Sociodemographic predictors of adherence to annual cervical cancer screening in minority women

Assessment of Knowledge and Attitudes of Patients About Cancer Screenings in Primary Care

Incidence of cancer is increasing in the developing countries such as Turkey. Screenings are important part of preventive medicine practices which can reduce deaths due to cancer. Our aim was to identify patient's awareness and knowledge level of cancers and screenings and to create a road map of what we need to do to increase screening rates. This study was a descriptive type, and the research population was the patients between the age of 30 and 75, who went to 18 different Family Health Centres in different places in Turkey for any reason in July-September 2016. The survey was completed by face-to-face interview and consisted of 20 questions about the socio-demographic attributes, level of cancer and cancer screenings knowledge, causes of screening, and reasons for not doing. Screening rates was self-reported by patients. A total of 643 patients, 394 women (61.3%) and 249 men (38.7%), participated in the study. The average age was 45.67 ± 11.49. The most well-known cancer type was breast cancer (79%). Having no screening was high in general population (64.7%). Having a screening was statistically significantly higher in women, over 50 year olds group, divorced/widower group, housewives, primary school graduates, the group who have green-card (having very low or no income) as social security, and in the group who have a history of family member with cancer. 55.8% of patients received the information about screenings from healthcare professionals. The reasons for not having a screening were "not seeing themselves as under risk" (27.4%), not having knowledge (22.8%), and fear of the results (15%). First of all, the importance of cancer screening as an important part of the preventive health services should be understood by family doctors through in-service training. Then family doctors would share the information and experience, clear the lack of knowledge of them and by doing this rates of screening would increase.

Psychometric Testing of Papanicolaou Testing Barriers and Self-efficacy Scales Among Black Women

BACKGROUND

Black women face cervical cancer disparities with higher rates of morbidity and mortality compared with White women. Identifying predictors of Papanicolaou (Pap) testing is a first step to decrease morbidity and mortality from cervical cancer, with barriers and self-efficacy being constructs that should be related to Pap testing adherence. Although barriers and self-efficacy scales have been developed, they have not been validated in Black women for Pap testing.

OBJECTIVE

The purpose of this study was to modify and psychometrically test barriers and self-efficacy to Pap testing in a Black population.

INTERVENTION/METHODS

Data were collected from a minority health fair. Internal consistency reliability testing was conducted using item analysis and Cronbach's α. Construct validity was assessed by exploratory factor analysis and logistic regression. Papanicolaou testing adherence was regressed on each scale (barriers and self-efficacy) while controlling for antecedents.

RESULTS

Data demonstrated 2 reliable scales: (1) barriers (Cronbach's α = .79), item-total correlation = 0.479 to 0.628; and (2) self-efficacy (Cronbach's α = .85), item-total correlation = 0.560 to 0.697. Exploratory factor analysis supported 2 unidimensional scales. The regression models supported a relationship between each scale and Pap testing adherence.

CONCLUSIONS

The data suggested barriers and self-efficacy scales were reliable and valid among Black women. Barriers and self-efficacy could be tailored in future interventions to increase Pap testing adherence.

IMPLICATIONS FOR PRACTICE

Nurses could use responses to these scales for framing discussions about Pap testing.

Patients Lost to Follow-Up for Cervical Cancer in the Limbe Regional Hospital

PURPOSE

Cervical cancer constitutes a public health problem in Cameroon where it represents 13.8% of cancers in women. We wanted to evaluate compliance with cervical cancer care with a focus on patients who are lost to follow-up from the time that symptoms suggestive of cervical cancer are clinically recognized to treatment.

PATIENTS AND METHODS

Sociodemographic data, attitude toward diagnosis and treatment, and reason for discontinuing care were recorded and analyzed for a period of 5 years from January 2010 to December 2015.

RESULTS

One hundred twenty-six patients had symptoms suggestive of cervical cancer, but only 110 (87.30%) could pay for biopsy, 29 (26.36%) of those did not collect their results, 17 (18.7%) denied their results, and 20 (19%) did not benefit from treatment. Only 44 of 110 patients were able to finish their cancer care treatment program. Reasons for discontinuing the cancer care included lack of financial means to pay for it, distance from the care center, and belief in alternative treatments.

CONCLUSION

This study highlights the magnitude of the difficulties of accessing and receiving cancer care in semiurban areas in Cameroon. Poverty, belief in alternative treatment options, and unequal distribution of care services determined which patients would be lost to follow-up. Redistribution of resources and cancer care providers is mandatory to improve this situation.

College Students' Knowledge Concerning Oropharyngeal Cancer, Human Papillomavirus, and Intent Toward Being Examined

The purpose of this study was to assess college students' knowledge of oral/oropharyngeal cancer and the relationship of human papillomavirus (HPV) to oropharyngeal cancer. Data were also collected to determine their perceived susceptibility to oropharyngeal cancer and awareness of emotions toward and intentions to receive an oral cancer examination in order to design tailored messages for promoting oropharyngeal cancer prevention on college campuses. Two hundred ten baccalaureate students in nonhealth majors from a public southeastern university were surveyed. Descriptive statistics were calculated, and multiple regression analysis was conducted to determine the predictors of knowledge of oral/oropharyngeal cancer and the HPV and intentions to be examined. Results indicated most were unaware of oropharyngeal cancer, did not understand the purpose of an oral cancer examination, and could not affirm they had received one or had one explained to them. Results also indicated poor understanding of some of the signs and risk factors of oropharyngeal cancer, especially HPV. In addition, oral/oropharyngeal cancer knowledge and negative emotions were predictors of examination intentions, confirming current behavioral theories that postulate rational decisions require collaboration from both cognitive and affective systems. Recommendations are offered for tailored educational communications and strategies about oropharyngeal cancer on college campuses.

