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Helgestad ADL, Andersen B, Njor SH, Larsen MB. The association of demographic and socioeconomic variables with cancer screening participation: A national cross-sectional study of three cancer screening programs in Denmark. Heliyon 2024; 10:e31163. [PMID: 39044972 PMCID: PMC11263647 DOI: 10.1016/j.heliyon.2024.e31163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 07/25/2024] Open
Abstract
Objective To analyze the demographic and socioeconomic determinants of non-participation in cervical, colorectal and breast cancer screening programs in Denmark. Study design and setting We conducted a cross-sectional study involving all women aged 53-65 years residing in Denmark on March 31, 2018, utilizing comprehensive individual data from population registries. Logistic regression models were employed to assess associations between demographic and socioeconomic factors and non-participation compared with participating in one, two, and three cancer screening programs, presenting odds ratios (ORs) with 95 % confidence intervals (CIs). Both unadjusted and adjusted models were applied for each level of screening participation. Results Significant associations with non-participation in the three cancer screening programs were observed across all demographic and socioeconomic covariates considered. Women with low incomes demonstrated the highest likelihood of non-participation (none vs. three programs attended, OR: 2.95, 95 % CI: 2.82-3.08). Similarly, increased odds of non-participation were noted among immigrants (Western immigrants: OR: 2.08, 95 % CI: 1.96-2.21; non-Western immigrants OR 1.26 95 % CI: 1.20-1.32), women living alone (OR: 2.08, 95 % CI: 2.02-2.14), women outside the labor force (OR: 1.92, 95 % CI: 1.86-1.99), and women with lower educational levels (OR: 1.44, 95 % CI: 1.39-1.50) in the model comparing non-participation to participating in three screening programs. A progressive intensification of the association with non-participation was noted with each incremental increase in screening participation (from one to two to three programs). Conclusions Demographic and socioeconomic variables are significantly associated with non-participation in all three Danish cancer screening programs, particularly affecting women from vulnerable demographic and socioeconomic backgrounds. Future research should prioritize strategies to enhance participation within this subgroup, aiming to alleviate social inequities in cancer screening.
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Affiliation(s)
- Anne Dorte Lerche Helgestad
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus N, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus N, Denmark
| | - Sisse Helle Njor
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus N, Denmark
- Department of Data, Innovation and Research, Lillebaelt Hospital, Vejle, Beriderbakken 4, 7100, Vejle, Denmark
| | - Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus N, Denmark
- Research Unit, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark
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Lyonnais E, Vigoureux S, Blondel B, Wylomanski S, Azria E. Women's country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources. BMC Cancer 2024; 24:595. [PMID: 38750453 PMCID: PMC11097417 DOI: 10.1186/s12885-024-12335-1] [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: 01/25/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, both for incidence and mortality. Prevention relies on screening with a Pap test to detect precancerous lesions, which can then be treated. Access to this screening is currently both improvable and inequitable. Pregnancy may be an ideal moment for women to catch up on their overdue cervical cancer screening. In the general population, women's risk of not being screened is associated with their place of birth and other social factors; this may be true as well among pregnant women. Our objective was to study the association between women's place of birth and their failure to catch up with this screening during pregnancy. METHODS The 2016 French National Perinatal Survey included 13,147 women who gave birth after 21 weeks of gestation. The association between their place of birth and failure to catch up on this screening (defined by the absence of a Pap test during pregnancy for women overdue for it) was adjusted for age, parity, education level, health insurance, and when they began prenatal care with logistic regression models. RESULTS Among the women for whom screening was then recommended, 49% were not up to date at the start of pregnancy, and of these, 53% were not caught up before delivery. After adjustment for other risk factors, maternal place of birth was not associated with a higher risk of failure to catch up with this screening during pregnancy. However, factors identified as associated with this risk included a low education level and late start of prenatal care. CONCLUSION About half of women overdue for cervical cancer screening did not catch up with it during their pregnancy. Professionals should pay special attention to women with lower education levels and late initiation of prenatal care, who constitute a group at high risk of not catching up on this screening during pregnancy.
