Beliefs and attitudes as determinants of cervical cancer screening: a community-based study in Singapore

Socio-cultural and financial issues against breast cancer screening behaviour among eligible Indian women: evidence for action

PURPOSE

Breast cancer, a common malignancy in Indian women, is preventable and curable upon early diagnosis. Screening is the best control strategy against breast cancer, but its uptake is low in India despite dedicated strategies and programmes. We explored the impact of socio-cultural and financial issues on the uptake of breast cancer screening behaviour among Indian women.

METHODS

Breast cancer screening-uptake and relevant social, cultural, and financial data obtained from the National Family Health Survey (NFHS) round 5 were used for analysis. We studied 399,039 eligible females to assess their breast cancer screening behavior and determine the impact of socio-cultural and financial issues on such behavior using multivariable logistic regression.

RESULTS

Most participants were 30-34-year-old (27.8%), educated to the secondary level (38.0%), and 81.5% had bank accounts. A third (35.0%) had health insurance, and anaemia was the most common comorbidity (56.1%). Less than 1.0% had undergone breast cancer screening. Higher age, education, urban residence, employment, less privileged social class, and access to the Internet and mass media were predictors of positive screening-uptake behavior (p < 0.05). Mothers of larger number of children, tobacco- and alcohol-users, the richer and having health insurance had negative uptake behavior (p < 0.05).

CONCLUSION

A clear impact of socio-cultural and financial factors on breast cancer screening behavior is evident among Indian women. Therefore, apart from the ongoing health system strengthening efforts, our findings call for targeted interventions against prevailing misconceptions and taboos along with economic and social empowerment of women for the holistic success of India's cancer screening strategy.

Cancer Screening Knowledge and Behavior in a Multi-Ethnic Asian Population: The Singapore Community Health Study

Background

Cancer has become the leading cause of mortality in Singapore and among other Asian populations worldwide. Despite the presence of National Cancer Screening programmes in Singapore, less than half of the population has had timely screening according to guidelines. The underlying factors of poor cancer screening rates and health outcomes among Asian ethnic groups remain poorly understood. We therefore examined cancer screening participation rates and screening behavior in a multi-ethnic Singapore population.

Methods

We collected data from 7,125 respondents of the 2015–2016 Singapore Community Health Study. Factors associated with cervical, breast, and colorectal cancer screening were evaluated using modified Poisson regression. Adjusted prevalence ratios were computed with 95% confidence intervals after adjusting for confounders.

Results

The mean age of the respondents was 57.7 ± 10.9 years; 58.9% were female and were predominately Chinese (73.0%), followed by Malay (14.2%), and Indian (10.9%). Less than half of the respondents in the recommended age groups had undergone cancer screening (cervical, 43%; breast, 35.1%; colorectal, 27.3%). Malay respondents were significantly less likely to screen as recommended for cervical (aPR = 0.75, CI = 0.65–0.86, p < 0.001), breast (aPR = 0.83, CI = 0.68–0.99, p = 0.045), and colorectal cancer (aPR = 0.55, CI = 0.44–0.68, p < 0.001), as compared to Chinese respondents. Respondents who had obtained lower secondary level education were 42% more likely to screen for cervical cancer (aPR = 1.42, CI = 1.23–1.64, p < 0.001), and 22% more likely to screen for breast cancer (aPR = 1.22, CI = 1.02–1.46, p = 0.032), compared to those with primary level education and below. Respondents with a household income ≥S$10,000/month were 71% more likely to screen for breast cancer (aPR = 1.71, CI = 1.37–2.13, p < 0.001), as compared with <$2,000/month.

Conclusions

Ethnicity and socio-economic status were significantly associated with lower uptake of cancer screening tests in Singapore. To improve the screening uptake among disadvantaged groups, a multi-faceted approach is needed that addresses the barriers to screening such as the adequacy of subsidy schemes and ethnic differences.

Barriers to and Facilitators of Cervical Cancer Screening among Women in Southeast Asia: A Systematic Review

In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection and treatment. Existing reviews on CCS have limited insights into the barriers and facilitators for SEA. Hence, this study aims to identify key barriers and facilitators among women living in SEA. A systematic literature review was conducted on Pubmed, Embase, PsycINFO, CINAHL, and SCOPUS. Primary qualitative and quantitative studies published in English that reported barriers and facilitators to CCS were included. The Mix Methods Appraisal Tool was used for the quality assessment of the included studies. Among the 93 included studies, pap smears (73.1%) were the most common screening modality. A majority of the studies were from Malaysia (35.5%). No studies were from Timor-Leste and the Philippines. The most common barriers were embarrassment (number of articles, n = 33), time constraints (n = 27), and poor knowledge of screening (n = 27). The most common facilitators were related to age (n = 21), receiving advice from healthcare workers (n = 17), and education status (n = 11). Findings from this review may inform health policy makers in developing effective cervical cancer screening programs in SEA countries.

Knowledge, attitude, and practice regarding the screening of cervical cancer among women in New Delhi, India

Objective:

Cervical cancer is one of the major concerns of public health importance in today's world. It is a leading cause of mortality in women of reproductive age group worldwide, mainly in developing countries. Reduction in mortality and morbidity due to cervical cancer is possible through early detection and treatment. The major factors influencing the early detection of cervical cancer are knowledge regarding risk factors, screening, Pap smear, and symptoms among women.

Materials and Methods:

The present cross-sectional study was carried out to assess the knowledge, attitude, and practice of women about the risk factors, symptoms, and prevention of cervical cancer. Data were obtained from 220 women who visited international trade fair using a pretested self-administered questionnaire.

Results:

Only 75 study women (50.0%) had ever heard of cervical cancer. The knowledge regarding cervical cancer and its various domains was significantly higher in students and unmarried women. The foul-smelling vaginal discharge was the most common early symptom of cervical cancer according to most of the study women (26, 17.3%). Most of the study women (19, 12.7%) reported tobacco and smoking as the most common risk factor associated with cervical cancer. Only 39 women (26%) had ever heard of cervical cancer screening. Only 27 women (18.0%) ever had Pap smear done in the past and 87 women (58.0%) were willing to undergo cervical cancer screening is offered free of cost.