Factors Associated with Self-Reported Cervical Cancer Screening Among Women Aged 18 Years and Older in the United States

In 2016, an estimated 4120 women will die as a result of cervical cancer. The objective of this study was to examine the factors associated with cervical cancer screening among women 18 years of age and older in the United States (U.S.). Using the 2012 Behavioral Risk Factor Surveillance System survey, women over the age of 18 in the U.S. were examined to assess factors associated with cervical cancer screening. Analyses were conducted using SAS 9.2. Of the 272,692 study participants, 258,496 (95 %) had obtained cervical cancer screening. After adjusting for demographic and socioeconomic factors, being non-Hispanic White, Hispanic or Latino, Asian, Native Hawaiian or Other Pacific Islander, in the age group 18-44 years and 75 years and above, having less than a high school education and an annual household income of less than a $25,000, having never married, and residing in the West region of the U.S. reduced the likelihood of participation in cervical cancer screening. Also, after adjusting for demographic and socioeconomic factors, being between the ages of 45-74 years of age, having more than a high school education, having a higher income, and residing in the South region of the U.S. increased the likelihood of participation in cervical cancer screening. The results of this study suggest that socio-demographic factors and region of residence are predictors of cervical cancer screening. These findings highlight the need to identify potential prevention strategies to promote cervical cancer screening among at-risk populations and groups.

A Systematic Review of the Factors Influencing Ethnic Minority Women's Cervical Cancer Screening Behavior: From Intrapersonal to Policy Level

BACKGROUND

Cervical cancer can be prevented by effective screening using Papanicolaou tests, but the utilization rate is lower among ethnic minorities than in the general population. Understanding the factors influencing minorities' use of such screening can aid the design of an appropriate intervention to increase their uptake rate.

OBJECTIVE

The aims of this study were to examine the factors that influence ethnic minority women in using cervical cancer screening and the similarities and differences in associated factors across different groups and to explore the interrelationships between the factors identified.

METHODS

A literature search was conducted using Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, PsycINFO, and PubMed. Furthermore, 1390 articles were retrieved, of which 24 met the inclusion criteria. Critical appraisal was performed by means of a quality assessment tool. The findings were summarized in tabular and narrative forms.

RESULTS

The findings showed that certain factors commonly affected ethnic minority women's screening behavior, including knowledge, attitude and perceptions, physician's recommendation, quality of care and service, language, and acculturation. Culture-related factors, religion, and acculturation exhibited close interrelationships with the attitude and perceptions factor, resulting in behavioral change.

CONCLUSIONS

The review sheds light on how common or unique are the factors across ethnic minorities and how these factors interact to influence behavior. Further studies are warranted to develop and test empirically a comprehensive model leading to a better understanding of the interrelationships between multiple factors.

IMPLICATIONS FOR PRACTICE

The model should be useful in informing policy makers about appropriate resource allocation and in guiding the development of culturally relevant programs to increase screening uptake.

Primary Care Issues in Inner-City America and Internationally

Inner-city patient populations are high-risk for poor outcomes, including increased risk of mortality. Barriers to delivering high-quality primary care to inner-city patients include lack of access, poor distribution of primary care providers (PCPs), competing demands, and financial restraints. Health care issues prevalent in this population include obesity, diabetes, cancer screening, asthma, infectious diseases, and obstetric and prenatal care. Population health management and quality improvement (QI) activities must target disparities in care. Partnering with patients and focusing on social determinants of health andmedical care are key areas inwhich to focus toimprove overall healthoutcomes inthispopulation.

Factors associated with cervical cancer screening participation among immigrants of Russian, Somali and Kurdish origin: a population-based study in Finland

Background

Previous studies revealed low participation in cervical cancer screening among immigrants compared with non-immigrants. Only a few studies about factors associated with immigrants’ lower participation rates have been conducted in European countries that have universal access for all eligible women. Our study aimed to explore factors associated with cervical screening participation among women of Russian, Somali, and Kurdish origin in Finland.

Methods

We used data from the Migrant Health and Well-being Survey, 2010-2012. Structured face-to-face interviews of groups of immigrants aged 25-60 yielded 620 responses concerning screening participation in the previous five years. Statistical analysis employed logistic regression.

Results

The age-adjusted participation rates were as follows: among women of Russian origin 73.9% (95% CI 68.1-79.7), for Somalis 34.7% (95% CI 26.4-43.0), and for Kurds 61.3% (95% CI 55.0-67.7). Multiple logistic regressions showed that the most significant factor increasing the likelihood of screening participation among all groups was having had at least one gynecological check-up in the previous five years (Odds ratio [OR] = 6.54-26.2; p < 0.001). Other factors were higher education (OR = 2.63; p = 0.014), being employed (OR = 4.31; p = 0.007), and having given birth (OR = 9.34; p = 0.014), among Kurds; and literacy in Finnish/Swedish (OR = 3.63; p = 0.003) among Russians.

