Does knowledge influence pap test screening among young African-American women?

The Impact of Continuity of Care on Cervical Cancer Screening: How Visit Pattern Affects Guideline Concordance

Cervical cancer can be prevented and highly curable if detected early. Current guidelines recommend women to receive cervical cancer screening starting at age 21. Our study aims to investigate how improving continuity of care (COC) may influence guideline concordance of cervical cancer screening. Using the eligibility and claims data, we created a person-month panel data set for women who were enrolled in Oregon Medicaid for at least 80% of the period from 2008 to 2015. We then selected our study cohort following the cervical cancer screening guidelines. Our dependent variable is whether a woman received cervical cancer screening concordant with guidelines in a given month, when she did not receive Pap test in the past 36 months and did not receive co-testing of HPV test plus Pap test in the past 60 months. We used both population-averaged logit model and conditional fixed-effect logit model to estimate the association between the guideline concordance and the COC index, after controlling for high risk, pregnancy, age, race, and ethnicity. A total of 466,526 person-month observations were included in our main models. A 0.1 unit increase of the COC score was significantly associated with a decrease in the odds of receiving guideline-concordant cervical cancer screening (population-averaged logit model: OR = 0.988, p < .001; conditional fixed-effect logit model: OR = 0.966, p < .001). Our findings remain robust to a series of sensitivity analyses. A better COC may not be necessarily beneficial to improving cervical cancer prevention. Educations for both physicians and patients should be supplemented to assure quality of preventive care.

Barriers to Pap Smear Among Homeless Women at Albuquerque Healthcare for the Homeless

The purpose of this cross-sectional survey study was to explore common barriers to adequate Pap smear utilization among homeless women, and the factors that may relate to cervical cancer testing in this population. Participants consisted of adult women recruited at a healthcare facility for the homeless. Data were collected through a self-completed questionnaire on knowledge, attitudes and intentions about Pap smears and cervical cancer. Analyses included descriptive and inferential statistics. Sixty participants who had experienced homelessness within the past year completed the study. The most frequently mentioned barrier to testing was not having enough time to obtain a Pap smear (n = 33; 55%). Linear regression found that there were no significant relationships between knowledge and attitudes about cervical cancer and intention to get a Pap smear. However, the study did find that women with a positive previous Pap smear experience had more positive attitudes about the process and outcomes of Pap smears (p = 0.011, p = 0.00, respectively). Participants with more knowledge about cervical cancer were less negative about Pap smear outcomes (p = 0.05), and that women with negative attitudes about Pap smear outcomes were less likely to have obtained a Pap smear in the past (p = 0.033). Interventions that promote positive attitudes about testing and outcomes, minimizing stress and inconvenience during the test, as well as increasing the ease of scheduling an appointment may help break down barriers to cervical cancer screening among homeless women.

Cervical Cancer Incidence and Mortality among Non-Hispanic African American and White Women, United States, 1999-2015

BACKGROUND

Cervical cancer, a preventable cancer, has disproportionately affected African American women. To better understand the burden of cervical cancer, we assessed incidence and mortality rates and analyzed trends among non-Hispanic (NH) African American and White women in the US from 1999 to 2015.

METHODS

From age-adjusted cervical cancer incidence and mortality rates, rate ratios (RR) and 95% confidence intervals (CI) were calculated for comparison between the two races. Trends were analyzed using joinpoint regression and expressed as annual percent change (APC) and average annual percent change (AAPC).

RESULTS

Cervical cancer incidence rates were significantly higher (RR: 1.46; 95% CI: 1.44, 1.47) among NH African Americans (10.8 per 100,000 females) than NH Whites (7.4 per 100,000 females). Similarly, mortality rates were significantly higher (RR: 2.05; 95% CI: 2.01, 2.09) in NH African Americans (4.4 per 100,000 females) compared to NH Whites (2.1 per 100,000 females). From 1999 to 2015, overall incidence and mortality trends decreased significantly for both races. Mortality rates steadily increased with age for both races, and incidence rates only increased with age in NH African American women.

