1
|
Hansen BT, Nygård M, Castle PE, Burger EA, Aasbø G. Sociodemographic characteristics associated with cervical cancer screening participation by send-to-all and opt-in HPV self-sampling: Who benefits? Results from a randomized controlled trial among long-term non-attending women in Norway. Int J Cancer 2024; 155:1053-1067. [PMID: 38751040 DOI: 10.1002/ijc.34989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/11/2024] [Accepted: 04/12/2024] [Indexed: 07/16/2024]
Abstract
With the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under-screened women, we randomized a random sample of 6000 women in Norway aged 35-69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in), or (iii) a self-sampling kit unsolicited (send-to-all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send-to-all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt-in arm, we observed smaller, and at times, non-significant increases within the range 0.7% (95% CI = -5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send-to-all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt-in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (-12.7%, 95% CI = -19.7% to -5.7%). Self-sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self-sampling, especially with the goal to reach long-term non-attending women.
Collapse
Affiliation(s)
- Bo T Hansen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Phil E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Interdisciplinary Health Science, University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Schmeising-Barnes N, Waller J, Marlow LAV. Intention to have blood-based multi-cancer early detection (MCED) screening: a cross-sectional population-based survey in England. Br J Cancer 2024:10.1038/s41416-024-02822-4. [PMID: 39191895 DOI: 10.1038/s41416-024-02822-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Trials assessing the clinical utility of blood-based multi-cancer early detection (MCED) tests are underway. Understanding public attitudes towards MCED screening is essential if these tests are to be used. We aimed to quantify MCED screening intention and potential barriers and facilitators to uptake. METHODS Adults aged 50-77 (n = 958) completed an online survey. The primary outcome was intention to have MCED screening if offered. Psychological variables including barriers and facilitators were assessed. We used logistic regressions to explore associations between socio-demographics and psychological factors and intention. RESULTS 93.8% of participants said they would 'definitely' or 'probably' have MCED screening if offered. Intention was significantly associated with previous screening participation and general cancer attitudes but not with socio-demographic factors. Participants were more likely to be intenders if they had higher health motivation, and perceived greater benefits of blood tests. Participants were less likely to be intenders if they perceived greater disadvantages of blood tests, more practical barriers, were more worried about the outcome and more concerned about a positive result. CONCLUSIONS AND IMPLICATIONS MCED screening intention was high. The lack of socio-demographic variation suggests equitable interest in this type of screening; however, future research should consider how intention translates to uptake.
Collapse
Affiliation(s)
- Ninian Schmeising-Barnes
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jo Waller
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Laura A V Marlow
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Farajimakin O. Barriers to Cervical Cancer Screening: A Systematic Review. Cureus 2024; 16:e65555. [PMID: 39192892 PMCID: PMC11347962 DOI: 10.7759/cureus.65555] [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: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
Cervical cancer remains a significant global health concern, particularly in underserved populations. Despite the availability of effective screening methods, uptake remains suboptimal in many regions. This systematic review aims to synthesize the current evidence on barriers to cervical cancer screening across diverse populations and healthcare settings. A comprehensive search of electronic databases was conducted to identify relevant studies published till June 2024. Studies examining barriers to cervical cancer screening in various populations were included. Data extraction and quality assessment were performed independently by two reviewers. A narrative synthesis approach was used to analyze and present the findings. Seventeen studies met the inclusion criteria, encompassing a wide range of study designs and populations. Common barriers identified across studies included lack of knowledge and awareness, economic constraints, access issues, cultural and religious factors, fear and embarrassment, and distrust in healthcare systems. Population-specific barriers were observed among immigrant and ethnic minority women, individuals in low- and middle-income countries, indigenous women, and LGBQ women. Healthcare system factors, socioeconomic influences, psychological and individual factors, and interpersonal and community dynamics also played significant roles in screening participation. This review highlights the complex and multifaceted nature of barriers to cervical cancer screening. Findings suggest that interventions to improve screening rates should be comprehensive, culturally sensitive, and tailored to specific population needs. Addressing both individual-level and systemic barriers is crucial for enhancing cervical cancer screening uptake globally.
Collapse
|
5
|
Andrew-Bassey UI, Oke DO, Okunlola MA, Morhason-Bello IO. Scoping review protocol on the perception and attitude of women on methods for collecting cervicovaginal samples for human papillomavirus testing in sub-Saharan Africa. BMJ Open 2024; 14:e085408. [PMID: 38910004 PMCID: PMC11328614 DOI: 10.1136/bmjopen-2024-085408] [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] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Sub-Saharan Africa (SSA) regions have the highest burden of cervical cancer (CC), accounting for nearly a quarter of global mortality. Many women in SSA are reluctant to access CC screening because they are uncomfortable exposing their private parts to healthcare providers. The perception of women who have experienced self-sampling in SSA is yet to be reviewed. This scoping review will explore the literature on the perception and attitude of women towards methods of collecting cervicovaginal samples for human papillomavirus (HPV) testing in SSA. METHODS AND ANALYSIS An extensive search using the Arksey and O'Malley framework will be conducted. The search criteria will be limited to original research conducted in community or clinical settings in SSA within the last 10 years. Four databases, namely, PUBMED, Cochrane, African Journals Online and Google Scholar, will be searched. Two independent persons (UIAB and DOO) will screen the titles and abstracts and later full texts using population, intervention, comparison and outcome criteria. IOMB will serve as a tiebreaker whenever there is no agreement on the choice of eligibility criteria. The screening process will be presented using Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review flow format. The descriptive analysis of eligible studies for scoping reviews will be summarised. We will describe themes of attitude and perception covering pain, embarrassment, privacy and comfortability, willingness to self-sample, anxiety and confidence. ETHICS AND DISSEMINATION This is a scoping review protocol and does not require ethical approval. Findings from this review will be disseminated through peer-reviewed publications, the production of policy briefs, and presentations at local and international conferences.
Collapse
Affiliation(s)
- Uduak Ima Andrew-Bassey
- Pan African University Life and Earth Sciences Institute (including Health and Agriculture), Ibadan, Oyo State, Nigeria
- Centre for Medical Informatics and Professional Development, Ibadan, Nigeria
| | - Deborah Olamiposi Oke
- Department of Epidemiology and Medical Statistics,College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- HPV Research Consortium, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Michael A Okunlola
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Imran O Morhason-Bello
- HPV Research Consortium, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| |
Collapse
|
6
|
Zhetpisbayeva I, Rommel A, Kassymbekova F, Semenova Y, Sarmuldayeva S, Giniyat A, Tanatarova G, Dyussupova A, Faizova R, Rakhmetova V, Glushkova N. Cervical cancer trend in the Republic of Kazakhstan and attitudes towards cervical cancer screening in urban and rural areas. Sci Rep 2024; 14:13731. [PMID: 38877051 PMCID: PMC11178783 DOI: 10.1038/s41598-024-64566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024] Open
Abstract
Cervical cancer (CC) continues to be a significant global health issue, which in part can be attributed to disparities in access to CC screening services. This study aims to conduct a trend of CC in Kazakhstan and to compare attitudes towards the screening program between women living in urban and rural areas. In the first stage, we conducted a trend study of CC indicators in Kazakhstan using official statistics. In the second stage, a cross-sectional study was conducted using a structured questionnaire to assess adherence to screening. The trend study reveals a decline in cervical cancer mortality rates (from 7.15 to 5.93 per 100,000 female inhabitants) over the period studied, while the incidence remains stable (from 18.51 to 19.38 per 100,000 female inhabitants). Regional variations in Period Prevalence rates were observed. Significant differences were found in screening participation rates between urban n = 41 (74%) and rural n = 23 (38%) women, p < 0.001, as well as awareness of the screening program (urban: n = 15 (27%), rural: n = 35 (58%), p < 0.001). The trend study highlights a decrease in cervical cancer mortality rates over the specified period, accompanied by a consistent incidence rate. Additionally, regional disparities in period prevalence rates of cervical cancer were observed. The primary factor contributing to the low adherence of rural women to screening was found to be a lack of awareness regarding the screening program. Therefore, increasing awareness about the importance of screening is crucial for improving adherence rates among rural women in Kazakhstan.
Collapse
Affiliation(s)
- Indira Zhetpisbayeva
- Department of General Medical Practice-2, Asfendiyarov Kazakh National Medical University, St.Tole Bi 94, 050000, Almaty, Kazakhstan.
- Department of Public Health and Social Sciences, Kazakhstan's Medical University "Kazakhstan School of Public Health", St.Utepova 19a, 050060, Almaty, Kazakhstan.
| | - Alexander Rommel
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Fatima Kassymbekova
- Department of Public Health and Social Sciences, Kazakhstan's Medical University "Kazakhstan School of Public Health", St.Utepova 19a, 050060, Almaty, Kazakhstan
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Sholpan Sarmuldayeva
- Department of the International Medical Faculty, University of International Business, Almaty, Kazakhstan
| | - Azhar Giniyat
- NJSC "National Center for Children's Rehabilitation", Astana, Kazakhstan
| | | | - Azhar Dyussupova
- Department of General Medical Practice, Semey Medical University, Semey, Kazakhstan
| | - Raida Faizova
- Department of General Medical Practice, Semey Medical University, Semey, Kazakhstan
| | - Venera Rakhmetova
- Department of Internal Diseases, Astana Medical University, Astana, Kazakhstan
| | - Natalya Glushkova
- Department of Epidemiology, Evidence Medicine and Biostatistics, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| |
Collapse
|
7
|
Benedetto V, Ferrè F, Nuti S. Including environmental and social sustainability in the planning process of healthcare services: A case study of cancer screening programs in an inner area in Italy. Health Policy 2024; 144:105074. [PMID: 38652936 DOI: 10.1016/j.healthpol.2024.105074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/20/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Healthcare systems plan their activities to achieve efficiency and effectiveness, without addressing environmental and social sustainability. This paper describes a new approach adopted in Italy to plan and deliver health prevention services in an inner area of the Tuscany region (in Italy) to guarantee proximity of care and environmental and social sustainability. The project examines the design and delivery of cancer screening programmes using a mobile screening unit to maximise social benefits while minimising environmental waste. A cost analysis was developed to estimate the difference in CO2 equivalent emissions, travel costs, and productivity losses, comparing the current screening programmes against the introduction of a comprehensive full-service mobile screening unit. The results indicate that the new service model reduces direct non-medical costs incurred by the population and improves environmental sustainability. This alternative can reduce, annually, over 95,000 euros in terms of travel costs and productivity losses, as well as 35 tons of CO2-equivalent travel emissions for a population of 59,000 inhabitants in a mountainous area with around 6000 people involved in the screening programme. The study supports the need to adopt a new planning methodology that considers environmental, social, and financial sustainability jointly in the provision of public health services in rural areas.
Collapse
Affiliation(s)
- Vera Benedetto
- Interdisciplinary Research Center for Health Science, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy.
