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Gale A. Increasing Referral Acceptance for Women's Health Services Among Hispanic Women. Nurs Womens Health 2024; 28:296-302. [PMID: 38761817 DOI: 10.1016/j.nwh.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/16/2024] [Accepted: 04/11/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To evaluate the effect of an individualized educational intervention on women's health referral acceptance rates among Hispanic women. DESIGN Quality improvement (QI) project. SETTING/LOCAL PROBLEM Barriers to cervical cancer screening among Hispanic women include a lack of access to women's health services and a lack of knowledge related to cervical cancer risk factors. Primary care providers at two medical clinics in eastern Pennsylvania did not routinely discuss cervical cancer risk factors, provide well-woman care, or perform cervical cancer screening during office visits. This gap in preventive care provided an opportunity for quality improvement. PARTICIPANTS A convenience sample of 65 self-identified Hispanic women presenting for primary care office visits. INTERVENTION/MEASUREMENTS Each consenting participant received a one-on-one education session lasting 5 to 10 minutes regarding individual risk factors for cervical cancer. Each woman was offered a referral for a well-woman examination, with or without cervical cancer screening. Data collection included the participant's response to the offered referral. RESULTS The majority of participants who received the educational intervention (96.9%, n = 63) accepted referrals for women's health services. CONCLUSION An educational intervention discussing individual cervical cancer risk factors was associated with increased women's health referral acceptance rates among Hispanic women.
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Guo M, Brar Prayaga R, Levitz CE, Kuo ES, Ruiz E, Torres-Ozadali E, Escaron A. Tailoring a Text Messaging and Fotonovela Program to Increase Patient Engagement in Colorectal Cancer Screening in a Large Urban Community Clinic Population: Quality Improvement Project. JMIR Cancer 2023; 9:e43024. [PMID: 37561562 PMCID: PMC10450532 DOI: 10.2196/43024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Appropriate annual screenings for colorectal cancer (CRC) are an essential preventive measure for the second-leading cause of cancer-related death in the United States. Studies have shown that CRC screening rates are influenced by various social determinants of health (SDOH) factors, including race, ethnicity, and geography. According to 2018 national data, participation in screening is lowest among Hispanic or Latinx individuals (56.1%). At an urban Federally Qualified Health Center, a quality improvement project was conducted to evaluate a texting program with a motivational fotonovela-a short narrative comic. Fotonovelas have previously been used in programs to improve knowledge of cervical cancer and human papillomavirus, vaccinations, and treatments for depression. OBJECTIVE This study aimed to encourage compliance with fecal immunochemical test (FIT) screening. Patient engagement involved a texting program with fotonovelas informed by behavior change techniques. This study sought to understand the qualitative characteristics of patient motivation, intention, and barriers to completing their screening. METHODS A total of 5241 English-speaking or Spanish-speaking Federally Qualified Health Center patients aged 50 to 75 years were randomized to either intervention (a 4-week tailored 2-way texting program with a fotonovela comic) or usual care (an SMS text message reminder and patient navigator phone call). The texting vendor used a proprietary algorithm to categorize patients in the intervention group into SDOH bands based on their home addresses (high impact=high social needs and low impact=low social needs). Over 4 weeks, patients were texted questions about receiving and returning their FIT, what barriers they may be experiencing, and their thoughts about the fotonovela. RESULTS The SDOH index analysis showed that most of the patient population was in the SDOH band categories of high impact (555/2597, 21.37%) and very high impact (1416/2597, 54.52%). Patients sent 1969 total responses to the texting system. Thematic analysis identified 3 major themes in these responses: messages as a reminder, where patients reported that they were motivated to return the FIT and had already done so or would do so as soon as possible; increasing patients' understanding of screening importance, where patients expressed an increased knowledge about the purpose and importance of the FIT; and expressing barriers, where patients shared reasons for not completing the FIT. CONCLUSIONS The texting program and fotonovela engaged a subset of patients in each SDOH band, including the high and very high impact bands. Creating culturally tailored messages can encourage patient engagement for accepting the content of the messaging, confirming intentions to complete their FIT, and sharing insights about barriers to behavior change. To better support all patients across the continuum of care with CRC screening, it is important to continue to develop and assess strategies that engage patients who did not return their home-mailed FIT.
