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Benites-Zapata VA, Hernandez-Bustamante EA, Acuña-Chávez LM, Escudero-Gaytan CP, Ulloque‑Badaracco JR, Alarcón-Braga EA, Venegas G, Herrera-Añazco P. Colposcopy in the Primary Health Care: A Scoping Review. J Prim Care Community Health 2023; 14:21501319231198942. [PMID: 37740513 PMCID: PMC10517605 DOI: 10.1177/21501319231198942] [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: 06/26/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/24/2023] Open
Abstract
AIM Low- and middle-income countries represent nearly 85% of all cervical cancer cases worldwide; thereby, it is extremely important to identify methods to improve the screening process. Therefore, this study aimed to summarize the primary characteristics of studies on accessibility, coverage, patient preferences, and factors associated with patient satisfaction or acceptance of colposcopy in primary healthcare. METHODS A search strategy, based on MeSH, Emtree, and free terms, was run through 5 databases (PubMed, Scopus, Embase, Ovid/Medline, and Web of Science). EndNote 20.1 © and Rayyan QCRI © were used for screening. A preset datasheet was used for data extraction. RESULTS The systematic search retrieved 1127 references, and after removing duplicates, screening the titles and abstracts, and reviewing the full text, 7 studies were included. The interrater reliability was 77.73% (kappa statistic = 0.1842). Most studies estimated the proportion of women that sought for colposcopy after a previous screening test for human papilloma virus. One study identifies barriers to colposcopy examination in women at risk of developing cervical cancer. Three studies assessed the decentralization of colposcopy from a tertiary healthcare center to a primary care center. Pap smear was the most common first-line screening test, followed by liquid-based cytology sample and visual inspection with acetic acid. CONCLUSION Only a few countries have investigated the use of colposcopy in primary care. Thus, barriers and the care structure for this implementation to be successful in reducing cervical cancer incidence and mortality should be identified.
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Affiliation(s)
- Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Enrique A. Hernandez-Bustamante
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Perú
| | - Luis M. Acuña-Chávez
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Perú
| | | | | | | | - Gino Venegas
- Clínica Angloamericana, Lima, Perú
- Universidad de Piura, Lima, Perú
| | - Percy Herrera-Añazco
- Universidad Privada del Norte, Trujillo, Perú
- Red Peruana de Salud Colectiva, Lima, Perú
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Morris CT, Kellam A, Spangler E, Shannon RA, Mechol R. Caught between Worlds: Assessing Generational Change in Palauan Foodways Post-Independence. Ecol Food Nutr 2021; 61:235-249. [PMID: 34597194 DOI: 10.1080/03670244.2021.1982710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Palauan foodways have changed significantly over the last 100 years. Current nutritional norms in Palau have led to increased prevalence of nutrition-based noncommunicable disease. While generational change in Palauan foodways in the decades immediately following World War II has been documented, less attention has been paid to change since national independence. Parents, teachers, and students at Palauan elementary schools participated in focus groups designed to advance understanding of the current state of Palauan nutrition across generations at home, school, and elsewhere (including after-school snacks and ritual events). We document these perspectives and share Palauan ideas for improving local nutrition.
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Affiliation(s)
- Chad T Morris
- Department of Sociology and Public Health, Roanoke College, Salem, VA, USA
| | - Allison Kellam
- Department of Sociology and Public Health, Roanoke College, Salem, VA, USA
| | - Emily Spangler
- Department of Sociology and Public Health, Roanoke College, Salem, VA, USA
| | - Rebecca A Shannon
- Department of Sociology and Public Health, Roanoke College, Salem, VA, USA
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Bromhead C, Wihongi H, Sherman SM, Crengle S, Grant J, Martin G, Maxwell A, McPherson G, Puloka ‘A, Reid S, Scott N, Bartholomew K. Human Papillomavirus (HPV) Self-Sampling among Never-and Under-Screened Indigenous Māori, Pacific and Asian Women in Aotearoa New Zealand: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910050. [PMID: 34639352 PMCID: PMC8507781 DOI: 10.3390/ijerph181910050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
In Aotearoa, New Zealand, the majority of cervical cancer cases occur in women who have never been screened or are under-screened. Wāhine Māori, Pacific and Asian women have the lowest rate of cervical screening. Self-sampling for human papillomavirus (HPV-SS) has been shown to increase participation in cervical cancer screening. A whole-of-system approach, driven by evidence in the most effective delivery of HPV-SS, is required to mitigate further widening of the avoidable gap in cervical screening access and outcomes between groups of women in Aotearoa. This single-arm feasibility and acceptability study of HPV self-sampling invited never- and under-screened (≥5 years overdue) 30–69-year-old women from general practices in Auckland, Aotearoa. Eligible women were identified by data matching between the National Cervical Programme (NCSP) Register and practice data. Focus groups were additionally held with eligible wāhine Māori, Asian and Pacific women to co-design new patient information materials. Questionnaires on HPV knowledge and post-test experience were offered to women. Our follow-up protocols included shared decision-making principles, and we committed to follow-up ≥90% of women who tested positive for HPV. Data matching identified 366 eligible never- and under-screened wāhine Māori, Pacific and Asian women in participating practices. We were only able to contact 114 women, and 17, during the discussion, were found to be ineligible. Identifying and contacting women overdue for a cervical screen was resource-intensive, with a high rate of un-contactability despite multiple attempts. We found the best uptake of self-sampling was at focus groups. Of the total 84 HPV-SS tests, there were five positive results (6%), including one participant with HPV18 who was found to have a cervical Adenocarcinoma at colposcopy. In our feasibility study, self-sampling was acceptable and effective at detecting HPV and preventing cervical cancer in under-screened urban wāhine Māori, Pacific and Asian women in Aotearoa. This is the first report of cervical Adenocarcinoma (Grade 1B) as a result of an HPV-18 positive self-sample in Aotearoa. We co-designed new patient information materials taking a health literacy and ethnicity-specific approach. This work provides policy-relevant information to the NCSP on the resources required to implement an effective HPV self-sampling programme to improve equity in national cervical cancer screening.
