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

What factors influence the uptake of bowel, breast and cervical cancer screening? An overview of international research

BACKGROUND

For cancer screening programmes to be effective in early detection it is important that those invited can access screening services and understand the benefits of participation. A better understanding of the factors that matter to potential participants of cancer screening programmes can assist in developing strategies to increase current uptake.

METHODS

We conducted an overview of systematic reviews to answer the question: What factors influence the uptake of cancer screening services (breast, bowel and cervical) in high-income countries? A thematic approach supported by tabular summaries and qualitative heat maps was used to categorize factors, described as 'barriers' or 'facilitators'.

RESULTS

A total of 41 systematic reviews met the criteria for inclusion. The barrier with the greatest number of 'hot spots' across all three screening programmes was a fear of the unknown regarding a possible diagnosis of cancer or abnormal screening results, followed closely by a general lack of knowledge surrounding cancer screening programmes. The greatest collective facilitator to uptake was recommendation by a healthcare provider to attend screening.

CONCLUSION

Across all factors 'trust' and 'building trusted relationships' can be seen as integral to the success of cancer screening programmes and must be reflective of collaborative efforts to mitigate barriers and enhance facilitators to uptake. There is future scope to consider interventions that (i) increase demand for screening services, (ii) reduce barriers to uptake of services and/or (iii) are relevant to the healthcare system and those providing services.

Attitudes and Preferences Towards Screening for Dementia with a Focus on Ethnic Minority and Low Socio-Economic Groups: A Systematic Review of Research Studies Written in the English Language

Background

Increased understanding of dementia risk-reduction and early detection of Alzheimer's disease and related disorders has spurred interest in the identification of risks for dementia, underlying putative biologies, or dementia itself. Implementation of such approaches require acceptability to the public. Research prior to 2012 indicated limited acceptability for population dementia screening. The changing landscape of dementia prevention research may influence recent perceptions. Additionally, perspectives from underserved populations, such as ethnic minorities and low socio-economic groups, are lacking.

Objective

In this systematic review, we sought published studies since 2012 on attitudes and preferences of people with dementia, carers and the general public from ethnic minorities and low socio-economic groups regarding dementia screening.

Methods

This review was preregistered on PROSPERO (CRD42023384115) and followed PRISMA guidelines. Key search terms were entered into five databases. Articles were included if they focused on population or risk screening for dementia via primary/community care-based assessments, and which included majority ethnic minority or low socio-economic groups or discretely considered these groups in data analysis. Data were synthesized narratively.

Results

Seven studies reported perspectives of ethnic minorities regarding dementia screening; one study included people from low socio-economic groups. Results indicated that participants from ethnic minorities were willing to undergo dementia screening. Predictors of willingness included belief in benefits, desire to boost diversity, and to implement lifestyle changes. Unwillingness was associated with anxiety regarding results.

Conclusions

Although there seems to be high acceptability for screening in the studied groups, more research is necessary to explore the practical considerations for screening such as cultural and economic barriers, trust, and post-screening actions.

Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States

BACKGROUND

In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism.

METHODS

We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development.

RESULTS

Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct.

CONCLUSIONS

Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.

Factors Influencing the Utilisation of Mammography Among Ethnic Minorities: A Framework-Driven Systematic Review and Meta-Analysis

Ethnic minority women experience disparities in mammography screening utilisation and breast cancer outcomes. This systematic review and meta-analysis synthesised multidomain and multilevel factors that intersect to influence the utilisation of mammography among ethnic minorities. A literature search was conducted in five databases (PubMed, Ovid MEDLINE, EMBASE, CINAHL, and PsycINFO) from inception to May 2022. Guided by the National Institute on Minority Health and Health Disparity research framework, the retrieved data were synthesised using narrative summaries and meta-analyses. Among the 27 studies, most (n = 24) reported individual, interpersonal, and community factors in the health care system domain. In the sociocultural domain, interpersonal and societal (n = 8) factors, such as modesty and karma beliefs, were less frequently identified than individual (n = 20) factors in relation to acculturation. Only individual-level factors were reported for the biological and physical/built environment (e.g., rural residence) domains. In the behavioural domain, cancer screening behaviours had a high combined prediction ability (odds ratio = 18.23; I2 = 23%), whereas interpersonal (e.g., family obligations) and community (e.g., neighbourhood violence) factors discouraged mammography screening. Special focus should be given to ethnic minority women, especially those living in rural areas, those with considerable family obligations, and those who have suffered from violence and other life pressures, to increase their access to mammography services. Multidomain and multilevel efforts, culturally appropriate strategies, and equity-advancing policies such as geographic access and insurance coverage would help to mitigate the ethnic disparities in mammography screening.

