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Almohammed HI. A Systematic Review to Evaluate the Barriers to Breast Cancer Screening in Women with Disability. J Clin Med 2024; 13:3283. [PMID: 38892994 PMCID: PMC11172480 DOI: 10.3390/jcm13113283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Breast cancer (BC) is one of the leading causes of mortality worldwide. There are observed disparities in patients with disability as compared to those without disability, which leads to poor BC screening attendance, thereby worsening disease management. Aim: The aim of this systematic review is to investigate if there are disparities in screening rates in women with disability as compared to those without disability, as well as the different factors that pose barriers to patients with disability for enrolment in BC screening programs. Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed published articles between 2008 and 2023, which assessed different factors that contributed to poor attendance in BC screening programs held across different countries. Detailed study characteristics were obtained, and methodological quality assessment was performed on the individual studies included in this review. Result: A total of fifty-three articles were identified as eligible studies based on the pre-defined inclusion and exclusion criteria. These included 7,252,913 patients diagnosed with BC (913,902 patients with disability/6,339,011 patients without disability). The results revealed there are demographic, clinical, financial, and service-related barriers that contributed to lower screening rates in disabled patients as compared to non-disabled. Patient age is the most common factor, with the highest effect observed for 80 years (vs. 30-44 years) [odds ratio (OR) = 13.93 (95% confidence interval (CI) = 8.27-23.47), p < 0.0001], followed by race/ethnicity for Hispanic (vs. non-Hispanic white) [OR = 9.5 (95%CI = 1.0-91.9), p < 0.05]. Additionally, patients with multiple disabilities had the highest rate of dropouts [OR = 27.4 (95%CI = 21.5-33.3)]. Other factors like education, income, marital status, and insurance coverage were essential barriers in screening programs. Conclusions: This study presents a holistic view of all barriers to poor BC screening attendance in disabled patients, thereby exacerbating health inequalities. A standardized approach to overcome the identified barriers and the need for a tailored guideline, especially for disability groups, is inevitable.
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Affiliation(s)
- Huda I Almohammed
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Kuper H, Andiwijaya FR, Rotenberg S, Yip JLY. Principles for Service Delivery: Best Practices for Cervical Screening for Women with Disabilities. Int J Womens Health 2024; 16:679-692. [PMID: 38650833 PMCID: PMC11034568 DOI: 10.2147/ijwh.s428144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
Background Cervical cancer screening is an important public health priority, yet many marginalized groups are not reached by existing programs. The nearly 700 million women with disabilities globally face substantial barriers in accessing cervical cancer screening and have lower coverage, yet there is limited evidence on what would support enhanced uptake among this population. Methods We updated a systematic review to estimate the disparity in screening uptake for women with disabilities. We conducted a scoping review to understand key barriers and the inclusion of disability in existing screening policies and possible solutions to improve screening uptakes amongst women with disabilities. We then formulated key principles for improved service delivery for this group, targeted predominantly at clinicians. Results Our updated review identified an additional five new studies, and confirmed that women with disabilities were less likely to be screened for cervical cancer (RR=0.65, 0.50-0.84). Disability-specific barriers to accessing screening pertained to: (1) knowledge and autonomy; (2) logistics; and (3) stigma and fear. Few guidelines included specific considerations for women with disabilities. Our scoping review showed that improving access to care must focus on improving (1) autonomy, awareness, and affordability; (2) human resources; and (3) health facility accessibility. Conclusion Screening programmes and health providers must ensure women with disabilities are included in cervical cancer screening programmes and thereby help to achieve their right to health and eliminate cervical cancer as a public health issue.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Fahrin Ramadan Andiwijaya
- Department of Physical Medicine and Rehabilitation, Airlangga University/ Dr. Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Sara Rotenberg
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer L Y Yip
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
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Orji AF, Gimm G, Desai A, Parekh T. The Association of Cervical Cancer Screening With Disability Type Among U.S. Women (Aged 25-64 Years). Am J Prev Med 2024; 66:83-93. [PMID: 37582416 DOI: 10.1016/j.amepre.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Despite a gradual decline in cervical cancer mortality because of greater use of screening, including Pap and human papillomavirus (HPV) tests, disparities in screening among adult women by disability type have not been examined. This study aims to assess the odds of cervical cancer screening using HPV tests by disability type among U.S. women aged 25-64 years. METHODS This study was analyzed in 2022 using pooled data from 2018 and the 2020 Behavioral Risk Factor and Surveillance System. The analytic sample included 189,795 women aged 25-64 years. Disability was defined as having any sensory disability, cognitive disability, physical disability, ≥2 disabilities, or no disability adapted from a standardized questionnaire. Descriptive analyses were used to estimate the proportion of HPV tests on the basis of 2020 American Cancer Society guidelines, which recommend testing within five years for all women aged 25-65 years. Multivariable analyses were conducted to estimate AORs of cervical cancer screening by disability type. RESULTS Overall, 53.8% of women met recommended 2020 American Cancer Society guidelines for cervical cancer screening using HPV tests. The proportion of HPV tests was higher in women with a cognitive disability (55.9%) and lower in those with sensory (49.7%), physical (48.2%), and ≥2 disabilities (47.8%) than in those without disabilities (54.8%). In adjusted analyses, women with any disability (AOR=0.95, 95% CI=0.88, 0.97), physical disability (AOR=0.96, 95% CI=0.80, 0.98), and ≥2 disabilities (AOR=0.88, 95% CI=0.78, 0.97) had lower odds of receiving cervical cancer screening with HPV testing than women without disabilities. CONCLUSIONS Disparities in screening with HPV tests among women with physical and ≥2 disabilities suggest the need for a targeted approach to improve prevention screening awareness, access, and availability in this population.
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Affiliation(s)
- Amarachukwu F Orji
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Gilbert Gimm
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Tarang Parekh
- College of Health Science, University of Delaware, Newark, Delaware.
