the choice, or lack thereof, to participate in the NBCSP. Informed choice is based on adequate knowledge, although this varied among our participants, highlighting the need for more health education in appropriate languages. An obligation to participate was found in the Iranian and Anglo-Australian groups and resulted from an established personal relationship with the doctor, a sense of duty, the acknowledgement of government investment and appreciation. Overall, this article makes a link between trust, choice and obligation, adding to literature on the sociology of trust and medical screening and highlighting important issues in the need of a policy and practice to improve CRC screening rates.
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Affiliation(s)
- Paul R Ward
- Discipline of Public Health, Flinders University, Australia
| | - Cushla Coffey
- Discipline of Public Health, Flinders University, Australia
| | - Samantha Meyer
- School of Public Health and Health Systems, Waterloo University, Canada
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Wätterbjörk I, Sahlberg-Blom E, Nilsson K, Blomberg K. Reasons for declining extended information visit on prenatal screening among pregnant women and their partners. Prenat Diagn 2015; 35:1232-7. [PMID: 26289796 DOI: 10.1002/pd.4683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A two-step model on information on prenatal screening consists of brief information at the first visit at the Maternal Health Care Centre and an offer of extended information at a separate visit. There is a lack of knowledge why some pregnant women and their partners refrain from the extended information visit. The aim of this study was to explore their reasons. METHOD Eight qualitative interviews were analyzed using Interpretive Description. RESULTS In the first theme 'From an individual view', the interviewees saw the invitation from their own points of view. They refrained because they did not want to receive any more information or had taken an individual position against chromosomal testing. In the theme, 'From a societal view', the interviewees perceived the offer as part of a societal view on prenatal screening that they could not support. CONCLUSION The findings show that these interviewees' reasons of declining an extended information visit are multidimensional and influenced by different views, from both an individual perspective and a more societal one. Health care professionals should be aware that some persons could have a different view on health care services and could be reluctant to accept offered services.
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Affiliation(s)
- Inger Wätterbjörk
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Sahlberg-Blom
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kerstin Nilsson
- School of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Azerkan F, Widmark C, Sparén P, Weiderpass E, Tillgren P, Faxelid E. When Life Got in the Way: How Danish and Norwegian Immigrant Women in Sweden Reason about Cervical Screening and Why They Postpone Attendance. PLoS One 2015; 10:e0107624. [PMID: 26158449 PMCID: PMC4497727 DOI: 10.1371/journal.pone.0107624] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 08/20/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Danish and Norwegian immigrant women in Sweden have an increased risk of cervical cancer compared to Swedish-born women. In addition, Danish and Norwegian immigrant women follow the national recommendations for attendance at cervical screening to much lesser extent than Swedish-born women. The aim of this study was to explore how Danish and Norwegian immigrant women in Sweden reason about attending cervical screening, focusing on women’s perceptions as to why they and their compatriots do not attend. Methods Eight focus group discussions (FGDs) were conducted with Danish and Norwegian immigrant women living in Stockholm. The women were between 26 and 66 years of age at the time of the FGDs, and were aged between <1 and 48 years old when they immigrated to Sweden. A FGD guide was used, which included questions related to cervical screening, and obstacles and motivators to attend cervical screening. The FGDs were tape recorded and transcribed, and the results analysed according to the principles of qualitative content analysis. Results The main theme was “Women have a comprehensive rationale for postponing cervical screening, yet do not view themselves as non-attenders”. Investigation of women’s rationale for non-attendance after being invited to cervical screening revealed some complex reasons related to immigration itself, including competing needs, organisational and structural factors and differences in mentality, but also reasons stemming from other factors. Postponing attendance at cervical screening was the category that linked all these factors as the reasons to why women did not attend to cervical screening according to the recommendations of the authorities. Conclusions The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend.
