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Alshammari AH, Ishii H, Hirotsu T, Hatakeyama H, Morishita M, di Luccio E. Bridging the gap in cervical cancer screening for underserved communities: MCED and the promise of future technologies. Front Oncol 2024; 14:1407008. [PMID: 39135996 PMCID: PMC11317246 DOI: 10.3389/fonc.2024.1407008] [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: 03/26/2024] [Accepted: 07/09/2024] [Indexed: 08/15/2024] Open
Abstract
Cervical cancer screening is a critical public health measure, especially vital for underserved communities where disparities in access and outcomes are pronounced. Despite the life-saving potential of regular screening, numerous barriers-including geographical isolation, cultural and linguistic challenges, and socioeconomic factors-severely hinder accessibility for these populations. Multicancer early detection (MCED) tests emerge as a potentially effective intervention, offering a less invasive, more accessible approach that could transform how screenings are conducted. This paper explores the existing challenges in traditional cervical cancer screening methods, the potential of MCED tests to address these barriers, and the implications of these technologies for global health equity. Through a comprehensive review, we highlight the need for culturally sensitive, tailored interventions and the importance of effectively overcoming logistical and financial difficulties to implement MCED tests. Despite the promise shown by MCED tests, the paper acknowledges significant implementation challenges, including cost, logistical obstacles, and the need for cultural acceptance and validation studies. This study emphasizes the necessity for equitable MCED test implementation strategies, highlighting the potential of these innovative technologies to advance global health equity in cervical cancer prevention.
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Affiliation(s)
| | - Hideshi Ishii
- Department of Medical Data Science, Center of Medical Innovation and Translational Research, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takaaki Hirotsu
- Shonan Research and Development Center, Hirotsu Bio Science Inc., Tokyo, Japan
| | - Hideyuki Hatakeyama
- Shonan Research and Development Center, Hirotsu Bio Science Inc., Tokyo, Japan
| | - Masayo Morishita
- Shonan Research and Development Center, Hirotsu Bio Science Inc., Tokyo, Japan
| | - Eric di Luccio
- Shonan Research and Development Center, Hirotsu Bio Science Inc., Tokyo, Japan
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Aubrey-Bassler K, Patel D, Fernandes C, Lofters AK, Campbell-Scherer D, Meaney C, Moineddin R, Wong T, Pinto AD, Shea-Budgell M, McBrien K, Grunfeld E, Manca DP. Chronic disease prevention and screening outcomes for patients with and without financial difficulty: a secondary analysis of the BETTER WISE cluster randomised controlled trial. BMJ Open 2024; 14:e078938. [PMID: 38626970 PMCID: PMC11029378 DOI: 10.1136/bmjopen-2023-078938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE Building on Existing Tools To improvE chronic disease pRevention and screening in primary care Wellness of cancer survIvorS and patiEnts (BETTER WISE) was designed to assess the effectiveness of a cancer and chronic disease prevention and screening (CCDPS) programme. Here, we compare outcomes in participants living with and without financial difficulty. DESIGN Secondary analysis of a cluster-randomised controlled trial. SETTING Patients of 59 physicians from 13 clinics enrolled between September 2018 and August 2019. PARTICIPANTS 596 of 1005 trial participants who responded to a financial difficulty screening question at enrolment. INTERVENTION 1-hour CCDPS visit versus usual care. OUTCOME MEASURES Eligibility for a possible 24 CCDPS actions was assessed at baseline and the primary outcome was the percentage of eligible items that were completed at 12-month follow-up. We also compared the change in response to the financial difficulty screening question between baseline and follow-up. RESULTS 55 of 265 participants (20.7%) in the control group and 69 of 331 participants (20.8%) in the intervention group reported living with financial difficulty. The primary outcome was 29% (95% CI 26% to 33%) for intervention and 23% (95% CI 21% to 26%) for control participants without financial difficulty (p=0.01). Intervention and control participants with financial difficulty scored 28% (95% CI 24% to 32%) and 32% (95% CI 27% to 38%), respectively (p=0.14). In participants who responded to the financial difficulty question at both time points (n=302), there was a net decrease in the percentage of participants who reported financial difficulty between baseline (21%) and follow-up (12%, p<0.001) which was similar in the control and intervention groups. The response rate to this question was only 51% at follow-up. CONCLUSION The BETTER intervention improved uptake of CCDPS manoeuvres in participants without financial difficulty, but not in those living with financial difficulty. Improving CCDPS for people living with financial difficulty may require a different clinical approach or that social determinants be addressed concurrently with clinical and lifestyle needs or both. TRIAL REGISTRATION NUMBER ISRCTN21333761.
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Affiliation(s)
- Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Dhruvesh Patel
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Carolina Fernandes
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Denise Campbell-Scherer
- Covenant Health, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Wong
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
| | - Andrew David Pinto
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Melissa Shea-Budgell
- Charbonneau Cancer Institute and Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Donna P Manca
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Covenant Health, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
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Devotta K, Vahabi M, Prakash V, Lofters AK. Implementation of a Cervical Cancer Screening Intervention for Under- or Never-Screened Women in Ontario, Canada: Understanding the Acceptability of HPV Self-Sampling. Curr Oncol 2023; 30:6786-6804. [PMID: 37504357 PMCID: PMC10378307 DOI: 10.3390/curroncol30070497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
With appropriate screening, cervical cancer can be prevented. In Ontario, Canada, some groups of women have low screening rates. South Asian, Middle Eastern and North African women are particularly at risk of under-screening. Currently, cytology-based screening is used in Ontario, although the growing evidence and adoption of HPV testing for cervical screening has encouraged many jurisdictions around the world to move towards HPV testing, with the option of self-sampling. We conducted an intervention beginning in June 2018, where we recruited over 100 under- or never-screened (UNS) women who identify as South or West Asian, Middle Eastern or North African from the Greater Toronto Area, to understand the uptake and acceptability of HPV self-sampling as an alternative to a Pap test. Participants self-selected if they tried the kit or not and completed both quantitative and qualitative research activities. This paper focuses on the qualitative arm of the study, where follow-ups and five focus groups were conducted with those who tried the kit (three groups) and those who did not (two groups), as well as eight key informant interviews with community champions and others who were involved in our recruitment. We used the Consolidated Framework for Implementation Research (CFIR) to guide our data collection and analysis. Major themes around convenience, privacy and comfort came from the data as important drivers of the uptake of the intervention. The role of community champions and peers in engaging and educating UNS women, as well as having self-confidence to collect the sample, also came out as factors impacting uptake and plans for continued use. Overall, the intervention showed that HPV self-sampling is an acceptable alternative to a Pap test for some but not all UNS women in Ontario.
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Affiliation(s)
- Kimberly Devotta
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5, Canada
| | - Vijayshree Prakash
- WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5, Canada
| | - Aisha K Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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Devotta K, Vahabi M, Prakash V, Lofters A. Reach and effectiveness of an HPV self-sampling intervention for cervical screening amongst under- or never-screened women in Toronto, Ontario Canada. BMC Womens Health 2023; 23:36. [PMID: 36698140 PMCID: PMC9876406 DOI: 10.1186/s12905-023-02174-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cervical cancer is almost entirely preventable with appropriate and timely screening. In Ontario, Canada, South Asian, Middle Eastern and North African women have some of the lowest rates of screening and a suggested higher burden of cervical cancer. With increasing international evidence and adoption of HPV testing, many screening programs are making the move away from Pap tests and towards HPV testing with the option of HPV self-sampling seeming promising for under- or never-screened (UNS) women. Our study aimed to understand the uptake and acceptability of an HPV self-sampling intervention amongst these disproportionately UNS women in Peel region and surrounding areas in Ontario. METHODS A community -based mixed methods approach guided by the RE-AIM framework was used to recruit approximately 100 UNS racialized immigrant women aged 30-69, during the period of June 2018 to December 2019. The main recruitment strategy included community champions (i.e. trusted female members of communities) to engage people in our selected areas in Peel Region. Participants completed a study questionnaire about their knowledge, attitudes and practices around cervical cancer screening, self-selected whether to use the HPV self-sampling device and completed follow-up questions either about their experience with self-sampling or going to get a Pap test. RESULTS In total, 108 women participated in the study, with 69 opting to do self-sampling and 39 not. The majority of women followed through and used the device (n = 61) and found it 'user friendly.' The experience of some participants suggests that clearer instructions and/or more support once at home is needed. Survey and follow-up data suggest that privacy and comfort are common barriers for UNS women, and that self-sampling begins to address these concerns. Across both groups addressing misinformation and misconceptions is needed to convince some UNS women to be screened. Family, friends and peers also seemed to play a role in the decision-making process. CONCLUSIONS HPV self-sampling is viewed as an acceptable alternative to a Pap test for cervical screening, by some but not all UNS women. This method begins to address some of the barriers that often prevent women from being screened and is already being offered in some jurisdictions as an alternative to clinical cervical cancer screening.
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Affiliation(s)
- Kimberly Devotta
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - Mandana Vahabi
- grid.68312.3e0000 0004 1936 9422Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Vijayshree Prakash
- grid.68312.3e0000 0004 1936 9422WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Aisha Lofters
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7 Canada
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Cervical Cancer Screening by Refugee Category in a Refugee Health Primary Care Clinic in Calgary, Canada, 2011-2016. J Immigr Minor Health 2022; 24:1534-1542. [PMID: 35233682 DOI: 10.1007/s10903-022-01345-5] [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: 02/07/2022] [Indexed: 10/19/2022]
Abstract
Newly arrived refugees and refugee claimants experience low cervical cancer screening (CCS) rates in Canada. We investigated CCS at a dedicated refugee clinic. We completed a retrospective cohort study among patients at the Mosaic Refugee Health Clinic in Calgary, Canada, between 2011 and 2016. We investigated CCS offers and completion by refugee category. We then used multivariable logistic regression to estimate the association of CCS screening and refugee category, accounting for sociodemographic and clinical factors. We included 812 refugees. Most were married (71%) and had limited English proficiency (57%). Overall, 88% and 77% of patients were offered and completed screening, respectively. Compared to government assisted refugees, privately sponsored refugees completed CCS more often (OR 1.60, 95% CI [1.02-2.49]). A dedicated refugee clinic may provide effective CCS to newly arrived refugees irrespective of refugee category, insurance status or other barriers.
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Pap Smear and Mammogram Screening Rates in a Refugee and General OB/GYN Clinic: A Retrospective Review. J Immigr Minor Health 2021; 24:111-117. [PMID: 34714467 DOI: 10.1007/s10903-021-01297-2] [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: 10/20/2021] [Indexed: 10/20/2022]
Abstract
Although multiple studies have shown that resettled refugee women are less likely to receive preventative cancer screenings like pap smears and mammograms, a small number have demonstrated the opposite. This retrospective chart review, conducted between January 2017 and October 2018, compares pap smear and mammogram rates of patients seen in a refugee-specific OB/GYN clinic with patients from the general OB/GYN clinic at the same institution. Data from 298 patients (149 refugee and 149 general clinic patients matched by age and date-of-visit) were analyzed. Pap smear screening rates were 90.60% in the refugee group and 73.83% in the general group [p < 0.009, aOR 3.46 (1.36-8.81)], while mammogram screening rates were 36.84% and 38.60%, respectively (p = 0.46). The provision of holistic services meeting refugee women's unique needs can effectively increase pap smear screening rates.