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Biggs MA, Schroeder R, Casebolt MT, Laureano BI, Wilson-Beattie RL, Ralph LJ, Kaller S, Adler A, Gichane MW. Access to Reproductive Health Services Among People With Disabilities. JAMA Netw Open 2023; 6:e2344877. [PMID: 38019515 PMCID: PMC10687653 DOI: 10.1001/jamanetworkopen.2023.44877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/14/2023] [Indexed: 11/30/2023] Open
Abstract
Importance People with disabilities face inequitable access to reproductive health (RH) services, yet the national prevalence of barriers to access experienced across disability types and statuses is unknown. Objective To assess the national prevalence of barriers to RH access experienced by people with disabilities. Design, Setting, and Participants This cross-sectional study analyzed results of an online probability-based national survey of RH experiences that was conducted from December 2021 to January 2022. The national sample consisted of English- and Spanish-speaking panel members of a market research firm. Panelists were invited to participate in a survey on their RH experiences and opinions. These participants were aged 15 to 49 years and assigned female at birth (AFAB). Weighted proportions were estimated, and bivariable and multivariable regression analyses were performed to assess associations between disability status and barriers to accessing RH services. Exposure Using 5 of the 6 Washington Group Short Set on Functioning items, 8 dichotomous disability indicators were created: (1) vision, (2) hearing, (3) mobility, (4) activities of daily living, (5) communication, (6) overall disability status (a lot or more difficulty functioning in ≥1 domain), (7) some difficulty functioning (below the disability threshold; some or more difficulty functioning in ≥1 domain), and (8) multiple disabilities (a lot or more difficulty functioning in ≥2 domains). Main Outcomes and Measures Number and types of barriers (logistical, access, cost, privacy, and interpersonal relationship) to accessing RH services in the past 3 years. Results After exclusion, the final sample included 6956 people AFAB, with a mean (SD) age of 36.0 (8.3) years. Of these participants, 8.5% (95% CI, 7.6%-9.5%) met the disability threshold. Participants with disabilities compared with those without disabilities were disproportionately more likely to be non-Hispanic Black (18.8% [95% CI, 14.4%-24.1%] vs 13.2% [95% CI, 11.9%-14.5%]) or Hispanic or Latinx (completed survey in English: 18.1% [95% CI, 14.0%-23.0%] vs 14.6% [95% CI, 13.3%-16.0%]; completed survey in Spanish: 8.9% [95% CI, 6.2%-12.8%] vs 6.2% [95% CI, 5.4%-7.1%]) individuals, to identify as LGBTQAI (lesbian, gay, bisexual, transgender, queer [or questioning], asexual [or allied], intersex; 16.4% [95% CI, 12.3%-21.6%] vs 11.8% [95% CI, 10.6%-13.1%]), to live below the federal poverty level (27.3% [95% CI, 22.3%-32.8%] vs 10.7% [95% CI, 9.7%-11.9%]), and to ever experienced medical mistreatment (49.6% [95% CI, 43.7%-55.5%] vs 36.5% [95% CI, 34.8%-38.2%]). Among those who had ever tried to access RH services (n = 6027), people with disabilities vs without disabilities were more likely to experience barriers (69.0% [95% CI, 62.9%-74.5%] vs 43.0% [95% CI, 41.2%-44.9%]), which were most often logistical (50.7%; 95% CI, 44.2%-57.2%) and access (49.9%; 95% CI, 43.4%-56.4%) barriers. The disability domains with the highest proportion of people who experienced 3 or more barriers in the past 3 years included activities of daily living (75.3%; 95% CI, 61.1%-85.6%), communication (65.1%; 95% CI, 49.5%-78.1%), and multiple (59.9%; 95% CI, 45.6%-72.7%) disabilities. Conclusions and Relevance This cross-sectional study found large disparities in access to RH services among people AFAB with disabilities. Findings indicated a need to alleviate barriers to RH care, including improving the transportation infrastructure and reinforcing patient-centered approaches that engender inclusivity in health care settings.
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Affiliation(s)
- M. Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - M. Tara Casebolt
- Morrissey College of Arts and Sciences, Boston College, Chestnut Hill, Massachusetts
| | | | | | - Lauren J. Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Aliza Adler
- Innovating Education in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Margaret W. Gichane
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
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Chen CY, Kung PT, Chiu LT, Tsai WC. Comparison of Cervical Cancer Screening Used between Individuals with Disabilities and Individuals without Disabilities. Healthcare (Basel) 2023; 11:healthcare11101363. [PMID: 37239649 DOI: 10.3390/healthcare11101363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Cervical cancer is the fourth most prevalent cancer in women worldwide. It is vital to achieve a high cervical cancer screening rate among women. We compared the Pap smear test (PST) used between individuals with disabilities and those without disabilities in Taiwan. METHODS Individuals registered in the Taiwan Disability Registration File and the National Health Insurance Research Database (NHIRD) were screened for this nationally representative retrospective cohort study. Women aged 30 and above in 2016 and who were still alive in 2016 were matched in a 1:1 ratio via propensity score matching (PSM); 186,717 individuals with disabilities and 186,717 individuals without disabilities were included. Controlling for relevant variables, the odds of receiving PST were compared using conditional logistic regression analysis. RESULTS A lower percentage of individuals with disabilities (16.93%) received PST than those without disabilities (21.82%). The odds of individuals with disabilities receiving PST were 0.74 times that of individuals without disabilities (OR = 0.74, 95% CI = 0.73-0.76). Compared to individuals without disabilities, individuals with intellectual and developmental disabilities had the lower odds of receiving PST (OR = 0.38, 95% CI = 0.36-0.40), followed by individuals with dementia (OR = 0.40, 95% CI = 0.33-0.48) or multiple disabilities (OR = 0.52, 95% CI = 0.49-0.54). CONCLUSIONS We highly recommend that healthcare practitioners recognize the unique needs of individuals with different types of disabilities, especially those with cognitive impairments.
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Affiliation(s)
- Chia-Yu Chen
- Graduate Institute of Public Health, China Medical University, Taichung 406040, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
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Lee MS, Peart JR, Armin JS, Williamson HJ. A Scoping Review of Barriers and Facilitators to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2021; 14:25-56. [PMID: 38550304 PMCID: PMC10978025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Background Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. Aim The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles. Method A scoping review was conducted where the research team searched United States academic literature from 1990 through February 2020 in PubMed, Medline, and CINAHL using general subject headings for disability, mental illness, and Pap testing. Results Thirty-two articles met inclusion criteria. More barriers than facilitators were mentioned in articles. Barriers and facilitators are organized into three groups according to social ecological model and include individual (e.g., socioeconomic status, anxiety, education), interpersonal (e.g., family, living environment), and organizational factors (health care provider training, health care system). Participant's race/ethnicity were often reported but minoritized populations were often not the focus of articles. Conclusions More articles discussed the difficulties that women with disabilities and women with serious mental illnesses face with receiving a Pap test than facilitators to Pap testing. Additional research should focus on the intersectionality race/ethnicity and women with disabilities and women with serious mental illnesses in relation to Pap testing.
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Affiliation(s)
- Michele Sky Lee
- The Institute for Human Development, Northern Arizona University
| | | | - Julie S Armin
- Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona
| | - Heather J Williamson
- Center for Health Equity Research and Department of Occupational Therapy, Northern Arizona University
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Abstract
This review highlights proposed pandemic-adjusted modifications in obstetric care, with discussion of risks and benefits based on available evidence. We suggest best practices for balancing community-mitigation efforts with appropriate care of obstetric patients.
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Sakellariou D, Anstey S, Polack S, Rotarou ES, Warren N, Gaze S, Courtenay M. Pathways of disability-based discrimination in cancer care. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1648762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Sally Anstey
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sarah Polack
- London School of Hygiene and Tropical Medicine, International Centre for Evidence in Disability, London, UK
| | | | - Narelle Warren
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Australia
| | - Sarah Gaze
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Kilic A, Tastan S, Guvenc G, Akyuz A. Breast and cervical cancer screening for women with physical disabilities: A qualitative study of experiences and barriers. J Adv Nurs 2019; 75:1976-1986. [PMID: 31087581 DOI: 10.1111/jan.14048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/20/2019] [Accepted: 04/17/2019] [Indexed: 12/24/2022]
Abstract
AIM To determine the experiences of women with physical disabilities regarding the barriers to their participation in breast and cervical cancer screening. DESIGN Qualitative descriptive study. METHOD Sixteen women who use wheelchairs were recruited. Data were collected via semi-structured face-to-face interviews between January - March 2017. Interviews were transcribed and data were analysed thematically. RESULTS Three main themes were uncovered: (a) Personal factors; such as lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others; (b) Environmental and structural factors; and (c) expectations and suggestions of women with disabilities to enable their participation in screening. CONCLUSION The participation rate of women with physical disabilities in screening is low. The participation of women with disabilities in breast and cervical cancer screening may increase if physical barriers to accessing healthcare services are removed, appropriate and less time-consuming examination conditions are met, and healthcare personnel are informed about the needs of persons with disabilities. IMPACT Knowing the barriers for women with physical disabilities to participate in cancer screening can help health professionals develop new procedures to increase their participation to cancer screening. Women with physical disabilities encountered various barriers such as; lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others, access to the healthcare services, environmental, physical limitations, and inadequate knowledge of healthcare professional about their disability. This study will guide healthcare professionals in developing strategies to increase the participation of women with physical disabilities in screening.
