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Garpenhag L, Dahlman D. Barriers to and facilitators of screening for cervical and breast cancer: Experiences of non-adherent women with current or previous drug use. Prev Med Rep 2024; 39:102641. [PMID: 38370982 PMCID: PMC10869932 DOI: 10.1016/j.pmedr.2024.102641] [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: 10/19/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Women with current or previous drug use (WCPDU) have an increased risk of poor cervical and breast cancer outcomes, and low participation in screening for these cancer forms. The aim of this study was to assess self-reported barriers to and facilitators of cervical and breast cancer screening, among WCPDU. Methods A survey based on results from a previous qualitative study about WCPDUs experiences of cancer screening was distributed to WCPDU at six opioid agonist treatment (OAT) clinics and one needle exchange program (NEP) in Malmö, Sweden, and through the Drug Users Union in Stockholm, Sweden. Data on barriers to and facilitators of cancer screening reported by 222 non-adherent WCPDU was analyzed by descriptive statistics. The barriers were structured according to an established model of healthcare access. Results The most frequently reported barriers to cervical as well as breast cancer screening were non-receipt of screening invitations (36 % and 25 %, respectively), trouble remembering the appointment (27 % and 30 %) and other priorities (26 % and 29 %). Common suggested facilitators for both cervical and breast cancer screening were screening access at, e.g., a NEP or OAT clinic (45 % and 40 %) and practical support to attend the screening appointment (40 % and 38 %). Conclusions In contrast to general population women, WCPDU report mainly practical barriers to cervical and breast cancer screening. However, NEP participants frequently reported experience of stigma and poor reception as barriers to screening. Interventions to minimize barriers to screening are crucial to decrease the increased cancer morbidity and mortality among WCPDU.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, BMC I12, 221 84 Lund, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Clinical Research Center/CRC, Lund University/Region Skåne, Box 503 22, Malmö, Sweden
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, BMC I12, 221 84 Lund, Sweden
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Garpenhag L, Dahlman D. Screening for breast and cervical cancer among OST patients: a qualitative study of barriers and suggested interventions to increase participation. Int J Qual Stud Health Well-being 2023; 18:2175767. [PMID: 36756664 PMCID: PMC9930823 DOI: 10.1080/17482631.2023.2175767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
PURPOSE Women with current or previous drug use are at risk of poor breast and cervical cancer outcomes. While screening is known to decrease cancer mortality, screening participation is sparsely investigated among drug dependent women. The aim of this study was to explore experiences of breast and cervical cancer screening-including barriers and suggested interventions to promote increased participation-among women in opioid substitution treatment (OST). METHODS Three focus group interviews were conducted at one OST clinic in Malmö, Sweden. The interviews were moderated by OST staff, assisted by a researcher. A descriptive qualitative analysis was carried out using a template analysis approach, employing a model of healthcare access to organize the description of barriers. RESULTS The 11 participants reported several barriers to screening access, affecting the perceived need of screening and the opportunities to seek and reach screening services. Some barriers appear to be specific to women with previous or current drug use. Suggested interventions were moral and practical support, integrated/specialized delivery of screening services, and enhanced screening invitation procedures. CONCLUSIONS The study findings provide insight to difficulties with screening compliance among women with current or previous drug use, and provide a knowledge base for quantitative and intervention studies.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Malmö, Sweden,CONTACT Lars Garpenhag Clinical Research Center, Centrum för primärvårdsforskning, Box 50322, 202 13, Malmö, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Malmö, Sweden,Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
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Sterlingova T, Nylander E, Almqvist L, Møller Christensen B. Factors affecting women's participation in mammography screening in Nordic countries: A systematic review. Radiography (Lond) 2023; 29:878-885. [PMID: 37421878 DOI: 10.1016/j.radi.2023.06.010] [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: 04/18/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Mammography screening programs have been implemented in European countries as prevention tools aimed at reducing breast cancer mortality through early detection in asymptomatic women. Nordic countries (Denmark, Finland, Iceland, Norway, Sweden, the Faroe Islands, and Greenland) demonstrated high participation rates; however, breast cancer mortality could be limited by further optimizing screening. This review aimed to explore factors that affect women's participation in mammography screening in Nordic countries. METHOD A systematic review of segregated mixed research synthesis using a deductive approach was conducted. The following databases and platforms were searched to identify relevant studies: CINAHL with Full Text (EBSCOHost), MEDLINE (EBSCOHost), PsycInfo (ProQuest), Scopus (Elsevier) and Web of Science Core Collection (SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, and ESCI). The Critical Appraisal Skills Program was used for quality assessment. The Health Promotion Model was applied to integrate findings from qualitative and qualitative research. All methodological steps followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS The final selection (16 articles) included studies from three Nordic countries: Denmark (four quantitative studies), Norway (one qualitative and four quantitative studies), and Sweden (three qualitative and seven quantitative studies). Sixty-three factors were identified as barriers, facilitators, or factors with no influence. CONCLUSION A substantial number of obtained factors, spread across a wide spectrum, describe (non-)participation in mammography screening as a versatile phenomenon. IMPLICATIONS FOR PRACTICE The findings of this review could benefit the mammography staff and providers regarding possible interventions aimed at improving screening participation rates.
