Cervical Cancer Literacy in Women of Reproductive Age and Its Related Factors

Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review

BACKGROUND

Health literacy (HL) is the ability to make informed decisions using health information. As health data and information availability increase due to online clinic notes and patient portals, it is important to understand how HL relates to social determinants of health (SDoH) and the place of informatics in mitigating disparities.

OBJECTIVE

This systematic literature review aims to examine the role of HL in interactions with SDoH and to identify feasible HL-based interventions that address low patient understanding of health information to improve clinic note-sharing efficacy.

METHODS

The review examined 2 databases, Scopus and PubMed, for English-language articles relating to HL and SDoH. We conducted a quantitative analysis of study characteristics and qualitative synthesis to determine the roles of HL and interventions.

RESULTS

The results (n=43) were analyzed quantitatively and qualitatively for study characteristics, the role of HL, and interventions. Most articles (n=23) noted that HL was a result of SDoH, but other articles noted that it could also be a mediator for SdoH (n=6) or a modifiable SdoH (n=14) itself.

CONCLUSIONS

The multivariable nature of HL indicates that it could form the basis for many interventions to combat low patient understandability, including 4 interventions using informatics-based solutions. HL is a crucial, multidimensional skill in supporting patient understanding of health materials. Designing interventions aimed at improving HL or addressing poor HL in patients can help increase comprehension of health information, including the information contained in clinic notes shared with patients.

Improving the reproductive health literacy of couples on the verge of marriage through the FOCUS-PDCA model: Mixed-method study

Background & Aims

Education and counseling during marriage is an opportunity to raise some issues needed by couples on the verge of marriage. This study was conducted with the aim of improving reproductive and sexual health literacy of couples on the verge of marriage.

Methods

This study was a mixed-methods participatory action research conducted based on the Find, Organize, Clarify, Understand, Select-Plan, Do, Check, Act (FOCUS-PDCA) model in nine steps during 2019-2020 in the city of Bandar Abbas. The Reproductive Health Literacy Scale and the Service Quality (SERVQUAL) Questionnaire were used to evaluate the interventions. Data were analyzed by SPSS version 26. A significance level of less than 0.05 was considered.

Results

The mean age of women and men participating in the quantitative part of the study was 21 ± 5 and 25.84 ± 3.9 years, respectively, which was similar to their counterparts in this part of the study, and the difference in the mean scores of reproductive health literacy before and after the changes in the program showed a significant difference (p > 0.001). The study results showed that, except for the understanding dimension, most participants were at an insufficient level in other dimensions of reproductive health literacy. The result of measuring the satisfaction of service recipients indicated good satisfaction in the two dimensions of warranty and accountability, and there was a gap in empathy, assurance, and tangibility dimensions, which the biggest gap was related to the empathy dimension.

Conclusion

The changes made in improving the reproductive health literacy of couples were effective, which can be taken into consideration based on the added items in the current program of providing educational services in marriage preparation classes for couples.

Developing an evaluation indicators of health literacy for cervical cancer among Chinese women: a modified Delphi method study

BACKGROUND

Increasing women's health literacy is the key to preventing cervical cancer, and various tools have been developed to assess women's cancer health literacy. However, many of these tools come from other countries and have not been adapted to Chinese requirements. Furthermore, a system for evaluating cervical cancer health literacy among Chinese women has not been developed. Therefore, we sought to establish an evaluation index system for cervical cancer health literacy among Chinese women and to provide an effective evaluation tool for tertiary prevention of cervical cancer in China.

METHODS

We invited 20 recognized experts to participate in two rounds of Delphi expert consultation, and the modified Delphi process with percentage weighting and multiplication was used. A literature review identified 67 potential indicators. Subsequent discussions within our research team led to the retention of 48 indicators following a rigorous screening process. On this basis, two rounds of Delphi expert consultation were conducted to rate and screen the indexes. Percentage weighting and multiplication were used to determine index weights.

RESULTS

Twenty experts participated in the first-round Delphi consultations (95.23% recovery rate). In the second-round Delphi consultations, 20 questionnaires were returned (100%), and the expert authority coefficient was 0.93 ± 0.02. After both rounds of Delphi consultation, 4 first-level indicators, 9 second-level indicators, and 32 third-level indicators were identified for cervical cancer literacy among Chinese women. On a five-point scale, importance ratings ranged from 3.76 to 4.95 points, with variation coefficients ranging from 0.06 to 0.25, while sensitivity ratings ranged from 3.71 to 4.83 points, with variation coefficients ranging from 0.08 to 0.24. Across both rounds, Kendall's W coefficients ranged from 0.168 to 0.248. The weights of first-level indicators of basic knowledge and attitudes about cervical cancer, primary prevention of cervical cancer literacy, secondary prevention of cervical cancer literacy, and tertiary prevention of cervical cancer literacy were 0.257, 0.249, 0.251, and 0.243, respectively.