Conclusions

Our results demonstrate that women who refrain from using reproductive health services, those who are unemployed and less educated, as well as those with poor language proficiency, might need more information on the importance of screening participation. Primary and occupational healthcare services may have a significant role in informing immigrant women about this importance.

Health Information Seeking and Cancer Screening Adherence Rates

Effective screening tools are available for many of the top cancer killers in the USA. Searching for health information has previously been found to be associated with adhering to cancer screening guidelines, but Internet information seeking has not been examined separately. The current study examines the relationship between health and cancer Internet information seeking and adherence to cancer screening guidelines for breast, cervical, and colorectal cancer in a large nationally representative dataset. The current study was conducted using data from the Health Information National Trends Survey from 2003 and 2007. The study examined age-stratified models which correlated health and cancer information seeking with getting breast, cervical, and colorectal cancer screening on schedule, while controlling for several key variables. Internet health and cancer information seeking was positively associated with getting Pap screening on schedule, while information seeking from any sources was positively associated with getting colorectal screening on schedule. People who look for health or cancer information are more likely to get screened on schedule. Some groups of people, however, do not exhibit this relationship and, thus, may be more vulnerable to under-screening. These groups may benefit more from targeted interventions that attempt to engage people in their health care more actively.

Early diagnosis behavior in Turkish women with and without a family history of cervical cancer

BACKGROUND

This study was planned as comparative and descriptive in order to measure and evaluate the knowledge and attitudes regarding early diagnosis of women with and without a family history of cervical cancer.

MATERIALS AND METHODS

The study sample consisted of the relatives of female patients (N=253) who were admitted to Istanbul University of Medicine. Women with a family history of cervical cancer formed the case group, while those without family history of cervical cancer constituted the control group. Two distinct data collection tools, a questionnaire and the Miller Behavioral Style Scale (MBSS), were used in order to obtain data for evaluation with SPSS for Windows 20.0 statistics package program.

RESULTS

It was found that 61.0% of the case group with family history of cervical cancer and 19.0% of the control group without family history of cervical cancer were using early diagnostic methods. Thus the presence of an individual with cervical cancer in the family affected the attitudes towards early diagnosis. It was further found that the level of knowledge on cervical cancer and PAP smear test was higher in the case group, which was more sensitive with regard to being informed about cervical cancer as compared to general society. However, the average MBSS scores were not significantly different compared to the control group.

CONCLUSIONS

It was noted that, women participating this study knowledgeable, but this did not necessarily transform into better behavior.

Evaluation of the pap smear test status of Turkish women and related factors

BACKGROUND

The Pap smear has an important value in the early diagnosis of cervical cancer, a serious problem in womens health. This study aimed to determine the status of Turkish women regarding participation in Pap smear testing and affecting factors.

MATERIALS AND METHODS

This descriptive study was conducted on married women between 18-61 years of age selected from those who applied to the Obstetrics and Gynaecology Polyclinic of Ataturk University in Erzurum between June-August 2010 for any reason. Data were collected using a questionnaire determining socio-demographic features and analyzed by descriptive statistics (mean, Sd, range, frequency, percentage) and Chi-square test. A level of p<0.05 was considered statistically significant.

RESULTS

Sixty six of the 301 women (21.9%) indicated that they heard a Pap smear test and 16.6% of women had experienced a test. The number of women participating increased with age, duration of marriage, number of births, knowledge about the Pap smear and perception of risk for cervical cancer.

CONCLUSIONS

The importance of the Pap smear test needs to be explained to Turkish women by health staff, to increase awareness and participation in regular screening.

Factors associated with the use of pap smear testing in Greece

OBJECTIVE

The purpose of this study was to describe the rate of Papanicolaou (Pap) smear test use among women participating in a breast cancer screening program in Greece and to determine related factors.

METHODS

Between March 2004 and July 2009, 9682 women aged between 40 and 69 years were recruited into the program. Baseline sociodemographic and lifestyle characteristics were recorded, together with familial medical history and the last time they had undergone a Pap test.

RESULTS

Almost 7% of the participants had never had a Pap test, and 28.8% had not had one within the last 3 years. Factors that were found to be independently associated with never receiving a Pap test or with not having one within the last 3 years included age, educational status, marital status, area of residence, health insurance, nationality, oral contraceptive use, cancer family history, body mass index (BMI), and stability of menstrual cycle.

CONCLUSIONS

The rate of Pap test use is high among women who reside in Greece, although it is possible that this rate is a little overestimated. Specific programs should be developed and implemented that aim to increase awareness of the benefits of regular cervical cancer screening among specific subgroups of women.

Linguistic and ethnic disparities in breast and cervical cancer screening and health risk behaviors among Latina and Asian American women

PURPOSE

This study intends to (1) describe breast and cervical cancer screening patterns and health risk behaviors for Latina and Asian American women, with consideration for their language, and (2) investigate the impact of health risk behaviors on breast and cervical cancer screenings after controlling for demographic characteristics and language.