Conclusion:

The study demonstrates the lack of awareness in women regarding cervical cancer and its screening modalities. This necessitates spreading awareness regarding early symptoms and risk factors associated with cervical cancer for early detection and treatment initiation.

Factors affecting Pap smear uptake in a maternity hospital: A descriptive cross-sectional study

AIM

To understand factors that influence women's decisions to go for Pap smears.

BACKGROUND

Globally, cervical cancer is the fourth most common cancer among women. In Singapore, cervical cancer is on the rise and has been found to be the eighth highest cause of death among women. Research has shown that regular screening for cervical cancer with Pap smear reduces cervical cancer-related mortality. However, Pap smear awareness is still limited and its uptake in Singapore is highly opportunistic, requiring the need for a deeper understanding of the factors that influence Pap smear uptake among women in Singapore.

DESIGN

A descriptive cross-sectional study design was used.

METHODS

Convenience sampling was used to recruit 350 participants (postnatal women of at least 21 years old) from a local maternity hospital. Data were collected using validated questionnaires. Logistic regression was used to analyse the data.

RESULTS

Demographic factors, such as age, ethnicity and religion, as well as women's beliefs about the effectiveness of Pap smear in detecting cervical cancer, the desire to discover health problems early and considering Pap smear to be painful, were found to be factors significantly influencing Pap smear uptake. Healthcare professionals need to be mindful of these factors to address women's needs to encourage women to go for Pap smears.

CONCLUSION

Various factors were found to influence Pap smear uptake. Future interventions can take these factors into account for increasing Pap smear awareness.

Mujer Sana, Familia Fuerte: The Effects of a Culturally-Relevant, Community-Based, <i>Promotores</i> Program to Increase Cervical Cancer Screening among Latinas

OBJECTIVE

Although cervical cancer can be prevented through screening and follow-up, Latinas' rate of Pap tests remains low due to knowledge gaps and cultural and attitudinal factors.

METHODS

This study used a single-group pre-/post-test design to evaluate the effectiveness of Mujer Sana, Familia Fuerte (Healthy Woman, Strong Family), an intervention intended to improve Latinas' cervical cancer prevention knowledge, attitudes, self-efficacy to obtain a Pap test, and intention to get tested. The intervention is delivered through a single session by promotores de salud, who use a culturally competent, linguistically appropriate toolkit. A total of 5,211 Latinas participated in the study.

RESULTS

The evaluation indicated that participants had increases in knowledge, positive attitudes, self-efficacy, and intention to test.

CONCLUSION

Latinas have a low rate of cervical cancer screening but a high rate of cervical cancer, and Mujer Sana, Familia Fuerte shows promise as a public health practice for use with this population.

Knowledge and attitude of women attending Subharti Medical College towards Pap smear

The aim of this prospective study was to assess the knowledge and attitude of women towards the Pap smear. It was carried out on the women coming to the Department of Obstetrics and Gynaecology at our University, with the help of a pre-formed questionnaire. We found that only 33% of the women were aware of the Pap smear, and of these hardly (10%) had the correct information. Sixty-five percent of the women said that they would have gotten the Pap smear done, if they had known about it earlier. Unless this knowledge amongst women is improved and their attitude is changed, the indices of cervical cancer cannot be improved. Impact statement What is already known on this subject? A Pap smear is used as a screening test to detect not only early stages of cervical cancer but also the precancerous conditions. A Pap smear is done every three years for routine screening, or every five years along with an HPV DNA test. What do the results of this study add? Despite the efforts from the medical fraternity and governments, the number of women undergoing this test in Uttar Pradesh is very minimal. This study analysed the knowledge and attitude of women towards the Pap smear. What are the implications of these findings for clinical practice and/or further research? The results have brought into light the many factors hindering an effective cervical cancer screening in India. Further actions need to be directed in the direction to address these issues.

Compliance with Breast and Cervical Cancer Screening Programs in Women: Results from a Population-Based Study

Aims and background

Women's adherence to mammography and PAP test screening guidelines is a fundamental topic regarding women's health. The aim of the study was to evaluate the knowledge and compliance to breast and cervical cancer screening programs in women living in three Italian towns, where a public screening program, consisting of free mammography every two years and free PAP test every three years, is ongoing.

Methods

An anonymous survey was mailed to a random sample of women. Eight 120-min focus discussions with groups of women exploring perceptions, knowledge and practices were carried out after analysis of the returned surveys.

Results

Replies were received from 1345 women (response rate, 27%). Almost every woman knew of the screening program, but women's practice of mammography was age-dependent: up to 72% of the women performed it before the age of 50. Conversely, the age of the first PAP test was rather late: up to 70% of the women performed it at over 30 years of age. Women with a lower educational level reported being screened less than those with a higher level. During the group discussions, women's perceptions, knowledge and beliefs regarding cancer and screening, together with aspects of the health care system, appeared to strongly influence the preventive practices. Many women deplored being infrequently instructed by health professionals.

Conclusions

Despite the limitations of the study due to the low response rate, we believe that health professionals should invest on encouraging factors and reduce the deterring factors to optimize screening practices.

Cultural Effects on Cancer Prevention Behaviors: Fatalistic Cancer Beliefs and Risk Optimism Among Asians in Singapore

Although culture is acknowledged as an important factor that influences health, little is known about cultural differences pertaining to cancer-related beliefs and prevention behaviors. This study examines two culturally influenced beliefs-fatalistic beliefs about cancer prevention, and optimistic beliefs about cancer risk-to identify reasons for cultural disparity in the engagement of cancer prevention behaviors. We utilized data from national surveys of European Americans in the United States (Health Information National Trends Survey 4, Cycle3; N = 1,139) and Asians in Singapore (N = 1,200) to make cultural comparisons. The odds of an Asian adhering to prevention recommendations were less than half the odds of a European American, with the exception of smoking avoidance. Compared to European Americans, Asians were more optimistic about their cancer risk both in an absolute and a comparative sense, and held stronger fatalistic beliefs about cancer prevention. Mediation analyses revealed that fatalistic beliefs and absolute risk optimism among Asians partially explain their lower engagement in prevention behaviors, whereas comparative risk optimism increases their likelihood of adhering to prevention behaviors. Our findings underscore the need for developing culturally targeted interventions in communicating cancer causes and prevention.