Knowledge, attitudes, and practices regarding cancer screening and primary prevention among ethnic minorities in mainland China: A literature review

Objective

Cancer screening and primary prevention are effective strategies for addressing the burden of cancer. However, cancer health disparity exists in accessing cancer screening services among ethnic minorities in mainland China. Exploring knowledge, attitudes, and practices regarding cancer screening and primary prevention is an effective way to understand minority groups' participation in these activities and the barriers to their participation. However, no review has summarized the relevant evidence. This study explored the evidence on cancer screening and primary prevention among ethnic minorities in mainland China, including their knowledge (knowledge level and awareness rate), attitudes (positive/negative attitudes, beliefs, and perceptions), and practices (uptake and participation rate).

Methods

Five online databases (MEDLINE, EMBASE, PubMed, China National Knowledge Infrastructure [CNKI], and Wanfang Data) were searched to identify literature. Data on knowledge, attitudes, and practices regarding cancer screening and primary prevention among ethnic minority groups and the influential factors were extracted and summarized.

Results

Twelve articles on studies with a total of 36,464 participants were included. Most of the studies focused only on breast and cervical cancer, women, and Uyghurs. The ethnic minority groups in the reviewed studies had a low level of knowledge about cancer screening and primary prevention and insufficient practices (cancer screening and primary prevention service uptake rate < 40.0%) but moderate to highly positive attitudes.

Conclusions

This review revealed the insufficient knowledge and practices of cancer screening and primary prevention among ethnic minority groups in mainland China, whose members hold generally positive attitudes toward screening. More evidence pertaining to diverse ethnic minority groups and other cancer types is needed.

Factors Influencing the Mammographic Screening Practices of South Asian Women in Hong Kong: A Qualitative Study

BACKGROUND

Breast cancer is a common type of cancer in South Asian women. Early detection by mammographic screening plays a significant role in improving survival rates. South Asian minorities in many countries have reported low mammographic screening rates.

OBJECTIVE

This study aimed to understand the factors that influence mammographic screening uptake among South Asian women in Hong Kong.

METHODS

This was a qualitative exploratory descriptive study. South Asian women 40 years or older with no history of breast cancer were recruited. In-depth face-to-face interviews were conducted following a semistructured interview guide. Thematic analysis was conducted to analyze the data.

RESULTS

A total of 31 South Asian women consented to participate. Among them, only 7 had ever undergone mammographic screening. The following themes of facilitating factors were identified: (1) influence of doctors, family, and friends; (2) strong sense of commitment to the family; and (3) accessibility and availability of mammographic screening information and services. The following themes for barriers to screening were identified: (1) beliefs about health management and social norms, (2) lack of knowledge and understanding of breast cancer and mammographic screening, (3) logistical barriers, and (4) physical barriers.

CONCLUSION

This study identified important facilitators and barriers that influence the uptake of mammographic screening among South Asian women in Hong Kong.

IMPLICATIONS FOR PRACTICE

The study findings can be used to guide the development and implementation of culturally relevant interventions to address barriers to screening, including the expected gender roles and responsibilities among women in their respective families.

Determinants of routine cervical screening participation in underserved women: a qualitative systematic review

OBJECTIVE

Routine, population-wide cervical screening programmes reduce cervical cancer incidence and mortality. However, socioeconomically deprived communities and ethnic minority groups typically have lower uptake in comparison to the general population and thus are described as 'underserved.' A systematic qualitative literature review was conducted to identify relevant determinants of participation for these groups.

METHODS

Online databases were searched for relevant literature from countries with well-established, call-recall screening programmes. Overall, 24 articles were eligible for inclusion. Data was synthesized via Framework synthesis. Dahlgren & Whitehead's social model of health was used as a broad a priori coding framework.