METHODS

Data derived from the California Health Interview Survey 2007, which was a random-digit-dial population-based survey, were used. Latina (n = 3513) and Asian American (n = 2538) women were included in this study. Breast and cervical cancer screenings were measured by recent mammography and Pap smear examinations, respectively. Physical activity, smoking habits, alcohol consumption, and body mass index (BMI) were measured to assess health risk behaviors.

RESULTS

This study demonstrated that Asian Americans have better outcomes in health risk behaviors in general. However, Latinas were more likely than Asian Americans to receive mammograms and Pap smears. English-speaking Latinas and Asian Americans showed better outcomes in cancer screening and health risk behaviors, but BMI patterns differed based on language. Unhealthy risk behaviors were related to low screening rates, except for BMI and drinking, among Latina women.

CONCLUSIONS

The findings reveal unique ethnic and linguistic patterns that are relevant to health risk behaviors and cancer screening and that influence overall health outcomes. These findings suggest that health risk behaviors and cancer screening for ethnic minority populations may be framed by cultural contexts. Intervention strategies designed to promote healthy lifestyles and cancer screening may have greater sustainable benefits.

Uptake of Pap smears among women in a large Israeli HMO between 2006 and 2008

OBJECTIVES

The Papanicolaou (Pap) smear test is used in many countries as a screening procedure for cervical cancer and precancerous lesions. The actual uptake of this screening test among women at risk for cervical cancer is unknown. The aim of this study was to estimate the percentage of women who are screened by Pap smears from the relevant population at risk, and to detect factors that are independently associated with uptake of cervical screening.

STUDY DESIGN

Retrospective database study.

METHODS

This study was undertaken at Maccabi Healthcare Services (MHS), the second largest publicly funded health maintenance organization in Israel. The study population consisted of Israeli women aged 21-59 years who were insured by MHS between 2006 and 2008. Logistic regression analyses were used to determine the independent relationships between immigration and socio-economic status and cervical screening.

RESULTS

The study population included 489,663 women who had a total of 313,602 Pap smears between 2006 and 2008. Fifty-four percent of the women did not have a Pap smear during the study period, 32% had at least one smear, and 14% had at least two smears. Living in a low socio-economic neighbourhood and recent immigration were independently and negatively associated with screening uptake.

CONCLUSION

Despite the clinical guidelines and the low costs, many Israeli women who are at risk for cervical cancer are not screened.

Cancer Screening Behaviors of African American Women Enrolled in a Community-Based Cancer Prevention Trial

Background: African American women have increased mortality rates for cervical, breast, and colorectal cancers, yet not all receive the recommended screening tests for these cancers. We characterized the cancer screening behaviors of African American women enrolled in a community-based cancer prevention trial. Methods: We examined cross-sectional data from 1123 African American customers aged ≥18 years from 37 beauty salons in North Carolina who completed the North Carolina BEAUTY and Health Project baseline survey. Mixed logistic regression models were used to identify correlates of receiving cervical, breast, and colorectal cancer screening tests within recommended screening guidelines. Results: Overall, 94% (1026 of 1089) of women aged ≥18 years reported receiving a Pap smear test within the last 3 years, 70% (298 of 425) of women aged ≥40 years reported receiving a mammography within the last year, and 64% (116 of 180) of women aged ≥50 years were considered to be within recommended screening guidelines for colorectal cancer. Age was correlated with recent Pap smear testing and mammography. Women who reported receiving a recent Pap smear test were more likely to report a mammogram in the last year, and women with a recent mammogram were more likely to be within recommended screening guidelines for colorectal cancer. Many women reported multiple barriers to getting recommended cancer screening tests. Conclusions: Almost all women reported receiving a Pap smear test within the last 3 years. Future interventions should focus on increasing breast and colorectal cancer screening among African American women.

Trends in cancer screening among Hispanic and white non-Hispanic women, 2000-2005

BACKGROUND

Hispanics are the largest and fastest growing ethnic group in the United States. Compared with white non-Hispanic women, however, Hispanic women have significantly lower cancer screening rates. Programs designed to increase cancer screening rates, including the national Screen for Life campaign, which specifically promoted colorectal cancer (CRC) screening, regional educational/research programs, and state cancer control programs, have been launched. Screen for Life and some of these other intervention programs have targeted Hispanic populations by providing educational materials in Spanish in addition to English.

METHODS

The objective of this study was to compare changes in colorectal, breast, and cervical cancer screening rates from 2000 to 2005 among Hispanic and white non-Hispanic women, using data from the National Health Interview Survey (NHIS). The age ranges of study subjects and the definitions of cancer screening were site specific and based on the American Cancer Society (ACS) screening recommendations.

RESULTS

Although overall screening rates were found to be lower among Hispanic women, CRC screening increased about 1.5-fold among both Hispanic and white non-Hispanic women, mainly driven by endoscopic screening, which increased 2.1-fold and 2.9-fold, respectively, from 2000 to 2005 (p < 0.01). Fecal occult blood testing (FOBT) for CRC declined among white non-Hispanic women and remained stable among Hispanic women during the same period. Mammogram and Pap smear screening tended to decline during the study period for both ethnic groups, especially white non-Hispanic women.