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management-Department Embeds, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy
| | - Sabina Nuti
- Interdisciplinary Research Center for Health Science, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy
| |
Collapse
|
8
|
Descamps P, Dixon S, Bosch Jose FX, Kyrgiou M, Monsonego J, Neisingh O, Nguyen L, O'Connor M, Smith JS. Turning the tide-Recommendations to increase cervical cancer screening among women who are underscreened. Int J Gynaecol Obstet 2024; 166 Suppl 1:3-21. [PMID: 38853590 DOI: 10.1002/ijgo.15600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Philippe Descamps
- Co-Chair, ACCESS Consensus Group, Professor and Chairman, Department of Obstetrics and Gynecology, University Hospital Angers, Former Vice President of FIGO, and President of International Relations Committee, CNGOF (French College of Obstetricians and Gynecologists), Angers, France
| | - Samantha Dixon
- Former Co-Chair, ACCESS Consensus Group, Former CEO, Jo's Cervical Cancer Trust, London, UK
| | - Francesc Xavier Bosch Jose
- Clinical Oncologist, Epidemiologist, Co-founder, HPV Information Center (ICO and IARC), Director, HPV World (HPW), Barcelona, Spain
| | - Maria Kyrgiou
- Consultant Surgeon in Gynecology and Gynecological Oncology, Imperial College London, London, UK
| | - Joseph Monsonego
- Gynecologist-Oncologist, Founding President of EUROGIN, President of 1000 Femmes 1000 Vies Patient Association, Paris, France
| | - Ody Neisingh
- Independent Consultant and Public Affairs Advisor, with Extensive Working Experience at WOMEN Inc. and UN Women, and Member of the European Economic and Social Committee on behalf of Gender Equality Civil Society, Amsterdam, The Netherlands
| | - Lananh Nguyen
- Director of Cytopathology and Assistant Professor, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Mairead O'Connor
- Research Officer, National Screening Service Ireland, Dublin, Ireland
| | - Jennifer S Smith
- Professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
9
|
Bøje RB, Bardou M, Mensah K, Rico Berrocal R, Giorgi Rossi P, Bonvicini L, Auzzi N, Taut D, Jiboc N, Tisler A, Reintamm K, Uusküla A, Teixeira M, Firmino-Machado J, Amorim M, Baia I, Lunet N, Michaylova R, Panayotova Y, Kotzeva T, Andersen B, Kirkegaard P. What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries. BMJ Open 2024; 14:e079921. [PMID: 38760040 PMCID: PMC11103196 DOI: 10.1136/bmjopen-2023-079921] [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: 09/19/2023] [Accepted: 03/31/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES The aim of this study was to map and compare stakeholders' perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries. DESIGN In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening. SETTING The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. PARTICIPANTS Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers. METHODS Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis. RESULTS 120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers' lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women's fear, shame and lack of priority to preventive healthcare were identified as psychological barriers. CONCLUSION The study provides an overview of stakeholders' perceived barriers towards vulnerable women's cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women's psychological barriers had several similarities.
Collapse
Affiliation(s)
- Rikke Buus Bøje
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Marc Bardou
- CIC-P INSERM 1432, Institut national de la santé et de la recherche médicale, Paris, France
| | - Keitly Mensah
- Early Detection, Prevention and Infections Branch, IARC, Lyon, France
| | - Raquel Rico Berrocal
- Centre d'Etudes des Mouvements Sociaux, Ecole des Hautes Etudes en Sciences Sociales, Paris, France
| | - Paolo Giorgi Rossi
- Servizio Interaziendale Epidemiologia, Azienda Unita Sanitaria Locale della Romagna, Ravenna, Italy
| | - Laura Bonvicini
- Servizio Interaziendale Epidemiologia, Azienda Unita Sanitaria Locale della Romagna, Ravenna, Italy
| | - Noemi Auzzi
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Osservatorio Nazionale Screening, Florence, Italy
| | - Diana Taut
- Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Anna Tisler
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kerli Reintamm
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Margarida Teixeira
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | - Mariana Amorim
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Ines Baia
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Nuno Lunet
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | | | | | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Kirkegaard
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
10
|
Smittenaar R, Quaife SL, von Wagner C, Higgins T, Hubbell E, Lee L. Impact of screening participation on modelled mortality benefits of a multi-cancer early detection test by socioeconomic group in England. J Epidemiol Community Health 2024; 78:345-353. [PMID: 38429085 PMCID: PMC11103338 DOI: 10.1136/jech-2023-220834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Cancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing to higher multi-cancer early detection (MCED) test sensitivity for poor-prognosis cancers and greater cancer burden in groups experiencing greater deprivation, MCED screening programmes may have greater relative benefits in these groups. We modelled potential differential benefits of MCED screening between deprivation groups in England at different levels of screening participation. METHODS We applied the interception multi-cancer screening model to cancer incidence and survival data made available by the National Cancer Registration and Analysis Service in England to estimate reductions in late-stage diagnoses and cancer mortality from an MCED screening programme by deprivation group across 24 cancer types. We assessed the impact of varying the proportion of people who participated in annual screening in each deprivation group on these estimates. RESULTS The modelled benefits of an MCED screening programme were substantial: reductions in late-stage diagnoses were 160 and 274 per 100 000 persons in the least and most deprived groups, respectively. Reductions in cancer mortality were 60 and 99 per 100 000 persons in the least and most deprived groups, respectively. Benefits were greatest in the most deprived group at every participation level and were attenuated with lower screening participation. CONCLUSIONS For the greatest possible population benefit and to decrease health inequalities, an MCED implementation strategy should focus on enhancing equitable, informed participation, enabling equal participation across all socioeconomic deprivation groups. TRIAL REGISTRATION NUMBER NCT05611632.
Collapse
Affiliation(s)
| | | | | | - Thomas Higgins
- National Cancer Registration and Analysis Service, Leeds, UK
| | | | | |
Collapse
|
11
|
Ozturk NY, Hossain SZ, Mackey M, Adam S, Brennan P. HPV and Cervical Cancer Awareness and Screening Practices among Migrant Women: A Narrative Review. Healthcare (Basel) 2024; 12:709. [PMID: 38610131 PMCID: PMC11011554 DOI: 10.3390/healthcare12070709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
This narrative review explores the barriers and facilitators that migrant women face globally. The review explored a range of studies conducted in various countries, including the United States of America (USA), the United Kingdom (UK), Canada, Australia, and the United Arab Emirates (UAE). It also specialises in the experiences of migrant women living in Sydney, Australia, and women living in Ras Al Khaimah (RAK), UAE. Cervical cancer ranks as the fourth most prevalent form of cancer among women worldwide. It is the fourteenth most common cancer among women in Australia and the fourth most common cancer in the UAE. Despite the availability of vaccinations and cervical screening initiatives in many countries, including the USA, the UK, Canada, Australia, and the UAE, migrant women living in these countries continue to experience considerable health gaps when accessing cervical cancer screening services. Addressing these disparities is crucial to ensuring everyone has equal healthcare access. An electronic search was conducted using three databases to identify articles published between 2011 and 2021. Qualitative, quantitative, and mixed-methods research studies were included in the search. The identified factors were classified into categories of barriers and facilitators of cervical screening uptake, which were then sub-categorized. This narrative review examines the awareness of cervical cancer and screening behaviours, attitudes, barriers, and facilitators associated with cervical cancer screening. According to the study, several factors pose significant obstacles for migrant women worldwide, particularly those living in the USA, the UK, Canada, and Sydney, Australia, and Emirati and non-Emirati women (migrant women) residing in RAK when it comes to undergoing cervical cancer screening. These barriers include inadequate knowledge and emotional, cultural, religious, psychological, and organisational factors. On the other hand, social support, awareness campaigns, and the availability of screening services were found to promote the uptake of cervical cancer screening. The findings from this review suggest that healthcare providers should adopt culturally sensitive approaches to enhance awareness and encourage participation in screening programs among migrant women. Based on the findings of this narrative review, it is strongly suggested that healthcare providers and policymakers prioritise developing culturally sensitive screening initiatives for migrant women. It is essential to address the psychological and emotional barriers that prevent migrant women from accessing screening services. This can be accomplished by offering education and awareness campaigns in their native languages and implementing a community-based approach to encourage social support and increase awareness of cervical cancer and screening services. Furthermore, healthcare providers and organisations should provide educational tools that address common misconceptions based on cultural and religious factors that prevent women from accessing screening services.
Collapse
Affiliation(s)
- Nuray Yasemin Ozturk
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW 2000, Australia; (N.Y.O.); (M.M.); (P.B.)
| | - Syeda Zakia Hossain
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW 2000, Australia; (N.Y.O.); (M.M.); (P.B.)
| | - Martin Mackey
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW 2000, Australia; (N.Y.O.); (M.M.); (P.B.)
| | - Shukri Adam
- Faculty of Nursing, RAK Medical and Health Science University, Ras Al Khaimah 11172, United Arab Emirates;
| | - Patrick Brennan
- Faculty of Medicine & Health, The University of Sydney, Sydney, NSW 2000, Australia; (N.Y.O.); (M.M.); (P.B.)
| |
Collapse
|
12
|
Pathak N, Zhang CX, Boukari Y, Burns R, Menezes D, Hugenholtz G, French RS, Gonzalez-Izquierdo A, Mathur R, Denaxas S, Hayward A, Sonnenberg P, Aldridge RW. Sexual and reproductive health and rights of migrant women attending primary care in England: A population-based cohort study of 1.2 million individuals of reproductive age (2009-2018). J Migr Health 2024; 9:100214. [PMID: 38327760 PMCID: PMC10847991 DOI: 10.1016/j.jmh.2024.100214] [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: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
Background Evidence on the sexual and reproductive health and rights (SRHR) of migrants is lacking globally. We describe SRHR healthcare resource use and long-acting reversible contraceptives (LARCs) prescriptions for migrant versus non-migrant women attending primary care in England (2009-2018). Methods This population-based observational cohort study, using Clinical Practice Research Datalink (CPRD) GOLD, included females living in England aged 15 to 49. Migration was defined using a validated codelist. Rates per 100 person years at risk (pyar) and adjusted rate ratios (RRs) were measured in migrants versus non-migrants for consultations related to all-causes, six exemplar SRHR outcomes, and LARC prescriptions. Proportions of migrants and non-migrants ever prescribed LARC were calculated. Findings There were 25,112,116 consultations across 1,246,353 eligible individuals. 98,214 (7.9 %) individuals were migrants. All-cause consultation rates were lower in migrants versus non-migrants (509 vs 583/100pyar;RR 0.9;95 %CI 0.9-0.9), as were consultations rates for emergency contraception (RR 0.7;95 %CI 0.7-0.7) and cervical screening (RR 0.96;95 %CI 0.95-0.97). Higher rates of consultations were found in migrants for abortion (RR 1.2;95 %CI 1.1-1.2) and management of fertility problems (RR 1.39;95 %CI 1.08-1.79). No significant difference was observed for chlamydia testing and domestic violence. Of 1,205,258 individuals eligible for contraception, the proportion of non-migrants ever prescribed LARC (12.2 %;135,047/1,107,894) was almost double that of migrants (6.91 %;6,728/97,364). Higher copper intrauterine devices prescription rates were found in migrants (RR 1.53;95 %CI 1.45-1.61), whilst hormonal LARC rates were lower for migrants: levonorgestrel intrauterine device (RR 0.63;95 %CI 0.60-0.66), subdermal implant (RR 0.72;95 %CI 0.69-0.75), and progesterone-only injection (RR 0.35;95 %CI 0.34-0.36). Interpretation Healthcare resource use differs between migrant and non-migrant women of reproductive age. Opportunities identified for tailored interventions include access to primary care, LARCs, emergency contraception and cervical screening. An inclusive approach to examining health needs is essential to actualise sexual and reproductive health as a human right.