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Affiliation(s)
- Elisabeth Lyonnais
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), FHU Prema, Université Paris Cité - INSERM, 75014, Paris, France.
| | - Solène Vigoureux
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), FHU Prema, Université Paris Cité - INSERM, 75014, Paris, France
| | - Béatrice Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), FHU Prema, Université Paris Cité - INSERM, 75014, Paris, France
| | | | - Elie Azria
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé Research Team), FHU Prema, Université Paris Cité - INSERM, 75014, Paris, France
- Maternity Unit, Paris Saint Joseph Hospital, Paris, France
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Lewis D, Wong WWL, Lipscomb J, Horton S. An Exploratory Analysis of the Cost-Effectiveness of a Multi-cancer Early Detection Blood Test Compared with Standard of Care Screening in Ontario, Canada. PHARMACOECONOMICS 2024; 42:393-407. [PMID: 38150120 DOI: 10.1007/s40273-023-01345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Determining whether multi-cancer early detection (MCED) tests are cost effective is important in deciding whether they should be included in the clinical path of cancer care, especially for cancers where screening tools do not exist. RESEARCH OBJECTIVE The main objective of this study is to determine the cost effectiveness of including a MCED screening regimen together with existing provincial screening protocols for selected cancers that are prevalent in Ontario, Canada, among average risk persons aged 50-75 years. The selected cancers include breast, colorectal, lung, esophageal, liver, pancreatic, stomach, and ovarian. METHODS Cost effectiveness was estimated from a provincial Ministry of Health perspective. A state-transition Markov model representing the decision path of both the proposed and existing screening strategies along the natural history of the selected types of cancers was implemented. The incremental cost-effectiveness ratio (ICER) was calculated using data from available literature and the guidelines published by the Canadian Agency for Drugs and Technologies in Health (CADTH) for conducting a cost-effectiveness analysis, which included a discount rate of 1.5% applied to all costs and outcomes. Costs were also converted to 2022 Canadian dollars. To test the robustness of the model, both univariate and probabilistic sensitivity analyses were conducted. RESULTS MCED screening resulted in more diagnosed cases of each type of cancer, even at an earlier stage of disease. This was also associated with fewer related deaths compared with standard of care. Notwithstanding, the analysis revealed that the MCED intervention was not cost effective [ICER: CAD$143,369 per quality-adjusted life year (QALY)], given a willingness to pay (WTP) threshold of $100,000 per QALY. The probabilistic sensitivity analyses revealed that the MCED intervention strategy was preferred to standard of care no more than 2% of the time at this WTP for both males and females. The model was most sensitive to the cost of MCED screening, and the levels of specificity of the MCED and colorectal cancer screening tests. CONCLUSION The main contribution of the study is to present and execute a methodological approach that can be adopted to test the cost effectiveness of an MCED tool in the Canadian setting. The model is also sufficiently generic that it could be adapted to other jurisdictions, and with consideration for increasing the WTP threshold beyond the common $100,000 per QALY limit, given the life-threatening nature of cancer, to ensure that MCED interventions are cost-effective.