CONCLUSION

Although cancer screening rates may be affected by multiple factors, culturally sensitive and linguistically appropriate national educational programs may have contributed to the increase in endoscopic CRC screening compliance.

Personal influences that affect motivation in pap smear testing among African American women

OBJECTIVE

To explore personal influencing factors that contribute to Papanicolaou (Pap smear) testing in African American women who do (routine-use group) and do not (non-routine-use group) obtain routine testing.

DESIGN

Qualitative using the interaction model of client health behavior.

SETTING

Community programs, homes, and churches.

PARTICIPANTS

Twenty four African American women aged 19 to 60.

METHODS

Face-to-face interviews. Data were analyzed using a constant comparison approach.

RESULTS

Routine-use group was socially influenced to value preventive health care while the non-routine-use group was not. Previous health care experiences with having a Pap smear and pelvic exam were positive for routine-use group and negative for non-routine-use group. Cognitively, both groups believed Pap smears tested for cancer and sexually transmitted diseases. Vulnerability to cervical cancer was thought to run in families; participants believed they were either safe from risk or hoped that the odds were in their favor. In addition, there was a link between avoiding routine preventive care and a trauma history (sexual, physical, medical), eliciting negative perceptions towards Pap smears and pelvic exams.

CONCLUSION

Differences and similarities in personal influencing factors associated with cervical cancer screening were found in the two groups. Further research is needed to explore these differences and similarities because they may contribute to the reason that African American women have a greater mortality rate from cervical cancer than White women.

Association of knowledge, anxiety, and fear with adherence to follow up for colposcopy

OBJECTIVES

To evaluate the association of pre-visit anxiety with pre- and post-visit knowledge, satisfaction, and adherence to colposcopy follow-up visits.

METHODS

A group of 122 women presenting for colposcopy between July 1999 and May 2000 were studied. Immediately prior to their appointment, 98% of eligible patients participated in a self-administered questionnaire. Patients were sent a follow-up questionnaire within two weeks of the appointment. Statistical analyses included Chi-Square and Fisher's exact tests for categorical variables.

RESULTS

The mean follow up was 112 days (SE 9.47). Although the mean fear score was 7.3 (SE 3, range 1-10) and mean anxiety score was 7.8 (SE 2.8, range 1-10), there was no significant association with pre-visit fear and adherence to follow up. Pre-evaluation knowledge was positively associated with fear, anxiety, post-visit knowledge, and adherence to follow up.

CONCLUSIONS

Pre-visit intervention may improve adherence and reduce anxiety associated with colposcopy.

From 'silent' to 'heard': professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear

While there is a large body of research on cervical cancer screening, fewer studies address the experiences of women receiving abnormal Pap smear results after routine screening. Those studies highlighting such experiences tend to concentrate on resulting psychosocial distress, with an absence in the literature about women's experiences of their bodies during medical follow-up for dysplasia, and no studies were found that explore such experiences over time. In this article, we focus on bodily experiences over time during medical follow-up of an abnormal Pap smear among a group of women in Sweden. This qualitative analysis is based on interview data from a total of 30 women, and with in-depth analysis of the content of 34 transcribed interviews with nine women who were followed longitudinally. We found that medical follow-up involved an experience of both "having" and "being" a body, which changed over time. Women described a process that ranged from having a cervix that was neither felt, 'heard', nor seen, to having a body that became known to them first indirectly through professional mediation and later through direct experience after professional manipulation. The conceptualization of bodily boundaries appeared to change, e.g. through visualization of the previously unfamiliar cervix, pain, vaginal discharge, and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Thus, bodily experiences appear to be an intrinsic part of medical follow-up of an abnormal Pap smear through which health, disease, and risks in the past, present, and future were reconceptualised.

How do women who choose not to participate in population-based cervical cancer screening reason about their decision?

In Stockholm, Sweden, women are invited to a cost-free population-based cervical cancer screening programme (PCCSP) at regular intervals. Despite this, many women choose not to attend screening at all or to take opportunistic tests instead. This study explores how women who actively declined participation in the PCCSP reasoned about their choice. Qualitative telephone interviews and fax messages from women who actively declined participation in the PCCSP were analysed inductively. The manner in which women defined and conceptualized distinctions between, and the roles and responsibilities of, both private and public spheres were found to be central in explanations of decision making. Factors related to women's decisions not to participate in screening at all include a lack of confidence in the benefits of screening, previous negative health care and preventive experiences, a belief in one's own ability to discern health changes or a belief that one was not at risk for cervical cancer, as well as a number of unconventional standpoints on social and political issues. Women who chose not to participate in the organized PCCSP, but who did use private opportunistic screening, generally motivated this with direct or indirect criticism of the screening programme itself. Not only was the examination itself sensitive but also all facets of the PCCSP, from invitation letter on, were found to influence women's decisions. Using Jepson et al.'s ethical framework to peruse the evidence-base underlying women's 'informed decision-making' about CCS is suggested to be more constructive than discussing potential participants' knowledge versus lack of knowledge.