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Affiliation(s)
- Ayse Kilic
- Florance Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
| | - Sevinc Tastan
- Health Sciences Faculty, Nursing Department, Eastern Meditarrenean University, Fagamusta, Turkey
| | - Gulten Guvenc
- Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
| | - Aygul Akyuz
- Florance Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
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Sakellariou D, Rotarou ES. Utilisation of mammography by women with mobility impairment in the UK: secondary analysis of cross-sectional data. BMJ Open 2019; 9:e024571. [PMID: 30878981 PMCID: PMC6429931 DOI: 10.1136/bmjopen-2018-024571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Research has shown that people with physical impairment report lower utilisation of preventive services. The aim of this study was to examine whether women with mobility impairments have lower odds of using mammography compared with women with no such impairment, and explore the factors that are associated with lower utilisation. SAMPLE AND DESIGN We performed secondary analysis, using logistic regressions, of deidentified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 9491 women from across the UK, 2697 of whom had mobility impairment. The survey method involved face-to-face and telephone interviews. OUTCOME MEASURES Self-report of the last time a mammogram was undertaken. RESULTS Adjusting for various demographic and socioeconomic variables, women with mobility impairment had 1.3 times (95% CI 0.70 to 0.92) lower odds of having a mammogram than women without mobility impairment. Concerning women with mobility impairment, married women had more than twice the odds of having a mammogram than women that had never been married (OR 2.07, 95% CI 1.49 to 2.88). Women in Scotland had 1.5 times (95% CI 1.08 to 2.10) higher odds of undertaking the test than women in England. Women with upper secondary education had 1.4 times (95% CI 1.10 to 1.67) higher odds of undergoing the test than women with primary or lower secondary education. Also, women from higher quintiles (third and fifth quintiles) had higher odds of using mammography, with the women in the fifth quintile having 1.5 times (95% CI 1.02 to 2.15) higher odds than women from the first quintile. CONCLUSIONS In order to achieve equitable access to mammography for all women, it is important to acknowledge the barriers that impede women with mobility impairment from using the service. These barriers can refer to structural disadvantage, such as lower income and employment rate, transportation barriers, or previous negative experiences, among others.
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Affiliation(s)
| | - Elena S Rotarou
- Centre of Environmental and Natural Resource Economics, Faculty of Economics and Business, Universidad de Chile, Santiago de Chile, Chile
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Sakellariou D, Rotarou ES. Utilisation of cancer screening services by disabled women in Chile. PLoS One 2017; 12:e0176270. [PMID: 28459874 PMCID: PMC5411071 DOI: 10.1371/journal.pone.0176270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/07/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research has shown that women with disabilities face additional challenges in accessing and using healthcare services compared to non-disabled women. However, relatively little is known about the utilisation of cancer screening services for women with disabilities. This study addresses this gap by examining the utilisation of the Papanicolaou test and mammography for disabled women in Chile. METHODS We used cross-sectional data, taken from a 2015 nationally-representative survey. Initially, we employed logistic regressions to test for differences in utilisation rates for the Papanicolaou test (66,281 observations) and the mammogram (35,294 observations) between disabled and non-disabled women. Next, logistic regressions were used to investigate the demographic, socioeconomic, and health-related factors affecting utilisation rates for cancer screening services for disabled women (sample sizes: 5,823 observations for the Papanicolaou test and 5,731 observations for the mammogram). RESULTS Disabled women were less likely to undergo screening tests than non-disabled women. For the Papanicolaou test and mammography, the multivariable regression models showed that living in rural areas, having higher education, being affiliated with a private health insurance company, giving a good health self-assessment score, and being under medical treatment for other illnesses were associated with higher utilisation rates. On the other hand, being single, inactive with regard to employment, and having a better income were linked with lower utilisation. While utilisation rates for both disabled and non-disabled women have increased since 2006, the utilisation disparity has slightly increased. CONCLUSIONS This study shows the influence of various factors in the utilisation rates of preventive cancer screening services for disabled women. To develop effective initiatives targeting inequalities in the utilisation of cancer screening tests, it is important to move beyond an exclusively single-disease approach and acknowledge the complexity of the patient population.
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Affiliation(s)
| | - Elena S Rotarou
- Department of Economics, University of Chile, Santiago, Chile
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Xu X, Mann JR, Hardin JW, Gustafson E, McDermott SW, Deroche CB. Adherence to US Preventive Services Task Force recommendations for breast and cervical cancer screening for women who have a spinal cord injury. J Spinal Cord Med 2017; 40:76-84. [PMID: 27077580 PMCID: PMC5376149 DOI: 10.1080/10790268.2016.1153293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
CONTEXT Women with spinal cord injury (SCI) may face barriers that result in disparities in receipt of recommended mammography and Papanicolaou testing. SETTING South Carolina. PARTICIPANTS South Carolina women with SCI were identified using International Classification of Diseases codes in 2000-2010 Medicaid and Medicare billing data. OUTCOME MEASURES Receipt of mammography and Pap testing was determined using procedure billing codes. Partial proportional odds models were estimated to examine the association between SCI and adherence with screening recommendations from the United States Preventive Services Task Force. Each individual's screening experience was classified as full adherence, partial adherence, or no screening. RESULTS The cohort for mammography consisted of 3,173 women with SCI and 6,433 comparison women without SCI. The cohort for Pap testing consisted 5,025 women with SCI and 9,538 comparison women. Women with SCI were less likely to have full adherence with mammography recommendations (aOR = 0.69, 95% CI 0.64, 0.76) and Pap test recommendations (aOR = 0.53, 95% CI 0.49, 0.57). They were more likely to have no mammography screening (aOR = 1.44, 95% CI 1.33, 1.57) and no Pap testing (aOR = 1.89, 95% CI 1.77, 2.03) than women without SCI. CONCLUSION Using longitudinal data with multiple outcome levels, women with SCI were less likely to be fully adherent with receipt of recommended breast and cervical cancer screenings and more likely to have no screenings during the eligible years when compared to women without SCI.