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Affiliation(s)
- T Sterlingova
- Research School of Health and Welfare, Jönköping University, P.O. Box 1026, 551 11 Jönköping, Sweden.
| | - E Nylander
- Jönköping University Library, Jönköping University, P.O. Box 1026, 551 11 Jönköping, Sweden
| | - L Almqvist
- School of Health, Care and Social Welfare, Mälardalen University, P.O. Box 883, 721 23 Västerås, Sweden
| | - B Møller Christensen
- School of Health and Welfare, Jönköping University, P.O. Box 1026, 551 11 Jönköping, Sweden
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Gummersbach E, Fuchs A, Lubisch D, in der Schmitten J, Pentzek M, Leve V. Was motiviert Frauen zur Teilnahme am Mammographiescreening? Ergebnisse einer qualitativen Analyse von Interviews. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2023. [DOI: 10.1007/s11553-023-01024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Zusammenfassung
Einleitung
Die Teilnahmerate am Mammographiescreening beträgt derzeit ca. 49 %. Über die Gründe für Frauen, am Screening teilzunehmen, ist bisher zu wenig bekannt.
Material und Methoden
Für eine qualitative Studie wurden aus den Teilnehmerinnen einer Fragebogenstudie zum Einfluss verschiedener Informationsbroschüren auf die Teilnahmebereitschaft 8 Frauen für Interviews ausgewählt. Die Frauen wurden nach den Kriterien Teilnahmebereitschaft (6 ja, 2 nein), Bildung (6 hoch, 2 niedrig) und Entscheidungssicherheit (6 hoch, 2 niedrig) ausgewählt und im Jahr 2014 in problemzentrierten Einzelinterviews befragt. Sequenzen der Interviewtranskripte wurden in multidisziplinären Teams inhaltsanalytisch ausgewertet.
Ergebnisse
Alle interviewten Frauen hatten Mammographieerfahrung. Es wurden übergreifende Themen in sechs Kategorien identifiziert: Pflichtgefühl, Autonomie, Zweifel, Unsicherheit, Arzt/Ärztin, Institution. Die Frauen sahen in der Screeningteilnahme die Chance, einer möglichen Bedrohung durch Brustkrebs zu entgehen. Erfahrungen mit Brustkrebs im Umfeld beeinflussten ihre Entscheidung. Einer selbstverantwortlichen Entscheidungsbildung wurde ein hoher Stellenwert zugesprochen, andererseits folgten sie dem Rat ihres Arztes/ihrer Ärztin. Bei der Durchführung des Screenings fühlten sie sich einer unpersönlichen und schmerzhaften Maschinerie ausgesetzt.
Schlussfolgerungen
Frauen treffen ihre Entscheidung, am Screening teilzunehmen oder nicht, eher auf der emotionalen Ebene. Um ihnen eine informierte Entscheidung zu ermöglichen, sollten in einem ärztlichen Gespräch neben sachlichen Informationen ihre Vorstellungen und Erfahrungen in Bezug auf das Mammographiescreening ergebnisoffen besprochen werden.
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Lubi K, Savicka V, Koor M, Nool I, Tupits M, Mets-Oja S. Practice theoretical approach on the reasons why target group women refrain from taking breast cancer screening. PATIENT EDUCATION AND COUNSELING 2021; 104:3053-3058. [PMID: 33836938 DOI: 10.1016/j.pec.2021.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Breast cancer is the most common cancer in women. Despite the availability of effective breast cancer screening programmes, there are only six countries in the European Union reaching the recommended target rate of 70% screened. In addition to the individual reasons for refraining from breast cancer screening, this research aims to follow earlier suggestions to use a practice theoretical approach. METHODS The study sites were Estonia and Latvia, where 9 and 12 semi-structured interviews were conducted, respectively. Convenience and snowball sampling methods were used. The research was approved by ethics committees in both countries. The interviews passed textual analysis and coding. RESULTS The findings revealed that there are three major types of reasons - habitual, practical, and emotional - that influence the formation of the final decision to participate in breast cancer screening. CONCLUSION The implementation of an individualistic approach is not sufficient to bring along desired health behaviour. All groups of reasons, individual and societal context are involved in the decision formation. Thus, structurally provided approaches and messages should be re-conceptualised and re-designed accordingly. PRACTICE IMPLICATIONS Future screening related campaigns and public health education should address the concerns derived from different types of reasons for refraining from screening.