Factors Affecting Uptake of Cervical Cancer Screening among Clinic Attendees in Trelawny, Jamaica

Background

Use of the Pap test has resulted in a decline in cervical cancer mortality in developed countries. Yet, despite established cervical cancer screening programs, a significant portion of Jamaican women are not undergoing screening for cervical cancer. This study was carried out to identify factors that affect Jamaican women's decisions to screen for cervical cancer.

Methods

A population survey was administered to 367 clinic-attending women 25 to 54 years of age in the Parish of Trelawny from May to July of 2005. An interviewer-administered questionnaire assessed the women's knowledge, attitudes, and practices regarding cervical cancer and cervical cancer screening.

Results

Overall, 11% of the women had never had a Pap smear and only 38% had a Pap test within the last year. Annual visits to a health provider have a strong influence on women's decisions to regularly screen for cervical cancer. Provider recommendation also positively affected initial receipt of a Pap smear as well as continued regular screening.

Conclusions

Programs that promote annual health checkups, encourage consistent provider recommendations, and emphasize screening as a preventive measure might positively influence women's decisions to screen for cervical cancer.

Examining the Cervical Screening Behaviour of Women Aged 50 or above and Its Predicting Factors: A Population-Based Survey

Under-screening may increase the risk of cervical cancer in middle-aged women. This study aimed to investigate cervical cancer screening behaviour and its predictors among women aged 50 years or above. A population-based sample of 959 women was recruited by telephone from domestic households in Hong Kong, using random methods, and a structured questionnaire developed to survey participants. Multivariable logistic regressions were performed to examine the factors independently associated with cervical screening behaviour. Nearly half the sample (48%) had never had a cervical smear test. Multivariable analyses showed that age, educational level, marital status, family history of cancer, smoking status, use of complementary therapy, recommendation from health professionals, and believing that regular visits to a doctor or a Chinese herbalist were good for their health were predictors of cervical screening behaviour. Misconceptions concerned with menopause may reduce women's perceived susceptibility to cervical cancer, especially if they are 50 or above, and exert a negative effect on their screening behaviour. Healthcare professionals should actively approach these high-risk groups-older unmarried women, smokers, those less educated and who are generally not much concerned with their health.

Perceptions and Experiences of Human Papillomavirus (HPV) Infection and Testing among Low-Income Mexican Women

BACKGROUND

HPV infection causes cervical cancer, a major contributor to morbidity and mortality among low-income Mexican women. Human papillomavirus (HPV) DNA testing is now a primary screening strategy in Mexico's early cervical cancer detection program (ECDP). Research on Mexican women's perceptions of HPV and testing is necessary for establishing culturally appropriate protocols and educational materials. Here, we explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants.

METHODS

We conducted semi-structured interviews with 24 ECDP participants from two primary care health clinics in Michoacán state, Mexico. Interviews addressed women's understandings of and experiences with HPV and HPV testing. Analysis was inductive and guided by the Health Belief Model with a focus on gender.

RESULTS

Women's confusion about HPV and HPV screening caused emotional distress. They understood HPV to be a serious disease that would always cause severe symptoms, often characterizing it as analogous to HIV or inevitably carcinogenic. Women also attributed it to men's sexual behaviors, specifically infidelity and poor hygiene. Women described both sexes' desire for sex as natural but understood men's negative practices of masculinity, like infidelity, as the causes of women's HPV infection. Some women believed dirty public bathrooms or heredity could also cause HPV transmission.

CONCLUSIONS

These results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of HPV, even among those receiving HPV testing. Our findings also reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to low-income and indigenous-language speaking patients, exacerbate women's negative emotions surrounding HPV testing. While negative emotions did not deter women from seeking testing, they could be ameliorated with better health education and communication.

Young Singaporean women's knowledge of cervical cancer and pap smear screening: a descriptive study

AIMS AND OBJECTIVES

To assess the knowledge of young female Singaporeans regarding cervical cancer and pap smear, the intention to participate in pap smear and whether there is any relationship between knowledge and intention to participate in pap smear screening.

BACKGROUND

While cervical cancer has poor prognosis in the later stages, pap smear is effective in identifying precancerous lesions, which are more treatable. Pap smear screening is available to women in Singapore, but its uptake is opportunistic. Research has shown that knowledge about pap smear and cervical cancer is important determinant of screening behaviour in Singaporean women.

DESIGN

Cross-sectional descriptive correlational design was used.

METHODS

Three hundred and ninety-three young Singaporean undergraduates, aged 18-25 years, were recruited via convenience sampling from a local university over a four-month period. Data were collected through self-administered questionnaires.

RESULTS

Majority of the participants knew the term 'pap smear' and its function. However, knowledge of the risk factors for cervical cancer was lacking among the young women. Knowledge of pap smear and cervical cancer had a weak correlation with the intention to go for the future uptake of pap smear.

CONCLUSIONS

Educational efforts among younger Singaporean women on the knowledge of pap smear and risk factors for cervical cancer are needed. Improving knowledge will enable them to understand the importance of reducing exposure to risk factors and regular pap smear screening.

RELEVANCE TO CLINICAL PRACTICE

All health professionals working with young Asian women should be prepared to educate and counsel young women to participate in pap smear screening according to current guidelines. In particular, knowledge of the age to attend the first pap smear and the recommended frequency for screening need to be targeted for health education.