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Affiliation(s)
- Xinling Xu
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Joshua R. Mann
- Department of Preventive Medicine. University of Mississippi Medical Center, Jackson, MS, USA
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Erin Gustafson
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Suzanne W. McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA,Correspondence to: Suzanne W. McDermott, Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Chelsea B. Deroche
- Biostatistics and Research Design Unit, University of Missouri Columbia School of Medicine, Columbia, MO, USA
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Welch Saleeby P, Hunter-Jones J. Identifying Barriers and Facilitators to Breast Health Services among Women with Disabilities. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:255-263. [PMID: 27092980 DOI: 10.1080/19371918.2015.1137509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Women with disabilities experience significant disparities in accessing breast health services. Many studies have focused on barriers, but few have explored facilitators to improving breast health services. This study used a participatory-research approach involving women with physical, mobility, sensory, and developmental disabilities to explore facilitators and barriers affecting the access and quality of breast health services. Findings confirmed commonly cited barriers including attitudinal, environmental, financial, and structural issues but also identified multiple facilitators such as enhancing accessibility of breast health facilities and equipment, improving information sources, and increasing training of health professionals. Findings from this study can be used in improving breast health services among women with disabilities by targeting not only the removal of barriers but also the increase in proven facilitators.
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Affiliation(s)
- Patricia Welch Saleeby
- a School of Social Work, Southern Illinois University Carbondale , Carbondale , Illinois , USA
| | - Josalin Hunter-Jones
- b Grace Crum Rollins School of Public Health, Emory University , Atlanta , Georgia , USA
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Trends in colorectal cancer screening over time for persons with and without chronic disability. Disabil Health J 2016; 9:498-509. [PMID: 27130194 DOI: 10.1016/j.dhjo.2016.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/10/2016] [Accepted: 02/19/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Persons with disabilities have often experienced disparities in routine cancer screening. However, with civil rights protections from the 1990 Americans with Disabilities Act, such disparities may diminish over time. OBJECTIVE To examine whether disability disparities exist for colorectal cancer screening and whether these screening patterns have changed over time. METHODS We analyzed National Health Interview Survey responses from civilian, non-institutionalized U.S. residents 50-75 years old from selected years between 1998 and 2010. We specified 7 chronic disability indicators using self-reported functional impairments, activity/participation limitations, and expected duration. Separately for women and men, we conducted bivariable and multivariable logistic regression analyses examining associations of self-reported colorectal cancer screening services with sociodemographic factors and disability type. RESULTS Patterns of chronic disability differed somewhat between women and men; disability rates generally rose over time. For both women and men, colorectal cancer screening rates increased substantially from 1998 through 2010. Over time, relatively few statistically significant differences were reported in colorectal cancer screening rates between nondisabled persons and individuals with various disabilities. In 2010, reported screening rates were generally comparable between nondisabled and disabled persons. In the few statistically significant differences, persons with disabilities almost always reported higher colorectal cancer screening rates than nondisabled individuals. CONCLUSIONS According to national survey data, reported use of colorectal cancer screening is similar between nondisabled persons and individuals with a variety of different disability types. Despite physical demands of some colorectal cancer screening tests, disparities do not appear between populations with and without disability.
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Suzuki R, Eusebius S, Makled M. Is complementary and alternative medicine use associated with cancer screening rates for women with functional disabilities? Complement Ther Med 2016; 24:73-9. [PMID: 26860805 DOI: 10.1016/j.ctim.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/29/2015] [Accepted: 11/28/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The purpose of this study was to examine the associations of complementary and alternative medicine (CAM) use with mammogram and Pap test rates and functional disabilities (FDs). DESIGN Cross-sectional study. SETTING Data were derived from the 2012 National Health Interview Survey (n=6576). ANALYSIS FDs was defined as physical and/or social limitations. The weighted logistic regression models were performed using SAS software. Study covariates were age, race, education, marital status, usual source of care, and insurance. RESULTS Of 6576 women, a majority were Caucasian (87%), with GED or less (40%), married (50%), having usual source of care (96%) and health insurance (91%), and with FDs (56%). The results indicated that some CAM practices were negatively associated with increased mammogram and Pap test rates while other CAM practices were positively associated. The results indicated that CAM practices that contribute to musculoskeletal problems such as acupuncture and massage were associated with the increased mammogram and Pap test rates. Contrary, women who used chiropractic manipulation, biofeedback, guided imagery, and energy hearing therapy were less likely to obtain cancer screenings regularly regardless of having FDs. CONCLUSIONS The use of several CAM therapies was more likely to be associated with mammogram and Pap test frequency, indicating that the CAM use may be associated with better screening rates due to the improvement of musculoskeletal problems. It is important to determine how each CAM therapy improves secondary health conditions in clinical trials to increase cancer screening rates for women with FDs.
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Affiliation(s)
- Rie Suzuki
- School of Health Professions and Studies, University of Michigan-Flint, United States.
| | - Small Eusebius
- School of Social Work, University of Texas at Arlington, United States
| | - Melissa Makled
- School of Health Professions and Studies, University of Michigan-Flint, United States
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Iezzoni LI, Kurtz SG, Rao SR. Trends in Pap Testing Over Time for Women With and Without Chronic Disability. Am J Prev Med 2016; 50:210-9. [PMID: 26372417 DOI: 10.1016/j.amepre.2015.06.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/18/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Data from 20 years ago--shortly after passage of the Americans with Disabilities Act--showed that women with significant mobility disability had 40% lower Pap test rates than other women. METHODS To examine whether disability disparities in Pap test rates have diminished over time, this study analyzed National Health Interview Survey responses from selected years between 1998 and 2010 from women aged 21-65 years without histories of cervical cancer or hysterectomy. Seven chronic disability types were identified using self-reported functional impairments or participation limitations. Self-reported Pap testing within the previous 3 years was studied. Bivariable analyses and multivariable logistic regression analyses controlling for sociodemographic variables were conducted in 2014. RESULTS Rates of all chronic disability types increased over time. Pap test rates remained relatively constant over time for all women, holding around 84%-87%. Bivariable analyses found statistically significantly lower rates of Pap testing for women with disability compared with nondisabled women. Multivariable analyses failed to find consistent evidence of lower Pap test rates among women across disability types compared with nondisabled women. In 2010, the AOR for reporting Pap testing for women noting the most severe movement difficulty compared with nondisabled women was 0.35 (95% CI=0.15, 0.79). However, the AOR for this disability type varied over time. CONCLUSIONS Little has changed over time in Pap test rates for all women. Women with certain disabilities continue to experience disparities compared with nondisabled women in receipt of this important screening test.
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Affiliation(s)
- Lisa I Iezzoni
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Stephen G Kurtz
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sowmya R Rao
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
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Toor GK, Harris JE, Escobar M, Yoshida K, Velikonja D, Rizoli S, Cusimano M, Cullen N, Sokoloff S, Colantonio A. Long-Term Health Service Outcomes Among Women With Traumatic Brain Injury. Arch Phys Med Rehabil 2016; 97:S54-63. [DOI: 10.1016/j.apmr.2015.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/12/2015] [Accepted: 02/14/2015] [Indexed: 10/24/2022]
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Selmouni F, Zidouh A, Alvarez-Plaza C, El Rhazi K. Perception and satisfaction of cervical cancer screening by Visual Inspection with Acetic acid (VIA) at Meknes-Tafilalet Region, Morocco: a population-based cross-sectional study. BMC WOMENS HEALTH 2015; 15:106. [PMID: 26597844 PMCID: PMC4657367 DOI: 10.1186/s12905-015-0268-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study aims to explore the perception and satisfaction of cervical cancer screening by Visual Inspection with Acetic acid (VIA) in Meknes-Tafilalet Region among target women. METHODS A cross-sectional study was conducted using face-to-face interviews with women, routinely attending health centers, who met the inclusion criteria. Descriptive analysis was undertaken to report data. RESULTS A total of 324 women were included in the study. Results revealed low awareness about cervical cancer (19.6 %) and a very high acceptability of VIA screening (94.5 %). Of the 306 women screened, 99 % stated that they would recommend the VIA testing to their friends and female relatives. All those women who were screened negative expressed their intent to repeat the test every three years. Those found VIA positive affirmed they would perform confirmatory explorations. The majority (96.3 %) of the women believed that screening by VIA could save their lives; cervical cancer was a concern for 98.6 %; and only 11.6 % felt anxious about repeating the VIA test. The majority of women (98.6 %) were satisfied with the service received at the health center. CONCLUSIONS This study showed that the participants had a strong perception about cervical cancer screening and were willing to have further confirmation or future retests.