Collapse
Affiliation(s)
- Neha Pathak
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute for Global Health, University College London, London, WC1E 6JB, UK
- Guy's & St Thomas's NHS Foundation Trust, London, SE1 9RT, UK
| | - Claire X. Zhang
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Dee Menezes
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Gregory Hugenholtz
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Rebecca S French
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- BHF Data Science Center, Health Data Research UK, London, NW1 2DA, UK
| | - Andrew Hayward
- Inclusion Health, UK Health Security Agency, London, UK
- Institute of Epidemiology and Healthcare, University College London, London, WC1E 7HB, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, WC1E 6JB, UK
| | | |
Collapse
|
13
|
Wearn A, Shepherd L. Determinants of routine cervical screening participation in underserved women: a qualitative systematic review. Psychol Health 2024; 39:145-170. [PMID: 35296200 DOI: 10.1080/08870446.2022.2050230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Routine, population-wide cervical screening programmes reduce cervical cancer incidence and mortality. However, socioeconomically deprived communities and ethnic minority groups typically have lower uptake in comparison to the general population and thus are described as 'underserved.' A systematic qualitative literature review was conducted to identify relevant determinants of participation for these groups. METHODS Online databases were searched for relevant literature from countries with well-established, call-recall screening programmes. Overall, 24 articles were eligible for inclusion. Data was synthesized via Framework synthesis. Dahlgren & Whitehead's social model of health was used as a broad a priori coding framework. RESULTS Participation was influenced by determinants at multiple levels. Overall, patient-provider relationships and peer support facilitated engagement. Cultural disparities, past healthcare experience and practical barriers hindered service access and exacerbated negative thoughts, feelings and attitudes towards participation. Complex interrelationships between determinants suggest barriers have a cumulative effect on screening participation. CONCLUSIONS These findings present a framework of psychosocial determinants of cervical screening uptake in underserved women and emphasise the role of policy makers and practitioners in reducing structural barriers to screening services. Additional work, exploring the experience of those living within socioeconomically disadvantaged areas, is needed to strengthen understanding in this area.
Collapse
Affiliation(s)
- Angela Wearn
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Lee Shepherd
- Department of Psychology, Northumbria University, Northumberland Building, Newcastle Upon Tyne, UK
| |
Collapse
|
14
|
Christensen K, Bauer AG, Burgin T, Williams J, McDowd J, Sutkin G, Bennett K, Bowe Thompson C, Berkley-Patton JY. "Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:137-150. [PMID: 36125430 DOI: 10.1177/0272684x221115494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3 years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.
Collapse
Affiliation(s)
- Kelsey Christensen
- Department of Family and Community Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Alexandria G Bauer
- Center for Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
| | - Tacia Burgin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joah Williams
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joan McDowd
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Gary Sutkin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kymberly Bennett
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jannette Y Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| |
Collapse
|
15
|
Chan DNS, Choi KC, Wong CL, So WKW, Fan N. Use of a Linguistically Appropriate Decision Aid for Cervical Cancer Screening of South Asian Ethnic Minority Women in Hong Kong: A Pilot Randomised Controlled Trial. Int J Behav Med 2023; 30:878-890. [PMID: 36482142 DOI: 10.1007/s12529-022-10143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Decision aids have been shown to be effective in assisting the decision-making process in healthcare settings. This study aimed to examine the feasibility and acceptability of a linguistically appropriate printed decision aid for cervical cancer screening in South Asian women and to preliminarily estimate its effects on decisional conflicts, clarity of values, risk perception, the screening decision and screening uptake. METHODS This was a pilot randomised controlled trial. Forty-eight South Asian women aged 25 to 64 years were recruited and allocated to either the intervention group or control group. The participants in the intervention group read a linguistically appropriate printed decision aid. RESULTS All of the participants in the intervention group agreed that the decision aid was useful in aiding their decision-making. These participants showed significantly greater improvement in decisional conflicts, clarity of values and risk perceptions than those in the control group (all p < 0.05). The screening uptake rate was significantly higher in the intervention group than in the control group (p < 0.001). CONCLUSIONS The decision aid was feasible and acceptable among South Asian women, and it resulted in reduced decisional conflict and increased screening uptake compared with usual care. To improve the convenience of using decision aids, they could be developed in various forms, such as printed and mobile application forms, to meet individual requirements. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry on 23 October 2021 (ChiCTR2100052225).
Collapse
Affiliation(s)
- Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, NT, Hong Kong SAR, China.
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, NT, Hong Kong SAR, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, NT, Hong Kong SAR, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, NT, Hong Kong SAR, China
| | - Ning Fan
- Yan Chai Hospital, Hospital Authority, Hong Kong SAR, China
| |
Collapse
|
16
|
Afsah YR, Kaneko N. Barriers to cervical cancer screening faced by immigrant Muslim women: a systematic scoping review. BMC Public Health 2023; 23:2375. [PMID: 38037019 PMCID: PMC10687813 DOI: 10.1186/s12889-023-17309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Uptake for cervical cancer screening (CCS) is extremely low among immigrant women, particularly Muslim women, because of barriers related to religious values, beliefs, and fatalism. This scoping review aimed to summarize and analyze the findings of previous studies regarding perceived barriers to CCS among Muslim immigrant women. METHODS A search of electronic databases of peer-reviewed articles, including MEDLINE, CINAHL, PubMed, and Scopus was conducted. The following criteria were used for the selection of the articles: (a) the study population consisted of immigrant Muslim women, (b) CCS barriers were the main focus of the study, (c) the articles were original research articles, (d) the research was conducted within the last 10 years, and (d) the study was reported in English language. RESULTS Barriers included sociodemographic factors, economic, language, cognitive, and emotional reactions. The healthcare system was classified as a community barrier, whereas culture and religion were categorized as social barriers. Beliefs that becoming ill and dying is the will of Allah and that health problems are a punishment from God were considered to be major barriers to CCS among immigrant Muslim women. CONCLUSION Access to health service centers and CCS among Muslim immigrant women is challenging. Information dissemination by health care workers is needed to increase awareness of CCS and access to CCS service points among immigrant Muslim women. Physician recommendations to attend CCS also play an important role.
Collapse
Affiliation(s)
- Yusi Riwayatul Afsah
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Bantul, Yogyakarta, 55183, Indonesia.
- Graduate School of Nursing, Global and Community Health Nursing, Nagoya City University, Nagoya, 467-0001, Japan.
| | - Noriyo Kaneko
- Graduate School of Nursing, Global and Community Health Nursing, Nagoya City University, Nagoya, 467-0001, Japan
| |
Collapse
|
17
|
Greenley R, Bell S, Rigby S, Legood R, Kirkby V, McKee M. Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature. Front Public Health 2023; 11:1144674. [PMID: 37304105 PMCID: PMC10247980 DOI: 10.3389/fpubh.2023.1144674] [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: 01/14/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Cervical cancer is a preventable and inequitably distributed disease. Screening plays a vital role in prevention, but many women face barriers to participation. The aims of this scoping review, undertaken to inform the co-design of interventions to equitably increase screening uptake, were to: (1) identify barriers and facilitators to cervical cancer screening for underserved populations, and (2) identify and describe the effectiveness of interventions aimed at improving participation in cervical cancer screening among underserved groups in Europe. Methods Qualitative, quantitative, and mixed methods studies focusing on barriers and facilitators to cervical screening participation and interventions to improve uptake undertaken in Europe and published after 2000 were included. Four electronic databases were searched to identify relevant papers. Titles and abstracts were screened, full text reviewed, and key findings extracted. Data were extracted and analyzed according to different health system strata: system-wide (macro), service specific (meso) and individual/community specific (micro). Within these categories, themes were identified, and the population groups impacted were recorded. All findings are presented in accordance with (PRISMA) guidelines. Results 33 studies on barriers and facilitators and eight intervention studies met the inclusion criteria. Collectively, the findings of these studies presented a wide array of screening uptake barriers, facilitators, and interventions, predominantly related to screening service and individual/community factors. However, although diverse, certain core themes around information provision, prompts for participation and the need for inclusive spaces were apparent. Implementation of screening programs should focus on: (1) reducing identifiable barriers, (2) increasing public awareness, and (3) providing patient reminders and measures to promote engagement by healthcare providers. Conclusion There are many barriers to uptake of cervical cancer screening and this review, nested within a larger study, will inform work to devise a solution alongside groups identified in three European countries.
Collapse
Affiliation(s)
- Rachel Greenley
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sadie Bell
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Samuel Rigby
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosa Legood
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victoria Kirkby
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
18
|
Bolarinwa OA, Holt N. Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review. BMC Health Serv Res 2023; 23:390. [PMID: 37087506 PMCID: PMC10122823 DOI: 10.1186/s12913-023-09410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Cancer is currently the leading cause of mortality globally, with new cancer cases estimated at 19.3 million and almost 10 million deaths in 2020. Specifically, breast and cervical cancer incidence and mortality prevalence among women of the minority group or marginalised populations in Europe have continued to be a public health concern due to the low uptake of cancer screening. Thus, this study utilised a mixed-method systematic review to identify barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom. METHODS Databases including PubMed, CINAHL, British Nursing Index, Web of Science, EMBASE, and Scopus databases, were systematically searched for studies on barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom published in English between January 2010 to July 2022. This mixed-method systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in reporting the included studies' results. The cluster mapping approach was used to identify and classify the barriers into themes. RESULTS Thirteen eligible studies were included in this current review. Seven of the thirteen studies used quantitative cross-sectional research design, while six used qualitative cross-sectional research design. These studies were conducted across the United Kingdom. Five themes were developed from the cluster mapping, and thirty-four sub-theme barriers to the uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom were identified. The developed themes in relation to the barriers include; socio-demographic characteristics, health service delivery, cultural, religious & language, the gap in knowledge & awareness, and emotional, sexual & family support. CONCLUSION The study concluded that barriers in socio-demographic characteristics, health service delivery, cultural, religious and language, the gap in knowledge & awareness, and emotional, sexual & family support were identified as non-uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom. Reducing or eliminating these barriers would improve the benefits of timely breast and cervical cancer screening in the United Kingdom.
Collapse
Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health & Well-Being, Faculty of Health & Social Care, University of Chester, Chester, UK.
- Institute for Advanced Studies in the Humanities, University of Edinburgh, Edinburgh, UK.
