1
|
Bikker AP, Macdonald S, Robb KA, Conway E, Browne S, Campbell C, Weller D, Steele R, Macleod U. Perceived colorectal cancer candidacy and the role of candidacy in colorectal cancer screening. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1680816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | - David Weller
- The Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Robert Steele
- Medical Research Institute, University of Dundee, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
2
|
|
3
|
Rothberg MB, Hu B, Lipold L, Schramm S, Jin XW, Sikon A, Taksler GB. A risk prediction model to allow personalized screening for cervical cancer. Cancer Causes Control 2018; 29:297-304. [PMID: 29450667 DOI: 10.1007/s10552-018-1013-4] [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: 11/23/2016] [Accepted: 02/09/2018] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Cervical cancer screening guidelines are in evolution. Current guidelines do not differentiate recommendations based on individual patient risk. OBJECTIVE To derive and validate a tool for predicting individualized probability of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) at a single time point, based on demographic factors and medical history. DESIGN The study design consisted of an observational cohort with hierarchical generalized linear regression modeling. SETTING The study was conducted in a setting of 33 primary care practices from 2004 to 2010. PARTICIPANTS The participants of the study were women aged ≥ 30 years. MAIN OUTCOME AND MEASURES CIN2+ was the main outcome on biopsy, and the following predictors were included: age, race, marital status, insurance type, smoking history, median income based on zip code, prior human papilloma virus (HPV) results. RESULTS The final dataset included 99,319 women. Of these, 745 (0.75%) had CIN2+. The multivariable model had a C-statistic of 0.81. All factors but race were independently associated with CIN2+. The model categorized women as having below-average CIN2+ risk (0.15% predicted vs. 0.12% observed risk), average CIN2+ risk (0.42% predicted vs. 0.36% observed), and above-average CIN2+ risk (1.76% predicted vs. 1.85% observed). Before screening, women at below-average risk had a risk of CIN2+ well below that of women with ASCUS and HPV negative (0.12 vs. 0.20%). CONCLUSIONS AND RELEVANCE A multivariable model using data from the electronic health record was able to stratify women across a 50-fold gradient of risk for CIN2+. After further validation, use of a similar model could enable more targeted cervical cancer screening.
Collapse
Affiliation(s)
- Michael B Rothberg
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. .,Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Bo Hu
- Quantitative Health Sciences Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Laura Lipold
- Department of Family Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Schramm
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Xian Wen Jin
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Andrea Sikon
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Glen B Taksler
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
4
|
Wamburu K, Busakhala N, Owuor K, Nyagero J. Association between stage at diagnosis and knowledge on cervical cancer among patients in a Kenyan tertiary hospital: a cross-sectional study. Pan Afr Med J 2016; 25:15. [PMID: 28439339 PMCID: PMC5390062 DOI: 10.11604/pamj.supp.2016.25.2.10684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/02/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction In Kenya, cervical cancer is the second most common cancer among women; almost half of all women with invasive cervical cancer are diagnosed at a late stage. Few women are aware of the symptoms and risk factors of cervical cancer and that its precursor lesions are detectable through screening thus most women seek treatment when the cancer is at an advanced stage. The study explored the influence of cervical cancer awareness on stage at diagnosis in patients attending Kenyatta National Hospital. Methods A cross-sectional survey was adapted to obtain socio-demographic information, knowledge on symptoms and risk factors from 361 women with histological diagnosis of cervical cancer conveniently sampled at Kenyatta National Hospital. Associations between stage at diagnosis and knowledge on cervical cancer were tested using chi-square statistic and fisher's exact test at 95% confidence interval. Results Seven in every 10 women (72.6%) presented with advanced stage cervical cancer. Knowledge on the sexually transmitted nature of cervical cancer was inadequate, 22% of women with early stage and 23.7% of women with advanced stage cervical cancer (p=0.874). Majority of the women were not aware of the causative link between cervical cancer and human papillomavirus (HPV), 8 (13.1%) of women with early stage and 5 (3.5%) of women with advanced stage cervical cancer (p=0.036). Conclusion Stage at presentation was advanced and knowledge on the role of a sexually transmitted virus in the cervical cancer aetiology was poor among the women. Increasing screening programs and providing information highlighting this association is necessary.