RESULTS

Participation was influenced by determinants at multiple levels. Overall, patient-provider relationships and peer support facilitated engagement. Cultural disparities, past healthcare experience and practical barriers hindered service access and exacerbated negative thoughts, feelings and attitudes towards participation. Complex interrelationships between determinants suggest barriers have a cumulative effect on screening participation.

CONCLUSIONS

These findings present a framework of psychosocial determinants of cervical screening uptake in underserved women and emphasise the role of policy makers and practitioners in reducing structural barriers to screening services. Additional work, exploring the experience of those living within socioeconomically disadvantaged areas, is needed to strengthen understanding in this area.

Use of a Linguistically Appropriate Decision Aid for Cervical Cancer Screening of South Asian Ethnic Minority Women in Hong Kong: A Pilot Randomised Controlled Trial

BACKGROUND

Decision aids have been shown to be effective in assisting the decision-making process in healthcare settings. This study aimed to examine the feasibility and acceptability of a linguistically appropriate printed decision aid for cervical cancer screening in South Asian women and to preliminarily estimate its effects on decisional conflicts, clarity of values, risk perception, the screening decision and screening uptake.

METHODS

This was a pilot randomised controlled trial. Forty-eight South Asian women aged 25 to 64 years were recruited and allocated to either the intervention group or control group. The participants in the intervention group read a linguistically appropriate printed decision aid.

RESULTS

All of the participants in the intervention group agreed that the decision aid was useful in aiding their decision-making. These participants showed significantly greater improvement in decisional conflicts, clarity of values and risk perceptions than those in the control group (all p < 0.05). The screening uptake rate was significantly higher in the intervention group than in the control group (p < 0.001).

CONCLUSIONS

The decision aid was feasible and acceptable among South Asian women, and it resulted in reduced decisional conflict and increased screening uptake compared with usual care. To improve the convenience of using decision aids, they could be developed in various forms, such as printed and mobile application forms, to meet individual requirements.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry on 23 October 2021 (ChiCTR2100052225).

Disparities in Gynecological Healthcare Service Utilization Among Ethnic Minority Women in Vietnam

The study aimed to investigate differences in the prevalence of gynecological healthcare service utilization in 12 ethnic minority groups and associated socio-demographic correlates with gynecological healthcare service utilization in Vietnam. Based on the national survey on healthcare utilization among 6912 people in 12 ethnic minorities, 900 women aged 21-49 years were included in the final analysis. Prevalence of gynecological healthcare service utilization in 12 ethnic minority groups was measured, based on the question "Have you ever used any gynecological healthcare services?" Socio-demographic characteristics including region, ethnicity, age, marital status, literacy level, education level, languages spoken, occupation, religion, household economy status, using contraception, and distance to the nearest healthcare facility were examined. The association between gynecological healthcare service utilization and socio-demographic characteristics was assessed by using logistic regression. The results showed that the prevalence of gynecological healthcare service utilization was 62.0% (95% CI: 58.7-65.2%), which ranged from 36.5 (Mnong) to 87.7% (Bru Van Kieu). Bru Van Kieu women had significantly higher odds of gynecological healthcare service utilization (OR = 9.42, 95% CI = 3.71-23.91), compared to those in Khmer ethnicity. Besides, Ba Na, Cham Ninh Thuan, and Dao women also had significantly higher odds of gynecological healthcare service utilization (Ba Na: OR = 5.73, 95% CI = 2.15-15.26; Cham Ninh Thuan: OR = 4.24, 95% CI = 1.79-10.06; Dao: OR = 3.43, 95% CI = 1.49-7.90), compared to those in Khmer ethnicity. Getting married, being older, being not poor, and using contraception had significantly higher odds of using gynecological healthcare services. Health education specialists and healthcare workers should be aware of these issues so that they can provide appropriate gynecological healthcare services and ensure high coverage of routine gynecological exams in ethnic minority women in reproductive age.