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Affiliation(s)
- Monica Guo
- Institute for Health Equity, AltaMed, Los Angeles, CA, United States
| | | | - Carly E Levitz
- Center for Community Health and Evaluation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Elena S Kuo
- Center for Community Health and Evaluation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Esmeralda Ruiz
- Institute for Health Equity, AltaMed, Los Angeles, CA, United States
| | | | - Anne Escaron
- Institute for Health Equity, AltaMed, Los Angeles, CA, United States
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Romli R, Abd Rahman R, Chew KT, Mohd Hashim S, Mohamad EMW, Mohammed Nawi A. Empirical investigation of e-health intervention in cervical cancer screening: A systematic literature review. PLoS One 2022; 17:e0273375. [PMID: 35984812 PMCID: PMC9390916 DOI: 10.1371/journal.pone.0273375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
Cervical cancer (CC) screening can detect the cancer early but is underutilized, especially among the developing countries and low- to middle-income countries. Electronic health (e-health) has the potential for disseminating health education and is widely used in the developed countries. This systematic literature review investigates the effectiveness of e-health intervention for improving knowledge of CC and the intention or uptake for CC screening. We followed the PRISMA 2020 guideline and registered with PROSPERO (registration ID CRD42021276036). We searched the Web of Science, Scopus and EBSCO Medline Complete databases for eligible studies. Studies that conveyed informational material through e-health intervention were selected. The results were analyzed using narrative synthesis, and the pooled estimates were calculated using meta-analysis. A total of six studies involving 1886 women were included in this review. The use of e-health aids alone led to increased knowledge. The meta-analysis demonstrated that the mixed-education method of e-health movies and video education with didactic sessions increased CC screening uptake. A random-effects model revealed that CC screening uptake following e-health interventions were almost double of that of their comparison (odds ratio = 2.29, 95% confidence interval: 1.28–4.10, p < 0.05). Various areas of study demonstrated e-health intervention effectiveness (minority communities, urban areas, rural areas). Health education through e-health intervention has huge potential for promoting CC screening in the community. Nevertheless, the use of appropriate frameworks, user engagement and culturally tailored e-health need to be prioritized.
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Affiliation(s)
- Rodziah Romli
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Institut Latihan Kementerian Kesihatan Malaysia Alor Setar, Ministry of Health, Putrajaya, Malaysia
| | - Rahana Abd Rahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Kah Teik Chew
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Syahnaz Mohd Hashim
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Emma Mirza Wati Mohamad
- Centre for Research in Media and Communication (MENTION), Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- * E-mail:
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Carrion IV, Neelamegam M, Estapé T, Doering T, Snyder O, Tollinchi E, Estapé J. Cancer Prevention and Diagnosis Knowledge among Spanish-speaking Older Latino/as Residing in Tampa, Florida. Ethn Dis 2022; 32:185-192. [PMID: 35909640 PMCID: PMC9311304 DOI: 10.18865/ed.32.3.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective Cancer remains the leading cause of death among Latino/as in the United States, and advancing age is a major risk factor for developing most cancer types. Given the growing population of Latino/as immigrants aged ≥60 years and the current lack of relevant data, this study aims to understand the cancer prevention and perception of cancer diagnosis among older Latinos to ensure that they receive effective prevention, intervention, and psychosocial care. Method A survey exploring attitudes about cancer was developed and administered in Spanish. Using convenience sampling, 168 individuals identifying as Latino/as were surveyed in Tampa, Florida. Descriptive analysis was conducted to understand study population characteristics. Frequencies were assessed to understand the participants' responses to cancer-related attitude questions. The effects of age, country of origin, length of stay in the United States, and marital status on the participants' cancer-related attitudes were assessed using logistic regression. Results The mean age of the study participants was 67.9 years, 34.5% were male, and the mean length of stay in the United States was 25.8 years. In total, 29% and 24.4% of the participants knew that breast cancer and prostate cancer, respectively, can be diagnosed early. Individuals with an elementary education were less likely to have sufficient knowledge of cancer prevention and diagnosis. Additionally, 93.5% of the population was aware that tobacco use can lead to cancer, and 84.5% knew that exposure to tobacco smoke can affect both the smoker and their family. Conclusion Older Latino/as possess knowledge about cancer causes yet lack knowledge regarding cancer prevention and diagnosis, potentially creating barriers and causing them to avoid treatment. Focusing on cancer-related health education among older Latino/as is a step toward appropriate and equitable cancer care.
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Affiliation(s)
- Iraida V. Carrion
- University of South Florida, School of Social Work, Tampa, FL, Address correspondence to Iraida V. Carrion, PhD, University of South Florida, School of Social Work, 13301 Bruce B. Downs Blvd., Tampa, FL 33612-3807.