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Walker MJ, Meggetto O, Gao J, Espino-Hernández G, Jembere N, Bravo CA, Rey M, Aslam U, Sheppard AJ, Lofters AK, Tammemägi MC, Tinmouth J, Kupets R, Chiarelli AM, Rabeneck L. Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: A provincial, population-based study. Prev Med 2021; 151:106586. [PMID: 34217413 PMCID: PMC9755643 DOI: 10.1016/j.ypmed.2021.106586] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/16/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022]
Abstract
It is essential to quantify the impacts of the COVID-19 pandemic on cancer screening, including for vulnerable sub-populations, to inform the development of evidence-based, targeted pandemic recovery strategies. We undertook a population-based retrospective observational study in Ontario, Canada to assess the impact of the pandemic on organized cancer screening and diagnostic services, and assess whether patterns of cancer screening service use and diagnostic delay differ across population sub-groups during the pandemic. Provincial health databases were used to identify age-eligible individuals who participated in one or more of Ontario's breast, cervical, colorectal, and lung cancer screening programs from January 1, 2019-December 31, 2020. Ontario's screening programs delivered 951,000 (-41%) fewer screening tests in 2020 than in 2019 and volumes for most programs remained more than 20% below historical levels by the end of 2020. A smaller percentage of cervical screening participants were older (50-59 and 60-69 years) during the pandemic when compared with 2019. Individuals in the oldest age groups and in lower-income neighborhoods were significantly more likely to experience diagnostic delay following an abnormal breast, cervical, or colorectal cancer screening test during the pandemic, and individuals with a high probability of living on a First Nation reserve were significantly more likely to experience diagnostic delay following an abnormal fecal test. Ongoing monitoring and management of backlogs must continue. Further evaluation is required to identify populations for whom access to cancer screening and diagnostic care has been disproportionately impacted and quantify impacts of these service disruptions on cancer incidence, stage, and mortality. This information is critical to pandemic recovery efforts that are aimed at achieving equitable and timely access to cancer screening-related care.
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Affiliation(s)
- Meghan J Walker
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Olivia Meggetto
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Julia Gao
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | | | - Michelle Rey
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Usman Aslam
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Amanda J Sheppard
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aisha K Lofters
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontairo, Canada; IC/ES, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Martin C Tammemägi
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Brock University, St. Catharines, Ontario, Canada
| | - Jill Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; IC/ES, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Kupets
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Anna M Chiarelli
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; IC/ES, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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The Effects of Ethno-cultural Origin-Destination Interactions on Immigrants' Longevity. J Immigr Minor Health 2021; 24:1345-1366. [PMID: 34529210 DOI: 10.1007/s10903-021-01245-0] [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: 06/30/2021] [Indexed: 10/20/2022]
Abstract
A large body of research has documented an immigrant mortality advantage. However, we still do not know enough about how interactions between the characteristics of origin and destinations countries shape variabilities in immigrants' experiences and health. In this paper, we examine the effects of ethno-cultural similarities and differences between the country of origin and the country of destination on immigrants' longevity. We use meta-regression methods to examine data on 78 origin and 16 destination countries (1092 risk estimates from 69 studies). In contrast to expectations from approaches that focus on immigration/acculturation stress, we found that a shared official linguistic family, moving to a country where one is not likely to be considered a visible minority, and more integrative immigration policies actually reduce or even eliminate the immigrant mortality advantage. We discuss potential explanations for these findings and argue that selection mechanisms provide a better account.
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Rollet Q, Tron L, De Mil R, Launoy G, Guillaume É. Contextual factors associated with cancer screening uptake: A systematic review of observational studies. Prev Med 2021; 150:106692. [PMID: 34166675 DOI: 10.1016/j.ypmed.2021.106692] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/19/2021] [Accepted: 06/17/2021] [Indexed: 12/13/2022]
Abstract
We conducted a systematic review of a wide range of contextual factors related to cancer screening uptake that have been studied so far. Studies were identified through PubMed and Web of Science databases. An operational definition of context was proposed, considering as contextual factors: social relations directly aimed at cancer screening, health care provider and facility characteristics, geographical/accessibility measures and aggregated measures at supra-individual level. We included 70 publications on breast, cervical and/or colorectal cancer screening from 42 countries, covering a data period of 24 years. A wide diversity of factors has been investigated in the literature so far. While several of them, as well as many interactions, were robustly associated with screening uptake (family, friends or provider recommendation, provider sex and experience, area-based socio-economic status…), others showed less consistency (ethnicity, urbanicity, travel time, healthcare density …). Screening inequities were not fully explained through adjustment for individual and contextual factors. Context, in its diversity, influences individual screening uptake and lots of contextual inequities in screening are commonly shared worldwide. However, there is a lack of frameworks, standards and definitions that are needed to better understand what context is, how it could modify individual behaviour and the ways of measuring and modifying it.
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Affiliation(s)
- Quentin Rollet
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France.
| | - Laure Tron
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Rémy De Mil
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Guy Launoy
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Élodie Guillaume
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
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Understanding the Acceptability and Uptake of HPV Self-Sampling Amongst Women Under- or Never-Screened for Cervical Cancer in Toronto (Ontario, Canada): An Intervention Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179114. [PMID: 34501703 PMCID: PMC8430523 DOI: 10.3390/ijerph18179114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022]
Abstract
Cervical cancer remains a global public health concern, even though scientific advancements have made the disease almost entirely preventable. With the link between human papillomavirus (HPV) and cervical cancer, and the subsequent improvement in screening technology, there is potential to improve access and coverage of cervical screening with the introduction of HPV self-sampling. In Ontario, Canada, a province with a cytology-based screening program (i.e., Pap test), women who identify as South Asian, West Asian, Middle Eastern and North African have some of the lowest rates of screening, and research suggests they have a higher burden of cervical cancer. In this study, we will use both quantitative and qualitative methods to understand the acceptability and uptake of a take-home HPV self-sampling kit. Working with community champions—people with pre-existing connections with local groups—we will recruit women from these groups who are under- or never-screened for cervical cancer. Women will self-select whether they are in the group that tries HPV self-sampling or in the group that does not. We will aim for 100 women in each group. All participants will provide feedback on the feasibility, acceptability and preferences for cervical screening through a survey and phone follow-up. Women who self-select the HPV self-sampling group, will be followed up to find out if they followed through with self-sampling and to understand their experience using the device. Women who do not want to try self-sampling will be followed up to see if they went on to get a Pap test. The qualitative phase of this study consists of five focus groups with participants and semi-structured interviews with key informants in the community.
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Mohareb AM, Brown B, Ikuta KS, Hyle EP, Annamalai A. Vaccine completion and infectious diseases screening in a cohort of adult refugees following resettlement in the U.S.: 2013-2015. BMC Infect Dis 2021; 21:582. [PMID: 34134644 PMCID: PMC8207756 DOI: 10.1186/s12879-021-06273-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugees are frequently not immune to vaccine-preventable infections. Adherence to consensus guidelines on vaccination and infectious diseases screening among refugees resettling in the U.S. is unknown. We sought to determine rates of vaccine completion and infectious diseases screening in refugees following resettlement. METHODS We conducted a retrospective cohort study of refugees resettling in a region in the U.S. using medical data from June 2013-April 2015. We determined the proportion of vaccine-eligible refugees vaccinated with measles-mumps-rubella (MMR), hepatitis A/B, tetanus, diphtheria, and acellular pertussis (Tdap), and human papillomavirus (HPV) following resettlement. We also determined the proportion of refugees who completed HIV and hepatitis C (HCV) screening. RESULTS One hundred and eleven subjects were included, primarily from Iraq (53%), Afghanistan (19%), and Eritrea (11%). Of the 84 subjects who were vaccine-eligible, 78 (93%) initiated and 42 (50%) completed vaccinations within one year of resettlement. Odds of completing vaccination were higher for men (OR: 2.38; 95%CI:1.02-5.71) and for subjects with English proficiency (OR: 3.70; 95%CI:1.04-17.49). Of the 78 subjects (70%) completing HIV screening, two (3%) were diagnosed with HIV. Nearly all subjects completed screening for HCV, and one had active infection. CONCLUSION While most refugees initiate vaccinations, only 50% completed vaccinations and 70% completed HIV screening within 1 year of resettlement. There is a need to emphasize vaccine completion and HIV screening in refugee patients following resettlement.
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Affiliation(s)
- Amir M Mohareb
- Medical Practice Evaluation Center, Massachusetts General Hospital, 16th Floor, 100 Cambridge Street, Boston, MA, 02114, USA. .,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Bryan Brown
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kevin S Ikuta
- Division of Infectious Diseases, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Division of Infectious Diseases, University of California Los Angeles, Los Angeles, CA, USA
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, 16th Floor, 100 Cambridge Street, Boston, MA, 02114, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Aniyizhai Annamalai
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Simkin J, Smith L, van Niekerk D, Caird H, Dearden T, van der Hoek K, Caron NR, Woods RR, Peacock S, Ogilvie G. Sociodemographic characteristics of women with invasive cervical cancer in British Columbia, 2004-2013: a descriptive study. CMAJ Open 2021; 9:E424-E432. [PMID: 33888548 PMCID: PMC8101640 DOI: 10.9778/cmajo.20200139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although cancer screening has led to reductions in the incidence of invasive cervical cancer (ICC) across Canada, benefits of prevention efforts are not equitably distributed. This study investigated the sociodemographic characteristics of women with ICC in British Columbia compared with the general female population in the province. METHODS In this descriptive study, data of individuals 18 years and older diagnosed with ICC between 2004 and 2013 were obtained from the BC Cancer Registry. Self-reported sociodemographic characteristics were derived from standardized health assessment forms (HAFs) completed upon admission in the BC Cancer Registry. Standardized ratios (SRs) were derived by dividing observed and age-adjusted expected counts by ethnicity or race, language, and marital, smoking and urban-rural status. Differences between observed and expected counts were tested using χ2 goodness-of-fit tests. General population data were derived from the 2006 Census, 2011 National Household Survey and 2011/12 Canadian Community Health Survey. RESULTS Of 1705 total cases of ICC, 1315 were referred to BC Cancer (77.1%). Of those who were referred, 1215 (92.4%) completed HAFs. Among Indigenous women, more cases were observed (n = 85) than expected (n = 39; SR 2.16, 95% confidence interval [CI] 2.15-2.18). Among visible minorities, observed cases (n = 320) were higher than expected (n = 253; 95% CI 1.26-1.26). Elevated SRs were observed among women who self-identified as Korean (SR 1.78, 95% CI 1.76-1.80), Japanese (SR 1.77, 95% CI 1.74-1.79) and Filipino (SR 1.60, 95% CI 1.58-1.62); lower SRs were observed among South Asian women (SR 0.63, 95% CI 0.62-0.63). Elevated SRs were observed among current smokers (SR 1.34, 95% CI 1.33-1.34) and women living in rural-hub (SR 1.29, 95% CI 1.28-1.31) and rural or remote (SR 2.62, 95% CI 2.61-2.64) areas; the SR was lower among married women (SR 0.90, 95% CI 0.90-0.90). INTERPRETATION Women who self-identified as visible minorities, Indigenous, current smokers, nonmarried and from rural areas were overrepresented among women with ICC. Efforts are needed to address inequities to ensure all women benefit from cervical cancer prevention.