Collapse
Affiliation(s)
- Kabura Wamburu
- Moi University, School of Public Health, Nairobi, Kenya.,AMREF Health Africa, Kenya
| | | | - Kevin Owuor
- United States Agency for International Development, Nairobi, Kenya
| | | |
Collapse
|
5
|
Smith SK, Kearney P, Trevena L, Barratt A, Nutbeam D, McCaffery KJ. Informed choice in bowel cancer screening: a qualitative study to explore how adults with lower education use decision aids. Health Expect 2014; 17:511-22. [PMID: 22512746 PMCID: PMC5060748 DOI: 10.1111/j.1369-7625.2012.00780.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Offering informed choice in screening is increasingly advocated, but little is known about how evidence-based information about the benefits and harms of screening influences understanding and participation in screening. OBJECTIVE We aimed to explore how a bowel cancer screening decision aid influenced decision making and screening behaviour among adults with lower education and literacy. METHODS Twenty-one men and women aged 55-64 years with lower education levels were interviewed about using a decision aid to make their screening decision. Participants were purposively selected to include those who had and had not made an informed choice. RESULTS Understanding the purpose of the decision aid was an important factor in whether participants made an informed choice about screening. Participants varied in how they understood and integrated quantitative risk information about the benefits and harms of screening into their decision making; some read it carefully and used it to justify their screening decision, whereas others dismissed it because they were sceptical of it or lacked confidence in their own numeracy ability. Participants' prior knowledge and beliefs about screening influenced how they made sense of the information. DISCUSSION AND CONCLUSIONS Participants valued information that offered them a choice in a non-directive way, but were concerned that it would deter people from screening. Healthcare providers need to be aware that people respond to screening information in diverse ways involving a range of literacy skills and cognitive processes.
Collapse
Affiliation(s)
- Sian K Smith
- Post-Doctoral Research FellowResearch AssistantAssociate Professor Screening and Test Evaluation Program, Centre for Medical Psychology and Evidence Based Decision-Making, Sydney School of Public Health, University of Sydney, NSW, AustraliaProfessor of Epidemiology, Centre for Medical Psychology and Evidence Based Decision-Making, Sydney School of Public Health, University of Sydney, NSW, AustraliaVice-Chancellor, Professor of Public Health, Office of the Vice-Chancellor, University of Southampton, UK
| | | | | | | | | | | |
Collapse
|
6
|
D'Orazio LM, Taylor-Ford M, Meyerowitz BE. Cervical Cancer Prevention among Latinas in a Post-HPV Vaccine World: Considering the Sociocultural Context. WOMEN & THERAPY 2014. [DOI: 10.1080/02703149.2014.897552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
7
|
Marlow LAV, Waller J. Communicating the changes to cervical cancer screening in England: the choice to have an HPV test. WOMENS HEALTH 2014; 10:221-3. [PMID: 24956287 DOI: 10.2217/whe.14.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Laura A V Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London WC1E 6BT, UK
| | | |
Collapse
|
8
|
Malkowski J. Confessions of a pharmaceutical company: voice, narrative, and gendered dialectics in the case of Gardasil. HEALTH COMMUNICATION 2013; 29:81-92. [PMID: 23402269 DOI: 10.1080/10410236.2012.719178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Despite the fact that both men and women carry the human papillomavirus (HPV) and jointly contribute to its status as an epidemic, the promotion of Gardasil, a vaccine that blocks infection from four strains of HPV, has largely been designated as a women's-only health issue. The following case study contributes to ongoing efforts in the field of health communication to identify problematic assumptions informing contemporary health policy and practices. Specifically, I analyze how Merck Pharmaceuticals, the creator of Gardasil, strategically imbues direct-to-consumer advertisements with contradiction to preserve traditional notions of both women and medicine. I found that three gendered dialectics characterize Merck's efforts to invoke complacency among female consumers: public/secret, education/ignorance, and structured/individualist. In the case of the HPV vaccination, the implications of these dialectics are the perpetuation of complacency among female audiences that threatens both the success of this particular technology and the overall status of women and health. In line with conclusions offered by Thompson (2010a), this study extends a call for health and communication scholars to continue to deconstruct dominant medical discourses and presents possibilities for re-storying narratives that mediate women's experiences with health.