| | - Malinee Neelamegam
- University of North Texas Health Science Center, School of Public Health, Fort Worth, TX
| | - Tania Estapé
- FEFOC, Fundación Contra El Cáncer, Barcelona, Spain
| | - Tracy Doering
- University of South Florida, School of Social Work, Tampa, FL
| | - Olivia Snyder
- University of South Florida, School of Social Work, Tampa, FL
| | - Ebony Tollinchi
- University of South Florida, School of Social Work, Tampa, FL
| | - Jorge Estapé
- FEFOC, Fundación Contra El Cáncer, Barcelona, Spain
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Levitz CE, Kuo ES, Guo M, Ruiz E, Torres-Ozadali E, Brar Prayaga R, Escaron A. Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Evaluation of a Quality Improvement Project (Preprint). JMIR Cancer 2022. [DOI: 10.2196/39645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Thiel de Bocanegra H, Dehlendorf C, Kuppermann M, Vangala SS, Moscicki AB. Impact of an educational tool on young women's knowledge of cervical cancer screening recommendations. Cancer Causes Control 2022; 33:813-821. [PMID: 35312891 PMCID: PMC9085671 DOI: 10.1007/s10552-022-01569-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/03/2022] [Indexed: 10/27/2022]
Abstract
PURPOSE Current cervical cancer screening guidelines recommend 3-year screening intervals, in contrast to the previous recommendation of annual screening, to prevent over screening and overtreatment. We evaluated the impact of viewing a tablet-based educational tool prior to seeing a clinician on young women's knowledge and understanding of cervical cancer screening, HPV vaccination follow-up of abnormal pap smears, and comfort in communicating with their providers. METHODS This cross-sectional study was part of a cluster-randomized study of fourteen primary care clinics from January 2015 to December 2016. We developed the cervical cancer education tool in English and Spanish using a community-based approach that included formative work and cognitive interviewing. Clinics were randomized to use the intervention (tablet-based patient education tool) or to participate as a control group. We administered surveys to a convenience sample of 229 English- or Spanish-speaking women aged 19 to 35 years in these clinics. We used descriptive analyses and logistic regression models with cluster-robust standard errors to compare differences among the two groups. RESULTS Compared to women seen in control clinics, women seen in intervention clinics demonstrated greater knowledge regarding human papilloma virus (HPV (p = 0.004) and understanding (p < 0.001) of cervical cancer screening. Comfort in communicating with providers was not statistically different (p = 0.053). Women in the intervention group felt that the tool helped them understand that an abnormal Pap smear does not require immediate treatment (61.5%). CONCLUSION Innovative online patient education that is offered prior to patients' interaction with their clinicians can improve their knowledge about cervical cancer prevention and treatment.
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Affiliation(s)
- Heike Thiel de Bocanegra
- Department of Obstetrics and Gynecology, School of Medicine, University of California, Irvine, 333 City Boulevard West, Suite 1400, Orange, CA, 92868, USA.
| | - Christine Dehlendorf
- Department of Family & Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sitaram S Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
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Lindsay AC, Delgado D, Valdez MJ, Restrepo E, Guzman YM. "I don't Think He Needs the HPV Vaccine Cause Boys Can't Have Cervical Cancer": a Qualitative Study of Latina Mothers' (Mis) Understandings About Human Papillomavirus Transmission, Associated Cancers, and the Vaccine. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:370-378. [PMID: 32654037 DOI: 10.1007/s13187-020-01824-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States and etiologically linked to several types of cancers including the cervix, vulva, vagina, penis, anus, and oropharynges. Evidence indicates certain types of HPV-associated cancers disproportionally affect Latinos in the United States. This qualitative study sought to explore Latina mothers' perceptions and understanding of HPV infection, HPV-associated cancers, and the HPV vaccination for their adolescent sons and daughters. Twenty-two individual, face-to-face interviews were conducted in 2018-2019 with mothers who had at least one child between the ages of 11 and 19 years. Data were analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Two major themes emerged from the analysis: (1) mothers' (mis) understanding about HPV infection transmission and HPV-associated cancer risk for girls and boys, and (2) mothers' (mis) understandings about the HPV vaccination for girls and boys. Results found that most mothers had inadequate understanding of HPV transmission, HPV-associated cancer risk for males, and need to vaccinate boys against the virus for their own personal health and prevention of HPV-associated cancers. Findings suggest that interventions should focus on improving Latina mothers' understanding of HPV transmission, addressing the lack or inadequate knowledge about HPV-associated cancer risk for males, as well as misconceptions about the importance of the HPV vaccination for males for their personal health and the prevention of HPV-associated cancers. Future research should quantify Latino parents' awareness, knowledge, and acceptability of the HPV vaccine for their sons and daughters.
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Affiliation(s)
- Ana Cristina Lindsay
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA.
| | - Denisse Delgado
- College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Madelyne J Valdez
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Emily Restrepo
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Yessica M Guzman
- Department of Public Policy and Public Affairs, McCormack Graduate School of Policy and Global Studies, University of Massachusetts-Boston, Boston, MA, USA
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Cheng L, Wang Y, Du J. Human Papillomavirus Vaccines: An Updated Review. Vaccines (Basel) 2020; 8:vaccines8030391. [PMID: 32708759 PMCID: PMC7565290 DOI: 10.3390/vaccines8030391] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Human papillomavirus (HPV) vaccines, which were introduced in many countries in the past decade, have shown promising results in decreasing HPV infection and related diseases, such as warts and precancerous lesions. In this review, we present the updated information about current HPV vaccines, focusing on vaccine coverage and efficacy. In addition, pan-gender vaccination and current clinical trials are also discussed. Currently, more efforts should be put into increasing the vaccine’s coverage, especially in low- and middle-income countries. Provision of education on HPV and vaccination is one of the most important methods to achieve this. Vaccines that target HPV types not included in current vaccines are the next stage in vaccine development. In the future, all HPV-related cancers, such as head and neck cancer, and anal cancer, should be tracked and evaluated, especially in countries that have introduced pan-gender vaccination programs. Therapeutic vaccines, in combination with other cancer treatments, should continue to be investigated.
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