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Affiliation(s)
- Farida Selmouni
- Complutense University of Madrid, Madrid, Spain. .,Higher Institute of Nursing Professions and Techniques of Health of Rabat, Rabat, Morocco.
| | - Ahmed Zidouh
- Lalla Salma Foundation, Cancer Prevention and Treatment, Rabat, Morocco.
| | | | - Karima El Rhazi
- Laboratory of Epidemiology, Clinical Research and Community Health, Sidi Mohamed Ben AbdIllah University, Fez, Morocco.
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Ramjan L, Cotton A, Algoso M, Peters K. Barriers to breast and cervical cancer screening for women with physical disability: A review. Women Health 2015; 56:141-56. [PMID: 26325597 DOI: 10.1080/03630242.2015.1086463] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review critically examined the barriers to breast and cervical cancer screening services for women with physical disability and discussed ways forward to change practice. When compared to the rest of the community, women with disability were less likely to use preventive health screening services for multiple reasons. Moreover, women with disability live longer than in previous years, and as age is linked to an increased risk of developing cancer, it is imperative that the barriers to screening for these women become a focus of discussion. We designed an integrative literature review to investigate this. Multiple databases were systematically searched for literature published between 2001 and 2013. Search terms used were a combination (AND/OR) of key terms. After excluding duplicates and articles not meeting the eligibility criteria, twenty-five articles were systematically and critically reviewed. Sociodemographic factors were associated with less access to preventive health screening for women with disability. The literature reviewed indicated that this was complicated further by three prominent barriers: health insurance, health care workers, and physical barriers. Sociodemographic, health insurance, health workers, and physical barriers impair access for disabled women to breast and cervical cancer screening, which are vital measures in the timely detection of breast and cervical cancers and preventable morbidity and mortality. Measures are needed to address these limiting factors for women with disability so that they can be active participants in health care, rather than being marginalized because of their disability.
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Affiliation(s)
- Lucie Ramjan
- a School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
| | - Antoinette Cotton
- a School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
| | - Maricris Algoso
- a School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
| | - Kath Peters
- a School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
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Iezzoni LI, Kurtz SG, Rao SR. Trends in mammography over time for women with and without chronic disability. J Womens Health (Larchmt) 2015; 24:593-601. [PMID: 26083235 DOI: 10.1089/jwh.2014.5181] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with disabilities often receive mammograms at lower rates than do nondisabled women, although this disparity varies by disability type and severity. Given the implementation of disability civil rights laws in the early 1990s, we examined whether disability disparities in mammogram use have diminished over time. METHODS We analyzed National Health Interview Survey responses of civilian, noninstitutionalized United States female residents 50 to 74 years old from selected years between 1998 and 2010. We identified seven chronic disability types using self-reported functional impairments, activity/participation limitations, and expected duration. We conducted bivariable and multivariable logistic regression analyses examining associations of self-reported mammogram use within the previous two years with sociodemographic factors and disability. RESULTS Most chronic disability rates rose over time. The most common disability was movement difficulties, with rates increasing from 35.6% (1998) to 39.8% (2010). Mammogram rates for all women remained relatively stable over time, ranging from 72% to 75%. Bivariable analyses generally found statistically significantly lower mammogram rates for women with disability versus nondisabled women. Over time, disparities grew significantly between women with any basic action difficulty or complex activity limitation and nondisabled women (p<0.01). In multivariable logistic analyses, having any difficulty with basic actions was significantly associated with lower adjusted odds of mammography; for example, adjusted odds [95% confidence interval]=0.5 [0.3-0.8], p=0.006, in the model involving movement disability. CONCLUSIONS Little has changed since 1998 in mammogram rates for women with versus without disabilities. Women with certain disabilities continue to experience disparities in mammography testing.
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Affiliation(s)
- Lisa I Iezzoni
- 1 Mongan Institute for Health Policy, Massachusetts General Hospital , Boston, Massachusetts.,2 Department of Medicine, Harvard Medical School , Cambridge, Massachusetts
| | - Stephen G Kurtz
- 3 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Sowmya R Rao
- 3 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts.,4 Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center , Bedford, Massachusetts
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Screening for cervical cancer: What are the determinants among adults with disabilities living in institutions? Findings from a National Survey in France. Health Policy 2015; 119:794-801. [DOI: 10.1016/j.healthpol.2015.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/18/2015] [Accepted: 02/04/2015] [Indexed: 11/18/2022]
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Merten JW, Pomeranz JL, King JL, Moorhouse M, Wynn RD. Barriers to cancer screening for people with disabilities: A literature review. Disabil Health J 2015; 8:9-16. [DOI: 10.1016/j.dhjo.2014.06.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 06/09/2014] [Accepted: 06/14/2014] [Indexed: 11/30/2022]
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Goossens M, Van Hal G, Van der Burg M, Kellen E, Van Herck K, De Grève J, Martens P, Van Limbergen E. Quantifying independent risk factors for failing to rescreen in a breast cancer screening program in Flanders, Belgium. Prev Med 2014; 69:280-6. [PMID: 25456812 DOI: 10.1016/j.ypmed.2014.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mammographic screening may reduce breast cancer mortality by about 20%, provided participation is high and women screen regularly. We quantified independent risk factors for failing to rescreen and built a model to predict how rescreening rates change if these risk factors would be modified. METHODS Multivariate analysis was used to analyze data from a prospective study which included a self-administered questionnaire and rescreening status 30months after a t0 mammogram, using a random sample of women 50-67years (Belgium 2010-2013). RESULTS A false positive result at the most recent past mammogram (Odds Ratio=5.0, 95% Confidence Interval 3.6-6.8), an interval until new invitation greater than 25months (Odds Ratio=4.8 for >29months, 95% Confidence Interval 2.9-8.1), waiting times in the mammography unit >1h (Odds Ratio=2.1, 95% Confidence Interval 1.2-3.7) and difficulties in reaching the unit (Odds Ratio=2.5, 95% Confidence Interval 1.4-4.4) were the strongest independent predictors for failing to rescreen. The area under the curve of the receiver operating characteristic analysis was 0.705 for the model development stage and 0.717 for the validation stage and goodness-of-fit was good. CONCLUSIONS Maintaining an invitation cycle of maximum 25months, limiting waiting time in the mammography unit and lowering the number of false positives could increase breast cancer screening compliance.