Factors affecting HPV vaccine uptake among ethnic minority adolescent girls: A systematic review and meta-analysis

Objective

Human papillomavirus (HPV) vaccination rates remain low among adolescent girls across ethnic minority groups that experience high incidences of HPV-related cervical cancer with poor outcomes. This systematic review aimed to synthesize the available evidence on the factors affecting HPV vaccination among ethnic minority adolescent girls.

Methods

Six databases (PubMed, OVID MEDLINE, EMBASE, CINAHL, PsycINFO, and Scopus) were searched from inception to October 17, 2022. Guided by the conceptual model of vaccine hesitancy, the factors affecting HPV vaccine uptake were descriptively synthesized and analyzed using meta-analyses.

Results

This review included 14 studies. The pooled uptake rate of at least one dose of HPV vaccine among ethnic minority adolescent girls was only 38% (95% confidence interval ​= ​0.22, 0.39). At individual level, age of adolescent girls, knowledge of HPV, perceived importance of HPV vaccination, and perceived risk of HPV infection promoted the vaccine uptake. Beliefs in conspiracy theories and lack of trust in the government and HPV vaccine discouraged the utilization. At social and policy levels, health professionals' recommendations, subjective norms, sexuality-related communication, and vaccine policies such as insurance coverage facilitated HPV vaccination. The religious and moral convictions regarding abstinence from sex until marriage negatively influenced the vaccine acceptance.

Conclusions

HPV vaccination among ethnic minority adolescent girls was influenced by multi-level factors that highlighted a combined effort, including culturally sensitive health education programmes, sexuality-related communication skills training, collaboration with religious organizations, debunking conspiracy theories in HPV vaccine, and promoting school-based vaccination programs, to increase the coverage.

Systematic review registration

PROSPERO, CRD42022366805.

Experience of South and Southeast Asian minority women in Hong Kong during COVID-19 pandemic: a qualitative study

BACKGROUND

Hong Kong has a relatively low incidence rate of COVID-19 across the globe. Nevertheless, ethnic minorities in Hong Kong, especially South Asians (SAs) and Southeast Asians (SEAs), face numerous physical, mental, social, economic, cultural and religious challenges during the pandemic. This study explores the experiences of SA and SEA women in a predominantly Chinese metropolitan city.

METHODS

Ten SA and SEA women were recruited and face-to-face interviews were conducted. Questions about participants' daily life experience, physical and mental health conditions, economic situation and social interaction amid COVID-19 pandemic were asked to assess the impact of COVID-19.

RESULTS

SAs and SEAs have a distinctive family culture, and women experienced significant physical and mental impact of COVID-19 due to their unique gender role in the family. In addition to taking care of their family in Hong Kong, SA and SEA women also had to mentally and financially support family members residing in their home countries. Access to COVID-related information was restricted due to language barrier. Public health measures including social distancing imposed extra burden on ethnic minorities with limited social and religious support.

CONCLUSIONS

Even when COVID-19 incidence rate is relatively low in Hong Kong, the pandemic made life even more challenging for SAs and SEAs, which is a community already struggling with language barriers, financial woes, and discrimination. This in turn could have led to greater health inequalities. Government and civil organizations should take the social determinants of health inequalities into account when implementing COVID-19-related public health policies and strategies.

A theory-driven, culture-tailored educational intervention for cervical cancer screening among rural Chinese females: A feasibility and pilot study

Objective

This study aimed to evaluate the feasibility and preliminarily estimate the effects of a theory-driven, culture-tailored, community-based educational intervention promoting cervical cancer screening among rural females.

Methods

An experimental study with the two-arm parallel, nonrandomized control trial design was implemented, followed by individual semi-structured interviews. Thirty rural females between 26 and 64 were recruited, with 15 in each group. Both groups were exposed to the usual care about cervical cancer screening promotion from the local clinics, while participants in the intervention group additionally received five educational sessions in 5 weeks. Data were collected at baseline and immediately postintervention.

Results

All participants completed the study, and the retention rate was 100%. Participants in the intervention group had more significant increments in cervical cancer screening-related self-efficacy (P ​< ​0.001), knowledge (P ​< ​0.001), and intention levels (P ​= ​0.003) than those in the control group. Most participants showed acceptance and satisfaction with this educational intervention.