Perception of cervical cancer risk and screening behavior: a literature review

PURPOSE

This review examines women's risk perception of cervical cancer, the factors influencing this perception, and the relationship between risk perception of cervical cancer and screening behavior.

METHODS

Integrative literature review method was used.

FINDINGS

The search procedure resulted in the identification of 42 studies, including 1 literature review and 41 primary studies. Trends and discrepancies in the literature are presented with interpretations and recommendations.

CONCLUSION

Existing theories of health behavior appear inadequate for understanding screening behavior, and further studies are recommended to enrich the knowledge base of nursing diagnoses in knowledge deficit and health-seeking behavior.

IMPLICATIONS FOR NURSING PRACTICE

Efforts would be made to improve nurses' understanding of risk perception of cervical cancer within specific cultural context.

Review of strategies in promoting attendance for cervical screening

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.

Perceived risk of cervical cancer in Appalachian women

OBJECTIVE

To examine perceptions of cervical cancer risk in elevated-risk Appalachians.

METHODS

Appalachian women (n=571) completed interviews examining self-regulation model factors relevant to perceived risk of cervical cancer.

RESULTS

Women with good/very good knowledge of cervical cancer, greater worry, and history of sexually transmitted infection had higher odds of rating their perceived risk as somewhat/much higher than did other women. Former smokers, compared to never smokers, had lower risk perceptions.

CONCLUSIONS

Self-regulation model factors are important to understanding perceptions of cervical cancer risk in underserved women. The relationship of smoking and worry to perceived risk may be a target for intervention.

Knowledge and acceptability of pap smears, self-sampling and HPV vaccination among adult women in Kenya

Objectives

Our study aimed to assess adult women’s knowledge of human papillomavirus (HPV) and cervical cancer, and characterize their attitudes towards potential screening and prevention strategies.

Methods

Women were participants of an HIV-discordant couples cohort in Nairobi, Kenya. An interviewer-administered questionnaire was used to obtain information on sociodemographic status, and sexual and medical history at baseline and on knowledge and attitudes towards Pap smears, self-sampling, and HPV vaccination at study exit.

Results

Only 14% of the 409 women (67% HIV-positive; median age 29 years) had ever had a Pap smear prior to study enrollment and very few women had ever heard of HPV (18%). Although most women knew that Pap smears detect cervical cancer (69%), very few knew that routine Pap screening is the main way to prevent ICC (18%). Most women reported a high level of cultural acceptability for Pap smear screening and a low level of physical discomfort during Pap smear collection. In addition, over 80% of women reported that they would feel comfortable using a self-sampling device (82%) and would prefer at-home sample collection (84%). Nearly all women (94%) reported willingness to be vaccinated to prevent cervical cancer if offered at no or low cost.

Conclusions

These findings highlight the need to educate women on routine use of Pap smears in the prevention of cervical cancer and demonstrate that vaccination and self-sampling would be acceptable modalities for cervical cancer prevention and screening.

Lower utilization of cervical cancer screening by nurses in Taiwan: a nationwide population-based study

OBJECTIVE

Using a nationwide population-based database in Taiwan, this study compares use of Pap smear testing by nurses and the general population.

METHOD

We compared 1093 practicing female nurses and 5465 randomly selected female patients from the 2006 National Health Insurance (NHI) database to evaluate the likelihood of receiving at least one Pap smear during a three-year period.

RESULTS

We found that 48.9% of the nurses and 56.2% of comparison subjects received a Pap test from 2004 to 2006 in Taiwan. Regression analysis showed that practicing female nurses were less likely to receive a Pap smear compared with the general population (OR=0.42, 95% CI=0.35-0.50, p<0.001), after adjusting for monthly incomes, number of ob/gyn ambulatory care visits, urbanization level and the geographic location of the communities where subjects resided.

CONCLUSION

Nurses were less likely to undergo cervical screening than the general population, despite ease of access and a national health insurance system providing universal coverage to residents of Taiwan. Efforts to raise the Pap screening rate among nurses may require addressing unique cultural and occupational concerns.

Cervical cancer screening: knowledge, health perception and attendance rate among Hong Kong Chinese women

Purpose:

Cervical cancer screening has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. However, cervical screening attendance rates are still far from satisfactory in many countries. Strategies, health promotion and education programs need to be developed with clear evidence of the causes and factors relating to the low attendance rate. The study aims to assess the prediction of cervical screening attendance rate by Chinese women’s knowledge about cervical cancer and cervical screening as well as their perception of health.

Patients and methods:

A survey with self-reported questionnaires was conducted on 385 Chinese women recruited from a community clinic in Hong Kong. Participants were Chinese women, Hong Kong residents, aged 18–65 years, able to read Chinese or English, and were not pregnant.

Results:

Women aged 37 years or less, with at least tertiary education, who perceived having control over their own health and had better knowledge on risk factors, were more likely to attend cervical cancer screening. Many participants had adequate general knowledge but were unable to identify correct answers on the risk factors.

Conclusion:

Health promotion efforts need to focus on increasing women’s knowledge on risk factors and enhancing their perceived health control by providing more information on the link between screening and early detection with lower incidence rates and mortality from cervical cancer.

Determinants of utilisation of cervical cancer screening facility in a low socio-economic setting in Nigeria

A prospective randomised structured questionnaire survey of 254 women in the low socio-economic class attending the general outpatient clinic at the University College Hospital (UCH), Ibadan revealed a high level of ignorance concerning cervical cancer prevention programmes. Only 3.5% of subjects have heard of a Papanicolaou smear and only 1.2% have had the test prior to this study. Peers (36%) were the most common source of information on cervical smears. The majority (84.6%) of the women were willing to be screened, however only 5.1% of those willing (4.3% of the women studied) actually reported for the test. Twenty-two percent (219) had high knowledge about cervical smears while moderate and poor knowledge were demonstrated in 33% respectively. Eleven per cent had no knowledge whatever. No significant association was found between the knowledge score on Papanicolaou smear and other variables. The cost of the test appeared to have prevented many of the women from having the test. It is recommended that more efforts need to be put into health education of women stressing the importance of the test and its availability.