Collapse
|
9
|
Rychetnik L, Carter SM, Abelson J, Thornton H, Barratt A, Entwistle VA, Mackenzie G, Salkeld G, Glasziou P. Enhancing Citizen Engagement in Cancer Screening Through Deliberative Democracy. J Natl Cancer Inst 2013; 105:380-6. [DOI: 10.1093/jnci/djs649] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
10
|
Armstrong N, Eborall H. The sociology of medical screening: past, present and future. SOCIOLOGY OF HEALTH & ILLNESS 2012; 34:161-176. [PMID: 22369578 DOI: 10.1111/j.1467-9566.2011.01441.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Medical screening raises fundamental issues for sociological inquiry, but at present a well-developed sociology of medical screening is lacking. This special issue on the sociology of screening brings together an exciting collection of new work that tackles medical screening from a variety of theoretical and methodological approaches. In this opening paper, we begin by explaining what we mean by screening, and why we believe screening merits sociological attention. Secondly, we reflect on the sociology of screening to date and provide an introduction for those new to this area. We then provide an overview of the papers in this collection, highlighting links and contrasts between papers. We conclude by reflecting on sociology's potential contribution to wider debates about screening, and propose future research directions.
Collapse
Affiliation(s)
- Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
| | | |
Collapse
|
11
|
Human Papillomavirus awareness, knowledge and vaccine acceptance: A survey among 18-25 year old male and female vocational school students in Berlin, Germany. Eur J Public Health 2011; 22:808-13. [DOI: 10.1093/eurpub/ckr188] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
12
|
Maree JE, Wright SCD. Cervical cancer: does our message promote screening? A pilot study in a South African context. Eur J Oncol Nurs 2010; 15:118-23. [PMID: 20675189 DOI: 10.1016/j.ejon.2010.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 06/29/2010] [Accepted: 06/30/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of the study was to explore if cervical cancer information presented in a non-stigmatizing manner could promote screening in women living in a resource poor environment in Tshwane, South Africa. METHODS An exploratory, contextual, quantitative door-to-door survey was conducted. The sampling method was convenience (n = 105). Structured interviews were used to gather self-reported data. Chi-square tests were used for secondary data analyses. RESULTS The study provided evidence that presenting information on cervical cancer in a non-stigmatizing manner based on the theme of self protection promoted cervical screening. The study further provided evidence that women preferred a cervical cancer message that does not focus on the sexual risk factors of this disease. More than a third of the sample preferring a message introducing cervical cancer as a sexually transmitted infection (n = 32) were of the opinion that this message were stigmatizing, blameful and displayed misunderstanding of their lives. CONCLUSIONS Cervical cancer screening is indeed not simple. The screening rate not only in South Africa but many other countries serves as proof. It can therefore not be afforded to add to the barriers by presenting information on cervical cancer in a way perceived as stigmatizing and blameful. Presenting information in way that women prefer might not only promote cervical screening, but might motivate them in such a way that they are screened.
Collapse
Affiliation(s)
- Johanna E Maree
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa.
| | | |
Collapse
|
13
|
Darwin Z, Campbell C. Understandings of Cervical Screening in Sexual Minority Women: A Q-Methodological Study. FEMINISM & PSYCHOLOGY 2009. [DOI: 10.1177/0959353509342919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Discursive perspectives argue that cervical screening carries social and moral meaning. Overlooked by research into the health needs of sexual minority women, previous literature that has examined uptake of cervical screening has instead targeted increasing attendance via information and service provision. In order to explore the diversity of meanings that British sexual minority women have about cervical screening, the Q-sorts of 34 sexual minority women were factor analysed by-person and rotated to simple structure using Varimax. The five factors are interpreted and discussed relative to competing discourses on information provision within cervical screening. The five accounts are labelled ‘cervical screening is’: an essential health check that women have the right to refuse; a woman’s health entitlement; a vital test but degrading experience; a sensible thing to do; and an unnecessary imposition for some women. Critical approaches to informed choice are explored with attention to recent developments in cervical cancer prevention. Findings highlighting the need for affirmation of diversity within healthcare are considered in relation to existing criteria for UK national screening programmes.