CONCLUSIONS

We have developed the first tertiary prevention-based, comprehensive evaluation index system for cervical cancer literacy among Chinese women, which will provide theoretical support for cervical cancer prevention and health education programs.

Cervical Cancer: Early Detection and Prevention in Reproductive Age Group

Cancer has been one of the major illnesses faced by people over many generations. Despite the advancements made in medicine, there are still many problems faced by humankind. Every year a large number of people are diagnosed with cervical cancer. It is the most common type of cancerous condition prevalent among females, especially females over thirty years of age. Like any other cancer, cervical cancer also occurs because of the rapid uncontrolled division of the body cells. A primary reason for its development is the longstanding infection of certain types of human papillomavirus (HPV). A screening test is done to confirm the presence of the virus in the cervix. Many screening tests are available today for accurate diagnosis or confirmation of the condition being suffered from. The main goal of screening is early detection and making certain lifestyle changes to deduce the potential harm of the disease and start the treatment as soon as possible. A thorough study of the already published articles by scholars, professors, and doctors is carried out to conclude the necessity of cervical cancer screening and early detection.

Modifiable predictors of health literacy in working-age adults - a rapid review and meta-analysis

Background

Health literacy comprises the ability to identify, obtain, interpret and act upon health information. Low health literacy is a major risk factor for hospitalizations, use of emergency care and premature mortality among others. Known risk factors for low health literacy such as lower educational attainment, migration history and chronic illnesses overlap with those for long-term unemployment – in itself a risk factor for low health literacy. These factors are difficult to address in interventions to support health literacy. Therefore, the objective of this review is to identify potentially modifiable predictors of HL in populations potentially affected by long-term unemployment.

Methods

A rapid review (PROSPERO registration number: 290873) was carried out in Pubmed and SCOPUS including quantitative studies on potentially modifiable predictors of health literacy in working-age populations following PRISMA guidelines for systematic reviews. Where possible, reported effect sizes were transformed into r, and random-effects meta-analyses were conducted where appropriate to pool effect sizes for the association between modifiable predictors and health literacy.

Results

In total, 4765 titles and abstracts were screened, 114 articles were assessed in full-text screening, and 54 were included in the review. Forty-one effect sizes were considered for 9 different meta-analyses. Higher language proficiency, higher frequency of internet use, using the internet as a source of health information more often, being more physically active, more oral health behaviours, watching more health-related TV and a good health status were significantly associated with higher health literacy. Significant heterogeneity suggests between-study differences.

Conclusions

Improving language proficiency and/or providing information in multiple and simplified languages, together with reliable and accessible health information on the internet and in linear media are potentially promising targets to improve health literacy levels in working-age populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13851-0.

Barriers to cervical cancer prevention in rural Cameroon: a qualitative study on healthcare providers' perspective

OBJECTIVE

Cervical cancer in Cameroon ranks as the second most frequent cancer among women and the leading cause of cancer-related deaths, mainly due to the lack of prevention. Our principal objective was to explore potential barriers to an human papillomavirus (HPV)-based cervical cancer screening from a healthcare provider (HCP) perspective in a low-income context. Second, we aimed to explore the acceptability of a single-visit approach using HPV self-sampling.

SETTINGS

The study took place in the District hospital of Dschang, Cameroon.

PARTICIPANTS

Focus groups (FGs) involved HCPs working in the area of Dschang and Mbouda.

PRIMARY AND SECONDARY OUTCOME MEASURES

All FGs were audiorecorded, transcribed and coded independently by two researchers using the ATLAS.ti software. A qualitative methodology was used to capture insights related to the way people perceive their surroundings. Discussion topics focused on perceived barriers, suggestions to improve cervical cancer screening uptake, and acceptability.

RESULTS

A total of 16 HCPs were interviewed between July and August 2019. The identified barriers were (1) lack of basic knowledge on cervical cancer among most women and men and (2) lack of awareness of the role and existence of a screening programme to prevent it. Screening for cervical cancer prevention using HPV self-sampling was considered as an acceptable approach for patients according to HCPs. Traditional chiefs were identified as key entry points to raise awareness because they were perceived as essential to reach not only women, but also their male partners.