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Affiliation(s)
- Diedron Lewis
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Joseph Lipscomb
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Cancer Prevention and Control Research Program, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Susan Horton
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Fu R, Tinmouth J, Li Q, Dare A, Hallet J, Coburn N, Lapointe-Shaw L, Look Hong NJ, Karam I, Rabeneck L, Krzyzanowska M, Sutradhar R, Eskander A. COVID-19 pandemic impact on the potential exacerbation of screening mammography disparities: A population-based study in Ontario, Canada. Prev Med Rep 2024; 37:102578. [PMID: 38222304 PMCID: PMC10787238 DOI: 10.1016/j.pmedr.2023.102578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/16/2024] Open
Abstract
Strategies to ramp up breast cancer screening after COVID-19 require data on the influence of the pandemic on groups of women with historically low screening uptake. Using data from Ontario, Canada, our objectives were to 1) quantify the overall pandemic impact on weekly bilateral screening mammography rates (per 100,000) of average-risk women aged 50-74 and 2) examine if COVID-19 has shifted any mammography inequalities according to age, immigration status, rurality, and access to material resources. Using a segmented negative binomial regression model, we estimated the mean change in rate at the start of the pandemic (the week of March 15, 2020) and changes in weekly trend of rates during the pandemic period (March 15-December 26, 2020) compared to the pre-pandemic period (January 3, 2016-March 14, 2020) for all women and for each subgroup. A 3-way interaction term (COVID-19*week*subgroup variable) was added to the model to detect any pandemic impact on screening disparities. Of the 3,481,283 mammograms, 8.6 % (n = 300,064) occurred during the pandemic period. Overall, the mean weekly rate dropped by 93.4 % (95 % CI 91.7 % - 94.8 %) at the beginning of COVID-19, followed by a weekly increase of 8.4 % (95 % CI 7.4 % - 9.4 %) until December 26, 2020. The pandemic did not shift any disparities (all interactions p > 0.05) and that women who were under 60 or over 70, immigrants, or with a limited access to material resources had persistently low screening rate in both periods. Interventions should proactively target these underserved populations with the goals of reducing advanced-stage breast cancer presentations and mortality.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jill Tinmouth
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Qing Li
- ICES, Toronto, Ontario, Canada
| | - Anna Dare
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julie Hallet
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Coburn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Rabeneck
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Darvishian M, Moustaqim-Barrette A, Awadalla P, Bhatti P, Broet P, McDonald K, Murphy RA, Skead K, Urquhart R, Vena J, Dummer TJB. Provincial variation in colorectal cancer screening adherence in Canada; evidence from the Canadian Partnership for Tomorrow's Health. Front Oncol 2023; 13:1113907. [PMID: 37397357 PMCID: PMC10313193 DOI: 10.3389/fonc.2023.1113907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Although colorectal cancer (CRC) screening program is proven to reduce CRC incidence and mortality, understanding patterns and predictors of suboptimal adherence in screening program requires further investigation in Canada. Methods We used self-reported data from five regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath), namely the BC Generations Project (BCGP), Alberta's Tomorrow Project (ATP), the Ontario Health Study (OHS), Quebec's CARTaGENE, and the Atlantic Partnership for Tomorrow's Health Study (Atlantic PATH). We stratified participants into the following four risk categories: 1) age 50-74 years, 2) family history in a first-degree relative, 3) personal history of chronic inflammatory bowel disease and/or polyps, and 4) co-existence of personal risk and family history. Multivariable logistic regression was used to identify predictors of adherence to the screening guidelines. Results Adherence to CRC screening varied considerably between regions, ranging from 16.6% in CARTaGENE to 47.7% in OHS. Compared to the largest cohort OHS, the likelihood of non-adherence to CRC screening was significantly higher in BCGP (OR 1.15, 95% CI 1.11-1.19), the Atlantic PATH (OR 1.90, 95% CI 1.82-1.99) and CARTaGENE (OR 5.10, 95% CI 4.85-5.36). Low physical activity, current smoking, presence of personal risk, family history of CRC significantly reduced the likelihood of adherence to screening recommendations. Discussion/conclusion Compared to the national target of ≥ 60% for participation in CRC screening, adherence to regular CRC screening was suboptimal in this cohort of Canadians and varied by region. Further efforts are needed to identify the specific barriers to screening adherence in different provinces and across risk categories.