Collapse
Affiliation(s)
- Zoë Darwin
- Maternal and Fetal Health Research Group, Faculty of
Medical and Human Sciences, University of Manchester, St Mary's Hospital,
Hathersage Road, Manchester, M13 0JH, UK,
| | - Carol Campbell
- Department of Natural Science and Public Health, College
of Arts and Sciences, Zayed University, Dubai Campus, PO Box 19282, United
Arab Emirates,
| |
Collapse
|
14
|
O'Brien BA, Mill J, Wilson T. Cervical Screening in Canadian First Nation Cree Women. J Transcult Nurs 2008; 20:83-92. [DOI: 10.1177/1043659608322418] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Attitudes and beliefs of First Nation Cree women living in a reserve community were explored to gain insights into how cervical screening could be better utilized. Method: Focused ethnography utilizing participant observation and interviews ( n = 8) with participants having experience with cervical screening and/or cancer was conducted. Results: Women did not believe they had adequate information and were resistant to screening because of embarrassment caused by the procedure and fear of cancer, which was viewed as a “death sentence.” Conclusions: Challenges faced by First Nation Cree women when contemplating cervical screening are presented. Nursing sensitivity is needed to strategize access to cervical screening that is culturally appropriate.
Collapse
|
15
|
Armstrong N, Murphy E. Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk. Soc Sci Med 2008; 67:1074-82. [PMID: 18640758 DOI: 10.1016/j.socscimed.2008.06.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Indexed: 10/21/2022]
Abstract
In line with the increasing emphasis on informed choice, women invited for cervical cancer screening in England receive a leaflet containing information on the risk factors and causation of the condition. However, data from a qualitative interview study with 35 women suggest that the ways in which women make sense of this information can vary and frequently do not correspond to the causal pathways and explanations which characterise contemporary professional medical explanations. This paper examines the complex interplay between lay and professional understandings that takes place as women attempt to weave the information they receive, their prior understandings and contextual factors together into some kind of coherent framework, in which each piece of information makes sense in relation to everything else. We conclude by arguing that, while presenting full and accurate information about orthodox medical understandings of cervical cancer causation in an accessible way maybe challenging, partial presentation of 'the facts' is likely to be ineffective.
Collapse
Affiliation(s)
- Natalie Armstrong
- Health Sciences, University of Leicester, 2nd Floor Adrian Building, University Road, Leicester, UK.
| | | |
Collapse
|
16
|
Khan A, Plummer D. Are printed sexually transmissible infection materials for patients appropriate? A physician perspective. Sex Health 2008; 5:307-8. [DOI: 10.1071/sh08012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 02/25/2008] [Indexed: 11/23/2022]
Abstract
The data from a postal survey of 409 general practitioners (GPs) practicing in New South Wales are analysed to explore GPs’ concerns, if any, about available printed information materials on sexually transmissible infections (STI) for patients. Just over half (55%) of GPs considered the materials for patients to be inadequate and/or inappropriate with 18% considering the materials as too technical for many patients and 13% considering the materials mostly out of date. Over a fifth reported that either STI materials were not available in their clinic or they did not know where to get those materials.
Collapse
|
17
|
Wray N, Markovic M, Manderson L. Discourses of normality and difference: Responses to diagnosis and treatment of gynaecological cancer of Australian women. Soc Sci Med 2007; 64:2260-71. [PMID: 17399878 DOI: 10.1016/j.socscimed.2007.02.034] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Indexed: 11/29/2022]
Abstract
By comparison to other cancers such as breast and lung cancer, women in Australia are relatively infrequently diagnosed with gynaecological cancers. Apart from cervical cancer, public health information on gynaecological cancer is limited, as are published stories from gynaecological cancer survivors in women's magazines. Our qualitative study investigated how women with gynaecological cancers develop an identity in relation to their illness, and examined the extent of, and reasons for, a sense of perceived difference. The study was conducted between 2001 and 2003 and included in-depth interviews with 52 women aged 27-80 years diagnosed with gynaecological cancer within the past 5 years. Our analysis illustrates how women draw on a wider cancer discourse to make sense of their own illness, which gave them a sense of commonality. However, some women, predominantly those who were diagnosed with cancer of the vulva or vagina, or who underwent particular uncommon or unfamiliar treatments such as brachytherapy, had difficulties situating their illness within the wider cancer discourse. This had implications for women when accessing social support.