CONCLUSIONS

Awareness campaigns about cervical cancer, its prevention and the availability of the screening programmes are crucial. Furthermore, involving male partners, as well as key community leaders or institutions was identified as a key strategy to encourage participation in the cervical cancer screening programme.

TRIAL REGISTRATION

Ethical Cantonal Board of Geneva, Switzerland (CCER, N°2017-0110 and CER-amendment n°2) and Cameroonian National Ethics Committee for Human Health Research (N°2018/07/1083/CE/CNERSH/SP).

Access to Personal Health Records and Screening for Breast and Cervical Cancer Among Women with a Family History of Cancer

It is essential for at-risk women to be screened for breast and cervical cancer in a timely manner. Despite a growing interest in the role of health information technology including personal health records (PHRs) to improve quality and outcomes in health care, less is known about the effectiveness of PHRs to promote breast and cervical cancer screening among women with a family history of cancer (FHC). We examined the association between access to PHRs and the use of a recommended mammography and a Pap smear testing among women with a FHC using data from the 2015 Health Information National Trends Survey (HINTS 4-cycle 4) and the 2016 Area Health Resource Files. The study sample was comprised of 1250 women aged 20-75 years with a FHC, a subsample of 3677 survey respondents. Of the 1250 women, 64.96% received a mammogram, and 75.44% underwent a Pap testing. Among women with a FHC, there was a significant and positive association between access to PHRs and the receipt of a mammogram (adjusted odds ratio (aOR) 4.20; 95% CI, 2.23-7.94; p < .001) and a Pap testing (aOR 3.13; 95% CI, 1.56-6.28; p < .01). Our findings suggest that at-risk women can benefit from greater access to PHRs. Policymakers should consider incentivizing providers and healthcare organizations who provide access to PHRs to their patients as well as developing programs that can help improve access to PHRs among at-risk women.

The role of knowledge, risk perceptions, and cues to action among Iranian women concerning cervical cancer and screening: a qualitative exploration

Background

Iran has a low incidence but higher rate of death from cervical cancer (CC). The country is in the process of implementing an organized screening program including HPV testing and cytology. Studies show high dropout in continued testing among eligible women. This qualitative study aimed to explore women’s awareness regarding CC and CC testing and the role of knowledge, perceived risk, and cues to action in this process.

Method

Through a qualitative study based on the Framework Method, we recruited 81 women aged 25–65 who participated in 15 focus group discussions (FGDs) and two in-depth interviews in Tehran. The interviewees were selected purposefully during January to May 2015 from households belonging to different socioeconomic classes until data saturation. The data were acquired through 11 open-ended questions and 32 related probe questions. All interviews were transcribed and independently analyzed by two researchers (Kappa and agreement testing respectively: 0.77, 97.11%).

Results

The coded texts were categorized under three themes and 13 subthemes. The three thematic areas referred to knowledge, cues to action, and perceived risks regarding CC and screening. The results showed that women had limited and unspecified knowledge about CC and screening, compounded by misconceptions regarding infection and cancer prevention measures. Social and cultural barriers hindered proper communication between health system/providers and clients and within communities on subjects related to CC and screening. The perceived risk of getting CC was low because of overestimating the role of hereditary factors for CC, difficulty in differentiating between cancer and sexually transmitted infections (STI), and the absence of visible symptoms.

Conclusion

The results indicate a strong need to invest more efforts to improve health education and communication in the current national health program to promote awareness of the need to screen for CC through, for example, establishing correct knowledge and risk perceptions among women. In addition, this intervention should address women’s social environment in order to prevent misconceptions being communicated to women.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12889-020-09701-6.

Health Literacy in Female – Association with Socioeconomic Factors and Effects on Reproductive Health

The aim of the study is to assess the health literacy of women who are using health services within the Gynecology Obstetric Clinic “Narodni Front” in Belgrade. Testing of health literacy was conducted as a cross-sectional study in the period October-November 2012. As instruments of research the following questionnaires are used: Short Test of Functional Health Literacy in Adults and General information questionnaire of respondents who referred to the demographic, social and economic characteristics of respondents, self-assessment of health, use of health services, health knowledge and behavior in the area of reproductive health. Inadequate health literacy level is registered in every ten respondents. The education level of the respondents proved to be a significant predictor of health literacy. Demographic and socio-economic characteristics of the patients (age, occupation, marital status) as well as self-evaluation of the health status were not significantly related to the health literacy. Health literacy respondents did not significantly dependent on risk behaviors related to reproductive health. The level of health literacy is consistent with the knowledge of subjects in the field of protection of reproductive health. Health literacy as the ability to function within the health care system is equally certain by individual characteristics and skills, characteristics of the health and education systems as well as a wide range of social and cultural factors. Health literacy is more systematic than individual problem, so it requires a broader social action.