Cervical cancer in Bangladesh: community perceptions of cervical cancer and cervical cancer screening

We investigated the awareness of, and the attitude towards screening for, cervical cancer in Bangladesh. We performed a qualitative study using focus group discussions (FGD). The framework approach to qualitative analysis was used. The study was performed in the catchment areas of Addin Hospital, Jessore, Southern Bangladesh (peri-urban) and LAMB hospital, Parbatipur, North West Bangladesh (rural). A total of 220 men, women and adolescents participated in 28 FGDs. Awareness of cervical cancer was widespread. Knowledge about causes was often inadequate. The perceived consequences of cervical cancer were numerous and awareness of the need for cervical cancer treatment was present. Barriers to accessing care include: low priority for seeking help for symptoms, limited availability of health services and cost. Most women were unaware of the possibility of screening via speculum examination, which was considered acceptable to women (and men), as long as the examination was done by a female healthcare provider in an environment with sufficient privacy. In conclusion, adequate gynaecological services are not available or accessible for most women in rural and peri-urban Bangladesh. However, awareness of cervical cancer is widespread. Screening for cervical cancer in these communities is acceptable if done by a female healthcare provider under conditions with sufficient privacy.

Cervical cancer in developing countries: how can we reduce the burden? Awareness raising, screening, treatment and palliation

Cervical cancer is an important health problem in developing countries. Most women present with advanced disease, resulting in low cure rates. Screening by Visual Inspection with the Aid of Acetic Acid and optionally HPV DNA detection as a second test is technically feasible. However, the majority of women appear to be reluctant to attend a screening clinic. This is probably due to lack of knowledge and a low priority of women's health in local communities. There is an obvious need to obtain more knowledge on communities' perceptions and understanding of cervical cancer. Furthermore, we need more information on what issues should be addressed in order to perform cervical cancer screening in an acceptable manner. Treatment of cervical cancer in developing countries is highly dependent on the resources and skills available. Efforts to provide adequate palliation should be enhanced as relief of troublesome symptoms can often be achieved by relatively simple and low-cost measures.

Pressing the key pad: trial of a novel approach to health promotion advice

BACKGROUND

A relatively simple procedure, the Pap test, is effective in detecting early changes in the cervix; however, many at-risk women, even in developed countries, do not have regular Pap tests.

METHODS

A randomized controlled trial of an interactive voice response (IVR) cervical screening brief advice involving 17,008 households is described. The IVR system automatically made calls to households and explained the nature of the call; selected one eligible woman aged 18-69 years; determined her screening status; delivered a message appropriate to her screening status; offered additional messages to counter common barriers; offered additional information on cervical screening and cancer; offered additional contact numbers; and offered to arrange for someone to call back. Cervical screening rate data were obtained from the Australian Health Insurance Commission (HIC) for 6 months before and following the intervention.

RESULTS

The cervical screening rate was found to have increased by 0.43% in intervention compared to the control postcodes, and the increase was greater for older women at 1.34%.

CONCLUSIONS

The overall conclusion was that IVR technology was a feasible means to contact women to deliver brief interventions aimed at increasing cervical screening rates and could economically target at-risk groups. The potential for linking IVR to centralized Pap test Registers to issue Pap test reminders should be explored.

Socio-cultural influences on Chinese women's attendance for cervical screening

BACKGROUND

Compared with other countries, Hong Kong has a relatively high rate of cervical cancer. Much of this morbidity should be avoidable with cervical screening, but uptake rates for screening in Hong Kong are low. In programmes to promote cervical screening attendance, it is essential that aspects of the socio-cultural system be taken into account to provide appropriate preventive health strategies.

AIM

This paper outlines an investigation of the cultural and social factors contributing to Chinese women's attendance for cervical screening.

METHOD

A mixed methods design was employed, combining and comparing two data sets. The initial data set was drawn from 10 focus groups involving both screened and unscreened Chinese women (n = 54). The second data set was drawn from a total population of Hong Kong doctors, and involved face-to-face semi-structured interviews (n = 28).

RESULTS

Thematic analysis of the data from women indicated that the social factors of cost, educational base, knowledge of risk, the social value of early detection and cultural issues such as modesty and embarrassment contributed to screening attendance. The doctors perceived a cultural tendency towards fatalism, as well as seeing the gender, interpersonal and interprofessional skills of the practitioner to be important in influencing levels of Chinese women's shyness and discomfort, and hence affecting attendance. The lay and practitioner data sets varied in the perceptions of women's pain, embarrassment and risk factors.

CONCLUSION

Programmes providing services for Chinese women need to ensure that the philosophy of the staff and the approach and materials used are culturally relevant. Recommendations are that nurses equipped with relevant social and cultural knowledge of population groups should have a central role in health promotion and screening services.

Knowledge and practice about cervical cancer and Pap smear testing among patients at Kenyatta National Hospital, Nairobi, Kenya

Invasive cervical cancer (ICC) is the leading cause of cancer-related death among women in developing countries. Population-based cytologic screening and early treatment does reduce morbidity and mortality associated with cervical cancer. Some of the factors related to the success of such a program include awareness about cervical cancer and its screening. The objective of this study was to assess knowledge and practice about cervical cancer and Pap smear testing among cervical cancer and noncancer patients using a structured questionnaire to obtain information. Fifty-one percent of the respondents were aware of cervical cancer while 32% knew about Pap smear testing. There were no significant differences in knowledge between cervical cancer and noncancer patients. Health care providers were the principal source of information about Pap testing (82%). Only 22% of all patients had had a Pap smear test in the past. Patients aware of cervical cancer were more likely to have had a Pap smear test in the past. The level of knowledge is low among ICC and noncancer patients. There is need to increase the level of knowledge and awareness about ICC and screening among Kenyan women to increase uptake of the currently available hospital screening facilities.