Collapse
Affiliation(s)
- Natalie Wray
- Monash University, Caulfield East, Victoria, Australia.
| | | | | |
Collapse
|
18
|
Jepson RG, Hewison J, Thompson A, Weller D. Patient perspectives on information and choice in cancer screening: a qualitative study in the UK. Soc Sci Med 2007; 65:890-9. [PMID: 17507131 DOI: 10.1016/j.socscimed.2007.04.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Indexed: 10/23/2022]
Abstract
The principle of informed choice has been recently incorporated into cancer screening policy. However, there is limited empirical or theoretical work on informed choice in this particular context. The main aim of the study reported here was to explore the information needs of people invited for screening, and to gain insights into the relationship between the information they wanted and the choices they made. A qualitative study (nine focus groups and 15 individual interviews) was undertaken with people who had contrasting experiences (and outcomes) of either breast, cervical, or colorectal cancer screening at two locations in Scotland, UK. Findings suggest that lay people define and conceptualise informed choice differently from policy makers. The study also found that information about the disease was as important to people as information on the risks and limitations of screening. However, information may have little part to play in the choices people make. Rather, it may have more impact on outcomes such as satisfaction and anxiety. An explicit policy aim in promoting informed choice is to enhance patient autonomy and to prevent people from being deceived or coerced. However, this research shows that the provision of evidence-based information alone does not necessarily mean that an informed choice is made. People may not read, want, or understand the information, and, additionally, they may not be able to carry out their intended choice. There may be personal barriers, such as physical or mental health problems and language, or organisational barriers, such as the availability of the service/intervention and access. Therefore, the term 'informed choice' might not be useful in this context.
Collapse
Affiliation(s)
- Ruth Gillian Jepson
- Department of Nursing and Midwifery, University of Stirling, Stirling FK9 4LA, UK.
| | | | | | | |
Collapse
|
19
|
Friedman AL, Shepeard H. Exploring the Knowledge, Attitudes, Beliefs, and Communication Preferences of the General Public Regarding HPV. HEALTH EDUCATION & BEHAVIOR 2006; 34:471-85. [PMID: 17000622 DOI: 10.1177/1090198106292022] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Genital human papillomavirus (HPV) infection is the most common sexually transmitted virus in the United States, causing genital warts, cervical cell abnormalities, and cervical cancer in women. To inform HPV education efforts, 35 focus groups were conducted with members of the general public, stratified by gender, race/ethnicity, and urban/rural location. Focus groups explored participants' knowledge, attitudes, and beliefs about HPV and a hypothetical HPV vaccine as well as their communication preferences for HPV-related educational messages. Audience awareness and knowledge of HPV were low across all groups. This, along with an apparent STD-associated stigma, served as barriers to participants' hypothetical acceptance of a future vaccine. Although information about HPV's high prevalence and link to cervical cancer motivated participants to learn more about HPV, it also produced audience fear and anxiety. This research suggests that HPV- and HPV-vaccine-related education efforts must be approached with extreme caution. Other practical implications are discussed.
Collapse
Affiliation(s)
- Allison L Friedman
- National Center for HIV, STD and TB Prevention, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | | |
Collapse
|
20
|
de Groot JM, Mah K, Fyles A, Winton S, Greenwood S, Depetrillo AD, Devins GM. The psychosocial impact of cervical cancer among affected women and their partners. Int J Gynecol Cancer 2006; 15:918-25. [PMID: 16174246 DOI: 10.1111/j.1525-1438.2005.00155.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study aimed to assess the range and intensity of psychosocial concerns experienced by women with cervical cancer and their male partners. A cross-sectional survey assessed 26 couples where the woman had invasive cervical cancer stage I-IV, up to 2 years posttreatment, using a concerns questionnaire and widely used psychosocial questionnaires. Respondents indicated their concerns about the impact of the disease and treatment as well as general psychosocial impact. Women with cervical cancer and their male partners expressed equal intensities of concern regarding the illness and its treatment, rating sexuality, prognosis, and communication with the treatment team most highly in terms of current concerns. Couples where the patient had a more advanced stage of cancer expressed higher concerns than those with earlier stage disease. Although women with cervical cancer reported more fatigue and illness intrusiveness than their male partners, both experienced disruptions in relationships, intimacy, and instrumental life domains. With increased time posttreatment, concerns differed subtly between affected women and their male partners. Effective psychosocial support for cervical cancer must be provided for both the affected woman and her male partner. Support and information should address the most salient concerns of patients and partners as these evolve over significant clinical milestones.