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK.
| | - Nicole Holt
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
| |
Collapse
|
19
|
Marques P, Geraldes M, Gama A, Heleno B, Dias S. What is the role of attitudinal barriers on cervical cancer screening non-attendance? Findings from a cross-sectional study with migrant women in Portugal. BMC Womens Health 2023; 23:52. [PMID: 36759781 PMCID: PMC9909634 DOI: 10.1186/s12905-023-02198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Cervical cancer is a common disease which can be effectively and timely detected by cervical cancer screening. However, access to cervical cancer screening is unequal, and it is known that migrant women have a lower attendance to cervical cancer screening. These inequalities are associated with several factors, including attitudes and beliefs of the women regarding screening practices, which prevents them from participating. This study aims to explore the attitudinal barriers to cervical cancer screening among migrant women in Portugal. METHODS A web-based cross-sectional survey was conducted with 1100 migrant women residing in Portugal. Women were recruited through social media platforms. The survey included items on socioeconomic characteristics, cervical cancer screening history and an 11-item attitudinal questionnaire to assess attitudinal barriers. Logistic regression models were used for statistical analysis. RESULTS The attitudinal barriers to CCS most often reported by participants were fear of the test result (25.3%), worry about seeing a male health professional (23.8%), perceiving the test as painful (23.1%), embarrassment (18.5%), difficulties scheduling the test (14.3%), and having a negative experience in screening (12.4%). Low perceived need in absence of symptoms and lack of motivation to be screened were reported by less than 5% of the women. However, the results suggest that most of the attitudinal barriers with higher agreement percentage have no association with cervical cancer screening attendance. Among all the attitudinal barriers, low perceived need of screening and lack of motivation were associated with CCS non-attendance. CONCLUSIONS Based on the findings, out of all the factors analyzed, low perceived need of screening and lack of motivation are the most relevant factors associated with non-attendance among migrants in Portugal. Promoting health literacy and empowering women with knowledge about benefits of screening may help overcoming these barriers. Therefore, this study provides a foundation for stakeholders on which areas should be prioritized when developing strategies aiming to reduced cervical cancer screening non-attendance among migrant women.
Collapse
Affiliation(s)
- Patrícia Marques
- grid.10772.330000000121511713NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Mariana Geraldes
- grid.10772.330000000121511713NOVA Nacional School of Public Health, Public Health Research Centre, NOVA University Lisbon, 1600-560 Lisbon, Portugal
| | - Ana Gama
- grid.10772.330000000121511713NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Bruno Heleno
- grid.10772.330000000121511713CHRC, NOVA Medical School, NOVA University Lisbon, 1169-056 Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
| |
Collapse
|
20
|
Wilding S, Prudenzi A, Conner M, O'Connor DB. Do reasoned action approach variables mediate relationships between demographics and cervical cancer screening intentions or behaviour? An online study of women from the UK. Soc Sci Med 2022; 313:115354. [PMID: 36191387 DOI: 10.1016/j.socscimed.2022.115354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/05/2022] [Accepted: 09/03/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In the UK, approximately 3,200 women are diagnosed with cervical cancer each year. Regular screening is one of the best ways to prevent cervical cancer from developing, yet screening rates are declining and vary by sociodemographic variables. The present stratified online study aimed to investigate relationships between sociodemographic factors and screening intentions and past behaviour. Reasoned Action Approach (RAA) variables were assessed as potential mediators. METHODS In total, 500 women living in the UK were recruited via an online research recruitment website to an online cross-sectional survey. Participant recruitment was stratified by age, socioeconomic status and ethnicity to ensure adequate representation of each strata. Participants completed measures on RAA variables (affective attitudes, cognitive attitudes, injunctive norms, descriptive norms, capability, autonomy, and intention) as well as screening past behaviour. RESULTS Among the demographic variables, age, ethnicity and deprivation were significantly related to screening intention. Younger women, those from less deprived areas, along with white women were more likely to report higher intentions to attend screening. Past behaviour was significantly negatively predicted by deprivation only, indicating that individuals from less deprived areas were more likely to be up to date with their screening. Both intention and past behaviour were significantly positively correlated with all RAA variables. Capability and cognitive attitude partially mediated the relationship between age and intention and fully mediated the relationship between ethnicity and intention. Capability fully mediated the relationships between deprivation and intention and between deprivation and past behaviour. CONCLUSION Intentions toward attending cervical cancer screening are related to age, ethnicity, and level of deprivation, with older women and those from areas of greater deprivation and ethnic minority groups reporting lower intentions. Capability (confidence engaging in cervical screening) and cognitive attitudes (how useful/beneficial screening is seen to be) are key variables to target to promote cervical screening attendance and reduce potential inequalities.
Collapse
Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Arianna Prudenzi
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Mark Conner
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK.
| | | |
Collapse
|
21
|
Kola‐Palmer S, Rogers M, Halliday A, Rickford R. "A lot can happen in five years": Women's attitudes to extending cervical screening intervals. Eur J Cancer Care (Engl) 2022; 31:e13655. [PMID: 35838304 PMCID: PMC9786642 DOI: 10.1111/ecc.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Evidence suggests that cervical screening intervals can be extended and lifetime cervical screening for human papillomavirus (HPV)-vaccinated women could be reduced. This study examines UK women's attitudes to extending screening intervals and assesses associations between knowledge, risk perception and HPV vaccination status, and acceptability of changes. METHODS Using a convenience sampling strategy, an anonymous mixed-methods online survey was used and data recorded from 647 women (mean age = 28.63, SD = 8.69). RESULTS Across the full sample, 46.1% of women indicated they would wait 5 years for their next cervical screening, while 60.2% of HPV-vaccinated women would be unwilling to have as few as three cervical screens in a lifetime. Multivariate analysis revealed those who are regular screened, those who intend to attend when invited, and those who perceive greater personal risk of cervical cancer are less likely to accept a 5-year screening interval. Qualitative findings relating to benefits of extending intervals included convenience of less tests, less physical discomfort, and psychological distress. Concerns identified included the likelihood of developing illness, increased psychological distress relating to what may be happening in the body, and worries about increased risk of cervical cancer. CONCLUSION Women need clear and specific information about HPV timelines, their relationship with cancer risk, and the rationale for extending screening intervals.
Collapse
Affiliation(s)
| | - Melanie Rogers
- Department of Nursing and MidwiferyUniversity of HuddersfieldHuddersfieldUK
| | - Abigail Halliday
- Department of PsychologyUniversity of HuddersfieldHuddersfieldUK
| | | |
Collapse
|
22
|
Abraham S, Foreman N, Sidat Z, Sandhu P, Marrone D, Headley C, Akroyd C, Nicholson S, Brown K, Thomas A, Howells LM, Walter HS. Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S14-S24. [PMID: 35648663 DOI: 10.12968/bjon.2022.31.10.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
More people in the UK are living with cancer than ever before. With an increasingly ethnically diverse population, greater emphasis must be placed on understanding factors influencing cancer outcomes. This review seeks to explore UK-specific variations in engagement with cancer services in minority ethnic groups and describe successful interventions. The authors wish to highlight that, despite improvement to engagement and education strategies, inequalities still persist and work to improve cancer outcomes across our communities still needs to be prioritised. There are many reasons why cancer healthcare inequities exist for minority communities, reported on a spectrum ranging from cultural beliefs and awareness, through to racism. Strategies that successfully enhanced engagement included language support; culturally-sensitive reminders; community-based health workers and targeted outreach. Focusing on the diverse city of Leicester the authors describe how healthcare providers, researchers and community champions have worked collectively, delivering targeted community-based strategies to improve awareness and access to cancer services.
Collapse
Affiliation(s)
- Shalin Abraham
- F2 Academic Foundation Doctor, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Nalini Foreman
- Quality Assistant, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Zahirah Sidat
- Senior Research Practitioner, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Pavandeep Sandhu
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Domenic Marrone
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Catherine Headley
- Senior Cancer Services Manager, Leicester City Clinical Commissioning Group, Leicester
| | - Carol Akroyd
- Collaboration for Leadership in Applied Health Research and Care Equality and Diversity Theme Manager, Centre for Ethnic Health Research, University of Leicester, Leicester
| | - Sarah Nicholson
- Hope Clinical Trials Facility Manager/Cancer, Haematology, Urology, Gastroenterology, General Surgery Research Lead, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Karen Brown
- Professor in Translational Cancer Research, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Anne Thomas
- Professor of Cancer Therapeutics, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Lynne M Howells
- Experimental Cancer Medicine Centre Translational Research Manager, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Harriet S Walter
- Associate Professor of Medical Oncology, Leicester Cancer Research Centre, University of Leicester, Leicester
| |
Collapse
|
23
|
Christie-de Jong F, Kotzur M, Amiri R, Ling J, Mooney JD, Robb KA. Qualitative evaluation of a codesigned faith-based intervention for Muslim women in Scotland to encourage uptake of breast, colorectal and cervical cancer screening. BMJ Open 2022; 12:e058739. [PMID: 35568495 PMCID: PMC9109091 DOI: 10.1136/bmjopen-2021-058739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This pilot study aimed to evaluate the acceptability of a codesigned, culturally tailored, faith-based online intervention to increase uptake of breast, colorectal and cervical screening in Scottish Muslim women. The intervention was codesigned with Scottish Muslim women (n=10) and underpinned by the reframe, reprioritise and reform model and the behaviour change wheel. SETTING The study was conducted online, using Zoom, due to the COVID-19 pandemic. PARTICIPANTS Participants (n=18) taking part in the intervention and subsequently in its evaluation, were Muslim women residing in Scotland, recruited through purposive and snowball sampling from a mosque and community organisations. Participants were aged between 25 years and 54 years and of Asian and Arab ethnicity. DESIGN The study's codesigned intervention included (1) a peer-led discussion of barriers to screening, (2) a health education session led by a healthcare provider, (3) videos of Muslim women's experiences of cancer or screening, and (4) a religious perspective on cancer screening delivered by a female religious scholar (alimah). The intervention was delivered twice online in March 2021, followed 1 week later by two focus groups, consisting of the same participants, respectively, to discuss participants' experiences of the intervention. Focus group transcripts were analysed thematically. RESULTS Participants accepted the content and delivery of the intervention and were positive about their experience of the intervention. Participants reported their knowledge of screening had increased and shared positive views towards cancer screening. They valued the multidimensional delivery of the intervention, appreciated the faith-based perspective, and in particular liked the personal stories and input from a healthcare provider. CONCLUSION Participatory and community-centred approaches can play an important role in tackling health inequalities in cancer and its screening. Despite limitations, the intervention showed potential and was positively received by participants. Feasibility testing is needed to investigate effectiveness on a larger scale in a full trial.