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Affiliation(s)
- Jonathan Simkin
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Laurie Smith
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Dirk van Niekerk
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Hannah Caird
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Tania Dearden
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Kimberly van der Hoek
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Nadine R Caron
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Ryan R Woods
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Stuart Peacock
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Gina Ogilvie
- School of Population and Public Health (Simkin, Caron, Ogilvie), University of British Columbia; Cancer Control Research (Simkin, van der Hoek, Woods, Peacock, Ogilvie), BC Cancer; Women's Health Research Institute (Simkin, Smith, Caird, Ogilvie); Cancer Control Research (Smith, van Niekerk, Caron), BC Cancer, Vancouver, BC; Faculty of Health Sciences (Caird, Woods, Peacock), Simon Fraser University, Burnaby, BC; School of Nursing (Dearden), University of British Columbia; Canadian Centre for Applied Research in Cancer Control (van der Hoek, Peacock); Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
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Datta GD, Mayrand MH, Qureshi S, Ferre N, Gauvin L. HPV sampling options for cervical cancer screening: preferences of urban-dwelling Canadians in a changing paradigm. ACTA ACUST UNITED AC 2020; 27:e171-e181. [PMID: 32489266 DOI: 10.3747/co.27.5089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction Of women in Canada diagnosed with invasive cervical cancer, 50% have not been screened according to guidelines. Interventions involving self-collected samples for human papillomavirus (hpv) screening could be an avenue to increase uptake. To guide the development of cervical cancer screening interventions, we assessed ■ preferred sample collection options,■ sampling preferences according to previous screening behaviours, and■ preference for self-sampling among women not screened according to guidelines, as a function of their reasons for not being screened. Methods Data were collected in an online survey (Montreal, Quebec; 2016) and included information from female participants between the ages of 21 and 65 years who had not undergone hysterectomy and who had provided answers to survey questions about screening history, screening interval, and screening preferences (n = 526, weighted n = 574,392). Results In weighted analyses, 68% of all women surveyed and 82% of women not recently screened preferred screening by self-sampling. Among women born outside of Canada, the United States, or Europe, preference ranged from 47% to 60%. Nearly all women (95%-100%) who reported fear or embarrassment, dislike of undergoing a Pap test, or lack of time or geography-related availability of screening as one of their reasons for not being screened stated a preference for undergoing screening by self-sampling. Conclusions The results demonstrate a strong preference for self-sampling among never-screened and not-recently-screened women, and provides initial evidence for policymakers and researchers to address how best to integrate self-sampling hpv screening into both organized and opportunistic screening contexts.
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Affiliation(s)
- G D Datta
- Research Centre of the Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC
| | - M H Mayrand
- Research Centre of the Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC
| | - S Qureshi
- Research Centre of the Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC
| | - N Ferre
- Research Centre of the Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC
| | - L Gauvin
- Research Centre of the Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC
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Turin TC, Ferdous M, Rumana N. Cervical cancer screening among immigrant women: Framing the barriers through solution oriented lens. Eur J Oncol Nurs 2019; 42:164-166. [PMID: 31375410 DOI: 10.1016/j.ejon.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Nahid Rumana
- Sleep Center, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
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Kouyoumdjian FG, McConnon A, Herrington ERS, Fung K, Lofters A, Hwang SW. Cervical Cancer Screening Access for Women Who Experience Imprisonment in Ontario, Canada. JAMA Netw Open 2018; 1:e185637. [PMID: 30646279 PMCID: PMC6324332 DOI: 10.1001/jamanetworkopen.2018.5637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE Women who experience imprisonment have higher rates of cervical cancer. Lack of access to cervical cancer screening in the community or in prison may contribute to increased cervical cancer incidence. OBJECTIVES To determine cervical cancer screening rates for women in provincial prison in Ontario, Canada, and to compare these data with data for the general population. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used correctional and health administrative data from January 1, 2006, to December 31, 2013. Participants included Ontario women aged 21 to 69 years during the follow-up period with no history of cervical cancer or hysterectomy. Analyses were conducted between July 2017 and September 2018. EXPOSURES Women admitted to Ontario provincial prison in 2009 or 2010 and released in 2010 were considered exposed, and women in the general population of Ontario were considered unexposed. MAIN OUTCOMES AND MEASURES Whether women were overdue for cervical cancer screening at the time of admission to prison or on July 1, 2010, for the general population, defined as not having been screened in the previous 3 years, and whether women who were overdue were still overdue after 3 years. RESULTS There were 4553 women in the prison group and 3 647 936 women in the general population group. The median (interquartile range) age was 36 (29-43) years in the prison group and 43 (34-53) years in the general population. Women in the prison group had 2.20 times (95% CI, 2.08-2.33) the odds of being overdue for cervical cancer screening compared with women in the general population after adjusting for neighborhood income quintile, at 53.9% (95% CI, 51.8%-56.1%) compared with 32.9% (95% CI, 32.8%-33.0%) (P < .001). Women in the prison group also had nearly twice the odds of still being overdue at 3 years, with an odds ratio of 1.87 (95% CI, 1.76-1.99) after adjusting for neighborhood income quintile, and rates of still being overdue of 36.2% (95% CI, 34.5%-38.0%) compared with 21.9% (95% CI, 21.8%-21.9%) (P < .001). CONCLUSIONS AND RELEVANCE Women who experience imprisonment have worse cervical cancer screening access than women in the general population. Work should be done to promote cervical cancer screening awareness and to improve access to acceptable screening in prison and in the community after prison release.
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Affiliation(s)
- Fiona G Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andres McConnon
- Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Aisha Lofters
- ICES, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephen W Hwang
- ICES, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
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Chisholm-Burns MA, Spivey CA, Pickett LR. Health literacy in solid-organ transplantation: a model to improve understanding. Patient Prefer Adherence 2018; 12:2325-2338. [PMID: 30464420 PMCID: PMC6229143 DOI: 10.2147/ppa.s183092] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Optimizing wellness and health are the most critical goals for patients post solid-organ transplantation. Low health literacy has important implications for wellness and health, increasing patient risk for negative health outcomes. More than 30% of the general US patient population has low health literacy, and solid-organ transplant recipients (SOTRs) may be especially vulnerable to low health literacy and its adverse impact on health outcomes. A comprehensive literature review was conducted and a model was adapted to better depict factors associated with low health literacy. Based on the Paasche-Orlow and Wolf model of health literacy, the Health Literacy Model in Transplantation (HeaL-T) provides a foundation to visually demonstrate the relationships among variables associated with low health literacy and to develop evidence-based strategies to improve care. The model depicts a number of patient and healthcare level factors associated with health literacy, several of which have bi-directional or reciprocal relationships, including access and utilization of healthcare, provider-patient interaction, and self-management/adherence. The impact of these factors and their relationships to SOTR outcomes are reviewed. The HeaL-T represents an important step in developing holistic understanding of the complexity of health literacy in SOTRs and offers clinicians a base from which to design strategies to mitigate adverse health effects including increased hospitalizations, graft failure, and mortality.
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Affiliation(s)
| | - Christina A Spivey
- University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Memphis, TN, USA
| | - Logan R Pickett
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA,
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Bacal V, Blinder H, Momoli F, Wu KY, McFaul S. Is Immigrant Status Associated With Cervical Cancer Screening Among Women in Canada? Results From a Cross-Sectional Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:824-831.e1. [PMID: 30361160 DOI: 10.1016/j.jogc.2018.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/24/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Cervical cancer accounts for the highest mortality rate from cancer in women worldwide. Despite widespread availability of cervical cancer screening programs in Canada, immigrant women are largely underscreened. The most recently published Canadian-wide study evaluated screening uptake from 2001 to 2002. The objectives included identifying the prevalence of underscreened women in Canada, determining the risk of underscreening for cervical cancer among immigrant women, and providing an update on Canadian screening practices. METHODS This study included women aged 20 to 69 who completed the Canadian Community Health Survey 2012. The prevalence of underscreening among Canadian-born and immigrant women was estimated. A log-binomial model was fit to estimate the relative risk (RR) of underscreening for immigrant women while controlling for age, income level, visible minority status, smoking status, and access to a regular physician. A secondary analysis compared immigrants residing in Canada for greater or less than 10 years to Canadian-born women. RESULTS Of the 17 854 women eligible for this study, 18.6% of Canadian-born women and 28.9% of immigrant women were underscreened (P < 0.05). Immigrant women were at significantly higher risk of being underscreened compared with Canadian-born women (RR 1.32; 95% CI 1.20-1.45). The relative risk did not change when stratifying by length of time since immigration (RRrecent immigrant 1.32; 95% CI 1.16-1.50; and RRlong-term immigrant 1.32; 95% CI 1.19-1.47). CONCLUSION Immigrant status continues to be associated with a significantly higher risk of underscreening, irrespective of time in Canada. Social and educational programs targeted towards immigrants are needed to mitigate the disparity in cervical cancer screening.
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Affiliation(s)
- Vanessa Bacal
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON.
| | - Henrietta Blinder
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Franco Momoli
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON
| | - Kai Yi Wu
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Susan McFaul
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
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Immigration and Adherence to Cervical Cancer Screening: A Provincewide Longitudinal Matched Cohort Study Using Multistate Transitional Models. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:813-823. [PMID: 31130182 DOI: 10.1016/j.jogc.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/04/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Previous studies highlighting inequities in cancer screening between immigrants and non-immigrants have been methodologically limited. This longitudinal matched cohort study used a multistate modelling framework to examine associations between immigration status and cervical cancer screening adherence. METHODS A 1:1 matched cohort of women aged 25 and older from 1992-2014 who were residing in Ontario was examined. For each woman, the proportion of time spent being non-adherent was determined. Disparities in cervical screening adherence, and specifically the association between immigration status and the rate of becoming adherent, were investigated with a three-state transitional model. The model was adjusted for individual- and physician-level characteristics, which were updated annually and incorporated as time-varying covariates. RESULTS The matched cohort consisted of 1 156 720 immigrant and non-immigrant women. The median proportion of time spent non-adherent was 38.9% for immigrants and 24.7% for non-immigrants. The rate of becoming adherent among immigrants was lower than that among non-immigrants, after accounting for individual- and physician-level characteristics (relative rate 0.933; 95% CI 0.928-0.937). Other characteristics such as socioeconomic status, immigrant region of origin, presence of primary physician, and physician's sex were found to be significantly associated with cervical screening adherence. CONCLUSION This study assessed the association between immigration status and adherence to cervical cancer screening. The insights from this work can be used to target groups of women vulnerable to underscreening and to minimize their time spent non-adherent to cancer screening. The methodology serves as a useful framework for examining adherence to other types of cancer screening.