Collapse
Affiliation(s)
- J M de Groot
- Psychosocial Oncology and Palliative Care Program, Princess Margaret Hospital and University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
21
|
Baay MFD, Verhoeven V, Avonts D, Vermorken JB. Risk factors for cervical cancer development: what do women think? Sex Health 2006; 1:145-9. [PMID: 16335302 DOI: 10.1071/sh04004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The current cervical cancer prevention strategy is exclusively directed towards screening, without taking into account any relationship with sexual risk factors. The introduction of human papillomavirus (HPV) detection into the screening procedure implicates that we should give attention to this relationship. The aim of this study was to investigate what knowledge women have of the relation between HPV and cervical cancer. METHODS Rather than asking about HPV specifically, we suggested 20 risk factors for the development of cervical cancer, including viral infection, and asked 73 women visiting their general practitioner, 67 women visiting a lecture on risk factors for cervical cancer and 28 female students in biomedical sciences to rate the importance of these risk factors on a scale of 1-5. RESULTS Genetic factors were rated highest with a mean score of 4.5. Bacterial infection ranked second highest with a mean score of 3.8. Smoking ranked fourth at a mean score of 3.6, whereas viral infection shared the sixth place with number of sexual partners with a mean score of 3.4. The presence of high voltage power lines and physical activity appropriately scored the last two places at 2.4 and 2.2, respectively. Twenty-one women suggested a role for sexually transmitted agents, but only five women (3.1%) could actually pinpoint HPV. CONCLUSION This enquiry indicates that the risk factor 'genetic factors' was over-rated, while knowledge of the most important risk factors, i.e. smoking and sexual habits and (sexually transmitted) infections, would appear to be present to a moderate level in our population. However, knowledge of the role of HPV in cervical cancer development is lacking.
Collapse
Affiliation(s)
- M F D Baay
- Department of Medical Oncology, University of Antwerp, Belgium.
| | | | | | | |
Collapse
|
22
|
Manderson L, Markovic M, Quinn M. “Like roulette”: Australian women's explanations of gynecological cancers. Soc Sci Med 2005; 61:323-32. [PMID: 15893049 DOI: 10.1016/j.socscimed.2004.11.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2004] [Accepted: 11/18/2004] [Indexed: 10/25/2022]
Abstract
Drawing on data from interviews and other ethnographic research, we examine how Australian women from different ethnic and cultural backgrounds make sense of having gynecological cancer. Alternative explanatory models often co-exist in a single narrative, but there is significant consistency in the etiology of cancer among Australian-born and immigrant women. In acknowledging the unpredictability of cancer and the prognosis of particular disease, women contextualize their own experience as a matter of luck, outside their control or influence. Most often women relate their own occurrence of cancer to their social setting and relational factors rather than personal behavior, but at the same time, they acknowledge the interaction of external forces and individual factors, particularly in the case of diet and stress. Women can control diet to some extent, although many note the irony of having developed cancer even when they have eaten well. Stress, on the other hand, is largely considered as external to and beyond women's control. Women speak of stress as a characteristic of contemporary social life, as well as their own public and domestic, physical and emotional lives; for these women stress in any of these areas can create physical vulnerability that may result in cancer. Since women associate cancer with loss of control, the idea of cancerous cells out-of-control within their bodies operates as a metonym of women's views of themselves interpersonally and socially.