Collapse
Affiliation(s)
| | - Marie Kotzur
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Rana Amiri
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | | | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
24
|
Chan DNS, So WKW. Influential barriers perceived by South Asians in Hong Kong to undergoing cervical cancer screening. Eur J Cancer Care (Engl) 2022; 31:e13556. [PMID: 35122343 DOI: 10.1111/ecc.13556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 06/11/2020] [Accepted: 01/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report the uptake rate of cervical cancer screening (the Papanicolaou [Pap] test) and identify the perceived barriers associated with screening uptake among South Asian women in Hong Kong. METHODS This cross-sectional study involved a structured survey of 776 South Asian women aged 21 and above, recruited from the community. The participants' demographic characteristics, Pap test uptake and responses to a validated 14-item scale of perceived barriers to screening was collected. The data were analysed using descriptive statistics and logistic regression. RESULTS The Pap test uptake rate was 40.3%. Multivariate analysis identified two perceived barriers significantly associated with the participants' Pap test uptake: (1) not knowing where to have the test and (2) the belief that they did not need a test if they felt well. CONCLUSION Although language problems and embarrassment are commonly reported barriers to screening by South Asians, the participants were more concerned about where to have the test and whether they needed it. Future interventions should thus focus on enhancing their access to the service and clarifying their understanding of the need.
Collapse
Affiliation(s)
- Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
25
|
So WKW, Law BMH, Chan CWH, Leung DYP, Chan HYL, Chair SY. Development and evaluation of a multimedia intervention to promote cervical cancer prevention among South Asian women in Hong Kong. ETHNICITY & HEALTH 2022; 27:284-296. [PMID: 31701760 DOI: 10.1080/13557858.2019.1687657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
Objective: The uptake of cervical cancer screening among South Asian ethnic minorities is low, rendering them at higher risk of developing cervical cancer. Interventions should, therefore, be developed to enhance their knowledge of this disease and its prevention. We developed and implemented a Health-Belief-Model-based and culturally sensitive multimedia intervention for South Asian women in Hong Kong, and evaluated its feasibility, acceptability and effectiveness using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework.Design: At post-intervention, a short survey was conducted to assess the participants' perceptions of the acceptability and effectiveness of the intervention. Focus group and/or telephone interviews with persons-in-charge of community organizations were conducted to collect feedback on the intervention's effectiveness and long-term sustainability.Results: The intervention was implemented successfully in partnership with 54 community organizations, of which 51 expressed a willingness to continue doing so at their centers. 1061 South Asian women received the intervention through attendance at the 51 health talks held. Over 90% of them agreed that the intervention was acceptable and effective.Conclusions: The intervention appeared to be feasible, and is potentially effective in enhancing participants' knowledge of cervical cancer and self-efficacy in undergoing screening.
Collapse
Affiliation(s)
- Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Bernard M H Law
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Helen Y L Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
26
|
Chohan N, Arzoky Z, Khan N. Twelve tips for incorporating migrant and ethnic minorities in the medical curriculum and healthcare. MEDICAL TEACHER 2021; 43:1122-1126. [PMID: 33136470 DOI: 10.1080/0142159x.2020.1841129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Migrant and ethnic communities face several challenges within healthcare systems as patients, physicians and medical students. For health inequalities to be addressed, changes need to be made within our healthcare systems, starting from how the medical curriculum is taught to prospective clinicians. In this article, we present twelve ways to challenge the difficulties migrant and ethnic minorities face in healthcare by incorporating patient, physician and medical student factors into the medical school curriculum and healthcare, in a hope to change outcomes for our widely diverse population of patients and colleagues.
Collapse
|
27
|
Pethick J, Chen C, Charnock J, Bowden R, Tzala E. Inpatient admissions and outpatient appointments in the first year post cancer diagnosis: A population based study from England. Cancer Epidemiol 2021; 74:102003. [PMID: 34425383 DOI: 10.1016/j.canep.2021.102003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Time spent in hospital (length of stay) is an important component of patient experience and the financial cost of cancer care. This study documents the length of stay across English cancer diagnoses at a national level and reports on variation by patient demographics and tumour characteristics. METHODS Data on all diagnoses of malignant neoplasms from the English National Cancer Registration and Analysis Service for 252,202 patients first diagnosed in 2015 was linked with NHS Digital's Admitted Patient Care and Outpatient Hospital Episode Statistics datasets to quantify length of stay within one year following diagnosis. Length of stay was modelled using linear regression adjusted for sex, age, tumour type, stage, time spent alive during the study period, vital status at end of study period, region, deprivation and ethnicity. RESULTS Patients spend a mean of 25 days (median = 17 days; IQR = 8-34 days) in hospital in their first year. Tumour type, stage, age and vital status corrections had the strongest effects in the model adjusting for other independent variables. Younger patients tended towards longer stays. CONCLUSION Length of stay varies among patients by tumour type, age and stage. Estimating future health service demands should account for changes in incident tumour characteristics.
Collapse
Affiliation(s)
- Joanna Pethick
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK.
| | - Cong Chen
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Health Data Insight (HDI) Community Interest Company (CIC), CPC4, Capital Park, Fulbourn, Cambridge, CB21 5XE, UK
| | - James Charnock
- National Cancer Registration and Analysis Service, National Disease Registration, Public Health England, South Wing, 6th Floor, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK; Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
| | - Rachel Bowden
- Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
| | - Evangelia Tzala
- Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ, UK
| |
Collapse
|
28
|
Jillapalli R, Radhakrishnan K. Cervical Cancer Screening Behaviors Among Asian Indians in the United States: A Systematic Review. J Immigr Minor Health 2021; 24:779-789. [PMID: 34273046 DOI: 10.1007/s10903-021-01237-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
While Asian Indians (AIs) are the third fastest-growing Asian minority population in the United States, they fall short of the Healthy People cervical cancer screening target goals, with rates averaging 70% compared to 83% among non-Hispanic Whites. The purpose of this systematic review is to examine factors influencing cervical cancer screening behaviors among AIs in the US. Medline, CINAHL, PubMed, PsychINFO, and ProQuest databases were searched for qualitative and quantitative studies conducted between 1990 and 2017 that focused on cervical cancer screening behaviors among AIs in the US. The seven selected quantitative cross-sectional descriptive studies show that acculturation, length of stay in the US, age, education level, employment, cultural beliefs, and language influence cervical cancer screening behaviors among AIs in the US. Results from this systematic review inform development of culturally sensitive interventions to raise awareness and engagement in cervical cancer screening among AIs.
Collapse
Affiliation(s)
- Regina Jillapalli
- St. David's School of Nursing, Texas State University, 100 Bobcat Way, Round Rock, TX, 78665, USA.
| | - Kavita Radhakrishnan
- School of Nursing, University of Texas - Austin, 1710 Red River Street, Austin, TX, 78701-1499, USA
| |
Collapse
|
29
|
Marques P, Gama A, Santos M, Heleno B, Vermandere H, Dias S. Understanding Cervical Cancer Screening Barriers among Migrant Women: A Qualitative Study with Healthcare and Community Workers in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147248. [PMID: 34299698 PMCID: PMC8305801 DOI: 10.3390/ijerph18147248] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/22/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation of migrant women living in Portugal. A qualitative study with online focus groups was conducted. Healthcare workers experienced in CCS and community workers working with migrant communities were purposively sampled. A semi-structured guide was used covering the participation of migrant women in CCS, barriers, and strategies to overcome them. Data were analyzed using content analysis. Participants considered that migrant women have low participation in CCS related to insufficient knowledge, low risk perception, and lack of interest on preventive care. Other barriers such as difficulties in accessing the healthcare services, relationship with healthcare workers, language, and cultural differences were highlighted. Promoting continuity of care, disseminating culturally tailored information, and use of self-sampling methods were suggested to improve participation in CCS. Inequalities in access to CCS among migrant women are mostly caused by information gaps and healthcare system-related barriers. Building a migrant-friendly healthcare system that creates opportunities for healthcare workers to establish relationships with their patients and delivering culturally and linguistically adapted information may contribute to overcoming those barriers and increasing the participation of migrant women in screening.
Collapse
Affiliation(s)
- Patrícia Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (P.M.); (A.G.); (M.S.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (P.M.); (A.G.); (M.S.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
| | - Mário Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (P.M.); (A.G.); (M.S.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
| | - Bruno Heleno
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
- NOVA Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Heleen Vermandere
- International Centre for Reproductive Health, Ghent University, 9000 Ghent, Belgium;
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal; (P.M.); (A.G.); (M.S.)
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal;
- Correspondence:
| |
Collapse
|
30
|
Wong CL, Choi KC, Chen J, Law BMH, Chan DNS, So WKW. A Community Health Worker-Led Multicomponent Program to Promote Cervical Cancer Screening in South Asian Women: A Cluster RCT. Am J Prev Med 2021; 61:136-145. [PMID: 33781617 DOI: 10.1016/j.amepre.2021.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION South Asian women in Hong Kong have low cervical cancer screening uptake because of multiple barriers to utilizing health resources. Interventions that effectively modify the cancer screening behaviors of this population are warranted. This study evaluates the effects of a community health worker-led multicomponent intervention on improving cervical cancer screening uptake among South Asian women in Hong Kong. STUDY DESIGN This study was an assessor-blind, cluster RCT that included a waitlist control group. SETTING/PARTICIPANTS Recruitment of eligible subjects took place in 6 nongovernmental organizations; these organizations were randomized into intervention and control groups with a 1:1 allocation ratio. INTERVENTION Participants in the intervention group received a 3-month multicomponent intervention comprising health education, monthly telephone follow-ups, and navigation assistance. MAIN OUTCOME MEASURES Participants' cervical cancer screening utilization and beliefs were assessed at baseline, after intervention, and 3 months after intervention. A longitudinal outcome comparison between the 2 groups was performed with generalized estimating equation analysis. Data were collected between September 2018 and January 2020 and were analyzed in 2019-2020. RESULTS A total of 387 participants completed the intervention. A significantly higher cervical cancer screening uptake was observed among participants in the intervention group (97.9%, 191 of 195) than among participants in the control group (52.6%, 101 of 192) at 3 months after intervention (p=0.005). Significantly greater decrements in perceived barriers to cervical cancer screening were found in the intervention group after intervention (-0.68, 95% CI= -1.35, -0.01, p=0.047) and 3 months after intervention (-0.86, 95% CI= -1.69, -0.04, p=0.041). CONCLUSIONS A community health worker-led multicomponent intervention is effective in promoting cervical cancer screening uptake and in reducing barriers to cancer screening utilization among South Asian women in Hong Kong. Combining a community health worker-led intervention with multiple intervention components could be an effective strategy for developing interventions to increase cervical cancer screening in underserved populations. TRIAL REGISTRATION This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn) ChiCTR1800017227 on July 18, 2018.