Personal influencing factors associated with pap smear testing and cervical cancer

Pap smear is a screening test that detects abnormal cells before they advance to cancer. Unfortunately, not all women obtain routine screening. The method used was a qualitative study exploring personal influences regarding Pap smears. Face-to-face interviews with 7 low-income African American women who do and do not obtain Pap smears (between 21 and 37 years of age) were conducted at a health department about their social influence, previous health care experience, and cognitive appraisal regarding Pap smears and cervical cancer. Women were found to be socially influenced by their family and their physician. Previous health care experience with the Pap and pelvic was perceived as negative. Cognitively, Pap smears were believed to test for sexually transmitted diseases, including HIV, and the women also felt that if one took good care of oneself it reduced the risk for cervical cancer. It was concluded that exploring beliefs associated with Pap smears and perceptions of vulnerability to cervical cancer and giving correct information and counseling may increase Pap smear screening in women.

Do women comply with recommendations for Papanicolaou smears following colposcopy? A retrospective study

The objective of this study was to determine compliance with follow-up serial Papanicolaou smears after the completion of colposcopic examination and treatment as required in women with abnormal Papanicolaou smears. Following a retrospective chart review, data were selected from 103 charts of women who had undergone colposcopy. Patient compliance with the treatment plan was tracked for 18 months. Compliance was defined as having at least two cervical cancer screenings performed in the year and a half following colposcopy. Thirty-two percent of the study population complied with the plan of care. Eighty-six percent of those patients who had at least one Papanicolaou smear in the 18 months following colposcopy had no progression of dysplasia. Less than one-third of the patients in this study population followed the recommendations given to them after their colposcopic examination and treatment. Health care providers will be aware of the low percentage of patient follow-up as well as the importance of educating patients about prevention of cervical cancer and reducing risk of cervical dysplasia.

Factors influencing cancer screening practices of underserved women

PURPOSE

This integrated review was conducted to evaluate the factors that inhibit or promote decisions by African American and Hispanic women to obtain cervical cancer screening.

DATA SOURCES

Research articles were identified using MEDLINE, PubMed, and Cumulative Index to Nursing and Allied Health literature, published between 1999 and 2005.

CONCLUSIONS

Cervical cancer screening practices of African American and Hispanic women were influenced by extrinsic motivators including lack of insurance, no usual source of health care, acculturation, and socioeconomic factors. Intrinsic motivators were related to beliefs and perceptions of vulnerability, such as ignoring cervical cancer screening when no symptoms were present; believing that not knowing if one had cervical cancer was better; and thinking that only women who engage in sexual risk-taking behaviors need to obtain Papanicolaou (Pap) smear testing.

IMPLICATIONS FOR PRACTICE

Nurse practitioners (NPs) have an opportunity to impact the incidence and mortality of cervical cancer by improving screening practices of minority women. They can emphasize the importance of obtaining Pap smears regularly, teach patients the risks for and signs and symptoms of cervical cancer, and provide recommendations for obtaining screening at low cost or no cost to the patient. To improve cancer screening practices, NPs need to address minority women's beliefs about cervical cancer and provide information and services in a culturally sensitive manner at an appropriate level of learning.

Cervical cancer educational pamphlets: Do they miss the mark for Mexican immigrant women's needs?

The rate of invasive cervical cancer in US Hispanic women is nearly doubled that of non-Hispanics. Using in-depth interviews and content/grade level analysis of educational materials, this study explores the relevance of cervical cancer education materials to the needs of Mexican immigrant women. It also addresses health literacy issues that create barriers to learning. Findings show aspects of language, content, reading level, structure, and visual images in 22 cervical cancer pamphlets from 11 health care sites in a Midwest city were not relevant to the learning needs or health literacy levels of local Mexican immigrant women. Further research is recommended to establish an evidence base regarding optimal presentation of key elements of the cervical cancer educational message for Mexican immigrant women.

Perimenopausal health self-efficacy among Hispanic Caribbean and non-Hispanic white women

The perimenopausal experience varies among different ethnic and cultural groups. This research examined perimenopausal health self-efficacy of Latinas and non-Hispanic White women and variables that predicted health in 147 women ages 40 to 60 in the Northeast United States. Self-efficacy scores were similar for both groups. Latinas scored lower, however, in the Cognition/Decision Making subscale of the Perimenopausal Health Self-Efficacy Survey (PHS-ES). Perceived health was predicted by control over health and stress for both, and greater self-efficacy was associated with higher perceptions of health. Subtle differences existed between the two groups, which may reflect cultural beliefs and barriers to care during midlife.

Pain predicts non-adherence to pap smear screening among middle-aged African American women

BACKGROUND

Middle-aged African American women have the highest incidence and mortality of invasive cervical cancer in the United States and the lowest adherence to pap smear screening.

METHODS

In 2001, we identified factors associated with non-adherence to screening recommendations using three focus group interviews and subsequently developed a questionnaire administered to 144 African American women aged 45 to 65 years.

RESULTS

The perception that the Pap test was painful was associated with non-adherence to screening recommendations (OR = 4.78; 95%CI: 1.67-13.7). Difficulty to pay for the office visit coupled with perceived pain was associated with a nearly sixfold increase in risk of non-adherence (OR = 5.8; 95%CI: 2.8-15.5). Previously identified barriers to screening including lower education and socioeconomic status, poor access to care, knowledge of and exposure to known risk factors of invasive cervical cancer, cancer fatalism, and perceived racism were not independently associated with non-adherence.