CONCLUSION

NH African American women had significantly higher cervical cancer incidence and mortality rates than NH Whites. Even as incidence and mortality trends declined significantly, older NH African Americans had three times the rate of cervical cancer than NH Whites. Prevention and treatment programs need to be enhanced for African Americans as failure to do so may widen cancer disparities.

CervixCheck: A Spiritually-Based Text Messaging Intervention to Promote Cervical Cancer Awareness and Pap Test Screening Intention among African-American Women

BACKGROUND/PURPOSE

On a national level, African-American women have a 34% higher incidence of cervical cancer and are twice as likely to die of the disease when compared to White women. In response to the need to improve cervical cancer prevention and Pap test screening knowledge and utilization, we developed and pilot tested a 16-day SMS text message-based intervention. The CervixCheck study was designed to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention aimed at increasing cervical cancer awareness and Pap test screening intention in church-attending African-American women ages 21-65. Methods/Approach: The Theory of Planned Behavior guided the development of the CervixCheck intervention. This intervention utilized a non-experimental one-group pretest-posttest design. In this article, we present findings from the pilot testing phase. Of the 52 participants at baseline, 46 completed the post-program survey.

RESULTS/FINDINGS

The current study provides evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There was a significant pre-post increase observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Findings post-intervention also revealed that 83% of participants reported being either "satisfied" or "very satisfied" with the CervixCheck intervention and 85% found the SMS text messages either "useful" or "very useful".

CONCLUSIONS/SIGNIFICANCE

A spiritually-based SMS text messaging intervention could be a culturally-appropriate and cost-effective method of promoting cervical cancer early detection information to church-attending African-American women.

A Spiritually-Based Text Messaging Program to Increase Cervical Cancer Awareness Among African American Women: Design and Development of the CervixCheck Pilot Study

BACKGROUND

Although Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women.

OBJECTIVE

The aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years.

METHODS

Through focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years.

RESULTS

Design and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility.

CONCLUSIONS

The design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities.

Knowledge of cervical cancer and attendance at cervical cancer screening: a survey of Black women in London

Background

Women from ethnic minority backgrounds are less likely to attend cervical screening, but further understanding of ethnic inequalities in cervical screening uptake is yet to be established. This study aimed to explore the socio-demographic and ethnicity-related predictors of cervical cancer knowledge, cervical screening attendance and reasons for non-attendance among Black women in London.

Methods

A questionnaire was completed by women attending Black and ethnic hair and beauty specialists in London between February and April 2013. A stratified sampling frame was used to identify Black hair specialists in London subdivisions with >10% Black population (including UK and foreign-born). Fifty-nine salons participated. Knowledge of cervical cancer risk factors and symptoms, self-reported screening attendance and reasons for non-attendance at cervical screening were assessed.

Results

Questionnaires were completed by 937 Black women aged 18–78, describing themselves as being predominantly from African or Caribbean backgrounds (response rate 26.5%). Higher educational qualifications (p < .001) and being born in the UK (p = .011) were associated with greater risk factor knowledge. Older age was associated with greater symptom knowledge (p < .001). Being younger, single, African (compared to Caribbean) and attending religious services more frequently were associated with being overdue for screening. Women who had migrated to the UK more than 10 years ago were less likely to be overdue than those born in the UK. Of those overdue for screening who endorsed a barrier (67/133), ‘I meant to go but didn’t get round to it’ (28%), fear of the test procedure (18%) and low risk perception (18%) were the most common barriers.

Conclusions

Ethnicity, migration and religiosity play a role in predicting cervical screening attendance among women from Black backgrounds. African women, those born in the UK and those who regularly attend church are most likely to put off attending. Additional research is needed to explore the attitudes, experiences and beliefs that explain why these groups might differ.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1096) contains supplementary material, which is available to authorized users.