Collapse
Affiliation(s)
- Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jieling Chen
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bernard M H Law
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Dorothy N S Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
| |
Collapse
|
31
|
Zhetpisbayeva I, Sarmuldayeva S, Glushkova N, Fedyanina E. СERVICAL CANCER’S EPIDEMIOLOGY IN THE REPUBLIC OF KAZAKHSTAN AND IN THE WORLD. IMPACT OF POPULATION ADHERENCE ON COVERAGE AND SUCCESS OF CERVICAL CANCER SCREENING PROGRAMS. REPRODUCTIVE MEDICINE 2021. [DOI: 10.37800/rm2021-2-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
For many years, the problem of the prevalence of cervical cancer has been one of the most pressing for public health in most countries of the world. Despite the increasing number of screening programs, cervical cancer is still one of the most common sites of malignant neoplasms of the female reproductive system. Screening programs are effective if they involve 70% or more of the population in the appropriate age groups. In Kazakhstan, this figure for cervical cancer screening is 48–50%. [1,2,3]
Collapse
|
32
|
Prevalence of positive screening test results and agreement between cytology and human papillomavirus testing in primary cervical cancer screening in North-Western Romania. Eur J Cancer Prev 2021; 29:141-148. [PMID: 31033568 DOI: 10.1097/cej.0000000000000522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Using data from a pilot study conducted in North-Western Romania, we aimed to estimate the prevalence of abnormal cytology and positive high-risk human papillomavirus (hr-HPV) test results in an ethnically diverse screening population and to assess the agreement between cytology and hr-HPV testing to evaluate the feasibility of integrating the latter as a primary test in the national cervical cancer screening program. The cross-sectional pilot study included Roma women, other ethnic minorities, and women in rural remote areas. Samples were taken for liquid-based cytology and hr-HPV testing (Hybrid Capture 2 DNA test) by a mobile health unit. The prevalence of positive screening results and the agreement between cytology and hr-HPV testing were estimated by κ coefficient. A total of 1019 women were included in the study. The population prevalence of positive screening results was similar for both tests (12%). The prevalence of abnormal cytology increased with increasing age, whereas the prevalence of positive hr-HPV test showed a bimodal age pattern. Substantial differences in the prevalence of abnormal cytology were found by ethnicity, with highest prevalence in Romanian women (14%), followed by Roma women (6%) and women of other ethnicities (5%) (P = 0.002). Similar ethnic differences in the prevalence of positive hr-HPV test were not observed. The overall agreement of positive screening results between the two methods was fair (κ = 0.25; 95% confidence interval = 0.18-0.30, P < 0.001) and ranged from poor to substantial depending on the age group. The prevalence of abnormal cytology result was high and similar to the prevalence of positive hr-HPV test result, which could allow for the implementation of hr-HPV testing as a primary test in the cervical cancer screening program in Romania.
Collapse
|
33
|
Stuart G, D'Lima D. Perceived barriers and facilitators to attendance for cervical cancer screening in EU member states: a systematic review and synthesis using the Theoretical Domains Framework. Psychol Health 2021; 37:279-330. [PMID: 34121540 DOI: 10.1080/08870446.2021.1918690] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To identify and synthesise peer-reviewed, published literature reporting perceived barriers and facilitators associated with cervical cancer screening attendance in EU member states with organised population-based screening programmes. METHODS Quantitative and qualitative studies reporting perceived barriers/facilitators to attendance for cervical cancer screening were searched for in databases Embase, HMIC, Medline and PsycInfo. Data were extracted and deductively coded to the Theoretical Domains Framework domains and inductive thematic analysis within domains was employed to identify specific barriers or facilitators to attendance for cervical cancer screening. RESULTS 38 studies were included for data extraction. Five theoretical domains ['Emotion' (89% of the included studies), 'Social influences' (79%), 'Knowledge' (76%), 'Environmental Context and Resources' (74%) and 'Beliefs about Consequences' (68%)] were identified as key domains influencing cervical cancer screening attendance. CONCLUSION Five theoretical domains were identified as prominent influences on cervical cancer screening attendance in EU member states with organised population-based screening programmes. Further research is needed to identify the relative importance of different influences for different sub-populations and to identify the influences that are most appropriate and feasible to address in future interventions.
Collapse
Affiliation(s)
- Gabriella Stuart
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
34
|
Starker A, Hövener C, Rommel A. Utilization of preventive care among migrants and non-migrants in Germany: results from the representative cross-sectional study 'German health interview and examination survey for adults (DEGS1)'. Arch Public Health 2021; 79:86. [PMID: 34030735 PMCID: PMC8142483 DOI: 10.1186/s13690-021-00609-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In Germany, different health checks for adults are offered for primary and secondary prevention. Previous findings indicate that preventive care utilization varies according to social determinants, especially migration background. This study examined the extent to which migration background is associated with preventive care utilization, independent of factors like age and socioeconomic status and whether length of stay in Germany has a positive effect on the use of preventive care. METHODS The first wave of the 'German Health Interview and Examination Survey for Adults' (DEGS1) is a comprehensive data collection facilitating the description of the utilization of general health checks, dental check-ups, skin cancer screening, and cervical cancer screening among people aged 18-79 years with and without migration background. Migration background was differentiated in first-generation migrants having immigrated to Germany themselves or second-generation migrants born in Germany. First-generation migrants were further differentiated by length of stay in Germany, and second-generation migrants as having one or two parents who were born abroad. Multivariate binary logistic regression models with average marginal effects were calculated to analyse the associations between preventive care utilization and migration background. RESULTS The sample comprised 7987 participants, 1091 of whom had a migration background. Compared with non-migrants, women and men with migration background- particularly first-generation migrants with length of stay <=20 years in Germany - make less use of preventive care. This association was observed statistically independent from sociodemographic factors. For dental check-ups a significantly lower use was also found for first-generation migrants who have lived in Germany for more than 20 years and second-generation of migrants with two parents born abroad. Post-model predictions showed that the utilization rates of first-generation migrants are gradually converging to the average values for non-migrants. CONCLUSIONS Our findings suggest inequalities in realized access to preventive care for first-generation migrants particularly for those who have lived in Germany for 20 years or less. Barriers to the utilization of preventive care may be addressed by informing migrant communities about preventive health care services at an early stage after immigration using migrant-sensitive information strategies.
Collapse
Affiliation(s)
- Anne Starker
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General Pape-Straße 62-66, 12101, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Public health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General Pape-Straße 62-66, 12101, Berlin, Germany
| | - Alexander Rommel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General Pape-Straße 62-66, 12101, Berlin, Germany
| |
Collapse
|
35
|
Nunes MF, Leite AH, Dias SF. Inequalities in adherence to cervical cancer screening in Portugal. Eur J Cancer Prev 2021; 30:171-177. [PMID: 32732693 DOI: 10.1097/cej.0000000000000612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cervical cancer is the second cancer with the highest incidence and mortality in women aged 15-44 living in Europe. Screening is an effective strategy to reduce these rates, although in Portugal, as in other European countries, adherence to screening still presents significant disparities. Thus, this study aimed to assess the prevalence and factors associated with cervical cancer screening (CCS) nonadherence in Portugal. Cross-sectional data from 5929 women aged 25-64 included in the 2014 Portuguese National Health Survey (2014 NHS) were analyzed. The prevalence of CCS nonadherence was estimated. The association between multiple factors and CCS nonadherence was analyzed, using logistic regression, adjusting for age and educational level. The weighted prevalence of nonadherence was 13.2% [95% confidence interval (CI): 12.0-14.0]. Additionally, 10.5% of women had performed the last cervical cytology 3 years ago or more. Higher odds of nonadherence to screening were found for younger women, with low levels of education and income, unemployed, single, born outside Portugal, who never had a medical appointment or had over 12 months ago, who were never pregnant and who had never had a mammography. No association was found with other variables studied, including having public/private health insurance, BMI or smoking status. This study showed that inequalities in CCS adherence in Portugal persist. These findings reinforce the need for developing strategies to reduce inequalities in CCS adherence.
Collapse
Affiliation(s)
- Mariana F Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon
| | - Andreia H Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde Amadora, Portugal
| | - Sónia F Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon
| |
Collapse
|
36
|
Andersson S, Belkić K, Mints M, Östensson E. Acceptance of Self-Sampling Among Long-Term Cervical Screening Non-Attenders with HPV-Positive Results: Promising Opportunity for Specific Cancer Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:126-133. [PMID: 31522376 PMCID: PMC7835166 DOI: 10.1007/s13187-019-01608-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This study aims to investigate acceptance of vaginal self-sampling for high-risk human papilloma virus (HPV) among long-term screening non-attenders at increased cervical cancer risk and to identify leverage points to promote screening adherence among these women. Forty-three long-term screening non-attenders performed home vaginal self-sampling for HPV, had positive HPV results, and subsequently attended gynecologic examination. Sixteen (37.2%) had high-grade cervical intraepithelial neoplasia (CIN2 or 3), and two had invasive cervical cancer. Forty-one of these women completed a questionnaire concerning Specific Knowledge about HPV, CIN, and cervical cancer, potential barriers to screening and views about self-sampling. Results were compared with 479 women treated for CIN2+ who attended gynecologic follow-up and also performed self-sampling. Significant multivariate predictors of long-term non-attender status compared with referents were low Specific Knowledge, high confidence in self-sampling, and potential barriers-refraining from activity to attend gynecologic examination, needing another's help to attend, and long travel time. Non-attenders citing fear/refraining from gynecologic examination as why they preferred self-sampling significantly more often had lowest Specific Knowledge compared with other non-attenders. All non-attenders could envision themselves doing self-sampling again while only 74% of referents endorsed this statement (p = 0.0003). We conclude that HPV self-sampling is an acceptable option for women at increased cervical cancer risk who have been long-term screening non-attenders. Educational outreach to enhance Specific Knowledge about HPV, CIN and cervical cancer is critical. Those non-attenders who explicitly avoid gynecologic examinations need special attention. Trial Registry: Clinicaltrials.gov NCT02750124.
Collapse
Affiliation(s)
- Sonia Andersson
- Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
- Claremont Graduate University, Claremont, CA, USA.
- Keck School of Medicine, University of Southern California, Los Angeles, USA.
| | - Miriam Mints
- Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebrö University, Örebrö, Sweden
| | - Ellinor Östensson
- Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden
| |
Collapse
|
37
|
What can be done to encourage women from Black, Asian and minority ethnic backgrounds to attend breast screening? A qualitative synthesis of barriers and facilitators. Public Health 2021; 190:152-159. [PMID: 33419526 DOI: 10.1016/j.puhe.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study is to identify the barriers to UK Black, Asian and Minority Ethnic (BAME) women attending breast screening and subsequently, support the growing evidence base providing solutions to the public health problem of ethnic variation within screening attendance. STUDY DESIGN A systematic review and thematic analysis of UK-based, qualitative studies concerning BAME women. METHODS The methodology of this review is based on Cochrane guidelines. A search strategy was applied to Embase, PubMed and Medline. Predefined inclusion and exclusion criteria yielded 8 final articles which were appraised and thematically analysed. RESULTS The main findings of the review revealed three overarching themes: knowledge-related, access-related and cultural-related factors. The emphasis of the importance of knowledge was highlighted by all studies identifying a lack of knowledge as a key barrier to screening attendance. CONCLUSIONS BAME women have disproportionally lower breast screening attendance and a lack of knowledge is an essential barrier to overcome when addressing this health inequality.