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Affiliation(s)
- Fatima Azerkan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Catarina Widmark
- Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Samfundet Folkhälsan, Helsinki, Finland
| | - Per Tillgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Public
Health Sciences, Global Health (IHCAR) Karolinska Institutet, Stockholm, Sweden
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Östensson E, Alder S, Elfström KM, Sundström K, Zethraeus N, Arbyn M, Andersson S. Barriers to and facilitators of compliance with clinic-based cervical cancer screening: population-based cohort study of women aged 23-60 years. PLoS One 2015; 10:e0128270. [PMID: 26011051 PMCID: PMC4444356 DOI: 10.1371/journal.pone.0128270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/23/2015] [Indexed: 11/22/2022] Open
Abstract
Objective This study aims to identify possible barriers to and facilitators of cervical cancer screening by (a) estimating time and travel costs and other direct non-medical costs incurred in attending clinic-based cervical cancer screening, (b) investigating screening compliance and reasons for noncompliance, (c) determining women’s knowledge of human papillomavirus (HPV), its relationship to cervical cancer, and HPV and cervical cancer prevention, and (d) investigating correlates of HPV knowledge and screening compliance. Materials and Methods 1510 women attending the clinic-based cervical cancer screening program in Stockholm, Sweden were included. Data on sociodemographic characteristics, time and travel costs and other direct non-medical costs incurred in attending (e.g., indirect cost of time needed for the screening visit, transportation costs, child care costs, etc.), mode(s) of travel, time, distance, companion’s attendance, HPV knowledge, and screening compliance were obtained via self-administered questionnaire. Results Few respondents had low socioeconomic status. Mean total time and travel costs and direct non-medical cost per attendance, including companion (if any) were €55.6. Over half (53%) of the respondents took time off work to attend screening (mean time 147 minutes). A large portion (44%) of the respondents were noncompliant (i.e., did not attend screening within 1 year of the initial invitation), 51% of whom stated difficulties in taking time off work. 64% of all respondents knew that HPV vaccination was available; only 34% knew it was important to continue to attend screening following vaccination. Age, education, and income were the most important correlates of HPV knowledge and compliance; and additional factors associated with compliance were time off work, accompanying companion and HPV knowledge. Conclusion Time and travel costs and other direct non-medical costs for clinic-based screening can be considerable, may affect the cost-effectiveness of a screening program, and may constitute barriers to screening while HPV knowledge may facilitate compliance with screening.
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Affiliation(s)
- Ellinor Östensson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Susanna Alder
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, Karolinska Institutet, Stockholm, Sweden
| | - K. Miriam Elfström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Zethraeus
- Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Marc Arbyn
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J Wytsmanstreet 14, B1050, Brussels, Belgium
| | - Sonia Andersson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, Karolinska Institutet, Stockholm, Sweden
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FitzGerald SM, Savage EB, Hegarty JM. The Human Papillomavirus: Men's Attitudes and Beliefs Toward the HPV Vaccination and Condom Use in Cancer Prevention. JOURNAL OF MEN'S HEALTH 2014. [DOI: 10.1089/jomh.2014.0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Olsson E, Lau M, Lifvergren S, Chakhunashvili A. Community collaboration to increase foreign-born women's participation in a cervical cancer screening program in Sweden: a quality improvement project. Int J Equity Health 2014; 13:62. [PMID: 25106490 PMCID: PMC4422324 DOI: 10.1186/s12939-014-0062-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The prevailing inequities in healthcare have been well addressed in previous research, especially screening program participation, but less attention has been paid to how to overcome these inequities. This paper explores a key factor of a successful improvement project: collaboration with local doulas to raise cervical cancer screening participation by more than 40 percent in an area with a large number of foreign-born residents. METHODS Data was collected through two focus group discussions with the doulas in order to design interventions and debrief after interventions had been carried out in the community. Various tools were used to analyze the verbal data and monitor the progress of the project. RESULTS Three major themes emerged from the focus group discussions: barriers that prevent women from participating in the cervical cancer screening program, interventions to increase participation, and the role of the doulas in the interventions. CONCLUSIONS This paper suggests that several barriers make participation in cervical cancer screening program more difficult for foreign-born women in Sweden. Specifically, these barriers include lack of knowledge concerning cancer and the importance of preventive healthcare services and practical obstacles such as unavailable child care and language skills. The overarching approach to surmount these barriers was to engage persons with a shared cultural background and mother tongue as the target audience to verbally communicate information. The doulas who helped to identify barriers and plan and execute interventions gained increased confidence and a sense of pride in assisting to bridge the gap between healthcare providers and users.