Development of a cervical cancer educational program for Chinese women using intervention mapping

This article describes the development of a program to increase Pap screening behavior among women in Taiwan. Intervention mapping, an innovative process of intervention design, guided the development of this program. The development process included a needs assessment identifying factors influencing Pap screening behavior relevant to Chinese women. The program used methods such as information transmission, modeling, persuasion, and facilitation. Strategies included direct mail communication, role-model stories and testimonials, and a telephone-counseling component. The delineation of specific plans for implementation and evaluation are also described.

Investigating Hong Kong's Filipino domestic workers' healthcare behavior, knowledge, beliefs and attitudes towards cervical cancer and cervical screening

The aim of this study was to investigate Hong Kong Filipino domestic workers health behaviors, knowledge, beliefs and attitudes about cervical screening and cancer. A concurrent cross sectional survey design used a snowball method of recruitment was used because of the acknowledged problematic access to a random sample of immigrant women. A total of 98 female domestic helpers were actively recruited through designated recreation centers. The women were between 24-45 years old (mean = 37.9, SD = 7.7). The majority of these women were employed as full-time domestic helpers (91%), were earning less than dollar 4000 Hong Kong dollars/month (92%), were married (82%), with children (91%), were non-smokers (88%), and had at least a secondary level of education (100%), with 66% of these women having completed post-secondary education. While the majority of women had previously heard about cervical smears (78%) more than half (53%) reported never having a cervical smear taken. Women who had a prior cervical smear had significantly more knowledge about cervical smears and cervical cancer (mean = 51.34, SD = 2.5) than those who never had a cervical smear (mean = 49.72, SD = 3.2). Recommendations are made for culturally tailored mass screening programmers out of office hours and health information to be provided in both written and oral Tagalong. Doctors and nurse ideally of Filipino origin should be used to deliver health messages that prioritize the importance of self protection for the family and future fertility issues, culturally prized within Filipino society.

Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy

OBJECTIVE

The purpose of this study was to compare patient acceptance of multidetector CT colonography, total colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema to ascertain any overall preference. SUBJECTS AND METHODS. One hundred sixty-eight patients underwent CT colonography followed by either flexible sigmoidoscopy (n = 59) or colonoscopy (n = 109). A 25-point questionnaire with principal components relating to satisfaction, worry, and physical discomfort was administered after CT colonography and after endoscopy, and a follow-up questionnaire was administered 1 week after the procedures. Questionnaires were also completed by 140 patients undergoing double-contrast barium enema examinations. Responses were compared using Wilcoxon's matched pairs test and the Mann-Whitney test.

RESULTS

Overall satisfaction was greater with colonoscopy (p = 0.01), but CT colonography caused less discomfort (p = 0.002), was better tolerated (p = 0.005), and was the preferred follow-up investigation of those expressing a preference (p = 0.003). Compared with flexible sigmoidoscopy, CT colonography caused less pain (p = 0.004), was more acceptable (p = 0.04), and was preferred as the follow-up investigation (p < 0.001). Tolerance of colonoscopy was significantly less in women (p = 0.03), but such was not the case for CT colonography (p = 0.58). Patients undergoing CT colonography were less worried (p < 0.001), were more satisfied (p = 0.001), and suffered less discomfort (p < 0.001) than those having barium enema.

CONCLUSION

Patients' experiences with barium enema examinations were significantly worse than with any other test. Although patients were most satisfied with colonoscopy, they reported more pain during both colonoscopy and sigmoidoscopy than during CT colonography, and they also found CT more acceptable. In patients expressing a preference, CT colonography was the preferred follow-up investigation.

Awareness of glaucoma, and health beliefs of patients suffering primary acute angle closure

AIM

To evaluate the factors associated with lack of awareness of glaucoma and late presentation to the doctor in Singapore Chinese patients with acute angle closure (AAC) METHODS: A prospective, hospital based case series of 105 patients aged 35 years and above who presented with a first attack of AAC in a tertiary hospital in Singapore was conducted. A research assistant interviewed all patients face to face in clinic and recorded demographic factors, awareness of glaucoma, and subjective barriers to seeing a doctor. The time from onset of symptoms to presentation at the clinic was noted.

RESULTS

Overall, 22.9% of patients had heard of glaucoma. The multivariate adjusted odds ratio (OR) of unawareness of glaucoma in older people (> 60 years) was 1.5 (95% confidence interval (CI) 0.5 to 4.6), 3.2 (95% CI 1.1 to 9.2) for adults who were not working, and 13.8 (95% CI 1.3 to 146.7) for patients who had less than a pre-university education. A significant proportion (31.7%) of patients presented to the doctor 24 hours or more after symptoms occurred. In a multiple logistic regression model, the adjusted OR of late presentation was 8.5 (95% CI 1.04 to 69.5) if there was no car access, 5.0 (95% CI 1.0 to 24.6) if the patients spoke Chinese, and 3.3 (95% CI 0.9 to 11.9) if there was nobody to accompany to hospital.

CONCLUSION

Glaucoma awareness among patients suffering AAC was not high. Lack of awareness was associated with increasing age, lack of formal education, and unemployment. A significant proportion of patients seek medical attention late. Risk factors for late presentation include lack of car access, nobody to accompany the patient, and speaking the Chinese language primarily. Health education programmes may help increase the knowledge and awareness of glaucoma.

Prevenção do câncer de colo do útero: um modelo teórico para analisar o acesso e a utilização do teste de Papanicolaou

Vários estudos têm apontado que a permanência das altas taxas de incidência e mortalidade por câncer cérvico-uterino deve-se à baixa qualidade e cobertura do teste de Papanicolaou, principalmente em países em desenvolvimento. Pretende-se neste artigo analizar alguns pontos relacionados às medidas de prevenção e controle do câncer cervical quanto à efetividade do teste de Papanicolaou, a lógica operacional e científica por detrás das políticas públicas de prevenção ao câncer cervical e a cobertura do teste em países norte-americanos, europeus e na América Latina. Consideram-se, ainda, os modelos explicativos que estão sendo propostos para avaliar o acesso e a utilização deste serviço, a partir da análise dos fatores associados à realização do teste de Papanicolaou descritos pela literatura. Propõe-se uma nova abordagem na investigação destes fatores, buscando a integração e interlocução de outros aspectos de cunho social, cultural e organizacional na análise do acesso e da utilização deste exame, visando um planejamento mais coerente das ações de prevenção e promoção à saúde com as necessidades e direitos das mulheres.