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Affiliation(s)
- M Goossens
- Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium.
| | - G Van Hal
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University of Antwerp, Medical Sociology and Health Policy, Universiteitsplein 1, 2610 Antwerp, Belgium. https://www.bevolkingsonderzoek.be
| | - M Van der Burg
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University of Antwerp, Medical Sociology and Health Policy, Universiteitsplein 1, 2610 Antwerp, Belgium. https://www.bevolkingsonderzoek.be
| | - E Kellen
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. https://www.bevolkingsonderzoek.be
| | - K Van Herck
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; Ghent University, Department of Public Health, De Pintelaan 185, 9000 Ghent, Belgium. https://www.bevolkingsonderzoek.be
| | - J De Grève
- Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - P Martens
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium
| | - E Van Limbergen
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. https://www.bevolkingsonderzoek.be
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Peters K, Cotton A. Barriers to breast cancer screening in Australia: experiences of women with physical disabilities. J Clin Nurs 2014; 24:563-72. [PMID: 25236777 DOI: 10.1111/jocn.12696] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of breast cancer screening for women with physical disabilities. BACKGROUND Despite women with disabilities having the same or greater risk of having breast cancer than women without disabilities, they are less likely to uptake breast cancer screening services. DESIGN Qualitative descriptive study. METHODS Twelve women with physical disabilities were recruited for the purpose of this study. Data were collected via semi-structured face to face or telephone interviews. Interviews were transcribed and data were analysed thematically. RESULTS Overwhelmingly, participants conveyed that their breast screening experiences were negative. The following four themes describe the experiences of breast cancer screening for women with physical disabilities: feeling I'm not in control; being ignored and not listened to; being helpless, alone and afraid and; experiencing pain, torture and humiliation. CONCLUSIONS Women with physical disabilities experience substantial barriers to breast cancer screening. This research highlights that the attitudes and poor communication skills of health professionals served as a deterrent to future screening for participants. RELEVANCE TO CLINICAL PRACTICE By exploring experiences of women with physical disabilities of breast cancer screening, nurses and other health-care professionals can use this to develop and implement optimal approaches, such as collaborative models of care which empower women with disabilities.
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Affiliation(s)
- Kath Peters
- School of Nursing & Midwifery, University of Western Sydney, Penrith, NSW, Australia
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Yun JE, Lim B, Ho SH. Trends and Factors Affecting Participation Rate in Korean National Health Screening among People with Disabilities. HEALTH POLICY AND MANAGEMENT 2014. [DOI: 10.4332/kjhpa.2014.24.2.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cervical cancer screening and psychosocial barriers perceived by patients. A systematic review. Contemp Oncol (Pozn) 2014; 18:153-9. [PMID: 25520573 PMCID: PMC4269002 DOI: 10.5114/wo.2014.43158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 05/26/2013] [Accepted: 07/16/2013] [Indexed: 12/02/2022] Open
Abstract
Aim of the study This study aimed at integrating research discussing the role of perceived psychosocial barriers in cervical cancer screening (CCS) uptake. In particular, we analyzed the evidence for the associations between CCS uptake and perceived psychosocial barriers and frequency of psychosocial barriers identified by women. Material and methods A systematic search of peer-reviewed papers published until 2011 in 8 databases yielded 48 original studies, analyzing data obtained from 155 954 women. The majority of studies (k = 43) applied correlational design, while 5 had experimental design. Results Experimental research indicated a positive effect of 75% of psychosocial interventions targeting barriers. The interventions resulted in a significant increase of CCS uptake. Overall 100% of correlational studies indicated that perceiving lower levels of barriers significantly predicted higher CCS uptake. 53 psychosocial barriers were listed in at least 2 original correlational studies: 9.5% of barriers were related to CCS facilities/environment, 67.9% dealt with personal characteristics of the patient, and 22.6% addressed social factors. As many as 35.9% of perceived barriers referred to negative emotions related to CCS examination procedures and collecting CCS results, whereas 25.7% of barriers referred to prior contacts with health professionals. Conclusions Leaflets or discussion on psychosocial barriers between patients and health professionals involved in CCS might increase CCS uptake and thus reduce cervical cancer mortality rates. Communication skills training for health professionals conducting CCS might focus on the most frequently reported barriers, referring to emotions related to CCS examination and collecting CCS results.
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Volker DL, Becker H, Kang SJ, Kullberg V. A double whammy: health promotion among cancer survivors with preexisting functional limitations. Oncol Nurs Forum 2013; 40:64-71. [PMID: 23269771 DOI: 10.1188/13.onf.64-71] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE/OBJECTIVES To explore the experience of living with a preexisting functional disability and a cancer diagnosis and to identify strategies that promote health in the growing population of cancer survivors. RESEARCH APPROACH Qualitative, descriptive. SETTING Four sites in the United States. PARTICIPANTS 19 female cancer survivors with preexisting disabling conditions. METHODOLOGIC APPROACH Four focus groups were conducted. The group discussions were audio recorded and transcribed and analyzed using content analysis techniques. FINDINGS Analytic categories included living with a cancer diagnosis, health-promotion strategies, and wellness program development for survivors with preexisting functional limitations. Participants described many challenges associated with managing a cancer diagnosis on top of living with a chronic disabling functional limitation. They identified strategies to maintain health and topics in health-promotion programs tailored for this unique group of cancer survivors. CONCLUSIONS The "double whammy" of a cancer diagnosis for people with preexisting functional limitations requires modification of health-promotion strategies and programs to promote wellness in this group of cancer survivors. INTERPRETATION Nurses and other healthcare providers must attend to patients' preexisting conditions as well as the challenges of the physical, emotional, social, and economic sequelae of a cancer diagnosis. KNOWLEDGE TRANSLATION Cancer survivors with preexisting functional disabilities had difficulties finding cancer care providers who could manage their unique needs. That may be because some cancer-care providers are inadequately prepared to care for patients with cancer who have complex preexisting conditions. Cancer survivors with preexisting conditions may benefit from health-promotion programs that emphasize self-advocacy strategies, management of the economic impact of multiple diagnoses, and wellness activities adapted to their unique functional limitations.
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Martin S, Orlowski M, Ellison SA. Sociodemographic predictors of cervical cancer screening in women with a medical disability. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:583-590. [PMID: 23944168 DOI: 10.1080/19371918.2013.774253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this project was to describe cervical cancer screening rates in women with medical disabilities living in Ohio, and explore the relationship of select sociodemographic factors to cervical cancer screening participation. A chart abstraction of 350 randomly selected women, ages 20 to 80 years and enrolled in a statewide home care waiver program, was completed in July 2008. Less than half of the women (45.4%) had obtained a cervical cancer screening within the past 3 years. Controlling for age and third-party insurance, the odds of being screened decreased 20% with each activity of daily living requiring assistance (odds ratio = .815, 95% confidence interval [.696, .953]). Previous studies indicate that women with self-reported limitations are less likely to report a cervical cancer screening. The gap for screenings appears greater for women with a medical disability.
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Affiliation(s)
- Shari Martin
- Center for Global Health, Wright State University, Dayton, OH 45435, USA.