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Affiliation(s)
- Kadi Lubi
- Tallinn Health Care College, Health Education Center, Kännu 67, 13418 Tallinn, Estonia; Department of Communication Studies, Riga Stradins University, 16 Dzirciema iela, Rīga LV-1007, Latvia.
| | - Vita Savicka
- Department of Communication Studies, Riga Stradins University, 16 Dzirciema iela, Rīga LV-1007, Latvia.
| | - Marilyn Koor
- Tallinn Health Care College, Health Education Center, Kännu 67, 13418 Tallinn, Estonia.
| | - Irma Nool
- Tallinn Health Care College, Chair of Nursing, Kännu 67, 13418 Tallinn, Estonia.
| | - Mare Tupits
- Tallinn Health Care College, Chair of Nursing, Kännu 67, 13418 Tallinn, Estonia.
| | - Silja Mets-Oja
- Tallinn Health Care College, Health Education Center, Kännu 67, 13418 Tallinn, Estonia.
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Kuo CP, Li PC, Chuang HL, Lee SH, Liao WC, Lee MS. The effect of multimedia health education on pain and anxiety in women undergoing mammography in Taiwan. Taiwan J Obstet Gynecol 2021; 60:1084-1089. [PMID: 34794742 DOI: 10.1016/j.tjog.2021.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Breast cancer is the most common cancer among women in Taiwan. However, the discomfort of receiving mammograms reduces the willingness to screen. MATERIALS AND METHODS This study using a quasi-experimental design and recruited 150 participants in a medical center, Taiwan. In the control group, only provided traditional health education sheets, the experimental group has joined the intervention of multimedia health education. State-Trait Anxiety Inventory and Visual Analogue Scale, respectively, were used to compare the differences in anxiety and pain between the two groups before and after receiving mammography. RESULTS After the intervention, the experimental group's state anxiety score was significantly lower than that of the control group (30.63 ± 8.43 vs. 33.77 ± 10.74, p < .05). However, there was no significant difference in pain scores (4.13 ± 2.37 vs. 4.57 ± 2.31; p = .25). CONCLUSIONS Younger, prior experience with mammography, and high trait anxiety affect pain and state anxiety of women undergoing mammography. The multimedia health education intervention could reduce anxiety effectively, but it does not significantly relieve the pain undergoing mammography.
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Affiliation(s)
- Ching-Pyng Kuo
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan; Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Pei-Ching Li
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan.
| | - Hsiao-Ling Chuang
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan; Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Shu-Hsin Lee
- School of Nursing, Chung Shan Medical University, Taichung, Taiwan; Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Wen-Chun Liao
- School of Nursing and Graduate Institute of Nursing, China Medical University, Department of Nursing, China Medical University Hospital, Taichung, Taiwan; Department of Nursing, Asian University, Taichung, Taiwan.
| | - Maw-Sheng Lee
- Institute of Medicine, Chung Shan Medical University, Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Perceived Barriers to Early Detection of Breast Cancer in Iranian Women: A Qualitative Content Analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.101467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Breast cancer is one of the most common cancers among Iranian women. The early diagnosis of this disease can decrease the mortality rate and promote patient survival. Objectives: This study aimed at identifying the barriers to early detection of breast cancer in Iranian women. Methods: In this qualitative study, which was extracted from a large research project, an exploratory sequential mixed-methods design was used, and conventional content analysis was carried out. Twenty-one participants were selected by purposeful sampling (ten health professionals and 11 female patients with breast cancer). Data were collected through in-depth, semi-structured interviews from July 2018 to June 2019. Results: The content analysis revealed three major themes related to delay in presentation: individual barriers (limited/lack of knowledge, other life preferences, negative reactions to the disease, and belief in fate), environmental barriers (insufficient social support, inaccurate information sources, and alternative therapy recommendations), and organizational barriers (poor quality of health services, inadequate access to health services, and role of media in informing people). Conclusions: Various perceived barriers, at different levels, play influential roles in the patients’ early detection. Therefore, collaboration between public health professionals, healthcare providers, and policymakers seems necessary for reducing delays in presentation among women.