Conclusions

This study revealed that the theory-driven, culture-tailored, community-based educational intervention was feasible among the rural populations to promote cervical cancer screening. A large-scale interventional study with a prolonged follow-up duration is warranted to explore this educational intervention's effectiveness further.

Factors influencing organised faecal occult blood test screening participation in culturally and linguistically diverse populations: a scoping review

OBJECTIVE

This review aims to provide a comprehensive overview of the literature examining factors influencing participation in organised faecal occult blood test (FOBT) screening programmes in culturally and linguistically diverse populations. This article addresses gaps in the literature by providing a mixed methods review of the multilevel influences on FOBT screening in culturally and linguistically diverse (CALD) populations. This review was guided by the question "What are the factors influencing participation in organised FOBT screening programs in CALD populations?"

STUDY DESIGN

Scoping review.

METHODS

A scoping review methodology was used to summarise the available evidence. A thematic analysis of the included studies was undertaken to identify factors influencing organised FOBT screening participation in CALD populations from the literature.

RESULTS

FOBT screening participation was lower by ethnicity, religion, birthplace and language spoken. Barriers to screening included, faecal aversion, fatalism, fear of cancer, language and literacy barriers, difficulty accessing translated materials and low colorectal screening knowledge and awareness. CALD populations also had lower perceived benefits, susceptibility and cues to action, higher perceived barriers and greater perceived external health locus control than non-CALD populations. Facilitators of screening included positive attitudes to screening, general practitioner recommendations and social support. Group education sessions and narrative-based screening information were found to increase screening participation.

CONCLUSION

This review highlights the range of interrelated factors influencing participation in organised FOBT screening programmes in CALD populations and proposes multicomponent interventions to address low screening uptake. Features of successful community-level interventions should be explored further. Narratives show promise for engaging CALD populations. Accessibility of screening information should be addressed at the system level. Leveraging the general practitioner relationship in promoting FOBT screening programmes may also be an effective strategy to target 'hard-to-reach' populations.

[Synthesis of evidence and recommendations: guidelines for cervical cancer screening, detection, and treatmentSíntese de evidências e recomendações: diretrizes para rastreamento, detecção e tratamento do câncer do colo do útero]

Objectives

Synthesize the recommendations developed by the World Health Organization (WHO) for the screening and treatment of women with pre-cancerous lesions for cervical cancer prevention, with a view to improving the quality of care and health outcomes.

Methods

The guidelines prepared by WHO follow the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) method for the preparation of guidelines, as set forth in the WHO Handbook for Guideline Development. A synthesis of the recommendations of two WHO guidelines was carried out. Additionally, a systematic search was conducted in PubMed, Lilacs, Mhealth Systems Evidence, Epistemonikos and gray literature of studies developed in the Americas to identify barriers, facilitators, implementation strategies, and indicators.

Results

A total of 19 recommendations and ten good practices were formulated for screening pre-cancerous lesions of the cervix and treating cervical cancer. Implementation barriers and facilitators were identified, and indicators were created for assessing adherence and outcomes.

Conclusions

The recommendations provide guidance for the screening and treatment of women with pre-cancerous lesions for cervical cancer prevention, with a view to improving the quality of care and health outcomes. Implementation in Latin America and the Caribbean is considered.

Achieving equitable access to cancer screening services to reduce the cancer burden in the Asia-Pacific region: Experience from Hong Kong

The global burden of cancer can be reduced through early detection by providing people with unrestricted access to cancer screening services. However, health disparities exist within and across countries and regions. This viewpoint article uses the Integrative Multicomponent Programme for Promoting South Asians' Cancer Screening Uptake (IMPACT) project as an example of sharing strategies, such as evidence-based multimedia interventions, community health worker-led interventions, strengthening relationships and building networks, that are being adopted to improve ethnic minorities' access to cancer screening services in Hong Kong. We find that the IMPACT project effectively increased South Asians' cancer screening uptake (e.g. the cervical cancer screening uptake rate saw a 42% increase over 5 years). Future directions for scaling up the IMPACT project have been suggested to contribute to achieving Goal 3 in the United Nations Sustainable Development Goals by 2030, that is, ensuring healthy lives and promoting the well-being of all people at all ages.