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Ferdous M, Lee S, Goopy S, Yang H, Rumana N, Abedin T, Turin TC. Barriers to cervical cancer screening faced by immigrant women in Canada: a systematic scoping review. BMC WOMENS HEALTH 2018; 18:165. [PMID: 30305056 PMCID: PMC6180489 DOI: 10.1186/s12905-018-0654-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/26/2018] [Indexed: 01/10/2023]
Abstract
Background The objective of this scoping study is to review the published literature and summarize findings related to barriers experienced by immigrant women in Canada while accessing cervical cancer screening. Methods Electronic databases of peer-reviewed articles and grey literature were searched using comprehensive sets of keywords, without restricting the time period or language. Articles were selected based on the following criteria: (a) the study population consisted of Canadian immigrant women and healthcare providers and other stakeholders serving immigrant women, (b) the research focused on the barriers to accessing cervical cancer screening, and (c) the study was conducted in Canada. Results Extracted data were grouped and analyzed, resulting in barriers comprised of six themes: economic barriers, cultural barriers, language barriers, healthcare system-related barriers, knowledge-related barriers, and individual-level barriers. Lack of education, low income, preference for a female physician, lack of knowledge, lack of effective communication, and embarrassment were some of the most common barriers mentioned. Conclusions Immigrant access to health services, including cervical cancer screening, is a complex issue concerning a wide range of barriers. Our findings offer insights into barriers to cervical cancer screening in immigrant communities in Canada that can be used to assist policymakers, healthcare providers, and researchers enhance the health and well-being of these populations by mitigating barriers and improving screening. Electronic supplementary material The online version of this article (10.1186/s12905-018-0654-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Room G012F, Health Sciences Center, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Sonya Lee
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Room G012F, Health Sciences Center, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | - Nahid Rumana
- Sleep Center, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Tasnima Abedin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Room G012F, Health Sciences Center, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Room G012F, Health Sciences Center, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Segmenting women eligible for cervical cancer screening using demographic, behavioural and attitudinal characteristics. Prev Med 2018; 114:134-139. [PMID: 29940291 DOI: 10.1016/j.ypmed.2018.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 11/23/2022]
Abstract
The best ways to communicate effectively to under-screened women about cervical cancer screening are unknown. Segmentation techniques create homogeneous segments of women in the population that are different from one another, and help to determine on whom communication efforts should be focused and how messaging should be tailored. We used segmentation techniques to better understand the demographics, attitudes and behaviours of women eligible for cervical screening. We developed a brief online questionnaire that consisted of demographic characteristics, attitudes toward health, and cervical screening behaviour. Simple descriptive statistics were used to describe the study population and principal components analysis was used to define the segments. The study sample consisted of 615 women living in Ontario, 508 from the general population and 107 from South Asia; 63.1% reported regular screening. We defined four segments that represented the sample: i) Proactive, ii) Family First, iii) Social and Stylish, and iv) Faith-Driven. South Asians were represented in all segments. Women who were in the Family First and Faith-Driven segments were least likely to have regular Pap tests and were least likely to know about human papilloma virus (HPV)'s role in cervical cancer. The Internet was very popular among women in all segments as a source of health information, particularly among Faith-Driven women. Only 69.2% of Family First women listed their family physician as a source of health information vs. 91.1% of Proactive women. Future research should focus on how to most effectively reach women who meet the Family First and Faith-Driven profiles, and through which communication media.
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Lofters AK, Mark A, Taljaard M, Green ME, Glazier RH, Dahrouge S. Cancer screening inequities in a time of primary care reform: a population-based longitudinal study in Ontario, Canada. BMC FAMILY PRACTICE 2018; 19:147. [PMID: 30157772 PMCID: PMC6116433 DOI: 10.1186/s12875-018-0827-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 08/14/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary care has been reformed in recent years in Ontario, Canada, with a move away from traditional fee-for-service to enhanced fee-for-service and capitation-based models. It is unclear how new models have affected disparities in cancer screening. We evaluated whether Ontario's enhanced fee-for-service model was associated with a change in the gaps in cancer screening for people living with low income and people who are foreign-born. METHODS We conducted a population-based longitudinal analysis from 2002 to 2013 of Ontario family physicians who transitioned from traditional fee-for-service to enhanced fee-for-service. The binary outcomes of interest were adherence to cervical, breast and colorectal cancer screening recommendations. Outcomes were analyzed using mixed-effects logistic regression. Analyses produced annual odds ratios comparing the odds of being up-to-date for screening among patients in enhanced fee-for-service versus patients in traditional fee-for-service for each social stratum separately. We calculated the ratios of stratum-specific odds ratios to assess whether the transition from traditional to enhanced fee-for-service was associated with a change in screening gaps between immigrants and long-term residents, and between people in the lowest and highest neighbourhood income quintiles. RESULTS Throughout the study period, cancer screening was consistently lower among immigrants and among people in the lowest income quintile. Transition to enhanced fee-for-service was generally associated with increased screening uptake for all, however for most years, ratios of ratios were significantly less than 1 for all three cancer screening types, indicating that there was a widening of the screening gap between immigrants and long-term residents and between people living in the lowest vs. highest income quintile associated with transitions. CONCLUSION The transition to enhanced fee-for-service in Ontario was generally associated with a widening of screening inequities for foreign-born and low-income patients.
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Affiliation(s)
- Aisha K. Lofters
- Department of Family & Community Medicine, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B1W8 Canada
- Department of Family & Community Medicine, University of Toronto, 500 University Ave. 5th Floor, Toronto, ON M5G1V7 Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St. 6th Floor, Toronto, ON M5T3M7 Canada
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
| | - Amy Mark
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
| | - Monica Taljaard
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
- Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON K1H 8L6 Canada
| | - Michael E. Green
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
- Department of Family Medicine, Queen’s University, 220 Bagot St, Kingston, ON K7L5E9 Canada
| | - Richard H. Glazier
- Department of Family & Community Medicine, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B1W8 Canada
- Department of Family & Community Medicine, University of Toronto, 500 University Ave. 5th Floor, Toronto, ON M5G1V7 Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St. 6th Floor, Toronto, ON M5T3M7 Canada
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
| | - Simone Dahrouge
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
- CT Lamont Primary Health Care Research Centre, Bruyere Research Institute, 43 Bruyère St, Ottawa, ON K1N5C8 Canada
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, ON K1G 5Z3 Canada
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Woods RR, McGrail KM, Kliewer EV, Kazanjian A, Mar C, Kan L, Sam J, Spinelli JJ. Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population-based study. Cancer Med 2018; 7:4044-4067. [PMID: 29984906 PMCID: PMC6089191 DOI: 10.1002/cam4.1608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 12/12/2022] Open
Abstract
Breast cancer screening programs operate across Canada providing mammography to women in target age groups with the goal of reducing breast cancer mortality through early detection of tumors. Disparities in breast screening participation among socio‐demographic groups, including immigrants, have been reported in Canada. Our objectives were to: (1) assess breast screening participation and retention among immigrant and nonimmigrant women in British Columbia (BC), Canada; and (2) to characterize factors associated with screening among screening‐age recent immigrant women in BC. We examined 2 population‐based cohorts of women eligible for breast screening participation (537 783 women) and retention (281 052 women) using linked health and immigration data. Breast screening rates were presented according to socio‐demographic and health‐related variables stratified by birth country. Factors associated with screening among recent immigrant women were explored using Poisson regression. We observed marked variation in screening participation across birth country cohorts. Eastern European/Central Asian women showed low participation (37.9%) with rates from individual countries ranging from 35.0% to 49.0%. Participation rates for immigrant women from the most common birth countries, such as China/Macau/Hong Kong/Taiwan (45.7%), India (44.5%), the Philippines (45.9%), and South Korea (39.0%), were lower than the nonimmigrant rates (51.2%). Retention rates showed less variation by birth country; however, some disparities between immigrant and nonimmigrant groups persisted. Associations between screening indicators and study factors varied considerably across immigrant groups. Primary care physician visits were consistently positively associated with screening participation; this variable was also the only predictor associated with screening within each of the groups of recent immigrants. Our study provides unique data on both screening participation and retention among Canadian immigrant women compiled by individual country of birth. Our results are further demonstration that screening disparities exist among immigrant populations as well as in comparison with nonimmigrant women.
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Affiliation(s)
- Ryan R Woods
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Population Oncology, BC Cancer, Vancouver, BC, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Erich V Kliewer
- Population Oncology, BC Cancer, Vancouver, BC, Canada.,Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Arminee Kazanjian
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Colin Mar
- Population Oncology, BC Cancer, Vancouver, BC, Canada
| | - Lisa Kan
- Population Oncology, BC Cancer, Vancouver, BC, Canada
| | - Janette Sam
- Population Oncology, BC Cancer, Vancouver, BC, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Population Oncology, BC Cancer, Vancouver, BC, Canada
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Datta GD, Blair A, Sylvestre MP, Gauvin L, Drouin M, Mayrand MH. Cervical cancer screening in Montreal: Building evidence to support primary care and policy interventions. Prev Med 2018. [PMID: 29524453 DOI: 10.1016/j.ypmed.2018.02.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In Canada, over 40% of invasive cervical cancers occur among women who have never been screened. Although 12% of Canadian women have never been screened, this number can be as high as 43% among certain social groups. Little is published on factors associated with screening uptake and inequalities among women residing in Quebec. Four waves of the Canadian Community Health Survey (2003, 2005, 2008, 2012, N = 6393) were utilized to assess lifetime screening and screening in the previous 3 years among women residing in Montreal. Chi-squared statistics were calculated, Poisson regression was utilized to model prevalence ratios, and prevalence differences were calculated. In total, 13.6% of women had never been screened and 12.1% had not been screened in the previous 3 years. Immigrant status was the strongest predictor of never being screened [recent vs non-immigrant: Prevalence Ratio (PR), 3.9 (95% Confidence Interval (CI): 2.9-5.4)] and not having a primary care physician (PCP) was the strongest predictors of not being screened recently [PR = 3.0 (95% CI: 2.3-3.9)]. The two most common reasons for not being screened were not "know[ing] it was necessary" and not "get[ting] around to it." These results provide a description of sub-populations which might benefit from cervical screening interventions: immigrants and women without a PCP. Interventions targeting access to PCPs, expanding training of non-physicians to conduct screening, organized screening, or autoadministered screening test may mitigate inequalities. Future work should assess their acceptability and feasibility, and evaluate the impact of these types of primary care and policy interventions.