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Affiliation(s)
- Erik Olsson
- Centre for Equity in Health/Kunskapscentrum för Jämlik Vård, Western Region of Sweden/Västra Götalandsregionen, Regionens Hus, SE-405 44, Göteborg, Sweden. .,Centre for Healthcare Improvement and Division of Quality Sciences, Chalmers University of Technology, SE-412 96, Göteborg, Sweden.
| | - Malena Lau
- Angered Local Hospital/Angereds Närsjukhus, Box 63, SE-424 22, Angered, Sweden.
| | - Svante Lifvergren
- Centre for Healthcare Improvement and Division of Quality Sciences, Chalmers University of Technology, SE-412 96, Göteborg, Sweden.
| | - Alexander Chakhunashvili
- Centre for Healthcare Improvement and Division of Quality Sciences, Chalmers University of Technology, SE-412 96, Göteborg, Sweden.
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O'Connor M, Murphy J, Martin C, O'Leary J, Sharp L. Motivators for women to attend cervical screening: the influential role of GPs. Fam Pract 2014; 31:475-82. [PMID: 24927724 DOI: 10.1093/fampra/cmu029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Participation in organized cervical cancer screening has declined recently. While research has focussed on barriers to screening participation, less attention has been paid to what motivates women to attend. Moreover, little is known about health care provider/practitioner-level barriers and facilitators to participation. Better understanding of these issues could help inform strategies to improve participation. OBJECTIVES To explore the role of GPs in influencing women's cervical screening behaviours and investigate other motivators for women to attend for a cervical smear. METHODS Ten focus groups were conducted in Ireland, shortly before the launch of a national cervical screening programme. Discussions were audio-recorded, transcribed verbatim and transcripts were analysed thematically. RESULTS GPs greatly influence women's screening behaviours and can have a positive or negative impact on women's participation in screening. Four major subthemes emerged in relation to this: the attitude of the GP; prompting by the GP; trust in the GP and women's relationships with their GP. Two main motivators to screening participation were identified: personal reasons/benefits (e.g. potential of smears to be life-saving); and practical issues/convenience. Women's also expressed desires for what they would like to see incorporated in the national screening programme (e.g. an 'out-of-hours' service). CONCLUSION GPs can impact positively and negatively on women's cervical screening participation. Providing on-going support to GPs around their cervical screening practices is essential to maximize screening attendance. Targeted information materials that focus on the personal reasons and benefits of having smear tests could help stimulate women to participate.
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Affiliation(s)
- Mairead O'Connor
- National Cancer Registry, Building 6800, Cork Airport Business Park, Kinsale Road, Cork and
| | - Judith Murphy
- National Cancer Registry, Building 6800, Cork Airport Business Park, Kinsale Road, Cork and
| | - Cara Martin
- Coombe Women and Infants University Hospital, Dolphin's Barn, Dublin 8, Ireland
| | - John O'Leary
- Coombe Women and Infants University Hospital, Dolphin's Barn, Dublin 8, Ireland
| | - Linda Sharp
- National Cancer Registry, Building 6800, Cork Airport Business Park, Kinsale Road, Cork and
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Teng FF, Mitchell SM, Sekikubo M, Biryabarema C, Byamugisha JK, Steinberg M, Money DM, Ogilvie GS. Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda. BMJ Open 2014; 4:e004783. [PMID: 24727360 PMCID: PMC3987737 DOI: 10.1136/bmjopen-2014-004783] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To define embarrassment and develop an understanding of the role of embarrassment in relation to cervical cancer screening and self-collected human papillomavirus (HPV) DNA testing in Uganda. DESIGN Cross-sectional, qualitative study using semistructured one-to-one interviews and focus groups. PARTICIPANTS 6 key-informant health workers and 16 local women, purposively sampled. Key informant inclusion criteria: Ugandan members of the project team. Focus group inclusion criteria: woman age 30-69 years, Luganda or Swahili speaking, living or working in the target Ugandan community. EXCLUSION CRITERIA unwillingness to sign informed consent. SETTING Primary and tertiary low-resource setting in Kampala, Uganda. RESULTS In Luganda, embarrassment relating to cervical cancer is described in two forms. 'Community embarrassment' describes discomfort based on how a person may be perceived by others. 'Personal embarrassment' relates to shyness or discomfort with her own genitalia. Community embarrassment was described in themes relating to place of study recruitment, amount of privacy in dwellings, personal relationship with health workers, handling of the vaginal swab and misunderstanding of HPV self-collection as HIV testing. Themes of personal embarrassment related to lack of knowledge, age and novelty of the self-collection swab. Overall, embarrassment was a barrier to screening at the outset and diminished over time through education and knowledge. Fatalism regarding cervical cancer diagnosis, worry about results and stigma associated with a cervical cancer diagnosis were other psychosocial barriers described. Overcoming psychosocial barriers to screening can include peer-to-peer education, drama and media campaigns. CONCLUSIONS Embarrassment and other psychosocial barriers may play a large role at the onset of a screening programme, but over time as education and knowledge increase, and the social norms around screening evolve, its role diminishes. The role of peer-to-peer education and community authorities on healthcare cannot be overlooked and can have a major impact in overcoming psychosocial and social barriers to screening.