CONCLUSIONS

These data suggest that, among middle-aged African American women, future interventions addressing pain during a Pap test will likely increase acceptability of and adherence to cervical cancer screening. Pain could be addressed either by providing information during the pap test and/or using smaller lubricated speculums.

An educational program to increase cervical and breast cancer screening in Hispanic women: a Southwest Oncology Group study

We conducted a community-based pilot study to train Hispanic cancer survivors as promotoras (lay health educators) to encourage their social contacts to obtain breast and cervical cancer screening. Promotoras were recruited from a private oncologist's practice at a Minority-Based Community Clinical Oncology Program (MBCCOP). Five Hispanic women were trained to serve as promotoras by attending a 12-week course. They shared cancer screening information with family and social contacts and encouraged them to obtain Papanicolaou smears and/or mammograms. Study endpoints included the number of women recruited and trained to serve as promotoras, the number of contacts made per promotora, and the number of contacts who were screened; data were based on contact logs maintained for 1 year. Screening examinations were documented by a postcard returned by the contact or by review of community health clinic records. Five promotoras contacted 141 (range = 24-49 per promotora) women to share cancer screening information. Fifty Hispanic women obtained screening after contact with a promotora. Twenty-nine underwent mammography (ages 25-58) and 43 received a Papanicolaou smear (ages 23-62). Hispanic female cancer survivors can be trained as promotoras. Screening information conveyed by a promotora can successfully prompt Hispanic women to obtain mammography and Papanicolaou smears.

Characteristics of Participation in Cervical Cancer Screening

Although Papanicolaou test screening rates are reportedly high, a significant proportion of women remain unscreened. With recent revision of Papanicolaou test guidelines, it is critical that interventions and programs for cervical cancer directed toward low participating groups or individuals be developed. The purpose of the study was to examine factors that influence participation in cervical cancer screening by quantifying characteristics of women who engage in Papanicolaou test screening in a 12-month period. Using the 2000 National Health Interview Survey and Cancer Topical Module, the sample (N = 18,388) consisted of women who were older than 18 years. The dependent variable was nominally identified as whether a woman had had a Papanicolaou test in the last 12 months. Independent variables examined were insurance, level of education, place for care, age, race, employment, place of residence, and income level. Using logistic regression, all variables except race and income level were found to be significant for participation in cervical cancer screening (P < .000). Each variable is discussed within the framework of the Institute of Medicine model of access to personal healthcare services. Study findings provide insight and guidance for the development and implementation of methods for accessing women who have lower participation rates.

Cervical cancer screening among Latinas: the importance of referral and participation in parallel cancer screening behaviors

Low cancer screening participation among medically underserved Latinas is largely due to lack of active referral to screening procedures by health care providers. We explored how physicians' referral and instruction on parallel screening procedures discriminates Latinas' cervical cancer screening practices in the context of relevant variables such as sociodemographic characteristics, health insurance, history of cancer, and level of acculturation. Of 153 women surveyed, 100 were compliant with yearly Pap smear while 53 were not compliant. Discriminant function analysis revealed that health care provider interventions and parallel breast cancer screening behaviors were significant discriminators between women who obtained a Pap smear within a year and those who were less compliant. A change in public health policy that facilitates to medically underserved Latinas access to reliable sources of health care referrals and services might increase their regular use of cervical cancer screening, which could potentially result in a reduction in cancer treatment costs and in lives lost to cervical cancer among these women.

Use of Pap test among Hispanics and non-Hispanic whites in a rural setting

BACKGROUND

Hispanic women in the United States have a higher incidence of invasive cervical cancer than non-Hispanic whites. A key factor related to the relatively high incidence is the underutilization of cancer-screening services. Several previous investigations have reported that Hispanic women are less likely to comply with screening recommendations for Pap testing; some have identified factors that are associated with non-compliance with screening recommendations.

METHODS

Using baseline personal interview data from a randomized community trial on cancer prevention in a rural area, we assessed the association between health barriers and non-compliance with cervical screening recommendations.

RESULTS

Among Hispanic women (n = 382), those with a lower level of acculturation were more likely than highly acculturated Hispanic and non-Hispanic white women (n = 385) to report personal barriers as reasons for not getting an initial or subsequent screening exam. Such barriers include fear of finding cancer, fear of finding diseases other than cancer, and embarrassment about receiving a physical exam. Certain structural barriers, such as cost of care, no time off work, and lack of transportation, were reported to be associated with non-compliance with routine cervical cancer screening, especially among non-Hispanic white women.

CONCLUSIONS

Future research should examine barriers related to initial and subsequent screening among Hispanics with varying levels of acculturation.

Predictors of regular Pap smears among Korean-American women

BACKGROUND

Many Korean-American women (KAW) are unaware of the importance of regular cancer screening. This research estimates rates and examines predictors of regular cervical cancer screening among KAW.

METHODS

Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing.