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Affiliation(s)
- Geetanjali D Datta
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada; L'École de Santé Publique de l'Université de Montréal (ESPUM), Department of Social and Preventive Medicine, Canada.
| | - Alexandra Blair
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada; L'École de Santé Publique de l'Université de Montréal (ESPUM), Department of Social and Preventive Medicine, Canada.
| | - Marie-Pierre Sylvestre
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada; L'École de Santé Publique de l'Université de Montréal (ESPUM), Department of Social and Preventive Medicine, Canada.
| | - Lise Gauvin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada; L'École de Santé Publique de l'Université de Montréal (ESPUM), Department of Social and Preventive Medicine, Canada.
| | - Mylene Drouin
- Direction régionale de santé publique du Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Canada.
| | - Marie-Helene Mayrand
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada; Université de Montréal, Faculty of Medicine, Department of Obstetrics and Gynecology, Canada.
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Shuldiner J, Liu Y, Lofters A. Incidence of breast and colorectal cancer among immigrants in Ontario, Canada: a retrospective cohort study from 2004-2014. BMC Cancer 2018; 18:537. [PMID: 29739346 PMCID: PMC5941319 DOI: 10.1186/s12885-018-4444-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/26/2018] [Indexed: 01/04/2023] Open
Abstract
Background Studies have shown that morbidity and mortality rates due to cancer among recent immigrants are lower than those among the native-born population. The objectives of this study were to describe the incidence of colorectal and breast cancer among immigrants from major regions of the world compared to Canadian-born residents of the province of Ontario and to examine the role of length of stay and neighborhood income. Methods Retrospective cohort study including all individuals 18 years and over residing in Ontario from 2004 to 2014. Age-standardized incidence rates (ASIR) were calculated for immigrants from each world region versus Canadian-born residents and stratified by neighborhood income quintile and length of stay. Binomial regression analysis was used to determine the association of neighbourhood income, length of stay, and location of birth with colorectal and breast cancer incidence. Results Canadian immigrants born in South Asia had the lowest colorectal and breast cancer incidence (colorectal: women: ASIR = 0.14; men: ASIR = 0.18; breast: ASIR = 1.00) compared to long-term residents during the study period (colorectal: women: ASIR = .57; men: ASIR = .72; breast cancer ASIR = 1.61). In multivariate analyses, neighboorhood income did not consistently play a significant role in colorectal cancer incidence; however higher neighbourhood income was a risk factor for breast cancer among immigrant women (adjusted relative risk for highest neighboorhood income quintile versus lowest income quintile =1.21, 95% CI = 1.18–1.24). Increased length of stay was associated with higher risk of cancer. After adjusting for age, neighborhood income, and length of stay, those born in Europe and Central Asia had the highest risk of colorectal cancer compared to those born in East Asia and Pacific and those born in the Middle East had the greatest additional risk of breast cancer. Conclusions After correcting for age, breast and colorectal cancer incidence rates among immigrants differ according to their region of birth and recent immigrants to Ontario have lower colorectal and breast cancer incidence rates than their native-born peers. However, those advantages diminish over time. These findings call for Ontario to generate tools and interventions to maintain the health of the immigrant population, particularly for those groups with a higher incidence of cancer.
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Affiliation(s)
- Jennifer Shuldiner
- University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
| | - Ying Liu
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Aisha Lofters
- Li Ka Shing Knowledge Institute, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
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25
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The Who, What, Why and When of Gynaecological Referrals for Refugee Women. J Immigr Minor Health 2018; 20:1347-1354. [DOI: 10.1007/s10903-018-0733-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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26
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Lofters AK, Vahabi M, Kim E, Ellison L, Graves E, Glazier RH. Cervical Cancer Screening among Women from Muslim-Majority Countries in Ontario, Canada. Cancer Epidemiol Biomarkers Prev 2017; 26:1493-1499. [DOI: 10.1158/1055-9965.epi-17-0323] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/06/2017] [Accepted: 07/05/2017] [Indexed: 11/16/2022] Open
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27
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Widdifield J, Ivers NM, Bernatsky S, Jaakkimainen L, Bombardier C, Thorne JC, Ahluwalia V, Paterson JM, Young J, Wing L, Tu K. Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada. Arthritis Care Res (Hoboken) 2017; 69:1495-1503. [DOI: 10.1002/acr.23178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Jessica Widdifield
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and Research Institute of the McGill University Health Centre and McGill University; Montreal Quebec Canada
| | - Noah M. Ivers
- Institute for Clinical Evaluative Sciences, University of Toronto, and Women's College Hospital; Toronto Ontario Canada
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre and McGill University; Montreal Quebec Canada
| | - Liisa Jaakkimainen
- Institute for Clinical Evaluative Sciences and University of Toronto; Toronto Ontario Canada
| | - Claire Bombardier
- University of Toronto and University Health Network; Toronto Ontario Canada
| | - J. Carter Thorne
- University of Toronto, Toronto, Ontario, Canada, and Southlake Regional Health Centre; Newmarket Ontario Canada
| | | | - J. Michael Paterson
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University; Hamilton Ontario Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Laura Wing
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, University of Toronto, Sunnybrook Health Sciences Centre, and University Health Network; Toronto Ontario Canada
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28
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Lofters AK, Vahabi M, Prakash V, Banerjee L, Bansal P, Goel S, Dunn S. Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement. Patient Prefer Adherence 2017; 11:495-503. [PMID: 28331296 PMCID: PMC5352230 DOI: 10.2147/ppa.s127147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach. MATERIALS AND METHODS Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months. RESULTS Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer) to 44.6% (breast cancer) of patients came in for screening within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties. DISCUSSION Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numerous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as explore how to provide infrastructure for lay health educator training and time.
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Affiliation(s)
- AK Lofters
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Department of Family and Community Medicine
- Centre for Urban Health Solutions, St Michael’s Hospital
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto
| | - V Prakash
- Screening Saves Lives Program, Canadian Cancer Society, Mississauga
| | - L Banerjee
- Wise Elephant Family Health Team, Brampton
| | - P Bansal
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Goel
- Wise Elephant Family Health Team, Brampton
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Dunn
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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29
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Describing the linkages of the immigration, refugees and citizenship Canada permanent resident data and vital statistics death registry to Ontario's administrative health database. BMC Med Inform Decis Mak 2016; 16:135. [PMID: 27769227 PMCID: PMC5073414 DOI: 10.1186/s12911-016-0375-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Ontario, the most populous province in Canada, has a universal healthcare system that routinely collects health administrative data on its 13 million legal residents that is used for health research. Record linkage has become a vital tool for this research by enriching this data with the Immigration, Refugees and Citizenship Canada Permanent Resident (IRCC-PR) database and the Office of the Registrar General's Vital Statistics-Death (ORG-VSD) registry. Our objectives were to estimate linkage rates and compare characteristics of individuals in the linked versus unlinked files. METHODS We used both deterministic and probabilistic linkage methods to link the IRCC-PR database (1985-2012) and ORG-VSD registry (1990-2012) to the Ontario's Registered Persons Database. Linkage rates were estimated and standardized differences were used to assess differences in socio-demographic and other characteristics between the linked and unlinked records. RESULTS The overall linkage rates for the IRCC-PR database and ORG-VSD registry were 86.4 and 96.2 %, respectively. The majority (68.2 %) of the record linkages in IRCC-PR were achieved after three deterministic passes, 18.2 % were linked probabilistically, and 13.6 % were unlinked. Similarly the majority (79.8 %) of the record linkages in the ORG-VSD were linked using deterministic record linkage, 16.3 % were linked after probabilistic and manual review, and 3.9 % were unlinked. Unlinked and linked files were similar for most characteristics, such as age and marital status for IRCC-PR and sex and most causes of death for ORG-VSD. However, lower linkage rates were observed among people born in East Asia (78 %) in the IRCC-PR database and certain causes of death in the ORG-VSD registry, namely perinatal conditions (61.3 %) and congenital anomalies (81.3 %). CONCLUSIONS The linkages of immigration and vital statistics data to existing population-based healthcare data in Ontario, Canada will enable many novel cross-sectional and longitudinal studies to be conducted. Analytic techniques to account for sub-optimal linkage rates may be required in studies of certain ethnic groups or certain causes of death among children and infants.
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Hulme J, Moravac C, Ahmad F, Cleverly S, Lofters A, Ginsburg O, Dunn S. "I want to save my life": Conceptions of cervical and breast cancer screening among urban immigrant women of South Asian and Chinese origin. BMC Public Health 2016; 16:1077. [PMID: 27733161 PMCID: PMC5062908 DOI: 10.1186/s12889-016-3709-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background Breast and cervical cancer screening rates remain low among immigrant women and those of low socioeconomic status. The Cancer Awareness: Ready for Education and Screening (CARES) project ran a peer-led multi-lingual educational program between 2012 and 2014 to reach under and never-screened women in Central Toronto, where breast and cervical cancer screening rates remain low. The objective of this qualitative study was to better understand how Chinese and South Asian immigrants – the largest and most under-screened immigrant groups according to national and provincial statistics - conceive of breast and cervical cancer screening. We explored their experiences with screening to date. We explicitly inquired about their perceptions of the health care system, their screening experiences with family physicians and strategies that would support screening in their communities. Methods We conducted 22 individual interviews and two focus groups in Bengali and Mandarin with participants who had attended CARES educational sessions. Transcripts were coded through an iterative constant comparative and interpretative approach. Results Themes fell into five major, overlapping domains: risk perception and concepts of preventative health and screening; health system engagement and the embedded experience with screening; fear of cancer and procedural pain; self-efficacy, obligation, and willingness to be screened; newcomer barriers and competing priorities. These domains all overlap, and contribute to screening behaviours. Immigrant women experienced a number of barriers to screening related to ‘navigating newness’, including transportation, language barriers, arrangements for time off work and childcare. Fear of screening and fear of cancer took many forms; painful or traumatic encounters with screening were described. Female gender of the provider was paramount for both groups. Newly screened South Asian women were reassured by their first encounter with screening. Some Chinese women preferred the anonymous screening options available in China. Women generally endorsed a willingness to be screened, and even offered to organize women in their community hubs to access screening. Conclusions The experience of South Asian and Chinese immigrant women suggests that under and never-screened newcomers may be effectively integrated into screening programs through existing primary care networks, cultural-group specific outreach, and expanding access to convenient community -based screening.
