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Kuper H, Andiwijaya FR, Rotenberg S, Yip JLY. Principles for Service Delivery: Best Practices for Cervical Screening for Women with Disabilities. Int J Womens Health 2024; 16:679-692. [PMID: 38650833 PMCID: PMC11034568 DOI: 10.2147/ijwh.s428144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
Background Cervical cancer screening is an important public health priority, yet many marginalized groups are not reached by existing programs. The nearly 700 million women with disabilities globally face substantial barriers in accessing cervical cancer screening and have lower coverage, yet there is limited evidence on what would support enhanced uptake among this population. Methods We updated a systematic review to estimate the disparity in screening uptake for women with disabilities. We conducted a scoping review to understand key barriers and the inclusion of disability in existing screening policies and possible solutions to improve screening uptakes amongst women with disabilities. We then formulated key principles for improved service delivery for this group, targeted predominantly at clinicians. Results Our updated review identified an additional five new studies, and confirmed that women with disabilities were less likely to be screened for cervical cancer (RR=0.65, 0.50-0.84). Disability-specific barriers to accessing screening pertained to: (1) knowledge and autonomy; (2) logistics; and (3) stigma and fear. Few guidelines included specific considerations for women with disabilities. Our scoping review showed that improving access to care must focus on improving (1) autonomy, awareness, and affordability; (2) human resources; and (3) health facility accessibility. Conclusion Screening programmes and health providers must ensure women with disabilities are included in cervical cancer screening programmes and thereby help to achieve their right to health and eliminate cervical cancer as a public health issue.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Fahrin Ramadan Andiwijaya
- Department of Physical Medicine and Rehabilitation, Airlangga University/ Dr. Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Sara Rotenberg
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer L Y Yip
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
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Legasu TD, Temesgen K, Ayele ZT, Chekole MS, Bayou FD, Fetene JC, Tibebu AT, Taye BT, Ali MA. Determinants of cervical cancer screening service utilization among women attending healthcare services in Amhara region referral hospitals: a case-control study. BMC Womens Health 2022; 22:484. [PMID: 36461054 PMCID: PMC9716695 DOI: 10.1186/s12905-022-02071-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical cancer is the second leading cause of cancer-related death and one of the top 20 causes of death among women in Ethiopia. Cervical cancer screening service has a vital value to reduce morbidity and mortality. Even though cervical cancer screening service utilization in Ethiopia is unacceptably low, its determinant factors were not well studied in the study area. Hence, this study was aimed at filling this information gap. This study aimed to identify determinants of cervical cancer screening service utilization among women attending healthcare services in Amhara region referral hospitals, Ethiopia. METHODS Hospital-based case-control study was conducted among 441 women (147 cases and 294 controls) from May to July 2021. Cases were included consecutively and controls were selected using a systematic random sampling technique from the randomly selected hospitals. A pretested interviewer-administered questionnaire was used to collect the data from respondents. The data were entered into Epi data version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analysis was employed. Adjusted odds ratio with its 95% confidence interval and p value < 0.05 were used to estimate the strength and significance of the association. RESULT A total of 147 cases and 294 controls were enrolled in this study. Women with 30-39 years-old [AOR = 2.3; 95% CI 1.21, 4.68] and 40-49 years-old [AOR = 4.4 95% CI 1.97, 10.12], urban residence [AOR = 2.6; 95% CI 1.36, 5.21], secondary education [AOR = 4.4; 95% CI 2.18, 8.87] and diploma and above [AOR = 2.0; 95% CI: 1.05, 4.59], ever gave birth [AOR = 9.4; 95% CI 4.92, 18.26], having multiple sexual partners [AOR = 2.8; 95% CI 1.60, 5.03], good knowledge towards cervical cancer screening [AOR = 3.6; 95% CI 2.07, 6.43] and positive attitude on cervical cancer screening [AOR = 2.0, 95% CI 1.20, 3.70] were significant determinants of cervical cancer screening service utilization. CONCLUSION In this study, age (30-39 and 40-49), urban residence, secondary education, ever gave birth, good knowledge of cervical cancer screening, positive attitude towards cervical cancer screening, and having multiple sexual partners were significant determinants of cervical cancer screening service utilization. There is a need to strengthen the policy and health education on safe sexual practices and healthy lifestyles through information dissemination and communication to scale up screening service utilization.