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Norfjord van Zyl M, Akhavan S, Tillgren P, Asp M. Non-participation in mammographic screening - experiences of women from a region in Sweden. BMC Public Health 2020; 20:219. [PMID: 32050943 PMCID: PMC7017469 DOI: 10.1186/s12889-020-8306-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/31/2020] [Indexed: 12/03/2022] Open
Abstract
Background Understanding women’s life conditions regarding their non-participation in different health-promoting and disease-preventing activities is important as it may draw attention to potential areas for improvement in the healthcare sector. Mammographic screening, a disease-preventing service, facilitates early detection of any potential malignancies and consequently prompts initiation of treatment. The reasons for non-participation in mammographic screening can be understood from different perspectives, such as socioeconomic and lifestyle-related determinants of health. This study aims to gain a deeper understanding of women’s experiences and perceptions about non-participation in mammographic screening in a Swedish region with a single mammographic facility. Methods Data from individual semi-structured interviews, conducted in 2018 with eleven women between the ages of 48 and 73, were analysed by a qualitative content analysis. Results The findings reveal three main categories: 1) doubts regarding mammographic screening and its organisation, 2) sense and sensibility in the decision to refrain from mammographic screening, and 3) dependency and options. These three categories indicate aspects, such as the individual’s life situation, accessibility to the offered service, and the flexibility of the healthcare system, that need to be considered to improve the organisation of mammographic screening. Conclusion Listening to the women’s voices regarding their experiences and perceptions about mammographic screening is important as individual characteristics and social circumstances interact with healthcare and affect the degree of participation.
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Affiliation(s)
- Maria Norfjord van Zyl
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
| | - Sharareh Akhavan
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Per Tillgren
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Margareta Asp
- Division of Caring Sciences and Health Care Pedagogics, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
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Barriers to, and facilitators of, access to cancer services and experiences of cancer care for adults with a physical disability: A mixed methods systematic review. Disabil Health J 2019; 13:100844. [PMID: 31668781 DOI: 10.1016/j.dhjo.2019.100844] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/20/2019] [Accepted: 10/07/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cancer services need to be inclusive and accessible to everybody, including people with disabilities. However, there is evidence suggesting that people with disabilities experience poorer access to cancer services, compared to people without disabilities. OBJECTIVES To investigate the barriers and facilitators of access to cancer services for people with physical disabilities and their experiences of cancer care. METHODS A mixed-method systematic review was conducted following the Evidence for Policy and Practice Information and Co-ordinating Centre approach. We used the Mixed Methods Appraisal Tool (MMAT -Version 11) to assess the quality of the included studies. We employed thematic synthesis to bring together data from across both qualitative and quantitative studies and we assessed the strength of synthesised findings using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. RESULTS Seven quantitative studies and 10 qualitative studies (across 18 publications) were included. The findings highlighted a dearth of research on the experiences of men with disabilities. Furthermore, only one study explored experiences of cancer treatment, with all other studies focusing on cancer screening. Five synthesised findings were identified that reflected barriers and facilitators, highlighting both what makes access to services difficult and what are the strategies that could improve it. CONCLUSIONS Knowing what works for people with disabilities can enable the delivery of appropriate services. The findings of this review suggest that the mere existence of services does not guarantee their usability. Services need to be relevant, flexible, and accessible, and offered in a respectful manner.
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Marzouq Muhanna A, Floyd MJ. A qualitative study to determine Kuwaiti Women's knowledge of breast cancer and barriers deterring attendance at mammography screening. Radiography (Lond) 2019; 25:65-71. [PMID: 30599833 DOI: 10.1016/j.radi.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/14/2018] [Accepted: 10/20/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although a Mammography Screening Service (MSS) has been established in Kuwait since 2014, the attendance rate for eligible women is only 4.2% in comparison to 72.1% attendance in the United Kingdom (UK) mammography screening service. The aim of this study was to determine Kuwaiti women's knowledge of breast cancer (BC), their attitudes toward BCS and the reasons for not attending Mammography Screening (MS). METHODS A pragmatic qualitative methodology was used which included the use of two focus groups conducted at two women only social organisations in Kuwait with a total of 23 women. One focus group was conducted at a social and cultural organisation; the second focus group took place at a social organisation whose primary role is the improvement of literacy though the use of religious scripture. Thematic analysis was applied to the recorded verbal transcripts from each focus group. RESULTS Thematic analysis revealed four major themes, accompanied by a series of subthemes (1) knowledge and awareness of BC health, (2) knowledge of MS (3) personal factors, (4) medical provision and social environment. CONCLUSION Findings suggest that participant's knowledge of BC and the decision to attend MS is influenced by a series of factors both personal and external. An increase in the awareness of BC, MS and the process of accessing MSS will enhance the uptake of MS among Kuwaiti women. Furthermore, doctors and health care providers will need to play a significant role in encouraging women to self-refer.
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Affiliation(s)
| | - M J Floyd
- Cardiff University, Heath Park Campus, CF14 4ER, UK
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