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Affiliation(s)
- Jennifer Hulme
- Emergency Department, University Health Network, University of Toronto, Toronto, Canada. .,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Catherine Moravac
- Postgraduate Medical Education, University of Toronto, Toronto, Canada
| | - Farah Ahmad
- Faculty of Health, School of Health Policy and Management, York University, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley Cleverly
- Postgraduate Medical Education, University of Toronto, Toronto, Canada.,Centre for Health Promotion, Department of Public Health Sciences, University of Toronto, Toronto, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada
| | - Ophira Ginsburg
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Sheila Dunn
- Women's College Research Institute, Toronto, Canada.,Women's College Hospital, Toronto, Canada
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Vahabi M, Lofters A. Muslim immigrant women's views on cervical cancer screening and HPV self-sampling in Ontario, Canada. BMC Public Health 2016; 16:868. [PMID: 27557928 PMCID: PMC4997745 DOI: 10.1186/s12889-016-3564-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/19/2016] [Indexed: 12/03/2022] Open
Abstract
Background Canada has observed significant decreases in incidence and mortality of cervical cancer in recent decades, and this has been attributed to appropriate screening (i.e., the Pap test). However, certain subgroups including Muslim immigrants show higher rates of cervical cancer mortality despite their lower incidence. Low levels of screening have been attributed to such barriers as lack of a family physician, inconvenient clinic hours, having a male physician, and cultural barriers (e.g., modesty, language). HPV self –sampling helps to alleviate many of these barriers. However, little is known about the acceptability of this evidence-based strategy among Muslim women. This study explored Muslim immigrant women’s views on cervical cancer screening and the acceptability of HPV self-sampling. Methods An exploratory community-based mixed methods design was used. A convenience sample of 30 women was recruited over a 3-month period (June–August 2015) in the Greater Toronto Area. All were between 21 and 69 years old, foreign-born, self-identified as Muslim, and had good knowledge of English. Data were collected through focus groups. Results This study provides critical insights about the importance of religious and cultural beliefs in shaping the daily and health care experiences of Muslim women and their cancer screening decisions. Our study showed the deterring impact of beliefs and health practices in home countries on Muslim immigrant women’s utilization of screening services. Limited knowledge about cervical cancer and screening guidelines and need for provision of culturally appropriate sexual health information were emphasized. The results revealed that HPV self-sampling provides a favorable alternative model of care to the traditional provider-administered Pap testing for this population. Conclusion To enhance Muslim immigrant women screening uptake, efforts should made to increase 1) their knowledge of the Canadian health care system and preventive services at the time of entry to Canada, and 2) access to culturally sensitive education programs, female health professionals, and alternative modes of screening like HPV self-sampling. Health professionals need to take an active role in offering screening during health encounters, be educated about sexual health communication with minority women, and be aware of the detrimental impact of preconceived assumptions about sexual activity of Muslim women.
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Affiliation(s)
- Mandana Vahabi
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada. .,Centre Global Health and Health Equity, Ryerson University, Toronto, ON, Canada. .,Graduate Program in Immigration and Settlement Studies, Ryerson University, Toronto, ON, Canada.
| | - Aisha Lofters
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Cullerton K, Gallegos D, Ashley E, Do H, Voloschenko A, Fleming M, Ramsey R, Gould T. Cancer screening education: can it change knowledge and attitudes among culturally and linguistically diverse communities in Queensland, Australia? Health Promot J Austr 2016; 27:140-147. [PMID: 27376437 DOI: 10.1071/he15116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 04/11/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed: Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low participation rates in cancer screening have been identified among migrant communities internationally. Attempting to improve low rates of cancer screening, the Ethnic Communities Council of Queensland developed a pilot Cancer Screening Education Program for breast, bowel and cervical cancer. This study determines the impact of education sessions on knowledge, attitudes and intentions to participate in screening for culturally and linguistically diverse (CALD) communities living in Brisbane, Queensland.Methods: Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) participated in a culturally-tailored cancer screening education pilot program that was developed using the Health Belief Model. A pre- and post-education evaluation session measured changes in knowledge, attitudes and intention related to breast, bowel and cervical cancer and screening. The evaluation focussed on perceived susceptibility, perceived seriousness and the target population's beliefs about reducing risk by cancer screening.Results: There were 159 participants in the three cancer screening education sessions. Overall participants' knowledge increased, some attitudes toward participation in cancer screening became more positive and intent to participate in future screening increased (n=146).Conclusion: These results indicate the importance of developing screening approaches that address the barriers to participation among CALD communities and that a culturally-tailored education program is effective in improving knowledge, attitudes about and intentions to participate in cancer screening.So what?: It is important that culturally-tailored programs are developed in conjunction with communities to improve health outcomes.
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Affiliation(s)
- Katherine Cullerton
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Ella Ashley
- Ethnic Communities Council of Queensland, 253 Boundary Street, West End, Qld 4101, Australia
| | - Hong Do
- Ethnic Communities Council of Queensland, 253 Boundary Street, West End, Qld 4101, Australia
| | - Anna Voloschenko
- Ethnic Communities Council of Queensland, 253 Boundary Street, West End, Qld 4101, Australia
| | - MaryLou Fleming
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Rebecca Ramsey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Trish Gould
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
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Plourde N, Brown HK, Vigod S, Cobigo V. Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature. Women Health 2016; 56:906-25. [PMID: 26812962 DOI: 10.1080/03630242.2016.1145169] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers' training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients' receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.
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Affiliation(s)
- Natasha Plourde
- c School of Psychology , University of Ottawa , Ottawa , Ontario , Canada
| | - Hilary K Brown
- a Women's College Research Institute , Toronto , Ontario , Canada
| | - Simone Vigod
- b Women's Mental Health Program , Women's College Hospital , Toronto , Ontario , Canada
| | - Virginie Cobigo
- c School of Psychology , University of Ottawa , Ottawa , Ontario , Canada
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Brown HK, Plourde N, Ouellette-Kuntz H, Vigod S, Cobigo V. Brief report: cervical cancer screening in women with intellectual and developmental disabilities who have had a pregnancy. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:22-27. [PMID: 26359630 DOI: 10.1111/jir.12225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDD) have lower cervical cancer screening rates than women without IDD. Key barriers to screening uptake include physician or caregiver assumptions that screening is unnecessary because women with IDD are not sexually active. Our objective was to compare cervical cancer screening rates in women with and without IDD who had had a pregnancy. METHOD We conducted a population-based retrospective cohort study using linked Ontario (Canada) health and social services administrative data. We identified 20- to 64-year-old women with (N = 5033) and without (N = 527 437) IDD who had had a pregnancy. We examined the occurrence of cervical cancer screening between April 1, 2007 and March 31, 2010. We compared screening rates in women with and without IDD using logistic regression, controlling for age, region of residence, neighbourhood income quintile and morbidity level. RESULTS Women with IDD who had had a pregnancy were more likely than those without IDD to be young, to live in the lowest neighbourhood income quintile, to live in rural areas and to have high or very high morbidity. Even after controlling for these factors, women with IDD were less likely than women without IDD to be screened (67.7% vs. 77.0%; adjusted odds ratio 0.61; 95% confidence interval 0.58-0.65). CONCLUSIONS Even among women who have had a pregnancy and are therefore known to have been sexually active, women with IDD face significant disparities in cervical cancer screening. Strategies to promote equitable uptake of cervical cancer screening for women with IDD need to be implemented.
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Affiliation(s)
- H K Brown
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - N Plourde
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - H Ouellette-Kuntz
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - S Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - V Cobigo
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Fernandes KA, Sutradhar R, Borkhoff CM, Baxter N, Lofters A, Rabeneck L, Tinmouth J, Paszat L. Small-area variation in screening for cancer, glucose and cholesterol in Ontario: a cross-sectional study. CMAJ Open 2015; 3:E373-81. [PMID: 26835437 PMCID: PMC4705009 DOI: 10.9778/cmajo.20140069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Screening for cervical, breast and colon cancers, and elevations of cholesterol and glucose, reduces premature cause-specific mortality from these cancers and circulatory diseases. Despite primary care reforms and incentives, and promotion of cancer-screening programs among individuals, participation is suboptimal. We aimed to examine participation as of Dec. 31, 2011, by factors of deprivation, demographics and primary care at the small-area level. METHODS From health care administrative databases, we identified people eligible for each screening test, and their participation, in each dissemination area (referred to as small areas, n = 18 950) in Ontario. We calculated rates for each test among small areas (overall and stratified by demographic, socioeconomic and primary care descriptors) and stratified by sex for all tests combined. We loaded all data into a geographic information system. Funnel plots were generated showing the percentage of eligible people who completed screening for all tests by small area, stratified by sex. Overall and stratified screening prevalence ratios were calculated among small areas. RESULTS Among small areas, the mean and SD for participation in all tests combined was 31.6% (SD 11.0%) for women and 41.2% (SD 12.0%) for men. Screening prevalence among small areas, for each test and for all tests combined, overall and stratified by sex, declined with decreasing percentage with high school completion, decreasing socioeconomic quintile, and decreasing percentage with an identifiable primary care physician. INTERPRETATION Our results show that the rate of participation in all eligible screening tests among small areas is much lower than the rate of participation in any one particular test. This finding has implications for the design and implementation of strategies to improve rates of screening.
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Affiliation(s)
- Kimberly A Fernandes
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Cornelia M Borkhoff
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Nancy Baxter
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Aisha Lofters
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Lawrence Paszat
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
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Vahabi M, Lofters A, Kumar M, Glazier RH. Breast cancer screening disparities among urban immigrants: a population-based study in Ontario, Canada. BMC Public Health 2015; 15:679. [PMID: 26194189 PMCID: PMC4508905 DOI: 10.1186/s12889-015-2050-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 07/10/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Breast cancer is one of the leading cause of mortality and morbidity in Canada. Screening is the most promising approach in identification and treatment of the disease at early stage of its development. Research shows higher rate of breast cancer mortality among ethno-racial immigrant women despite their lower incidence which suggests disparities in mammography screening. This study aimed to compare the prevalence of appropriate mammography screening among immigrant and native borne women and determine predicators of low mammography screening. METHODS We conducted secondary data analyses on Ontario linked social and health databases to determine the proportion of women who were screened during the two-year period of 2010-2012 among 1.4 million screening-eligible women living in urban centres in Ontario. We used multivariate Poisson regression to adjust for various socio-demographic, health care-related and migration related variables. RESULTS 64% of eligible women were appropriately screened. Screening rates were lowest among new and recent immigrants compared to referent group (Canadian-born women and immigrant who arrived before 1985) (Adjusted Rate Ratio (ARR) (0.87, 95% CI 0.85-0.88 for new immigrants and 0.90, 95% CI 0.89-0.91 for recent immigrants. Factors that were associated with lower rates of screening included living in low-income neighborhoods, having a male physician, having internationally-trained physician and not being enrolled in primary care patient enrolment models. Those not enrolled were 22% less likely to be screened compared to those who were (ARR 0.78, 95% CI 0.77-0.79). CONCLUSION To enhance immigrant women screening rates efforts should made to increase their access to primary care patient enrolment models and preferably female health professionals. Support should be provided to interventions that address screening barriers like language, acculturation limitations and knowledge deficit. Health professionals need to be educated and take an active role in offering screening guidelines during health encounters.