Predictors of cervical cancer screening for refugee women attending an international family medicine clinic in the United States

PURPOSE

Cervical cancer screening (CCS) rates are lower for foreign-born women in the United States (U.S.) compared with the overall population. This study aimed to determine the CCS rate and predictors among refugees who were identified as female attending a family medicine clinic.

METHODS

A retrospective chart review included refugee individuals aged 21+, seen in the previous 3 years (3/23/2015-3/20/2018), without hysterectomy (n = 525). Lab results determined CCS rate. Chi-square and logistic regression models explored predictors of CCS.

RESULTS

Overall, 60.0% were up-to-date (UTD) on CCS. Individuals aged 30-49, married, and with [Formula: see text] 1 child had higher odds of being UTD. Ten or more years living in the U.S. was a significant bivariate predictor of CCS, and approached significance in the multivariate model.

CONCLUSION

This study begins to fill gaps in knowledge about cervical cancer control among individuals who resettled in the U.S. as refugees and, given that CCS rates are suboptimal, informs clinical practice improvements and directions for future research.

Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions

Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane were searched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Force were included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709.

Influential barriers perceived by South Asians in Hong Kong to undergoing cervical cancer screening

OBJECTIVE

To report the uptake rate of cervical cancer screening (the Papanicolaou [Pap] test) and identify the perceived barriers associated with screening uptake among South Asian women in Hong Kong.

METHODS

This cross-sectional study involved a structured survey of 776 South Asian women aged 21 and above, recruited from the community. The participants' demographic characteristics, Pap test uptake and responses to a validated 14-item scale of perceived barriers to screening was collected. The data were analysed using descriptive statistics and logistic regression.

RESULTS

The Pap test uptake rate was 40.3%. Multivariate analysis identified two perceived barriers significantly associated with the participants' Pap test uptake: (1) not knowing where to have the test and (2) the belief that they did not need a test if they felt well.

CONCLUSION

Although language problems and embarrassment are commonly reported barriers to screening by South Asians, the participants were more concerned about where to have the test and whether they needed it. Future interventions should thus focus on enhancing their access to the service and clarifying their understanding of the need.

Cervical cancer screening programme attendance and compliance predictors regarding Colombia's Amazon region

BACKGROUND

Cervical cancer (CC) promotion and prevention (P&P) programmes' challenge lies in guaranteeing that follow-up strategies have a real impact on reducing CC-related mortality rates. CC P&P programme compliance and coverage rates are relevant indicators for evaluating their success and good performance; however, such indicators' frequency rates are considerably lower among women living in rural and border areas. This study was aimed at identifying factors associated with CC screening programme attendance for women living in Colombia's Amazon region.

METHODS

This study (qualitative and quantitative phases) was carried out between September 2015 and November 2016; women residing in the border towns of Leticia and Puerto Nariño participated in it. The first phase (qualitative) involved interviews and focus group discussions; this led to establishing factors related to CC P&P programme attendance which were used in the quantitative phase for designing a survey for determining the strength of association in a logistic regression model. The terms attendance and compliance were considered to apply to women who had followed the 1-1-3 scheme throughout their lives, i.e. a cytology examination every 3 years after receiving two consecutive negative annual cytology results.

RESULTS

Inclusion criteria were met by 309 women (≥18-year-olds having an active sexual life, having resided in the target community for at least one year); 15.2% had suitable P&P programme follow-up. Screening programme attendance was positively associated with first intercourse after becoming 20 years-old (aOR: 3.87; 1.03-9.50 95%CI; p = 0.045), frequent contraceptive use (aOR: 3.11; 1.16-8.33 95%CI; p = 0.023), awareness of the age to participate in P&P programmes (aOR: 2.69; 1.08-6.68 95%CI; p = 0.032), awareness of cytology's usefulness in identifying cervical abnormalities (aOR: 2.43; 1.02-5.77 95%CI; p = 0.043) and considering cytology important (aOR: 2.64; 1.12-6.19 95%CI; p = 0.025). Women living in rural areas had a lower probability (aOR 0.43: 0.24-0.79 95%CI; p = 0.006) of adhering to CC P&P programmes.