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Affiliation(s)
- Temesgen Dessalegne Legasu
- grid.449426.90000 0004 1783 7069Department of Midwifery, College of Medicine and Health Sciences, Jigjiga University, P. Box 1020, Jigjiga, Ethiopia
| | - Kibir Temesgen
- grid.467130.70000 0004 0515 5212Department of Clinical Midwifery, School of Nursing &Midwifery, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
| | - Zenebe Tefera Ayele
- grid.467130.70000 0004 0515 5212Department of Clinical Midwifery, School of Nursing &Midwifery, College of Medicine and Health Sciences, Wollo University, Wollo, Ethiopia
| | - Moges Sisay Chekole
- grid.464565.00000 0004 0455 7818School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Fekade Demeke Bayou
- grid.449426.90000 0004 1783 7069Department of Epidemiology, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Jemberu Chane Fetene
- grid.449426.90000 0004 1783 7069Department of Midwifery, College of Medicine and Health Sciences, Jigjiga University, P. Box 1020, Jigjiga, Ethiopia
| | - Abebe Tadesse Tibebu
- grid.449426.90000 0004 1783 7069Department of Midwifery, College of Medicine and Health Sciences, Jigjiga University, P. Box 1020, Jigjiga, Ethiopia
| | - Birhan Tsegaw Taye
- grid.464565.00000 0004 0455 7818School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mohammed Ahmed Ali
- grid.449426.90000 0004 1783 7069Department of Midwifery, College of Medicine and Health Sciences, Jigjiga University, P. Box 1020, Jigjiga, Ethiopia
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Baruch L, Bilitzky-Kopit A, Rosen K, Adler L. Cervical Cancer Screening Among Patients with Physical Disability. J Womens Health (Larchmt) 2022; 31:1173-1178. [PMID: 35072543 PMCID: PMC9419959 DOI: 10.1089/jwh.2021.0447] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Pap smear has a central role in cervical cancer screening. Previous studies have found that female patients with disabilities are less likely to receive a Pap smear as recommended by guidelines. The aim of our study was to examine the association between physical disability and Pap smear receipt in Israel. Methods: This cross-sectional study was conducted using the electronic medical records of the second largest health care maintenance organization in Israel. All female patients during 2012–2017 aged 25–65 were identified. The exposure variable was physical disability, and the outcome variable was Pap smear receipt. We used logistic regression to control for covariates. Results: A total of 391,259 patients were eligible for this study, 6,720 (1.7%) with physical disability. 56.7% of patients with disabilities had received Pap smear compared to 63.3% of patients without disabilities, odds ratio (OR) 0.76, 95% confidence interval [CI] 0.72–0.80. When adjusting to sociodemographic and clinical covariates, patients with disabilities were less likely to receive Pap smear, adjusted OR 0.83, 95% CI 0.79–0.88. For all patients, older age, lower socioeconomic status, religious minorities, cardiovascular disease, type-2 diabetes mellitus, hypertension, smoking, and obesity were associated with lower odds of receipt of Pap smear. A history of nongynecologic oncologic disease was associated with increased odds of Pap smear receipt. Conclusion: Our study highlights the disparities between patients with and without physical disability with regard to screening for cervical cancer by receipt of Pap smear. Creating an appropriate practice with adequate access to patients with disability should be a focus for health care providers and policy makers.
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Affiliation(s)
- Lior Baruch
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Lior Baruch, MD, Founder of HealthyHer-Feminist Medicine, integrating intersectional feminism in medical practice. A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in women's and LGBTQI+ health and in reducing health disparities
| | - Avital Bilitzky-Kopit
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Avital Bilitzky-Kopit, MD, MPH, A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in nutrition interventions and public health
| | - Keren Rosen
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Keren Rosen, MD, A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in immunology, preventive medicine, and women's health
| | - Limor Adler
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Limor Adler, MD, A specialist in Family Medicine in the Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Works as a family physician in Maccabi Health care Services. Interested in community health research, addiction medicine, and women's health
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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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Prateek S, Gupta S, Gupta A, Choudhary S, Prakash D, Nain G. Knowledge and attitude of women attending Subharti Medical College towards Pap smear. J OBSTET GYNAECOL 2018; 38:996-998. [PMID: 29553837 DOI: 10.1080/01443615.2018.1437616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of this prospective study was to assess the knowledge and attitude of women towards the Pap smear. It was carried out on the women coming to the Department of Obstetrics and Gynaecology at our University, with the help of a pre-formed questionnaire. We found that only 33% of the women were aware of the Pap smear, and of these hardly (10%) had the correct information. Sixty-five percent of the women said that they would have gotten the Pap smear done, if they had known about it earlier. Unless this knowledge amongst women is improved and their attitude is changed, the indices of cervical cancer cannot be improved. Impact statement What is already known on this subject? A Pap smear is used as a screening test to detect not only early stages of cervical cancer but also the precancerous conditions. A Pap smear is done every three years for routine screening, or every five years along with an HPV DNA test. What do the results of this study add? Despite the efforts from the medical fraternity and governments, the number of women undergoing this test in Uttar Pradesh is very minimal. This study analysed the knowledge and attitude of women towards the Pap smear. What are the implications of these findings for clinical practice and/or further research? The results have brought into light the many factors hindering an effective cervical cancer screening in India. Further actions need to be directed in the direction to address these issues.