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Affiliation(s)
- Mandana Vahabi
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
- Immigration and Settlement Studies, Ryerson University, Toronto, Canada.
- Ryerson Centre for Global Health and Health Equity, Toronto, Canada.
| | - Aisha Lofters
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Matthew Kumar
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Richard H Glazier
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Dalla, Lana School of Public Health, University of Toronto, Toronto, Canada.
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Sewali B, Pratt R, Abdiwahab E, Fahia S, Call KT, Okuyemi KS. Understanding cancer screening service utilization by Somali men in Minnesota. J Immigr Minor Health 2015; 17:773-80. [PMID: 24817627 PMCID: PMC4227966 DOI: 10.1007/s10903-014-0032-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined factors that influence use of cancer screening by Somali men residing in Minnesota, USA. To better understand why recent immigrants are disproportionately less likely to use screening services, we used the health belief model to explore knowledge, beliefs, and attitudes surrounding cancer screening. We conducted a qualitative study comprised of 20 key informant interviews with Somali community leaders and 8 focus groups with Somali men (n = 44). Somali men commonly believe they are protected from cancer by religious beliefs. This belief, along with a lack of knowledge about screening, increased the likelihood to refrain from screening. Identifying the association between religion and health behaviors may lead to more targeted interventions to address existing disparities in cancer screening in the growing US immigrant population.
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Affiliation(s)
- Barrett Sewali
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Rebekah Pratt
- Corresponding author: Barrett Sewali, Department of Family Medicine and Community Health, 717 Delaware St. SE. Ste. 166, Minneapolis, MN 55414, Phone: 612-625-4912, Fax: 612-626-6782,
| | - Ekland Abdiwahab
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Saeed Fahia
- Confederation of Somali Community in Minnesota, Minneapolis, MN
| | - Kathleen Thiede Call
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
- Center for Health Equity, University of Minnesota, Minneapolis, MN
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kolawole S. Okuyemi
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
- Center for Health Equity, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
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Lofters AK. Ethnicity and breast cancer stage at diagnosis: an issue of health equity. ACTA ACUST UNITED AC 2015; 22:80-1. [PMID: 25908905 DOI: 10.3747/co.22.2414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Almost 25 years ago, prominent health researcher Margaret Whitehead, in conjunction with the World Health Organization, developed a definition of the term “health inequities,” which has since become widely used in the international health literature. While health inequality is quite simply a difference in health between groups, health inequity is a normative concept [...]
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Affiliation(s)
- A K Lofters
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Department of Family and Community Medicine, University of Toronto, Toronto, ON
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Ghiabi E, Matthews DC, Brillant MS. The oral health status of recent immigrants and refugees in Nova Scotia, Canada. J Immigr Minor Health 2015; 16:95-101. [PMID: 23371840 DOI: 10.1007/s10903-013-9785-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There are no published reports on the oral health status of adult immigrants and refugees in Canada. An oral health interview and clinical oral examination were conducted on 45 recent immigrants and 41 recent Bhutanese refugees, aged 18-67, in Nova Scotia, Canada. Over half (53%) of the immigrants and 85% of the refugees had untreated decay. Most (89% of immigrants; 98% of refugees) had moderate to severe gingivitis and the majority (73% of immigrants; 85% of refugees) had moderate to severe periodontitis. Despite these, 64% of immigrants and 49% of refugees rated their oral health as good, very good or excellent, and most believed they did not need fillings or periodontal treatment. Oral disease among the study sample was higher than the Canadian average and there was a striking discrepancy between self-reported and clinically determined need for dental care.
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Affiliation(s)
- Edmond Ghiabi
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, 5981 University Avenue, PO BOX 15000, Halifax, NS, B3H 4R2, Canada,
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Lofters AK, Ng R, Lobb R. Primary care physician characteristics associated with cancer screening: a retrospective cohort study in Ontario, Canada. Cancer Med 2014; 4:212-23. [PMID: 25430885 PMCID: PMC4329005 DOI: 10.1002/cam4.358] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022] Open
Abstract
Primary care physicians can serve as both facilitators and barriers to cancer screening, particularly for under-screened groups such as immigrant patients. The objective of this study was to inform physician-targeted interventions by identifying primary care physician characteristics associated with cancer screening for their eligible patients, for their eligible immigrant patients, and for foreign-trained physicians, for their eligible immigrant patients from the same world region. A population-based retrospective cohort study was performed, looking back 3 years from 31 December 2010. The study was performed in urban primary care practices in Ontario, Canada's largest province. A total of 6303 physicians serving 1,156,627 women eligible for breast cancer screening, 2,730,380 women eligible for cervical screening, and 2,260,569 patients eligible for colorectal screening participated. Appropriate breast screening was defined as at least one mammogram in the previous 2 years, appropriate cervical screening was defined as at least one Pap test in the previous 3 years, and appropriate colorectal screening as at least one fecal occult blood test in the previous 2 years or at least one colonoscopy or barium enema in the previous 10 years. Just fewer than 40% of physicians were female, and 26.1% were foreign trained. In multivariable analyses, physicians who attended medical schools in the Caribbean/Latin America, the Middle East/North Africa, South Asia, and Western Europe were less likely to screen their patients than Canadian graduates. South Asian-trained physicians were significantly less likely to screen South Asian women for cervical cancer than other foreign-trained physicians who were seeing region-congruent patients (adjusted odds ratio: 0.56 [95% confidence interval 0.32–0.98] versus physicians from the USA, Australia and New Zealand). South Asian patients were the most vulnerable to under-screening, and decreasing patient income quintile was consistently associated with lower likelihood of screening, although less so for immigrant patients. This study highlights certain physician characteristics that are associated with cancer screening for eligible patients, including immigrant patients, and that should be considered when designing physician-targeted interventions. We have also highlighted an ethnic community, South Asians, which requires particular attention, both among its patients and its primary care providers. Future research should further explore the reasons for these findings.
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Affiliation(s)
- Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
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Decker KM, Demers AA, Kliewer EV, Biswanger N, Musto G, Elias B, Griffith J, Turner D. Pap test use and cervical cancer incidence in First Nations women living in Manitoba. Cancer Prev Res (Phila) 2014; 8:49-55. [PMID: 25403849 DOI: 10.1158/1940-6207.capr-14-0277] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined Papanicolaou (Pap) test utilization, Pap test results, and cervical cancer incidence among First Nations (FN) women living in Manitoba, Canada taking into account age group, time period, and area of residence. Six population-based data sources were linked at an individual level. Negative binomial regression was used to compare Pap test utilization and results between FN and all other Manitoba (AOM) women. Poisson regression was used to compare cervical cancer incidence. Among women younger than 25 years, FN were more likely than AOM women to have had a Pap test [rate ratio (RR) = 1.37, 95% confidence intervals (CI), 1.22-1.53, 18-19 year olds; RR = 1.17, 95% CI, 1.05-1.31, 20-24 year olds]. There was no difference in Pap test use for women 25 to 29 or 30 to 39 years. FN 40 years and older were less likely to have a Pap test than AOM women (RR = 0.84, 95% CI, 0.75-0.93, 40-49 years old; RR = 0.71, 95% CI, 0.63-0.79, 50-59 years old; RR = 0.59, 95% CI, 0.52-0.66, 60-69 years old). FN were more likely than AOM women to have a high (RR = 1.88, 95% CI, 1.65-2.13) or low-grade Pap test result (RR = 1.60, 95% CI, 1.48-1.73). The invasive cervical cancer incidence rate was double for FN women 25 to 39 years of age (21.9 per 100,000, FN; 10.2 per 100,000, AOM, P = 0.006) and 40 to 69 years of age (24.3 per 100,000, FN; 12.3 per 100,000, AOM, P = 0.007). In conclusion, cervical cancer screening among FN women over 40 years of age must be increased to address the higher cervical cancer incidence.
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Affiliation(s)
- Kathleen M Decker
- Screening Programs, CancerCare Manitoba, Winnipeg, Manitoba, Canada. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alain A Demers
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Erich V Kliewer
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada. Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Grace Musto
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Brenda Elias
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jane Griffith
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Donna Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
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Malagón T, Drolet M, Boily MC, Laprise JF, Brisson M. Changing inequalities in cervical cancer: modeling the impact of vaccine uptake, vaccine herd effects, and cervical cancer screening in the post-vaccination era. Cancer Epidemiol Biomarkers Prev 2014; 24:276-85. [PMID: 25380735 DOI: 10.1158/1055-9965.epi-14-1052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inequalities in cervical cancer may be increased following mass vaccination against the human papillomavirus (HPV) if girls with low vaccine uptake also have low future participation in cervical cancer screening. We evaluated how vaccine uptake distribution affects inequalities in squamous cell carcinoma (SCC) incidence between groups with different screening participation. METHODS We used an individual-based transmission dynamic model of HPV infection and disease (HPV-ADVISE). Females were stratified by routine screening frequency. We modeled the impact of vaccination on SCC incidence rate differences (absolute inequality) and incidence rate ratios (relative inequality) between women who have routine screening intervals of <5 years (frequently screened), ≥5 years (underscreened), and who are never screened. We compared simulations with uniform vaccine uptake with scenarios with unequal vaccine uptake, in which never and underscreened women have lower vaccine uptake than frequently screened women. RESULTS Absolute SCC inequalities between groups with different screening rates were predicted to decrease after vaccination, even when women with the lowest screening participation had the lowest vaccine uptake. Herd effects helped reduce absolute inequalities when vaccine uptake was unequal. Conversely, relative SCC inequalities remained unchanged or increased after vaccination. Results were robust to different overall vaccination coverages and sexual mixing scenarios. CONCLUSION Though mass HPV vaccination is predicted to substantially decrease SCC incidence rates, never screened women will still have the highest disease burden after vaccination. IMPACT To reduce both absolute and relative SCC inequalities, public health initiatives will need to address inequalities in both vaccine uptake and in cervical cancer screening participation.
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Affiliation(s)
- Talía Malagón
- Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada. Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec City, Québec, Canada
| | - Mélanie Drolet
- Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada. Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec City, Québec, Canada
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom
| | - Jean-François Laprise
- Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec City, Québec, Canada
| | - Marc Brisson
- Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada. Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec City, Québec, Canada. Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom.