CONCLUSIONS

This study's findings suggested the need for including novel strategies in screening programmes which will promote CC P&P activities going beyond hospital outpatient attendance to reach the most remote or widely scattered communities, having the same guarantees regarding access, opportunity and quality. Including education-related activities and stimulating the population's awareness regarding knowledge about CC prevention could be one of the main tools for furthering the impact of attendance at and compliance with P&P programmes.

The experience of under-screened and never-screened participants using clinician-supported self-collection cervical screening within the Australian National Cervical Screening Program

Background:

Australia has had significant successes in the prevention of cervical cancer. However, there is considerable scope for improving screening participation. In December 2017, Australia shifted from cytology to a human papillomavirus–based screening program as part of the renewed National Cervical Screening Program. This provided the opportunity to introduce a clinician-supported self-collection cervical screening pathway, which allows screening participants aged 30 years or more and who are under-screened or never-screened to screen via a self-collected human papillomavirus test.

Objective:

This study aimed to explore screening participant experiences of a clinician-supported self-collection cervical screening pathway.

Methods:

Interviews (n = 45) were conducted with participants who had used the clinician-supported self-collection cervical screening pathway in the Australian National Cervical Screening Program between December 2017 and April 2019. Interviews were analyzed using template analysis.

Results:

Under-screened and never-screened participants reported a variety of interrelated barriers to cervical screening due to the nature of the test. For these participants, self-collection was a preferable way to perform screening as it overcame various barriers, was easy to use and promoted a sense of empowerment. Participants reported that the role of their practitioner was influential in their decision to undertake cervical screening, and that the support and information provided was a key factor in their experiences of the self-collection pathway.

Conclusion:

Findings support the use of a clinician-supported model of care, as an alternative screening modality in Australia’s National Cervical Screening Program. As more countries consider the move from a cytology to human papillomavirus–based cervical screening program, this model may assist in greater engagement of under-screened participants.

Religion and cancer prevention: study protocol for a systematic review

INTRODUCTION

Several studies explored a relationship between religiousness and the utilisation of cancer screenings, as religious people may obtain an increased social network or could have certain personality traits that enhance screening use. To the best of our knowledge, there is no systematic review that sums up the evidence gained from research on that relationship. Thus, our review aims to appraise the findings of observational studies regarding that relationship. Its findings may be useful in addressing specific target groups to increase ineffectively the low cancer screening rates.

METHODS AND ANALYSIS

Employing a predefined search algorithm, three online databases (CINAHL, PsycInfo and PubMed) will be searched. In addition, the bibliographies of the studies included in our review will be searched through manually and independently by two reviewers. We are looking for observational studies (both cross-sectional and longitudinal) which examine the association between religion and cancer screening utilisation. However, studies regarding specific samples (as ethnic minorities or religious sects) will be excluded. We expect that the studies examine various dimensions of religion, such as religious attendance or religious intensity. We will extract data that describe methodology, sample characteristics and the findings concerning our object of investigation. Moreover, a quality assessment will be performed. Two reviewers will independently select the studies, extract the data and assess the studies' quality. Disagreements will be dissolved by discussion or by inclusion of a third party. The findings will be presented narratively in text and tables. If possible, a meta-analysis will be carried out.

ETHICS AND DISSEMINATION

As no primary data are collected, the approval from an ethics committee is not required. Our review will be published in a peer-reviewed, scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42021229222.

Knowledge, perception of HIV symptom severity and cervical cancer screening behaviour among women living with HIV in China

OBJECTIVE

This study aimed to examine the previous uptake of cervical cancer screening and intention to be screened and its associated factors among women living with HIV in China.

METHODS

We conducted a cross-sectional survey of 213 women living with HIV to collect information about cervical cancer screening behaviour, demographics, knowledge about cervical cancer and screening, and perception of HIV symptom severity.

RESULTS

Seventy-eight women living with HIV (36.6%) had undergone cervical cancer screening, and 83 (61.5%) of the nonscreened women had the intention to be screened in the future. Using multivariate analysis, women who had more knowledge about cervical cancer screening (OR = 2.373, 95% CI = 1.593-3.534, p = 0.000) and had at least one nongynecological symptom (OR = 0.446, 95% CI = 0.204-0.978, p = 0.044) were more likely to have received screening previously.