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Affiliation(s)
- Collette Bromhead
- School of Health Sciences, Massey University, Wellington 6021, New Zealand;
| | - Helen Wihongi
- Ngāti Porou, Ngāpuhi, Te Whānau a Apanui, Ngāti Hine, Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand;
| | | | - Sue Crengle
- Waitaha, Kāti Mamoe and Kāi Tahu, Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand;
| | - Jane Grant
- Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand; (J.G.); (A.M.)
| | - Georgina Martin
- Te Rarawa, Te Aupōuri, Ngāpuhi, Wai Research, Te Whānau O Waipareira. Level 1, 6-8 Pioneer Street, Henderson, Waitakere City, Auckland 0605, New Zealand;
| | - Anna Maxwell
- Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand; (J.G.); (A.M.)
| | - Georgina McPherson
- Makea Ngāti Kao, Ngāti Tane, Waitematā District Health Board, Auckland 0740, New Zealand;
| | - ‘Aivi Puloka
- The Fono Health & Social Services, Henderson, Auckland 0612, New Zealand;
| | - Susan Reid
- Te Rarawa, Health Literacy New Zealand Limited, Auckland 1347, New Zealand;
| | - Nina Scott
- Ngāpuhi, Ngāti Whātua, Waikato, Waikato District Health Board, Hamilton 3240, New Zealand;
| | - Karen Bartholomew
- Waitematā District Health Board and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand; (J.G.); (A.M.)
- Correspondence:
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Adcock A, Stevenson K, Cram F, MacDonald EJ, Geller S, Hermens J, Lawton B. He Tapu Te Whare Tangata (sacred house of humanity): Under-screened Māori women talk about HPV self-testing cervical screening clinical pathways. Int J Gynaecol Obstet 2021; 155:275-281. [PMID: 34382217 DOI: 10.1002/ijgo.13873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/12/2021] [Accepted: 08/10/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To develop an in-depth understanding of HPV self-testing cervical screening clinical pathways for never-/under-screened Māori women. METHODS Based on a community-based cluster randomized controlled trial in Aotearoa (New Zealand), a Kaupapa Māori (by Māori, for Māori) qualitative study enrolled Māori women who met the eligibility criteria of the HPV trial intervention (aged 25-69 years, no screen in >4 years). In total, 28 were recruited (22 had a negative test, six had a positive test and colposcopy). They were asked about their clinical pathway. RESULTS The HPV self-test was seen as empowering and promoting bodily autonomy, although some women expressed fears or misconceptions about this new technology. While those with a negative test were relieved, for the six women who had a positive test, there were many fears, compounded by seeking out information on the Internet. When attending colposcopy, the importance of support and responsive care was emphasized. CONCLUSION HPV self-testing has the potential to improve access to cervical screening and reduce inequities for Māori. Care must be taken in the delivery of screening and colposcopy results. Primary care and colposcopy services need to take special care with never-/under-screened Māori women to provide sensitive, responsive care, and mitigate trauma.
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Affiliation(s)
- Anna Adcock
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Kendall Stevenson
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand.,The Dragon Institute for Innovation, Auckland, Aotearoa New Zealand
| | - Fiona Cram
- Katoa Ltd., Auckland, Aotearoa New Zealand
| | - Evelyn Jane MacDonald
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Stacie Geller
- Division of Academic Internal Medicine, Department of Medicine, Center for Research on Women and Gender, College of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Jordanna Hermens
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Beverley Lawton
- Te Tātai Hauora o Hine Centre for Women's Health Research, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
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