Collapse
|
38
|
Idehen EE, Virtanen A, Lilja E, Tuomainen TP, Korhonen T, Koponen P. Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217899. [PMID: 33126544 PMCID: PMC7663516 DOI: 10.3390/ijerph17217899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/24/2020] [Accepted: 10/24/2020] [Indexed: 12/24/2022]
Abstract
Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008–2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010–2012 and Health 2011 Survey; aged 30–64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9–66.6), Somalis 19% (16.4–21.6), Kurds 69% (66.6–71.1), and Finns 67% (63.3–69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74–1.16), Somalis 0.16 (0.11–0.22), and Kurds 1.37 (1.02–1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27–2.35), gynecological 2.47 (1.65–3.68), or other reasons 1.53 (1.12–2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.
Collapse
Affiliation(s)
- Esther E. Idehen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, School of Medicine, University of Eastern Finland, Yliopistonranta 1, P.O. Box 1627, 70211 Kuopio, Finland;
- Correspondence: ; Tel.: +358-503678612
| | - Anni Virtanen
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland;
- Department of Pathology, University of Helsinki and HUS Diagnostic Center, Helsinki, University Hospital, Haartmaninkatu 3, 00029 HUS Helsinki, Finland
| | - Eero Lilja
- Department of Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland;
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, School of Medicine, University of Eastern Finland, Yliopistonranta 1, P.O. Box 1627, 70211 Kuopio, Finland;
| | - Tellervo Korhonen
- Institute for Molecular Medicine Finland (FIMM) University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland;
| | - Päivikki Koponen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland;
| |
Collapse
|
39
|
Hoque MR, Haque E, Karim MR. Cervical cancer in low-income countries: A Bangladeshi perspective. Int J Gynaecol Obstet 2020; 152:19-25. [PMID: 32989750 DOI: 10.1002/ijgo.13400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/18/2020] [Accepted: 09/24/2020] [Indexed: 11/06/2022]
Abstract
Cervical cancer is the fourth most common cancer among women worldwide, with approximately 70% of cases involving infection with human papillomavirus (HPV) genotypes 16 and 18. According to International Agency for Research on Cancer, more than 50 million Bangladeshi women are at risk of developing cervical cancer, and 17 686 new cases and 10 362 deaths occur annually. If diagnosed at the precursor stage, however, cervical cancer is a condition that can be successfully treated. As a result, screening programs are necessary to identify the disease before it progresses to invasive cancer. In the present review, we discuss the overall situation of cervical cancer in Bangladesh, summarizing the sociodemographic status of affected women, associated risk factors, screening approaches, and treatment options. We emphasize the potential of visual inspection with acetic acid (VIA) as a cost-effective screening approach for detecting cervical lesions among poor women in the community. In a resource-limited country such as Bangladesh, VIA may represent an ideal model to build an effective awareness campaign through urban and rural hospitals, community-based clinics, and other health facilities available in industry.
Collapse
Affiliation(s)
- Mohammad Razuanul Hoque
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong, Bangladesh
| | - Effi Haque
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Magdalenka, Poland
| | - M Rezaul Karim
- Laboratory for Cancer Biology, Department of Biotechnology and Genetic Engineering, Jahangirnagar University, Savar, Dhaka, Bangladesh
| |
Collapse
|
40
|
Barriers and Facilitators to Cervical Screening among Migrant Women of African Origin: A Qualitative Study in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207473. [PMID: 33066565 PMCID: PMC7602139 DOI: 10.3390/ijerph17207473] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022]
Abstract
Globally, cervical cancer constitutes a substantial public health concern. Evidence recommends regular cervical cancer screening (CCS) for early detection of "precancerous lesions."Understanding the factors influencing screening participation among various groups is imperative for improving screening protocols and coverage. This study aimed to explore barriers and facilitators to CCS participation in women of Nigerian, Ghanaian, Cameroonian, and Kenyan origin in Finland. We utilized a qualitative design and conducted eight focus group discussions (FGDs) in English, with women aged 27-45 years (n = 30). The FGDs were tape-recorded, transcribed verbatim, and analyzed utilizing the inductive content analysis approach. The main barriers to CCS participation included limited language proficiency, lack of screening awareness, misunderstanding of screening's purpose, and miscomprehension of the CCS results. Facilitators were free-of-charge screening, reproductive health services utilization, and women's understanding of CCS's importance for early detection of cervical cancer. In conclusion, among women, the main barriers to CCS participation were language difficulties and lack of screening information. Enhancing screening participation amongst these migrant populations would benefit from appropriate information about the CCS. Those women with limited language skills and not utilizing reproductive health services need more attention from healthcare authorities about screening importance. Culturally tailored screening intervention programs might also be helpful.
Collapse
|
41
|
Pankakoski M, Heinävaara S, Anttila A, Sarkeala T. Differences in cervical test coverage by age, socioeconomic status, ethnic origin and municipality type - A nationwide register-based study. Prev Med 2020; 139:106219. [PMID: 32693176 DOI: 10.1016/j.ypmed.2020.106219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
An invitational organized cervical cancer screening together with widely spread opportunistic testing has coexisted for decades in Finland. The aim of this study was to examine the coverage of cervical tests by age, socioeconomic status, ethnicity and municipality type within and outside the organized screening program. We had a cohort of women of whom 1,2 million were in the target age range of screening and residing in Finland in 2010-2014. Data on Pap and/or HPV -tests within and outside the screening program were collected from the Mass Screening Registry, the pathology laboratories and the health insurance reimbursement registry and five-year population coverages of tests were reported. The total test coverage was 86.0%; 95% CI, (85.8-86.1), and was notably lower for those with an unknown socioeconomic status and pensioners (68.8%; 95% CI, (67.9-69.6) and 77.1%; 95% CI, (76.5-77.6), respectively) compared to upper-level employers (89.8%; 95% CI, (89.5-90.2)). Coverage was also lower for non-native speaking women (72.4%; 95% CI, (71.8-73.0)) compared to native speakers (86.9%; 95% CI, (86.7-87.0)) and for women living in urban municipalities (85.5%; 95% CI, (85.3-85.7)) compared to semi-urban (87.4%; 95% CI, (87.0-87.8)). Although overall coverage was high, tests within and outside the program seemed to concentrate on women with presumably good access to health services. Tests outside the program were especially common among young women who are at a low risk of invasive cervical cancer. Efforts should be made to reduce excessive opportunistic testing and to increase attendance at the program among hard-to-reach populations.
Collapse
Affiliation(s)
- Maiju Pankakoski
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland; Faculty of Medicine, University of Helsinki, P.O. Box 4, 00014, Finland.
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland; Faculty of Medicine, University of Helsinki, P.O. Box 4, 00014, Finland
| | - Ahti Anttila
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Tytti Sarkeala
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| |
Collapse
|
42
|
Marques P, Nunes M, Antunes MDL, Heleno B, Dias S. Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review. Int J Equity Health 2020; 19:160. [PMID: 32917224 PMCID: PMC7488650 DOI: 10.1186/s12939-020-01275-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/02/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical cancer screening has been effective in reducing incidence and mortality of cervical cancer, leading European countries to implement screening programs. However, migrant women show lower screening participation compared to nationals. This scoping review aims to provide a synthesis of the growing evidence on factors associated with participation in cervical cancer screening among migrant women in Europe. METHODS Electronic peer-reviewed databases were searched in November 2019 for studies on factors related to the participation of migrants in cervical cancer screening conducted in EU/EFTA countries, using comprehensive search expressions. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Factors were classified in barriers and facilitators and were divided into further categories. RESULTS Twenty out of 96 articles were selected and analyzed. Factors associated with participation in cervical cancer screening were classified in categories related to sociodemographic, healthcare-system, psychological, migration, knowledge, language, and cultural factors. Lack of information, lack of female healthcare providers, poor language skills, and emotional responses to the test (especially fear, embarrassment and discomfort) were the most reported barriers to cervical cancer screening. Encouragement from healthcare providers and information available in migrants' languages were frequently stated as facilitators. Results on the role of sociodemographic factors, such as age, education, employment and marital status, are the most conflicting, highlighting the complexity of the issue and the possibility of interactions between factors, resulting in different effects on cervical cancer screening participation among migrant women. Several identified barriers to screening are like those to access to healthcare services in general. CONCLUSIONS Efforts to increase migrant women's participation in CCS must target barriers to access to healthcare services in general but also specific barriers, including cultural differences about sexuality and gender, past traumatic personal experiences, and the gender and competences of healthcare professionals performing CCS. Healthcare services should strengthen resources to meet migrants' needs, including having CCS information translated and culturally adapted, as well as healthcare providers with skills to deal with cultural background. These findings can contribute to improve CCS programs among migrant women, reducing health disparities and enhancing their overall health and well-being.
Collapse
Affiliation(s)
- Patrícia Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Mariana Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria da Luz Antunes
- ESTeSL (Instituto Politécnico de Lisboa), Lisbon, Portugal
- APPsyCI - Applied Psychology Research Center Capabilities & Inclusion, ISPA, Lisbon, Portugal
| | - Bruno Heleno
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
| |
Collapse
|
43
|
Hull R, Mbele M, Makhafola T, Hicks C, Wang SM, Reis RM, Mehrotra R, Mkhize-Kwitshana Z, Kibiki G, Bates DO, Dlamini Z. Cervical cancer in low and middle-income countries. Oncol Lett 2020; 20:2058-2074. [PMID: 32782524 PMCID: PMC7400218 DOI: 10.3892/ol.2020.11754] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022] Open
Abstract
Cervical cancer is a malignant tumour that occurs in the cervix and is classified into two histological types, adenocarcinoma and squamous cell carcinoma (SCC); SCC is more common and accounts for 70% of all cases. In 2018 there were ~569,000 new cases of cervical cancer diagnosed worldwide and ~311,000 deaths were attributed to cervical cancer. Of these, between 84 and 90% occurred in low- and middle-income countries (LMICs) such as South Africa, India, China and Brazil. The most common cause of cervical cancer is persistent infection caused by the sexually transmitted human papilloma virus. Other factors that contribute to the incidence of cervical cancer include geography, traditional practices and beliefs, the screening levels, socioeconomic status, healthcare access, public awareness, use of oral contraceptives, smoking and co-infection with HIV. An estimated 11 million women from LMICs will be diagnosed with cervical cancer in the next 10-20 years. The aim of this review was to explore various types of genetic and epigenetic factors that influence the development, progression or suppression of cervical cancer.