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Lofters A, Guilcher S, Glazier RH, Jaglal S, Voth J, Bayoumi AM. Screening for cervical cancer in women with disability and multimorbidity: a retrospective cohort study in Ontario, Canada. CMAJ Open 2014; 2:E240-7. [PMID: 25485249 PMCID: PMC4251502 DOI: 10.9778/cmajo.20140003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People with disability, multiple chronic conditions or both may experience challenges in accessing primary care. We aimed to determine the association between appropriate cervical cancer screening and level of disability among women eligible for screening in Ontario and the influence of relevant sociodemographic and health-related variables, including level of morbidity (measured by number of chronic conditions), on screening. METHODS We used multiple linked databases, including 2 waves of the Canadian Community Health Survey (2005 and 2007/08). Of the 22 824 women included in the study, 7600 reported some level of disability. We used Ontario Health Insurance Plan fee codes to identify appropriate cervical cancer screening. RESULTS Compared with women without disability, women with disability were older, less educated, had lower income and had more chronic conditions (36.2% had at least 2 conditions v. 8.4% of women without disability). Women with no disability and no chronic conditions were more frequently screened appropriately than those with severe disability and 2 or more chronic conditions (64.5% v. 39.8%). In multivariable logistic regression analysis, age, rurality, education, marital status and household income were each independently associated with cervical cancer screening. There was a significant interaction between level of morbidity and level of disability. Women with a higher level of disability were less likely to be screened than women with lower level of disability as their level of morbidity increased. CONCLUSION The rate of screening for cervical cancer is low among women with both disability and multimorbidity. Policymakers should note these results as they work toward improving cancer screening rates for an aging population with complex medical needs.
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Affiliation(s)
- Aisha Lofters
- St. Michael’s Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ont
- Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ont
- Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - Sara Guilcher
- Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ont
| | - Richard H. Glazier
- St. Michael’s Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ont
- Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ont
- Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - Susan Jaglal
- Institute for Clinical Evaluative Sciences, Toronto, Ont
- Toronto Rehabilitation Institute, Toronto, Ont
| | - Jennifer Voth
- Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - Ahmed M. Bayoumi
- St. Michael’s Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ont
- Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ont
- Department of Medicine, University of Toronto, Toronto, Ont
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Ojikutu B, Nnaji C, Sithole-Berk J, Bogart LM, Gona P. Barriers to HIV Testing in Black Immigrants to the U.S. J Health Care Poor Underserved 2014; 25:1052-66. [PMID: 25130224 PMCID: PMC4442684 DOI: 10.1353/hpu.2014.0141] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Late HIV testing is common among immigrants from sub Saharan Africa and the Caribbean. Since 2010, HIV testing is no longer a required component of immigrant screening examinations or mandatory for immigrants seeking long term residence in the US. Thus, barriers to HIV testing must be addressed. METHODS Five hundred and fifty-five (555) immigrants completed a barriers-to-HIV testing scale. Univariate and multivariate linear regression were performed to examine predictors of barriers. RESULTS In multivariate analysis, primary language other than English (β=2.9, p=.04), lower education (β=5.8, p=.03), low income [= below $20K/year] (β=4.6, p=.01), no regular provider (β=5.2, p=.002) and recent immigration (β=5.7, p=.0008) were independently associated with greater barriers. Barriers due to health care access, privacy, fatalism, and anticipated stigma were greater for recent versus longer term immigrants. DISCUSSION Immigrants from sub-Saharan Africa and the Caribbean face significant barriers to HIV testing. Interventions to improve access and timely entry into care are needed.
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Prévention des cancers du col de l’utérus et du sein chez les femmes en situation de grande précarité : étude épidémiologique. Bull Cancer 2014; 101:663-8. [DOI: 10.1684/bdc.2014.1919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rosen D, Nakar S, Cohen AD, Vinker S. Low rate of non-attenders to primary care providers in Israel - a retrospective longitudinal study. Isr J Health Policy Res 2014; 3:15. [PMID: 24808941 PMCID: PMC4012543 DOI: 10.1186/2045-4015-3-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/14/2014] [Indexed: 11/17/2022] Open
Abstract
Background A model that combines reactive and anticipatory care within routine consultations has become recognized as a cost-effective means of providing preventive health care, challenging the need of the periodic health examination. As such, opportunistic screening may be preferable to organized screening. Provision of comprehensive preventive healthcare within the primary care system depends on regular attendance of the general population to primary care physicians (PCPs). Objectives: To assess the proportion of patients who do not visit a PCP even once during a four-year period, and to describe the characteristics of this population. Methods An observational study, based on electronic medical records of 421,012 individuals who were members of one district of Clalit Health Services, the largest health maintenance organization in Israel. Results The average annual number of visits to PCPs was 7.6 ± 8.7 to 8.3 ± 9.0 (median 5, 25%-75% interval 1–11) and 9.5 ± 10.0 to10.2 ± 10.4 (median 6, 25%-75% interval 1–14) including visits to direct access consultants) in the four years of the study. During the first year of the study 87.2% of the population visited a PCP. During the four year study period, only 1.5% did not visit a PCP even once. In a multivariate analysis having fewer chronic diseases (for each additional chronic disease the OR, 95% CI was 0.40 (0.38¬0.42)), being a new immigrant (OR, 95% CI 2.46 (2.32¬2.62)), and being male (OR, 95% CI 1.66 (1.58¬1.75)) were the strongest predictors of being a non-attender to a PCP for four consecutive years. Conclusions The rate of nonattendance to PCPs in Israel is low. Other than new immigrant status, none of the characteristics identified for nonattendance suggest increased need for healthcare services.
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Affiliation(s)
- Dana Rosen
- Department of Family Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sasson Nakar
- Department of Family Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel ; Department of Family Medicine, Central District, Clalit Health Services, Rehovot, Israel
| | - Arnon D Cohen
- Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Chief Physician Office, headquarters, Clalit Health Services, 17/2 Yehoshua Bin-Nun St., Hod Hasharon, Tel Aviv 45236, Israel
| | - Shlomo Vinker
- Department of Family Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel ; Department of Family Medicine, Central District, Clalit Health Services, Rehovot, Israel
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Factors Associated with Access to Sexual Health Services Among Teens in Toronto: Does Immigration Matter? J Immigr Minor Health 2014; 16:638-45. [DOI: 10.1007/s10903-013-9961-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lobb R, Carothers BJ, Lofters AK. Using organizational network analysis to plan cancer screening programs for vulnerable populations. Am J Public Health 2014; 104:358-64. [PMID: 24328613 PMCID: PMC3935666 DOI: 10.2105/ajph.2013.301532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined relationships among organizations in a cancer screening network to inform the development of interventions to improve cancer screening for South Asians living in the Peel region of Ontario. METHODS From April to July 2012, we surveyed decision-makers, program managers, and program staff in 22 organizations in the South Asian cancer screening network in the Peel region. We used a network analytic approach to evaluate density (range = 0%-100%, number of ties among organizations in the network expressed as a percentage of all possible ties), centralization (range = 0-1, the extent of variability in centrality), and node characteristics for the communication, collaboration, and referral networks. RESULTS Density was similar across communication (15%), collaboration (17%), and referral (19%) networks. Centralization was greater in the collaboration network (0.30) than the communication network (0.24), and degree centralization was greater in the inbound (0.42) than the outbound (0.37) referral network. Diverse organizations were central to the networks. CONCLUSIONS Certain organizations were unexpectedly important to the South Asian cancer screening network. Program planning was informed by identifying opportunities to strengthen linkages between key organizations and to leverage existing ties.
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Affiliation(s)
- Rebecca Lobb
- Rebecca Lobb is with the Department of Surgery, Division of Public Health Sciences, School of Medicine, and Bobbi J. Carothers is with the George Warren Brown School of Social Work, Center for Public Health Systems Science, Washington University, St Louis, MO. Rebecca Lobb is also with the Keenan Research Centre, Li Ka Shing Knowledge Institute, and Aisha K. Lofters is with the Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON
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Khadilkar A, Chen Y. Rate of cervical cancer screening associated with immigration status and number of years since immigration in Ontario, Canada. J Immigr Minor Health 2014; 15:244-8. [PMID: 22918694 DOI: 10.1007/s10903-012-9711-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cervical cancer screening is a vital public health measure intended to reduce the morbidity and mortality from what is a largely preventable cancer. Previous Canadian studies have documented that immigrants have significantly lower Papanicolaou (Pap) testing rates than women born in Canada. However, the impact of number of years since immigration is less clear. Data were taken from the 2007-2008 Canadian Community Health Survey. Responses from 16, 706 women living in Ontario, Canada were included. The focus was on self-reported Pap testing rates within the last 3 years, immigrant status and number of years since immigration. A robust Poisson regression model was used to determine prevalence ratios (PR) with 95 % confidence intervals (CIs) after adjustment for covariates. The results demonstrated that recent immigrant women (less than 10 years in Canada) were less likely to have had a Pap test in the past 3 years than those who were Canadian-born (PR = 0.77; 95 % CI: 0.71, 0.84). In contrast, immigrants who had lived in Canada for 10 years or longer showed similar compliance with recommended Pap testing intervals as non-immigrants. Higher income, higher level of education, younger age and being married were independently associated with better Pap testing rates. A strategy targeting recent immigrants to Canada is needed to promote Pap testing in this population and reduce their risk of invasive cervical cancer.
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Affiliation(s)
- Amole Khadilkar
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Rodríguez-Salés V, Roura E, Ibañez R, Peris M, Bosch FX, de Sanjosé S. Coverage of Cervical Cancer Screening in Catalonia for the Period 2008-2011 among Immigrants and Spanish-Born Women. Front Oncol 2013; 3:297. [PMID: 24392348 PMCID: PMC3868944 DOI: 10.3389/fonc.2013.00297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/25/2013] [Indexed: 01/09/2023] Open
Abstract
Background: Female immigration in Catalonia, Spain, increased dramatically in the last 10 years. The Public Health system in the Region, provides a free of charge opportunistic cervical cancer screening. Aim: This study examines cervical cancer screening coverage and prevalence of cytology abnormalities in Catalonia by immigration status. Methods: The study analyzes the cytologies registered among women aged 25–65 that have been attended at the Primary Health Centers (PHC) for any reason (n = 1,242,230) during 2008–2011. Coverage was estimated from Governmental data base Information System Primary Care (SISAP) that includes 77% of PHC. The database is anonymous, and includes information on age, country of birth, diagnostic center, and cytology results. Results: During the period 2008–2011, 642,643 smears were performed in a total of 506,189 women over 14 years, of whom 18.3% were immigrants. Cytology coverage was higher among immigrant women compared to Spanish born (51.2 and 39% respectively). Immigrant women also had a higher prevalence of abnormal Paps compared to the Spanish population, 4.5 and 2.9% respectively (p < 0.001). Conclusion: Immigrant women in Catalonia had a high access to the Public Health Services and to cervical cancer screening facilities. The higher prevalence of abnormal cytologies in immigrant women compared to native women indicates the relevance to prioritize cervical cancer screening activities on a regular base in new comers.
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Affiliation(s)
- Vanesa Rodríguez-Salés
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain
| | - Esther Roura
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain ; CIBER en Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain
| | - Raquel Ibañez
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain
| | - Mercè Peris
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain
| | - F Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain
| | - Sílvia de Sanjosé
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain ; CIBER en Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain
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