Exploring metabolomics biomarkers for evaluating the effectiveness of concurrent radiochemotherapy for cervical cancers

Background

Cervical cancer is the second most common female malignancy worldwide. The main method to evaluate the effect of concurrent chemoradiotherapy (CCRT) in the locally advanced stage is imaging which cannot meet the clinical needs. This study aimed to explore potential cervical cancer biomarkers via plasma metabolomics and evaluate the effectiveness of CCRT and disease progression.

Methods

Twenty-four primary and thirty recurrent patients were enrolled between November 2016 and November 2017. Plasma samples were obtained by centrifugation of whole blood collected from enrolled patients at admission and from primary patients after CCRT. Plasma metabolic profiles were determined via ultra-performance liquid chromatography with quadrupole time-of-flight mass spectrometry. Multivariate analyses and public databases were used to screen and identify differential metabolites. Pathway analysis was conducted using MetaboAnalyst.

Results

Metabolic profiles obtained were significantly different among primary, post-CCRT-treated, and recurrent patients. Multivariate analyses showed that 37 metabolites differed significantly among the three groups, of which the levels of 22 metabolites changed significantly after CCRT and recovered or even exceeded the levels in primary patients when the tumor reappeared. These 22 metabolites were mainly lipids involved in sphingolipid and glycerophospholipid metabolism. Among them, 8 metabolites with area under curve values above 0.75 between each pair of groups exhibited great potential for evaluating CCRT effectiveness and disease progression.

Conclusions

Our results show significantly different plasma metabolic profiles among the three cervical cancer groups; 8 metabolites were identified as potential biomarkers to evaluate the effectiveness of CCRT and disease progression, which can help evaluate the prognosis and treatment of cervical cancer in a timely manner.

Ten Years’ Survival in Patients with Cervical Cancer and Related Factors in West Azerbaijan Province: Using of Cox Proportion Hazard Model

Objective: There are two basic ways to analyze survival data including nonparametric and parametric methods. Considering that cervical cancer is the fourth most common cancer among women, this study was conducted using a suitable regression model for survival data for patients with cervical cancer in Urmia. Material and Methods: In this historical retrospective study, all patients with cervical cancer who referred to Motahhari Hospital of Urmia during 2004 and 2015 were included in the study and consisted of 109 women with cervical cancer. The data were collected using checklist which filled with records of patients. The data were described with percent, mean and standard deviation. The survival function was computed with the Kaplan-Meier method. The adjusted Hazard Ratio for variables were estimated after fitting the Cox proportion hazard model using Forward Stepwise Likelihood Ratio method with PE=0.1, PR=0.15. Results: Of the 109 patients, the mean (SD) time of diagnosis was 50.1% (11.7) years. The mean (SD) and median of follow-up time was 38.23 (32.50) and 27.1 months (Mim:2 months and Max:132 months). Ninty-Three of patients (88.7%) were in urban area. Using Log-Rank test, the mean score of survival in patients with recurrence of 38.8 months was significantly lower than those without recurrence (102.5 months) (P <0.001). The results of the COX model showed that the adjusted relative risk of mortality with a diagnostic age of 50 years or more compared to those under 50 years of age was 1.978. The risk for marriage under age 20 was 3.189 compared to the marriage age of 20 years or more. Conclusion: According to results, the low age of marriage increases the occurrence of advanced stages of cancer in older ages and as a social and cultural factor has a significant effect on the survival of patients with cervical cancer.

Optical coherence tomography in gynecology: a narrative review

Modern gynecologic practice requires noninvasive diagnostics techniques capable of detecting morphological and functional alterations in tissues of female reproductive organs. Optical coherence tomography (OCT) is a promising tool for providing imaging of biotissues with high resolution at depths up to 2 mm. Design of the customized probes provides wide opportunities for OCT use in gynecology. This paper contains a retrospective insight into the history of OCT employment in gynecology, an overview of the existing gynecologic OCT probes, including those for combination with other diagnostic modalities, and state-of-the-art application of OCT for diagnostics of tumor and nontumor pathologies of female genitalia. Perspectives of OCT both in diagnostics and treatment planning and monitoring in gynecology are overviewed.