Collapse
Affiliation(s)
- Rodney Hull
- SA-MRC/UP Precision Prevention and Novel Drug Targets for HIV-Associated Cancers Extramural Unit, Pan African Cancer Research Institute, Faculty of Health Sciences, University of Pretoria, Hatfield 0028, South Africa
| | - Mzwandile Mbele
- SA-MRC/UP Precision Prevention and Novel Drug Targets for HIV-Associated Cancers Extramural Unit, Pan African Cancer Research Institute, Faculty of Health Sciences, University of Pretoria, Hatfield 0028, South Africa
| | - Tshepiso Makhafola
- SA-MRC/UP Precision Prevention and Novel Drug Targets for HIV-Associated Cancers Extramural Unit, Pan African Cancer Research Institute, Faculty of Health Sciences, University of Pretoria, Hatfield 0028, South Africa
| | - Chindo Hicks
- Bioinformatics and Genomics Centre, School of Medicine, Department of Genetics, Louisiana State University, New Orleans, LA 70112, USA
| | - Shao-Ming Wang
- National Cancer Centre, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Rui Manuel Reis
- Molecular Oncology Research Centre, Barretos Cancer Hospital, Sao Paulo 14784-400, Brazil
| | - Ravi Mehrotra
- Indian Council of Medical Research, New Delhi, Delhi 110029, India
| | | | - Gibson Kibiki
- East African Health Research Commission, East African Community, Bujumbura, Bujumbura Mairie 350, Burundi
| | - David O Bates
- Queen's Medical Centre, University of Nottingham, Nottingham, Nottinghamshire NG7 2UH, UK
| | - Zodwa Dlamini
- SA-MRC/UP Precision Prevention and Novel Drug Targets for HIV-Associated Cancers Extramural Unit, Pan African Cancer Research Institute, Faculty of Health Sciences, University of Pretoria, Hatfield 0028, South Africa
| |
Collapse
|
44
|
McGeechan GJ, James B, Burke S. 'Well that's the most ridiculous thing I have ever heard! No excuse'. A discourse analysis of social media users' othering of non-attenders for cervical screening. Psychol Health 2020; 36:290-306. [PMID: 32456477 DOI: 10.1080/08870446.2020.1772258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: For women cervical cancer is the fourth most commonly diagnosed cancer worldwide, incidences of which have increased by 20% in the UK in two decades. A growing number of people access health information online and as such health promotion campaigns are utilising social media to reach wider audiences.Design: This study adopts a discourse analysis approach to analysing online interactions in relation to cervical cancer screening campaigns. Data were collected from Facebook and Twitter between August 2017 and August 2018.Results: Three approaches in the discursive strategy of othering were identified: (1) Cervical cancer screening presented as an easy, and obvious choice; (2) Footing and the use of statistics to add credibility to posts; (3) Morality positioning and shaming of non-attenders. The findings suggest that in response to such campaigns there is an element of online 'othering' in terms of shaming non-attenders and attempting to delegitimise reasons for non-attendance.Conclusion: Whilst health promotion campaigns should be designed to empower individuals to make informed choices, at times they can lead to stigmatisation of those who do not conform. Future campaigns should focus more on understanding the reasons why women do not attend without dismissing them.
Collapse
Affiliation(s)
- Grant J McGeechan
- Centre for Applied Psychological Sciences, Teesside University, Middlesbrough, UK
| | | | - Shani Burke
- Centre for Applied Psychological Sciences, Teesside University, Middlesbrough, UK
| |
Collapse
|
45
|
Lee HY, Beltran R, Kim NK, Lee DK. Racial Disparities in Cervical Cancer Screening: Implications for Relieving Cervical Cancer Burden in Asian American Pacific Islander Women. Cancer Nurs 2020; 42:458-467. [PMID: 30624249 DOI: 10.1097/ncc.0000000000000642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While cervical cancer is considered preventable and the overall Papanicolaou (Pap) test utilization rate has gradually increased in the United States, certain Asian American Pacific Islander (AAPI) women consistently rate lower in Pap test receipt compared with non-Latina whites (NLWs), leading to a higher cervical cancer mortality rate for various AAPI women. Few studies, however, have focused on female AAPI college students' cervical cancer screening behavior in comparison with NLW students. OBJECTIVE This study aimed to investigate cervical cancer screening behaviors among college-aged females by (1) determining AAPIs' and NLWs' screening rates, (2) assessing their knowledge about Pap tests, and (3) discovering factors associated with Pap test receipt. Andersen's Health Behavioral Model was used as a theoretical framework. METHODS Using a simple random sampling strategy, 2270 female students (15% AAPIs, 85% NLWs) completed an online health survey. RESULTS Results indicate AAPI students had significantly lower Pap test knowledge and Pap test receipt rate compared with NLW students. Age, nativity, human papillomavirus vaccination completion, frequency of obstetrician/gynecologist (OB/GYN) visits, and the number of sexual partners were associated with AAPI students' lower rate of Pap test receipt, whereas the Pap test receipt rate for NLW students was influenced by the same factors with the addition of having increased prior knowledge about Pap tests. CONCLUSION Results show the importance of OB/GYN visits in obtaining Pap tests for AAPI and NLW students. IMPLICATION FOR PRACTICE Health practitioners should pay attention to students' race/ethnicity in their practice and provide corresponding ethnic group-specific preventive care.
Collapse
Affiliation(s)
- Hee Yun Lee
- Author Affiliations: School of Social Work, University of Alabama, Tuscaloosa (Dr Lee); and School of Social Work (Ms Beltran), Department of Educational Psychology (Mr Kim), and School of Medicine (Mr Lee), University of Minnesota, Twin Cities
| | | | | | | |
Collapse
|
46
|
Khan A, Khan F. Can a cervical smear ever be a 'positive experience'? - medical students' perspective. EDUCATION FOR PRIMARY CARE 2020; 31:192. [PMID: 32098590 DOI: 10.1080/14739879.2020.1734491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anas Khan
- Imperial College London , London, UK,
| | | |
Collapse
|
47
|
A Theory-Based and Culturally Aligned Training Program on Breast and Cervical Cancer Prevention for South Asian Community Health Workers: A Feasibility Study. Cancer Nurs 2020; 42:E20-E30. [PMID: 28945633 DOI: 10.1097/ncc.0000000000000543] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cancer screening uptake among South Asian ethnic minorities is reported to be relatively low. An outreach program, led by community health workers (CHWs), may increase the minority group's awareness of the importance of cancer screening. OBJECTIVE The aim of this study was to assess the feasibility and effectiveness of a theory-based, culturally sensitive program to train South Asian women in Hong Kong as CHWs. METHODS A CHW training program, guided by the Empowerment Model and the Health Belief Model, was developed and implemented. Its feasibility was evaluated through the recruitment of South Asian women to the program and their satisfaction with it. Its effectiveness was assessed by a test of knowledge, the participants' self-efficacy and competence, and their readiness to work as CHWs. RESULTS Five South Asian women were recruited to the training program. Outcomes included increased participants' knowledge of cancer and improved self-efficacy and competence in working as CHWs. All participants were highly satisfied with the program, although the addition of practical sessions in the South Asian community was suggested as a further improvement. CONCLUSION It seems to be feasible to train South Asian CHWs to deliver interventions to promote their peers' awareness of breast and cervical cancer prevention, although challenges exist in recruitment of trainees. More hands-on practical opportunities as CHWs would likely increase their effectiveness. IMPLICATIONS FOR PRACTICE The theoretical framework of our CHW training program and the incorporated cultural components could be useful for the development of future programs for training South Asian CHWs in delivering interventions on cancer prevention.
Collapse
|
48
|
IPVS policy statement. Equity in cervical cancer prevention: for all and not just for some. PAPILLOMAVIRUS RESEARCH 2019; 9:100192. [PMID: 31809806 PMCID: PMC7217985 DOI: 10.1016/j.pvr.2019.100192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022]
|
49
|
Williams ED, Whitaker KL, Piano M, Marlow LAV. Ethnic differences in barriers to symptomatic presentation in primary care: A survey of women in England. Psychooncology 2019; 28:2336-2343. [PMID: 31509888 DOI: 10.1002/pon.5225] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 08/22/2024]
Abstract
OBJECTIVE The majority of cancers are diagnosed following a decision to access medical help for symptoms. People from ethnic minority backgrounds have longer patient intervals following identification of cancer symptoms. This study quantified ethnic differences in barriers to symptomatic presentation including culturally specific barriers. Correlates of barriers (eg, migration status, health literacy, and fatalism) were also explored. METHODS A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women aged 30 to 60 (n = 120/group) was carried out in England. Barrier items were taken from the widely used cancer awareness measure; additional culturally specific barriers to symptomatic presentation were included following qualitative work (11 barriers in total). Migration status, health literacy, and fatalism were included as correlates to help-seeking barriers. RESULTS Ethnic minority women reported a higher number of barriers (P < .001, 2.6-3.8 more than White British women). Emotional barriers were particularly prominent. Women from ethnic minority groups were more likely to report "praying about a symptom" (P < .001, except Bangladeshi women) and "using traditional remedies" (P < .001, except Caribbean women). Among ethnic minority women, adult migration to the United Kingdom, low health literacy, and high fatalistic beliefs increased likelihood of reporting barriers to symptomatic presentation. For example, women who migrated as adults were more likely to be embarrassed (OR = 1.83; CI, 1.06-3.15), worry what the GP might find (OR = 1.91; CI, 1.12-3.26), and be low on body vigilance (OR = 4.44; CI, 2.72-7.23). CONCLUSIONS Campaigns addressing barriers to symptomatic presentation among ethnic minority women should be designed to reach low health literacy populations and include messages challenging fatalistic views. These would be valuable for reducing ethnic inequalities in cancer outcomes.
Collapse
Affiliation(s)
| | | | - Marianne Piano
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Laura A V Marlow
- Department of Behavioural Science and Health, University College London, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
| |
Collapse
|
50
|
Thulaseedharan JV, Frie KG, Sankaranarayanan R. Challenges of health promotion and education strategies to prevent cervical cancer in India: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:216. [PMID: 31867380 PMCID: PMC6905291 DOI: 10.4103/jehp.jehp_156_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/13/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Although there is a reduction in cervical cancer incidence over the years, it keeps the second position of the most common cancers among females in India. The aim of this review is to understand the challenges of health promotion and education strategies to prevent cervical cancer in India. MATERIALS AND METHODS This review is based on 78 studies published during 1993-2017 on the topics of awareness, attitude, and acceptance toward cervical cancer, screening, and human papilloma virus vaccination among Indians. The extracted information was summarized according to different populations such as people from different social and community groups, women and men attended clinics, students (nursing/medical/nonmedical), health-care providers (doctors, nurses, and other health workers), migrated Indians, and cervical cancer patients. RESULTS The awareness about cervical cancer and its prevention was very poor among women from different communities and the majority had a negative attitude toward screening and vaccination in general. The health professionals and medical students were more aware of cervical cancer and its prevention compared to the general population. Majority of students irrespective of medical or nonmedical background had a positive attitude toward vaccination. Only a small proportion of women in the general population were ever screened. CONCLUSIONS Observations from this review indicate immediate attention of the public health authority to take appropriate actions to educate and motivate general population toward cervical cancer prevention and to improve the facilities to incorporate the much needed preventive and early detection interventions in India.
Collapse
Affiliation(s)
- Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kirstin Grosse Frie
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Rengaswamy Sankaranarayanan
- Research Triangle Institute Global India Private Limited (RTI International), New Delhi, 100 037, India
- International Agency for Research on Cancer (IARC/WHO), Lyon CEDEX 08, France
| |
Collapse
|