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Affiliation(s)
- Maryam Darvishian
- Cancer Control Research, British Columbia (BC) Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amina Moustaqim-Barrette
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia (BC) Centre for Disease Control, Vancouver, BC, Canada
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Parveen Bhatti
- Cancer Control Research, British Columbia (BC) Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Philippe Broet
- Department of Preventive and Social Medicine, École de Santé Publique, Université de Montréal, Montreal, QC, Canada
- Research Centre, CHU Sainte Justine, Montreal, QC, Canada
| | - Kelly McDonald
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Rachel A. Murphy
- Cancer Control Research, British Columbia (BC) Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kimberly Skead
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Vena
- Alberta Health Services, Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Edmonton, AB, Canada
| | - Trevor J. B. Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Dong K, Gagliardi AR. Person-centered care for diverse women: Narrative review of foundational research. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231192317. [PMID: 37596928 PMCID: PMC10440084 DOI: 10.1177/17455057231192317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
Despite advocacy and recommendations to improve health care and health for persons who identify as women, women continue to face inequities in access to and quality of care. Person-centered care for women is one approach that could reduce gendered inequities. We conducted a series of studies to understand what constitutes person-centered care for women and how to achieve it. The overall aim of this article is to highlight the key findings of those studies that can inform policy, practice, and ongoing research. We conducted a narrative review of all studies related to person-centered care for women conducted in our group starting in 2018 over a 5-year period, which was general at the outset, and increasingly focused on racialized immigrant women who constitute a large proportion of the Canadian population. We organized study summaries by research phase: synthesis of person-centered care for women research, exploration of existing person-centered care for women guidance, consultation with key informants, consensus survey of key informants to prioritize strategies to achieve person-centered care for women, and consensus meeting with key informants to prioritize future research. We conducted the reported research in collaboration with an advisory group of diverse women and managers of community agencies. Our research revealed that little prior research had fully established what constitutes person-centered care for women, and in particular, how to achieve it. We also found little acknowledgment of person-centered care for women or strategies to support it in medical curriculum, clinical guidelines, or healthcare policies. We subsequently consulted women who differed by age, ethno-cultural group, health issue, education and geography, and clinicians of different specialties, who offered considerable insight on strategies to support person-centered care for women. Other diverse women, clinicians, healthcare managers, and researchers prioritized issues that warrant future research. We hope that by compiling a summary of our completed research, we draw attention to the need for person-centered care for women and motivate others to pursue it through policy, practice, and research.
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Affiliation(s)
- Kelly Dong
- Division of General Surgery and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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Vahabi M, Pui-Hing Wong J, Moosapoor M, Akbarian A, Fung K. Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial. JMIR Form Res 2022; 6:e32136. [PMID: 35084337 PMCID: PMC9090443 DOI: 10.2196/32136] [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: 08/01/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background
Temporary migrant live-in caregivers constitute a vulnerable stream of temporary foreign workers in Canada. This is because the majority are racialized women from the Global South, the gendered nature of caregiving work has historically been undervalued, and their working and living spheres are intertwined which makes application of labor laws and surveillance almost impossible. Their invisible position in the fabric of Canadian society along with their precarious employment and immigration status place their mental health at jeopardy. There is a paucity of research about psychological support for this population.
Objective
Our pilot study Women Empowerment—Caregiver Acceptance and Resilience E-Learning (WE2CARE) aimed to assess the efficacy of a 6-week online delivery of a psychological intervention based on acceptance and commitment therapy (ACT) in reducing psychological distress and promoting resiliency among live-in care givers in the Greater Toronto Area.
Methods
A pilot randomized wait list controlled design was used. Participants were recruited by two community peer champions working with community health organizations serving migrant live-in caregivers. A total of 36 participants were recruited and randomly assigned to the intervention and wait list control groups; 7 dropped out of the study due to competing life priorities. Standardized self-reported surveys were administered online pre-, post-, and 6-week postintervention to assess mental distress (DASS-21), psychological flexibility (AAQ-2), mindfulness (CAMS-R), and Multi-System Model of Resilience (MSMR-I). Independent and dependent t tests were used to compare study outcomes at pre, post, and 6-week follow-up across and within both arms of the study. Linear mixed effects models were created for each outcome of interest from baseline to postintervention among intervention and control participants. Self-reported impact of the WE2CARE intervention was examined using independent t tests across the study arms.