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Abstract
There is evidence that early detection from breast cancer screening is an effective means to reduce overall mortality from breast cancer. Findings from multiple research studies suggest that women with chronic disabling conditions are less likely to participate in breast cancer screening due to the multiple barriers they face. Barriers include those related to finances, environment, physical limitations, health carers' attitudes and lack of knowledge, and psychosocial issues. The purpose of this article is to provide an overview of the existing evidence of the barriers to breast cancer screening experienced by women with physical disabilities. Rehabilitation nurses that work with women who have chronic disabling conditions can be instrumental in eliminating these barriers to breast cancer screening through their efforts to promote health which is consistent with the philosophy of maximizing the health potential and quality of life of these women whose needs are often overlooked.
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Affiliation(s)
- Ana Todd
- University of Texas at Austin-School of Nursing, Austin, TX 78701-1499, USA.
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Guilcher SJT, Newman A, Jaglal SB. A comparison of cervical cancer screening rates among women with traumatic spinal cord injury and the general population. J Womens Health (Larchmt) 2012; 19:57-63. [PMID: 20088659 DOI: 10.1089/jwh.2008.1319] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous qualitative and survey studies have suggested women with spinal cord injury (SCI) are screened less often for cervical cancer compared with the general population. We investigated whether cervical cancer screening rates differ between population-based women with and without traumatic SCI, matched for age and geography. METHODS A double cohort design was used, comparing women with SCI to the general population (1:4) using administrative data for Ontario, Canada. Women with SCI, identified using the Discharge Abstract Database for the fiscal years 1995-1996 to 2001-2002, were female residents of Ontario between the ages of 25 and 66, admitted to an acute care facility with a traumatic SCI (ICD-9 CM code 806 or 952). Women in the general Ontario population were randomly matched by age and geography. Screening rates were calculated from fee codes related to Papanicolaou (Pap) smear tests for a 3-year period preinjury and postinjury. RESULTS There were 339 women with SCI matched to 1506 women in the general Ontario population. Screening rates pre-SCI were 55% for women with SCI and 57% during this same time period for matched women in the general population; post-SCI rates were 58% for both the two groups. Factors predicting the likelihood of receiving a Pap test for SCI cases included younger age and higher socioeconomic status. CONCLUSIONS Utilization data suggest that there are no significant differences in screening rates for women with SCI compared with the general population. However, screening rates for women with SCI were significantly influenced by age as well as income.
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Leung DY, Leung AY, Chi I. Breast and Colorectal Cancer Screening and Associated Correlates among Chinese Older Women. Asian Pac J Cancer Prev 2012; 13:283-7. [DOI: 10.7314/apjcp.2012.13.1.283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Courtney-Long E, Armour B, Frammartino B, Miller J. Factors associated with self-reported mammography use for women with and women without a disability. J Womens Health (Larchmt) 2011; 20:1279-86. [PMID: 21732810 DOI: 10.1089/jwh.2010.2609] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although their risk of breast cancer is similar to that of women without a disability, women with a disability might be less likely to obtain a mammogram within the recommended time frame. The purpose of this study was to expand our knowledge of the association between mammography use and having a disability by controlling for sociodemographic and health variables. METHODS Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) were used to obtain prevalence of self-reported mammography use in the past 2 years among U.S. women ≥40 years of age (n=204,981) as well as women 50-74 years of age (n=122,374). Logistic regression was used to estimate associations between disability and obtaining a mammogram for each age cohort, controlling for sociodemographic factors. RESULTS Prevalence of self-reported mammography use is lower for women with a disability (72.2% for women ≥40 years of age and 78.1% for women 50-74 years of age) than women without a disability (77.8% and 82.6%, respectively). Women with a disability had lower odds of mammography use than women without a disability for both age cohorts (≥40, adjusted odds ratio [aOR] 0.92, p=0.01; 50-74 years, aOR 0.92, p=0.03). CONCLUSIONS Disparities in obtaining a mammogram at recommended screening intervals persist for women with disabilities. This demonstrates the need for continued health promotion and prevention activities directed toward women with a disability to improve their accessibility to obtaining a mammogram.
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Affiliation(s)
- Elizabeth Courtney-Long
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Todd A, Stuifbergen A. Barriers and Facilitators to Breast Cancer Screening: A Qualitative Study of Women with Multiple Sclerosis. Int J MS Care 2011; 13:49-56. [PMID: 22942803 DOI: 10.7224/1537-2073-13.2.49] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE: Recent literature indicates that women with various types of chronic disabling conditions are less likely to participate in routine breast cancer screening compared to those without disabling conditions. The purpose of this study is to identify the barriers and facilitators related to breast cancer screening among women with MS. METHODS: After receiving approval from the IRB, a semi-structured interview in a private setting was conducted with 36 women with MS, whose mean age was 55. Interviews were audio-taped and transcribed verbatim. The interview questions informed by the Health Belief Model, addressed knowledge, experience, barriers and facilitators related to breast cancer screening. Qualitative descriptive techniques were used to analyze the data. The majority of the women in the sample were White, 67% were married, 47% had at least a bachelor's degree and about 31% were unemployed due to their disability. FINDINGS: Findings show that 70% of these women had received annual mammograms and 50% had performed monthly breast self-exams. Of the women who had not received mammograms, most (80%) had mobility limitations. Some of the women in this study described various environmental and intrapersonal barriers to breast cancer screening. Among these were barriers related to transportation, difficulty in positioning for the exam, health care provider attitudes, not remembering, fear, discomfort, and "having enough to handle." Facilitators included annual reminders and helpful health care providers.
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Affiliation(s)
- Ana Todd
- The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, Texas 78701,
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Iezzoni LI, Kilbridge K, Park ER. Physical access barriers to care for diagnosis and treatment of breast cancer among women with mobility impairments. Oncol Nurs Forum 2010; 37:711-7. [PMID: 21059583 PMCID: PMC3008578 DOI: 10.1188/10.onf.711-717] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE/OBJECTIVES To explore the perceptions of patients with breast cancer with mobility impairments of the physical accessibility of healthcare facilities and equipment. RESEARCH APPROACH Individual audiotaped interviews lasting one to two hours. SETTING Interviews in homes or workplaces or by telephone. PARTICIPANTS 20 women with chronic mobility impairments who developed early-stage breast cancer prior to age 60. Three were recruited from oncologist panels and 17 from informal social networks of disabled women nationwide. METHODOLOGIC APPROACH Qualitative analyses of interview transcripts to identify common themes. MAIN RESEARCH VARIABLES Extent and nature of mobility impairments and concerns raised by patients about barriers to care. FINDINGS The 20 participants identified issues with inaccessible equipment, including mammography machines, examining tables, and weight scales. The patients sometimes needed to insist on being transferred to an examining table when physicians preferred to examine them seated in their wheelchairs. When staff would transfer them, patients feared injury or felt badly when clinical personnel were injured during transfers. Other issues included difficulties with positioning and handling patients' uncontrollable movements. Even when clinical sites had accessible equipment, this equipment was sometimes unavailable for the appointment. CONCLUSIONS Women with major mobility issues who developed breast cancer confronted numerous physical barriers during the course of their breast cancer diagnosis and treatment. INTERPRETATION With the aging of the baby boomer generation, an increasing number of people with mobility impairments will be seeking healthcare services. Healthcare providers should be proactive in planning to accommodate these patients by considering accessibility whenever they acquire new equipment, renovate older structures, or build new facilities. They also should establish policies and procedures to ensure that equipment is available during appointments of patients with mobility issues and that staff are trained in safe transferring procedures. Ensuring accommodations and accessibility will benefit patients with impaired mobility and clinical staff.