RESULTS

Thirty-nine percent of women had regular Pap smears. Regular Pap smear rates varied with age, with women 65 years and older least likely to have regular Pap smears. In multiple logistic regression, the strongest correlate of regular Pap smear was knowledge of guidelines. Physician recommendation, having health insurance, and having friends or family members receiving Pap smears were also important facilitators. Spoken English proficiency interacted with education for an outcome; women with a low level of education and low English proficiency had lower rates of Pap smears than those who had a high level of education and high proficiency. The most frequently given reason for lack of a regular Pap smear was a belief that screening was unnecessary if a woman had no symptoms of cervical cancer.

CONCLUSIONS

Strategies for education on screening guidelines, along with physician referrals, should be implemented. Culturally appropriate educational programs about cervical cancer screening should be developed for less educated and less acculturated immigrant women.

An examination of sociocultural factors associated with cervical cancer screening among low-income Latina immigrants of reproductive age

The purpose of this study was threefold: 1) to examine whether low-income Latina immigrants were less likely to receive a Pap smear than low-income non-Latinas; 2) to examine ethnic differences regarding cervical cancer knowledge; and 3) to examine the sociocultural factors associated with cervical cancer screening among low-income Latina immigrants. Participants included 225 low-income women of reproductive age attending a WIC (Women, Infants, and Children) clinic (50% Latina immigrants and 50% non-Latinas). Latina immigrants were less educated, less likely to have health insurance, and more likely to be married or living with a partner than non-Latinas (ps<0.05). All non-Latinas had a Pap smear in the past compared to 81.3% of Latina immigrants (p<0.001). Latina immigrants displayed significantly less knowledge regarding cervical cancer than non-Latinas (ps<0.01). Latina immigrants tended to display culturally based knowledge and beliefs regarding cervical cancer and screening that may influence getting a Pap smear.

The role of nursing in cervical cancer prevention and treatment

Nurses today assume multiple roles, such as patient advocate, care provider, and research investigator. At the Second International Conference on Cervical Cancer (April 11-14, 2002, Houston, TX), nurses presented original research describing these roles in the context of cervical cancer screening, prevention, and detection in the United States and Sweden; outlined the uses of practice guidelines; and suggested future directions for nursing research. In the 20th century, nurses expanded their patient care responsibilities and promoted cancer control by expanding their skills. Some sought to broaden the spectrum of care by investigating cervical cancer screening disparities, behavioral aspects of screening, and differences between the stated purposes of screening programs and those of the nurse-midwives operating them. In the 21st century, nurses interested in cervical cancer control expect to broaden the scope of their care and their research roles further by continuing to improve training, advocating screening (and increased education about screening), and helping to establish new sources of funding for research.

Inner-city African American women who failed to receive cancer screening following a culturally-appropriate intervention: the role of health insurance

Culturally-appropriate health promotion programs are thought to be more effective among minority groups than those designed for the population at large. We investigated factors associated with failure to obtain cervical and breast cancer screening among inner-city African American women who received a culturally-appropriate educational intervention. Women who completed the intervention, but did not obtain a Pap smear, a clinical breast examination, and/or a mammogram at follow-up were compared with those who did obtain these tests. Women with private health insurance were more likely to be screened following the intervention than those covered by Medicaid or Medicare or those who were not insured (P < 0.001). Post-intervention screening was not associated with age, education, income, employment, or marital status. The effectiveness of a culturally-appropriate intervention is likely to be reduced if women's ability to respond is limited by inadequate insurance coverage.

Breast and cervical cancer knowledge, attitudes, and screening practices of Hispanic women diagnosed with cancer

BACKGROUND

Cancer survivors' screening participation is important to prevent cancer recurrence and to maintain health for the growing number of Hispanic cancer survivors.

METHODS

Using a case comparison study design, data from a survey of Hispanic breast (n = 54) and cervical cancer (n = 58) survivors were analyzed by bivariate analysis.

RESULTS

Knowledge of screening guidelines was low for all participants, especially regarding cervical cancer screening. Breast cancer survivors were most knowledgeable. Although survivors held positive cancer attitudes, participation in preventive cancer screening was low indicating the need for more effective cancer prevention communication processes.

CONCLUSIONS

Hispanic cancer survivors need culturally sensitive cancer prevention education and the associated communication processes that acknowledges differences among the varying Hispanic subgroups.

Breast and cervical cancer screening among migrant and seasonal farmworkers: a review

Women constitute about one in five hired farmworkers in the US. Their health may be affected by exposure to unhealthy living and working conditions, by increased exposure to health hazards, by poverty, and by poor utilization of health care and preventive services. About 69% of migrant and seasonal farmworkers were born outside the US, mostly in Mexico and central America, and many speak little English. The health concerns of women who are migrant and seasonal farmworkers include breast and cervical cancer, which can be prevented or controlled through routine screening, but cancer incidence and mortality data for migrant workers are sparse. We reviewed published studies that examined breast and cervical cancer screening in this population. These studies include cross-sectional surveys, health needs assessments, and randomized and non-randomized intervention trials. A review of published studies of cancer screening among women who are migrant and seasonal farmworkers indicates that underutilization of mammograms and Papanicolau (Pap) tests among this population may stem from their limited awareness of the importance of cancer screening and cultural beliefs. Other barriers include cost, lack of health insurance, lack of transportation and child care difficulties. The extent to which results obtained in selected localities are generalizable to other settings is uncertain, but results to date provide important information about possible approaches for increasing cancer screening among women migrant farmworkers.