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Affiliation(s)
- Flora F Teng
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheona M Mitchell
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Musa Sekikubo
- Department of Obstetrics and Gynecology, Makerere University/Mulago, National Referral Hospital, Kampala, Uganda
| | - Christine Biryabarema
- Department of Obstetrics and Gynecology, Makerere University/Mulago, National Referral Hospital, Kampala, Uganda
| | - Josaphat K Byamugisha
- Department of Obstetrics and Gynecology, Makerere University/Mulago, National Referral Hospital, Kampala, Uganda
| | - Malcolm Steinberg
- British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Deborah M Money
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia's Women's Hospital, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Gina S Ogilvie
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
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Fabrizio CS, Shea CM. Disseminating a cervical cancer screening program through primary physicians in Hong Kong: a qualitative study. BMC Health Serv Res 2014; 14:85. [PMID: 24568606 PMCID: PMC3975957 DOI: 10.1186/1472-6963-14-85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 02/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organized screening programs are more effective and equitable than opportunistic screening, yet governments face challenges to implement evidence-based programs. The objective of this study was to identify reasons for low levels of adoption among primary care physicians of a government sponsored Cervical Screening Program (CSP). METHODS We conducted in-depth interviews with a snowball sample of primary care private and public primary care physicians in Hong Kong. Rogers' theory of diffusion of innovation was used to understand the factors that influenced the physicians' practice decisions. RESULTS Our study found that Hong Kong physicians made the decision to encourage cervical screening and to participate in the CSP based primarily upon their clinical and business practice needs rather than upon the scientific evidence. The low rates of adoption of the CSP can be attributed to the physicians' perceptions that the program's complexity and incompatibility exceeded its relative advantages. Furthermore, women's knowledge, attitudes and practices, identified as barriers by physicians, were also barriers to physicians adopting the CSP. CONCLUSIONS In both private and public health care systems, screening programs that rely on physicians must align program incentives with the physicians' motivators or pursue additional demand creation policies to achieve objectives.
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Affiliation(s)
- Cecilia S Fabrizio
- School of Public Health, University of Hong Kong, 5th Floor, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China.
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A questionnaire assessing women's care needs related to gynaecological cancer screening: development of the GCSCNS. Eur J Obstet Gynecol Reprod Biol 2013; 170:235-40. [DOI: 10.1016/j.ejogrb.2013.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/05/2013] [Accepted: 06/20/2013] [Indexed: 11/22/2022]
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Demirtas B. Review of strategies in promoting attendance for cervical screening. Asian Pac J Cancer Prev 2013; 14:3263-7. [PMID: 23803113 DOI: 10.7314/apjcp.2013.14.5.3263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of cervical screening has been addressed in numerous studies. However, reviews conducted to explore of strategies to promoting attendance for cervical screening have been limited. This study aimed to explore strategies to promote attendance for cervical screening. MATERIALS AND METHODS A literature search from databases (1994-2011) was undertaken to include papers that identified strategies related to the cervical screening. RESULTS Twenty-four papers were included in this review. The review of existing strategies identified valuable information on cervical screening and areas that could be improved in meeting womens' needs. CONCLUSIONS The review highlighted important aspects of cervical screening that could be further addressed by promoting strategies to attendance. Assessing women's health beliefs, inpatient cervical cancer screening, nurse-led screening, and cognition-emotion focused programs are among the strategies to promote attendance for pap smear testing.
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Affiliation(s)
- Basak Demirtas
- Nursing Department, Faculty of Health Sciences, Ankara University, Ankara, Turkey.