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Affiliation(s)
- Shashi Prateek
- a Subharti Medical College , Meerut , Uttar Pradesh , India
| | - Smriti Gupta
- a Subharti Medical College , Meerut , Uttar Pradesh , India
| | - Akanksha Gupta
- a Subharti Medical College , Meerut , Uttar Pradesh , India
| | | | - Diksha Prakash
- a Subharti Medical College , Meerut , Uttar Pradesh , India
| | - Geetika Nain
- a Subharti Medical College , Meerut , Uttar Pradesh , India
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Lee FH, Wang HH, Tsai HM, Lin ML. Factors associated with receiving Pap tests among married immigrant women of Vietnamese origin in southern Taiwan. Women Health 2015; 56:243-56. [PMID: 26362802 DOI: 10.1080/03630242.2015.1088113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to explore the factors associated with Pap testing among married immigrant women of Vietnamese origin residing in Taiwan, including demographics, knowledge of cervical cancer, knowledge of Pap tests, fatalism, attitudes toward cervical cancer, and barriers to receiving Pap tests. A cross-sectional correlational design was used. Data were collected from July 2012 to January 2013. Participants were recruited through snowball sampling in two communities in Southern Taiwan. A total of 451 married immigrant women of Vietnamese origin aged 30 years and over were invited to participate in the study and 427 participated. Data analysis included descriptive statistics and multivariate logistic regression. Participants with no children were significantly less likely to have received a Pap test (odds ratio = 0.278, 95% confidence interval [CI] = 0.135-0.569); each additional point of knowledge about Pap tests increased the likelihood of having a Pap test by 19% (odds ratio = 1.190, 95% CI = 1.093-1.297), and each additional point in barriers to receiving Pap tests decreased the chances of having received a Pap test (odds ratio = 0.714, 95% CI = 0.637-0.800). The results can provide governments with a reference for developing policies for cervical cancer prevention among married immigrant Vietnamese women.
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Affiliation(s)
- Fang-Hsin Lee
- a Department of Nursing , Chung Hwa University of Medical Technology , Tainan , Taiwan
| | - Hsiu-Hung Wang
- b College of Nursing , Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Hsiu-Min Tsai
- c Department of Nursing , Chang Gung University of Science and Technology , Taoyuan , Taiwan
| | - Miao-Ling Lin
- d Health Management Division , Kaohsiung City Government Department of Health , Taiwan
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Merten JW, Pomeranz JL, King JL, Moorhouse M, Wynn RD. Barriers to cancer screening for people with disabilities: A literature review. Disabil Health J 2015; 8:9-16. [DOI: 10.1016/j.dhjo.2014.06.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 06/09/2014] [Accepted: 06/14/2014] [Indexed: 11/30/2022]
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Yen CF, Lin JD, Chiu TY. Comparison of population pyramid and demographic characteristics between people with an intellectual disability and the general population. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:910-915. [PMID: 23291507 DOI: 10.1016/j.ridd.2012.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/21/2012] [Indexed: 06/01/2023]
Abstract
The purposes of this study were to measure disparities of age structure between people with an intellectual disability and general population, and to explore the difference of demographic characteristics between these two populations by using data from a population based register in Taiwan. Data were analyzed by SPSS 20.0 statistical software. Results found that the gender and mean age were significantly different between people with an intellectual disability and general population (mean age: 28.86 years vs. 35.26 years; p<0.001). The shape of the pyramid in general population tended to be fatty in the middle age, and intellectual disability population was more populous in the younger age. Furthermore, there were very few people with an intellectual disability can live more than 65 years old (3%) while there were nearly 10% of the general population were the elderly. The results also showed that two groups were different in marital status, educational levels, family status of veteran and aborigine (p<0.001). As the premature aging and short life span of people with an intellectual disability, this study suggested that the government authority should initiate necessary assistance for this group of people in the future.
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Affiliation(s)
- Chia-Feng Yen
- Department of Public Health, Tzu-Chi University, Hualien City, Taiwan
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