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Affiliation(s)
- Lisa I Iezzoni
- Department of Medicine at Harvard Medical School, Mongan Institute for Health Policy at Massachusetts General Hospital, Boston, USA.
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Iezzoni LI, Park ER, Kilbridge KL. Implications of mobility impairment on the diagnosis and treatment of breast cancer. J Womens Health (Larchmt) 2010; 20:45-52. [PMID: 21034276 DOI: 10.1089/jwh.2009.1831] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Among women with chronic, preexisting mobility impairments, we sought to explore how their mobility difficulties affected the diagnosis and treatment of early-stage breast cancer METHODS This is a qualitative analysis of transcripts from in-depth in-person or telephone interviews with 20 English-speaking women who had early-stage breast cancer, were <60 years of age, and had chronic difficulty walking or used wheeled mobility aids at the time of their breast cancer diagnoses RESULTS Nine women were disabled by polio as children or had postpolio syndrome, 3 had cerebral palsy, 3 had spinal cord injury, and 5 had other conditions. Most women reported difficulty obtaining mammograms, primarily because of inaccessible equipment, positioning problems, and difficulties with uncontrollable movements. Many women made decisions about surgical approach and chemotherapy by explicitly considering how various therapies would affect their arms, which are essential to their mobility (they use ambulation aids, self-propel manual wheelchairs, or otherwise rely on their arms for mobility or safety). Managing at home after surgery posed major mobility challenges, especially for women who lived alone. Several women reported feeling they suffered more chemotherapy side effects than do women without mobility problems. Weight gains with endocrine therapy compromised the mobility of several women. CONCLUSIONS Increasing numbers of American women are living with mobility disabilities and entering age ranges with increased risks of breast cancer. Mobility impairments can affect women at every point during early-stage breast cancer diagnosis, therapy, and recovery. Clinicians must consider women's mobility functioning in making therapeutic recommendations to women with impaired mobility who develop breast cancer.
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Affiliation(s)
- Lisa I Iezzoni
- Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Department of Medicine, Boston, MA 02114, USA.
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Park SJ, Park WS. Identifying barriers to Papanicolaou smear screening in Korean women: Korean National Health and Nutrition Examination Survey 2005. J Gynecol Oncol 2010; 21:81-6. [PMID: 20613896 DOI: 10.3802/jgo.2010.21.2.81] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/11/2010] [Accepted: 05/04/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study was conducted to provide a nationwide analysis on barriers to cervical cancer screening in Korea. METHODS Data used for this study was obtained in a survey called Korean National Health and Nutrition Examination Survey (KNHANES) 2005, which collected data from 2,590 Korean women aged older than 21 years who had not had a hysterectomy and were eligible for Papanicolaou (Pap) smears. Multivariate analysis was adopted to control each demographic factor and unhealthy behavior variable. Demographic factors included age, education, income, job and region; health-related behavior factors were defined as current smoking, obesity, hormone replacement therapy and disability. RESULTS The study found that cervical cancer screening rate was significantly positively associated with income (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001 to 1.002), with education (OR, 1.324; 95% CI, 1.030 to 1.703), with job (OR, 1.420; 95% CI, 1.030 to 1.957), and with hormone replacement therapy (OR, 3.732; 95% CI, 2.354 to 5.916). Meanwhile, the age (OR, 0.977; 95% CI, 0.968 to 0.985), disability (OR, 0.358; 95% CI, 0.143 to 0.894) and smoking (OR, 0.447; 95% CI, 0.280 to 0.715) were significantly negatively associated with one's chances to take cervical cytology. CONCLUSION In order to increase the rates of Korean women taking Pap test, cervical cancer screening programs will have to pay special attention to the elderly, low-income group, smokers, and the disabled.
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Affiliation(s)
- Su Jeong Park
- Yesarang Obstetrics and Gynecology Clinic, Seoul, Korea
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Armour BS, Thierry JM, Wolf LA. State-level differences in breast and cervical cancer screening by disability status: United States, 2008. Womens Health Issues 2009; 19:406-14. [PMID: 19879454 DOI: 10.1016/j.whi.2009.08.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 08/28/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND BACKGROUND Despite reported disparities in the use of preventive services by disability status, there has been no national surveillance of breast and cervical cancer screening among women with disabilities in the United States. To address this, we used state-level surveillance data to identify disparities in breast and cervical cancer screening among women by disability status. METHODS Data from the 2008 Behavioral Risk Factor Surveillance System were used to estimate disability prevalence and state-level differences in breast and cervical cancer screening among women by disability status. RESULTS Overall, modest differences in breast cancer screening were found; women with a disability were less likely than those without to report receiving a mammogram during the past 2 years (72.2% vs. 77.8%; p < .001). However, disparities in breast cancer screening were more pronounced at the state level. Furthermore, women with a disability were less likely than those without a disability to report receiving a Pap test during the past 3 years (78.9% vs. 83.4%; p < .001). DISCUSSION This epidemiologic evidence identifies an opportunity for federal and state programs, as well as other stakeholders, to form partnerships to align disability and women's health policies. Furthermore, it identifies the need for increased public awareness and resource allocation to reduce barriers to breast and cervical cancer screening experienced by women with disabilities.
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Affiliation(s)
- Brian S Armour
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Clark MA, Rogers ML, Wen X, Wilcox V, McCarthy-Barnett K, Panarace J, Manning C, Allen S, Rakowski W. Repeat mammography screening among unmarried women with and without a disability. Womens Health Issues 2009; 19:415-24. [PMID: 19775912 DOI: 10.1016/j.whi.2009.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 08/05/2009] [Accepted: 08/06/2009] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Unmarried women with disabilities may be a particularly vulnerable group for underutilization of repeat mammography screening. Our goal was to compare the breast cancer screening experiences of unmarried women with disabilities (WWD) versus women with no disabilities (WND), and determine whether these experiences are associated with adherence to repeat screening. METHODS We conducted a matched cohort study of 93 WWD and 93 WND to compare mammography experiences by disability status, examine rates of repeat mammography by disability status, and identify factors that are associated with repeat mammography. RESULTS WWD were less likely to be on-schedule than WND in univariable (54.8% vs. 71.0%; relative risk, 0.77; 95% confidence limits, 0.61, 0.97), but not multivariable, analyses. In multivariable analyses, there was a significant interaction between disability status and positive experiences as the reasons for returning to the same mammography facility. Among WND, repeat screening ranged from 59% to 86%, depending on the number of positive experiences endorsed (range, 1-5). In contrast, among WWD, screening rates were only 37% among those who did not report any positive experiences and increased to a maximum of 60% regardless of whether women endorsed one to four or all five positive experiences. Severity and type of disability were not associated with repeat screening. CONCLUSION WWD may be less likely than WND to remain on-schedule for mammography. WWD who do not report any positive experiences as reasons for returning to a mammography facility may be at particularly high risk of underutilization of screening.
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Affiliation(s)
- Melissa A Clark
- Departmentsof Community Health, Brown University Warren Alpert School of Medicine and Program in Public Health, Providence, Rhode Island 02912, USA.
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