Cultural attitudes to cancer management in traditional South-East Asian patients

Cultural differences might influence patients' attitudes to decision-making for cancer management. In a Western medical system promoting shared decision-making and patient autonomy, the effects of traditional South-East Asian cultural and religious attitudes might provoke confusion for both the patient and health-care provider. Especially in oncology, these beliefs might influence patients' perceptions of diagnosis, symptoms, interventions and approaches to death. For the clinician, the potential conflicts in patient disclosure and discussion of diagnosis are evident, as well as patient avoidance of certain interventions. This review article explores the background and interpretation of cultural aspects experienced by Australasian-trained oncologists working in Singapore. Explanations of traditional health beliefs of South-East Asian patients are outlined, and provide a perspective for oncologists managing similar patients within Australasia's multicultural community.

Relationship between the intention to repeat a papanicolaou smear test and affective response to a previous test among Korean women

The purposes of this descriptive cross-sectional study were to describe (1). women's affective (emotional) responses before, during, and after a Papanicolaou smear test and after receiving the test result and (2.) the difference in affective response between women who did or did not intend to repeat the Papanicolaou smear test in the future. The theory of reasoned action was used as the theoretical basis for this study. Participants were selected by convenience sampling and included 515 women aged 24 to 69 years who had a previous Papanicolaou smear test, did not have cervical cancer, and who agreed to participate. Affective response was measured with an instrument developed by Park. Intention to repeat the Papanicolaou smear test was measured with a single question on intention of repeating the Papanicolaou smear test. Women with intention to repeat the Papanicolaou smear test showed higher apprehension after the test ( = 2.695, =.04) and higher positive affective responses such as feeling relieved, great, and comfortable after receiving the test result ( = 3.014, =.003). This result suggests that women with the intention to repeat the test are more concerned with the test result and that emotional relief after confirming normal findings is an important motivator for repeating the Papanicolaou smear test.

Women's knowledge about cervical cancer and cervical screening practice: a pilot study of Hong Kong Chinese women

Cervical cancer is the seventh leading cause of death and the fourth most common type of cancer among Hong Kong Chinese women. Despite the provision of cervical screening programs, women's attendance for screening remains low at 59%. Evidence suggests that women's knowledge about cervical cancer and preventive strategies are significant to their screening practice. A preliminary pilot study consisting of a two-phase descriptive design using quantitative and qualitative methods of data collection was undertaken to investigate the level of knowledge about cervical cancer and cervical screening among a population of Hong Kong Chinese women. From a total sample of 467 women, 242 (52%) responded to a confidential questionnaire, 18 of whom, aged between 30 and 54 years, volunteered to participate in a semistructured interview. A total of 135 (57%) women had attended screening, with those who were married with children significantly more likely to attend. Although no significant difference was found between the overall level of knowledge of attenders and nonattenders, individual items such as women's knowledge of risk factors were significant. The need for further knowledge about the preventive nature of cervical screening and regular screening was demonstrated. Other factors influencing Chinese women's attendance patterns included advice from practitioners and the significance of children to women's propensity for self-care. The implications of these findings to women's attendance patterns for screening are considered, particularly the need for culturally sensitive health promotion and intervention strategies.

Effectiveness of an intervention to increase Pap test screening among Chinese women in Taiwan

This study assessed the effectiveness of a theory-based direct mail campaign in encouraging non-compliant women, aged 30 and older or younger if married, to obtain a Pap test. Participants were female family members of inpatients admitted to one of the major teaching hospitals in Taiwan during August-September 1999. A total of 424 women were recruited in the randomized intervention trial. Three months following implementation of the intervention, women in the intervention group reported a higher rate of Pap test screening than women in the comparison group (50% versus 32%) (p = 0.002). Women in the intervention group also showed higher perceived pros of a Pap test at follow-up (p = 0.031). Although women in both groups showed an increased knowledge and intention to obtain a Pap, only the intervention group had significantly higher follow-up scores on perceived pros and susceptibility. The results shows that the intervention was effective in increasing Pap test screening among Chinese women within three months. The results also support the use of Intervention Mapping, a systematic program development framework for planning effective interventions.

Factors important in promoting cervical cancer screening among Canadian women: findings from the 1996-97 National Population Health Survey (NPHS)

Although routine Pap screening represents an effective tool in the early detection of cervical cancer, it remains underused by some Canadian women. This study examines selected sociodemographic, health, lifestyle, and system barriers to Pap test participation among 33,817 women aged 18+ years in the cross-sectional 1996-97 National Population Health Survey (NPHS). Among women 18 years and over, 87% reported ever having had a Pap test while 72% reported a recent (< 3 years) test. A report of ever and recent use was most common among women 25-34 (92% and 86.9%, respectively). Only 0.6% of recently screened women reported access problems. Among those without a recent test, most (53%) reported that they did not think it was necessary. Pap test use varied little across provinces and was less common among older and single women, those with lower education, a spoken language other than English, a birth place outside Canada and negative health and lifestyle characteristics.