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Arvidsson B, Bodin L, Rask E, Schvarcz E, Möller M. Reference data for bone mineral density in Swedish women using digital x-ray radiometry. J Clin Densitom 2013; 16:183-8. [PMID: 22704219 DOI: 10.1016/j.jocd.2012.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/01/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
During the last decade, digital X-ray radiometry (DXR) has been used to measure bone mineral density (BMD) in the metacarpal bones. The aim of this study was to establish Swedish reference material for bone mass in women, measured in the metacarpal bones with DXR, and compare these data with the data from the manufacturer. A sample of 1440 women aged 20-79yr living in Örebro County was randomly assigned from the population register. Microdose mammography was used (Sectra MDM L30; Sectra Imtec AB, Linköping, Sweden) to measure BMD. Cole's LMS method was used to calculate DXR. Six hundred sixty-nine (48.3%) women participated. Peak bone mass occurred at the age of 43.4yr with a BMD of 0.597g/cm(2) (standard deviation: 0.050). Our Swedish data correlated well with the manufacturer's material. Only among women aged 50-59yr did BMD differ, where the Swedish sample had lower values. The LMS method can be used to describe the DXR data and provide a more detailed picture of bone density distribution. DXR-BMD in Swedish women aged 20-79yr is equivalent to findings from other studies, showing the same distribution of BMD in most age groups except for ages 50-59yr.
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Affiliation(s)
- Bo Arvidsson
- Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden.
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Broberg G, Jonasson JM, Ellis J, Gyrd-Hansen D, Anjemark B, Glantz A, Söderberg L, Ryd ML, Holtenman M, Milsom I, Strander B. Increasing participation in cervical cancer screening: Telephone contact with long-term non-attendees in Sweden. Results from RACOMIP, a randomized controlled trial. Int J Cancer 2013; 133:164-71. [DOI: 10.1002/ijc.27985] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/12/2012] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Joy Ellis
- Department of Obstetrics and Gynecology; Institute of Clinical Science; Sahlgrenska Academy at University of Gothenburg; Sweden
| | | | | | - Anna Glantz
- Department of Obstetrics and Gynecology; Institute of Clinical Science; Sahlgrenska Academy at University of Gothenburg; Sweden
| | | | - Mare-Liis Ryd
- Regional Cancer Centre; Western Health Care Region; Gothenburg; Sweden
| | - Mikael Holtenman
- Regional Cancer Centre; Western Health Care Region; Gothenburg; Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology; Institute of Clinical Science; Sahlgrenska Academy at University of Gothenburg; Sweden
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Andrae B, Andersson TML, Lambert PC, Kemetli L, Silfverdal L, Strander B, Ryd W, Dillner J, Törnberg S, Sparén P. Screening and cervical cancer cure: population based cohort study. BMJ 2012; 344:e900. [PMID: 22381677 PMCID: PMC3291751 DOI: 10.1136/bmj.e900] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death. DESIGN Nationwide population based cohort study. SETTING Sweden. PARTICIPANTS All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years. MAIN OUTCOME MEASURES Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age, histopathological type, and FIGO (International Federation of Gynecology and Obstetrics) stage. RESULTS In the screening ages, the cure proportion for women with screen detected invasive cancer was 92% (95% confidence interval 75% to 98%) and for symptomatic women was 66% (62% to 70%), a statistically significant difference in cure of 26% (16% to 36%). Among symptomatic women, the cure proportion was significantly higher for those who had been screened according to recommendations (interval cancers) than among those overdue for screening: difference in cure 14% (95% confidence interval 6% to 23%). Cure proportions were similar for all histopathological types except small cell carcinomas and were closely related to FIGO stage. A significantly higher cure proportion for screen detected cancers remained after adjustment for stage at diagnosis (difference 15%, 7% to 22%). CONCLUSIONS Screening is associated with improved cure of cervical cancer. Confounding cannot be ruled out, but the effect was not attributable to lead time bias and was larger than what is reflected by down-staging. Evaluations of screening programmes should consider the assessment of cure proportions.
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Affiliation(s)
- Bengt Andrae
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, S-80188 Gävle, Sweden.