Results
Average age of participants was 38 years. Many were born in the Philippines (23/29, 79%). The data on the impact of the psychological intervention showed a lower level of depression, anxiety, and stress among the intervention group compared with the control. However, the differences were not significant due to small sample size and COVID-19 crisis (6.94 vs 9.50, P=.54; 6.94 vs 10.83, P=.20; 7.76 vs 10.33, P=.44, respectively). There was a significant improvement in mindful qualities and external resilience, particularly in life satisfaction and accessible support among the intervention group (37.18 vs 32.92, t22=2.35, P=.03; 20.29 vs 16.5, t21=2.98, P=.007; 8.47 vs 6.75, t14=2.41, P=.03; 7.59 vs 5.33, t16=.008, respectively).
Conclusions
WE2CARE is among the first studies exploring the efficacy of online delivery of ACT in addressing mental health challenges among live-in caregivers. While there are increased web-based ACT interventions, few use group videoconferencing to promote peer connection and mutual support. WE2CARE showed promising results in reducing psychological distress and promoting mindfulness and resiliency. The intervention highly motivated participants to engage collectively in building social support networks.
International Registered Report Identifier (IRRID)
RR2-10.2196/preprints.31211
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Affiliation(s)
- Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | | | - Masoomeh Moosapoor
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Abdolreza Akbarian
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Kenneth Fung
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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O'Connor M, Céilleachair AÓ, O'Brien K, O'Leary J, Martin C, D'Arcy T, Flannelly G, McRae J, Prendiville W, Ruttle C, White C, Pilkington L, Sharp L. Health-related quality of life in women after colposcopy: results from a longitudinal patient survey. Qual Life Res 2021; 30:2509-2520. [PMID: 33792833 DOI: 10.1007/s11136-021-02831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Information concerning the health-related quality-of-life (HRQoL) consequences of colposcopy is limited, particularly over time. In a longitudinal study, we investigated women's HRQoL at 4, 8 and 12 months post colposcopy and the factors associated with this. METHODS Women attending colposcopy at two large hospitals affiliated with the national screening programme in Ireland were invited to complete questionnaires at 4, 8 and 12 months post colposcopy. HRQoL was measured using the EQ-5D-3L and compared across a range of socio-demographic, clinical and attitudinal variables. A mixed-effects logistic multivariable model was employed to investigate associations between these variables and low HRQoL. RESULTS Of 584 women initially recruited, 429, 343 and 303 completed questionnaires at 4, 8 and 12 months, respectively. The mean overall HRQoL score for the sample across all time points was 0.90 (SD 0.16). Approximately 18% of women experienced low HRQoL at each of the three time points. In multivariable testing, over the entire 12-month follow-up period, non-Irish nationals (OR 8.99, 95% CI 2.35-34.43) and women with high-grade referral cytology (OR 2.78, 95% CI 1.08-7.13) were at higher odds of low HRQoL. Women who were past (OR 0.20, 95% CI 0.07-0.58) or never (OR 0.42, 95% CI 0.16-1.12) smokers were at lower odds of low HRQoL than current smokers. As women's satisfaction with their healthcare increased their odds of experiencing low HRQoL fell (OR per unit increase 0.51, 95% CI 0.34-0.75). CONCLUSIONS Women's HRQoL did not change over the 12 months post colposcopy, but some subgroups of women were at higher risk of experiencing low HRQoL. These subgroups may benefit from additional support.
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Affiliation(s)
- M O'Connor
- School of Public Health, University College Cork, 4th Floor, Western Gateway Building, Western Road, Cork, Ireland.
| | | | - K O'Brien
- National Cancer Registry Ireland, Cork, Ireland
| | - J O'Leary
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - C Martin
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - T D'Arcy
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - G Flannelly
- National Maternity Hospital, Dublin, Ireland
| | - J McRae
- National Cancer Registry Ireland, Cork, Ireland
| | - W Prendiville
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - C Ruttle
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - C White
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - L Pilkington
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - L Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, England
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