Chinese women's experiences and images of the Pap smear examination

Cervical cancer remains a significant cause of mortality and morbidity in Chinese women, despite the efficacy of the screening procedure for the disease. This article focuses on specific gender and culturally related experiences of Chinese women presenting for Papancolaou (Pap) tests. The first phase of a descriptive exploratory study involved the administration of a questionnaire to a total population of female Hong Kong Chinese clerical and technical staff working in academic departments of a tertiary institution. The second phase consisted of in-depth semistructured interviews with a purposive sample of women to explore experiences of Pap smear screening. Of these women, 68.2% associated pain with a Pap smear. In addition, 78.6% of the women associated a Pap smear with embarrassment. Older women were more likely to experience pain and embarrassment during the procedure. In the qualitative data, women's personal images and experiences reflected four subthemes including pain, sexual connotations of the procedure, vulnerability, and diminished embarrassment after childbirth. The second substantive theme, characteristics of the practitioner, highlighted the importance of procedural, interpersonal, and culturally sensitive skills, particularly in respect to information-giving and interaction with women. The conclusion outlines the nursing implications for Chinese women presenting for Pap smears in terms of cultural sensitivity as a means of enhancing attendance patterns.

Increasing uptake rates of cervical cancer screening amongst Hong Kong Chinese women: the role of the practitioner

Women's attendance for regular cervical screening has been identified as a significant factor in the prevention of cervical cancer. Evidence suggests, however, that both extrinsic and intrinsic factors influence women's attendance patterns for screening. Extrinsic factors, in particular the practitioner undertaking the screening procedure, have been shown to influence women's return rates for further screening. In Hong Kong, where uptake rates amongst Chinese women remain comparatively low, a study was undertaken to examine Chinese women's experiences and perceptions of cervical screening undertaken by either a female doctor or nurse. A multiple case study design using both qualitative and quantitative methods of data collection was employed. This paper reports the findings from the qualitative data obtained from 52 women participating in 12 focus group interviews held in the two case studies. Thematic analysis of the data demonstrated the importance of the caring nature, communication skills, experience and expertise of the practitioner to women's attendance pattern for screening. The experience and expertise of the practitioner, described by women as teaching, minimizing pain and discomfort and being considerate, were considered more influential to uptake rates than the professional discipline of the practitioner. Findings such as these indicate the importance of the influence of the practitioner in determining uptake rates for cervical screening amongst this population group.

Motivating smoking cessation among dental patients: smokers' interest in biomarker testing for susceptibility to tobacco-related cancers

This study examined interest in receiving biomarker testing for tobacco-related cancer susceptibility among 148 smokers seeking routine oral health care in a public dental clinic. Patients completed a brief, self-report survey assessing their smoking history, tobacco-related illness history, readiness to quit smoking, perceived risk and worry about cancer, and their interest in being tested for genetic susceptibility for tobacco-related cancers. Participants were socioeconomically and ethnically diverse, and were primarily long-standing, nicotine-dependent smokers. Most reported (83%) interest in biomarker feedback, and most (86%) understood that a certain genetic make-up could place them at increased risk for tobacco-related cancers. Those participants who felt that quitting smoking would reduce future cancer risk, were at least in the contemplation stage of quitting readiness, felt more worried and more at risk for developing cancer, women and younger smokers were more interested in genetic testing (all ps < 0.20). Multivariate logistic regression analyses indicated that gender and risk perceptions were associated with interest in testing. The public dental clinic setting holds potential for innovative smoking cessation interventions using personalized risk feedback.

A case study of the effectiveness of nurse-led screening programmes for cervical cancer among Hong Kong Chinese women

Cervical cancer remains a cause of morbidity and mortality among women despite the efficacy of Pap smear screening. Uptake rates for Papanicolaou (Pap) smears among Hong Kong Chinese women remain low and evidence suggests that both intrinsic and extrinsic factors influence women's attendance for Pap smear screening, particularly the practitioner taking the smear. This study examined the experiences and perceptions of Hong Kong Chinese women of having a Pap smear taken by a female doctor or a female nurse using a case study design. A convenience sample of 50 women was selected from the two case study settings. Data collection involved a confidential structured interview, followed by focus group interviews with a sample of women participating in the structured interview. The findings relating to the technical quality and outcome of care provide the focus for this paper. Although women were highly satisfied with the care provided by both practitioners, women were more satisfied with the information given about the procedure by the nurse (P = 0.0130) and had more confidence in the nurse (P = 0.024). One of the five criteria used to assess the quality of smears demonstrated the doctor achieved a statistically significant higher number of smears containing the required percentage of endocervical cells (P = 0. 0180). Nevertheless, none of the smears taken by the nurse required repeating due to an inadequate specimen. These findings suggest, despite the need for audit of Pap smears, that appropriately qualified nurses can make an important contribution to the uptake of Pap smears among this population.

Prostate cancer testing in SA men: influence of sociodemographic factors, health beliefs and LUTS

This study investigates the prevalence and determinants of prostate cancer screening in the South Australian community. An interview-based survey of a probability sample of the SA population (N = 3,016) in 1995 addressed previous PSA testing, beliefs about vulnerability to prostate cancer and efficacy of screening, presence of uncomplicated lower urinary tract symptoms (LUTS) and sociodemographic variables. Of 736 men, 40 years and over with no history of prostate cancer, 24.7% (182/736) reported ever having had a test and 53.9% (397) reported an intention to test; 74% (547) agreed that prostate cancer could be cured if detected early, while only 14.9% (109) believed they were unlikely to suffer from prostate cancer. In a logistic regression model, visit to a doctor for (but not presence of) LUTS was a strong, independent predictor of participation in PSA testing (OR 9.0, 95% CI 5.0, 16.0). Beliefs, occupation and education were not. In a similar model examining intention to test, belief in vulnerability to prostate cancer was the strongest predictor (OR 3.32, 95% CI 1.9, 5.9), followed by doctor visit for urinary symptoms. These data are consistent with widespread PSA testing and with seeking treatment for LUTS being a major determinant of previous testing. NHMRC Clinical Guidelines for LUTS recommend against PSA testing for investigation of uncomplicated LUTS. Implementation of those guidelines may therefore have a significant effect on PSA testing rates. Belief in personal vulnerability to prostate cancer remains a significant component of reported future testing, suggesting a focus for community education.