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After-effects reported by women having follow-up cervical cytology tests in primary care: a cohort study within the TOMBOLA trial. Br J Gen Pract 2011; 61:e333-9. [PMID: 21801512 DOI: 10.3399/bjgp11x578007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although it is recognised that some women experience pain or bleeding during a cervical cytology test, few studies have quantified physical after-effects of these tests. AIM To investigate the frequency, severity, and duration of after-effects in women undergoing follow-up cervical cytology tests, and to identify subgroups with higher frequencies in Grampian, Tayside, and Nottingham. DESIGN Cohort study nested with a multi-centre individually randomised controlled trial. METHOD The cohort included 1120 women, aged 20-59 years, with low-grade abnormal cervical cytology who completed a baseline sociodemographic questionnaire and had a follow-up cervical cytology test in primary care 6 months later. Six weeks after this test, women completed a postal questionnaire on pain, bleeding, and discharge experienced after the test, including duration and severity. The adjusted prevalence of each after-effect was computed using logistic regression. RESULTS A total of 884 women (79%) completed the after-effects questionnaire; 30% of women experienced one or more after-effect: 15% reported pain, 16% bleeding, and 7% discharge. The duration of discharge was ≤2 days for 66%, 3-6 days for 22%, and ≥7 days for 11% of women. Pain or bleeding lasted ≤2 days in more than 80% of women. Severe after-effects were reported by <1% of women. The prevalence of pain decreased with increasing age. Bleeding was more frequent among nulliparous women. Discharge was more common among oral contraceptive users. CONCLUSION Pain, bleeding, and discharge are not uncommon in women having follow-up cervical cytology tests. Informing women about possible after-effects could better prepare them and provide reassurance, thereby minimising potential non-adherence with follow-up or non-participation with screening in the future.
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Chinese-Australian Women’s Knowledge, Facilitators and Barriers Related to Cervical Cancer Screening: A Qualitative Study. J Immigr Minor Health 2011; 13:1076-83. [DOI: 10.1007/s10903-011-9491-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Matejic B, Vukovic D, Pekmezovic T, Kesic V, Markovic M. Determinants of preventive health behavior in relation to cervical cancer screening among the female population of Belgrade. HEALTH EDUCATION RESEARCH 2011; 26:201-211. [PMID: 21273186 DOI: 10.1093/her/cyq081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Identifying the factors that deter or stimulate the women to participate in screening activities is very important in order to design effective education and motivation strategies, particularly in the countries without an organized system. The study employed a case-control design. The participants were recruited in four primary health care institutions in Belgrade over a month. The study group comprised all women aged 18-70 years, who demonstrated an initiative for a PAP- smear. The controls were women with no Pap smears within the last 4 years, matched by age (±2 years), education and marital status with the study group participants. The study instrument was the 62-item self-administered questionnaire. According to multivariate analysis, adherence to cervical cancer screening practices is significantly related to better financial status [odds ratio (OR) = 10.8, P = 0.001], no gender preference for a gynecologist (OR = 3.1, P = 0.015), consultations with a gynecologist (OR = 4.7, P = 0.029), conversation with the women with cervical cancer about that disease (OR = 2.8, P = 0.029) and higher media exposure to information about cervical cancer prevention (OR = 5.0, P = 0.004). Open communication, social networks and improving social-economic status of women in our society are the most prominent factors, most of which are mainly outside the health services' domain and require multisectoral collaboration to improve women's reproductive health.
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Affiliation(s)
- Bojana Matejic
- Institute of social medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Moss EL, Askew S, Jones PW, Redman CWE, Pearmain P. Implementing the national invasive cervical cancer audit: correlation between local and regional classification. J Med Screen 2011; 17:190-4. [PMID: 21258129 DOI: 10.1258/jms.2010.010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the accuracy of information recorded regionally and locally on the screening classification of cervical cancer cases using the national invasive cervical cancer audit categories. METHODS Comparison of the audit categorization of all cervical cancer cases diagnosed at the University Hospital of North Staffordshire (UHNS) between January 2003 and December 2006 with the classification assigned by the West Midlands Cervical Screening Quality Assurance Reference Centre (WMQARC). RESULTS Eighty-seven cases of cervical cancer were diagnosed during the three-year study period. There was agreement between the UHNS and WMQARC classification of cases in 52 cases (59.7%), moderate agreement κ = 0.51 (95% CI 0.39-0.63). The greatest disparity was seen in the classification of lapsed attenders, with nine of the 26 cases categorized as 'lapsed' by the UHNS being assigned to the 'lost to follow-up' category by WMQARC. Three cases were deemed unclassifiable by WMQARC using the national classification since the women were over the age of 70 years but had previously been enrolled in the screening programme, and currently there is no national category for these women. CONCLUSIONS Accurate and consistent classification of invasive cervical cancer cases is essential in order to obtain useful information on the efficiency of the national screening programme at a local, regional and national level. The use of a national algorithm would provide reassurance that all data used in the national evaluation of the NHS Cervical Screening Programme are consistent, meaning that robust conclusions could then be drawn from the data.