Collapse
Affiliation(s)
- Lenore Manderson
- Faculty of Medicine, Dentistry and Health Sciences, Key Centre for Women's Health in Society, Department of Public Health, The University of Melbourne, 1/305 Cardigan Street, Carlton, Victoria 3053, Australia.
| | | | | |
Collapse
|
23
|
Waller J, McCaffery KJ, Forrest S, Wardle J. Human papillomavirus and cervical cancer: issues for biobehavioral and psychosocial research. Ann Behav Med 2004; 27:68-79. [PMID: 14979865 DOI: 10.1207/s15324796abm2701_9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
There is now overwhelming evidence that high-risk, sexually transmitted types of human papillomavirus (HPV) are the main causal agent in cervical cancer. Biobehavioral and psychosocial research is uniquely capable of addressing many of the issues raised by HPV and its link with cervical cancer. In this article we review current findings in this area and identify issues for future research. The first of the three sections explores issues associated with the introduction of HPV testing for the detection and management of cervical abnormalities and the impact of growing public awareness of the sexually transmitted nature of cervical cancer. The implications for public understanding of cervical cancer, psychosocial issues associated with screening, and the potential impact on screening uptake are discussed. The second section addresses the role of biobehavioral factors in the persistence and progression of HPV infection as well as possible interventions to minimize the risk of persistence. Finally, primary prevention of HPV is discussed.
Collapse
Affiliation(s)
- Jo Waller
- Cancer Research UK Health Behaviour Unit, University College London, UK.
| | | | | | | |
Collapse
|
24
|
Abstract
BACKGROUND The introduction of human papillomavirus (HPV) testing into cervical screening has the potential to alter public perceptions of cervical cancer by making explicit the role of a sexually transmitted virus in its etiology. HPV knowledge has been found to be poor, although there is evidence of public awareness of a link between sexual activity and cervical cancer risk. We explored beliefs about the risk factors for cervical cancer in a large population sample. METHODS Face-to-face interviews were carried out with a representative sample of the British population. All participants were asked what they thought increased a women's chances of developing cervical cancer. RESULTS The response rate was 71% (n = 1940). The most common single response was 'don't know' (38%). Forty-one percent of respondents mentioned factors relating to sex, but only 14% were aware of a link with sexual transmission and fewer than 1% named HPV. Women and more educated people had better knowledge of the established risk factors. The patterning of risk factor awareness by age varied across risk factors. CONCLUSIONS Awareness of the role of a sexually transmitted virus in the etiology of cervical cancer is very low in Britain. Provision of information associated with the introduction of HPV testing could change public perceptions of cervical cancer.
Collapse
Affiliation(s)
- Jo Waller
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, UCL, London WC1E 6BT, UK.
| | | | | |
Collapse
|
25
|
Philips Z, Johnson S, Avis M, Whynes DK. Communicating mild and borderline abnormal cervical smear results: how and what are women told? Cytopathology 2002; 13:355-63. [PMID: 12485171 DOI: 10.1046/j.1365-2303.2002.00447.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The way in which women are informed about borderline or mild smear results can have a significant psychological impact. By means of a questionnaire survey of general practices in Nottingham, England, this study audited the means by which abnormal smear results were normally communicated to subjects and analysed the content of these communications. Transmitting abnormal smear results, either by letter or by telephone call, was typically the responsibility of the practice nurse, and communications varied widely in informational content. We conclude that the method and content of communications imparting mild or borderline smear results differs between general practices, even within a small geographical area.
Collapse
Affiliation(s)
- Z Philips
- Trent Institute for Health Services Research, University of Nottingham, UK
| | | | | | | |
Collapse
|
26
|
Abstract
The education provided to women patients has been used historically to deliver messages of social and medical control. I suggest ethical standards of practice to tilt the balance toward use of education to serve women's perceived needs. Specific steps include standards and guidelines that specifically address appropriate gender differences in educational messages, regular elicitation from women of educational needs and satisfaction with educational services, and research that specifically tests the impact of patient education services on women and on men. More broadly, patient education must be legitimated as an essential service for which providers and institutions are accountable, and the predominately nonphysician providers who deliver it must be empowered to challenge current practice. Current work on health care as a gendered system suggests that patient education practice can rid itself of only some of the gender bias that exists.
Collapse
Affiliation(s)
- Barbara K Redman
- Wayne State University, College of Nursing, Detroit, Michigan 48202, USA.
| |
Collapse
|
27
|
|
28
|
Braun V, Gavey N. “Bad girls” And “Good girls”? sexuality and cervical cancer. WOMENS STUDIES INTERNATIONAL FORUM 1999. [DOI: 10.1016/s0277-5395(99)00007-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|