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Affiliation(s)
- E L Moss
- University Hospital of North Staffordshire, Stoke on Trent, UK
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Vacher-Lavenu MC. Dépistage du cancer du col utérin : actualités en 2010. Ann Pathol 2010; 30:28-31. [DOI: 10.1016/j.annpat.2010.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 07/28/2010] [Indexed: 11/26/2022]
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Warman J. Cervical cancer screening in young women: saving lives with prevention and detection. Oncol Nurs Forum 2010; 37:33-8. [PMID: 20044338 DOI: 10.1188/10.onf.33-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jessica Warman
- School of Nursing, University of California, Los Angeles, USA.
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Waller J, Bartoszek M, Marlow L, Wardle J. Barriers to cervical cancer screening attendance in England: a population-based survey. J Med Screen 2009; 16:199-204. [DOI: 10.1258/jms.2009.009073] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To explore barriers to cervical screening attendance in a population-based sample, and to compare barriers endorsed by women who were up-to-date with screening versus those who were overdue. We also tested the hypothesis that women who were overdue for screening would be more generally disillusioned with public services, as indexed by reported voting behaviour in elections. Setting A population-based survey of women in England. Methods Face-to-face interviews were carried out with 580 women aged 26–64 years, and recruited using stratified random probability sampling as part of an omnibus survey. Questions assessed self-reported cervical screening attendance, barriers to screening, voting behaviour and demographic characteristics. Results Eighty-five per cent of women were up-to-date with screening and 15% were overdue, including 2.6% who had never had a smear test. The most commonly endorsed barriers were embarrassment (29%), intending to go but not getting round to it (21%), fear of pain (14%) and worry about what the test might find (12%). Only four barriers showed significant independent associations with screening status: difficulty making an appointment, not getting round to going, not being sexually active and not trusting the test. We found support for our hypothesis that women who do not attend for screening are less likely to vote in elections, even when controlling for barrier endorsement and demographic factors. Conclusions Practical barriers were more predictive of screening uptake than emotional factors such as embarrassment. This has clear implications for service provision and future interventions to increase uptake. The association between voting behaviour and screening uptake lends support to the hypothesis that falling screening coverage may be indicative of a broader phenomenon of disillusionment, and further research in this area is warranted.
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Affiliation(s)
- Jo Waller
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
| | - Marta Bartoszek
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
| | - Laura Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
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Kwon YD, You CH, Oh EH, Kang S. Demographic and socioeconomic determinants of the use of periodic health examinations: public vs. private sector. TOHOKU J EXP MED 2009; 219:223-30. [PMID: 19851051 DOI: 10.1620/tjem.219.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Periodic health examinations (PHEs) are prevalent in Korea. While some people frequently use public PHEs, others use private PHEs with high fees. This study examined the determinants of the use of public and private PHEs using a multinomial logit model. We used the data from the Korean Longitudinal Study of Aging (KLoSA) Wave I conducted in 2006. The KLoSA was a national longitudinal study of a representative sample of individuals (n = 10,253) aged 45 years or older. The mean age of the sample was 61.6 years; 77.8% of subjects were married and 37.5% had at least a high school education. The most frequent type of PHE usage was public PHEs only (38.9%), followed by private PHEs only (7.3%) and both public and private PHEs (6.5%). This study found that subjects who lived in rural areas or who were employed were significantly more likely to use public PHEs because of many public health facilities in rural area and mandatory public PHEs for employees. Those who used private PHEs only were educated, wealthy, or unhealthy, because private PHEs required out-of-pocket payments and provided higher quality services. Those who used both types of PHE had a high socio-economic status or a bad health status. The authors suggest that policy makers pay attention to the use of public PHEs among populations with lower socio-economic status. As for the group of subjects who use both types of PHE, their overutilization of PHEs must be reduced through cooperation between the public and private PHEs.
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Affiliation(s)
- Young Dae Kwon
- Department of Medical Humanities and Social Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ackerson K, Preston SD. A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. J Adv Nurs 2009; 65:1130-40. [DOI: 10.1111/j.1365-2648.2009.04981.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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