CONCLUSION

This study emphasised that knowledge, as a salient factor, was crucial to promoting cervical cancer screening behaviour among women living with HIV. Effective measures should be taken to promote the knowledge about cervical cancer prevention. A new healthcare model, including preventive healthcare in addition to HIV/AIDS care, may be needed to address the complex needs of women living with HIV in China.

A Community Health Worker-Led Multicomponent Program to Promote Cervical Cancer Screening in South Asian Women: A Cluster RCT

INTRODUCTION

South Asian women in Hong Kong have low cervical cancer screening uptake because of multiple barriers to utilizing health resources. Interventions that effectively modify the cancer screening behaviors of this population are warranted. This study evaluates the effects of a community health worker-led multicomponent intervention on improving cervical cancer screening uptake among South Asian women in Hong Kong.

STUDY DESIGN

This study was an assessor-blind, cluster RCT that included a waitlist control group.

SETTING/PARTICIPANTS

Recruitment of eligible subjects took place in 6 nongovernmental organizations; these organizations were randomized into intervention and control groups with a 1:1 allocation ratio.

INTERVENTION

Participants in the intervention group received a 3-month multicomponent intervention comprising health education, monthly telephone follow-ups, and navigation assistance.

MAIN OUTCOME MEASURES

Participants' cervical cancer screening utilization and beliefs were assessed at baseline, after intervention, and 3 months after intervention. A longitudinal outcome comparison between the 2 groups was performed with generalized estimating equation analysis. Data were collected between September 2018 and January 2020 and were analyzed in 2019-2020.

RESULTS

A total of 387 participants completed the intervention. A significantly higher cervical cancer screening uptake was observed among participants in the intervention group (97.9%, 191 of 195) than among participants in the control group (52.6%, 101 of 192) at 3 months after intervention (p=0.005). Significantly greater decrements in perceived barriers to cervical cancer screening were found in the intervention group after intervention (-0.68, 95% CI= -1.35, -0.01, p=0.047) and 3 months after intervention (-0.86, 95% CI= -1.69, -0.04, p=0.041).

CONCLUSIONS

A community health worker-led multicomponent intervention is effective in promoting cervical cancer screening uptake and in reducing barriers to cancer screening utilization among South Asian women in Hong Kong. Combining a community health worker-led intervention with multiple intervention components could be an effective strategy for developing interventions to increase cervical cancer screening in underserved populations.

TRIAL REGISTRATION

This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn) ChiCTR1800017227 on July 18, 2018.

Perceptions of cervical cancer prevention among a group of ethnic minority women in Denmark-A qualitative study

BACKGROUND

Cervical cancer screening (CCS) and human papillomavirus vaccination (HPVV) are effective measures against cervical cancer (CC). Attendance in HPVV and CCS provides the greatest protection, while combined non-attendance in HPVV and CCS provides little to no protection. It is hence concerning that some large ethnic minority groups show considerably lower HPVV and CCS attendance than other women-especially women from Middle-Eastern and North African (MENA) countries and Pakistan. Little is, however, known about the reasons for this low combined attendance pattern n.

AIM

To explore perceptions of and barriers to HPVV and CCS, among MENA and Pakistani women in Denmark.

METHOD

Focus group interviews were conducted. Data was transcribed verbatim, and analysed using systematic text condensation.

FINDINGS

Seventeen long-term resident women originating from six major MENA countries and Pakistan were included. Mean age was 36 years. We found that these women, across different age groups and descent, had sparse knowledge and understanding about CC, and their perceived relevance of disease prevention was low. Compared to HPVV, their barriers to CCS were more fixed and often linked to socio-cultural factors such as taboos related to female genitals and sexuality. Moreover, they presented unmet expectations and signs of mistrust in the healthcare system. However, at the end of the interviews, participants became more attentive toward CC prevention, particularly toward HPVV.

CONCLUSION

Elements of insufficient knowledge and understanding of CC and its prevention were found among a group of MENA and Pakistani women. Their socio-cultural background further represents a barrier particularly towards CCS. Additionally, negative experiences and unmet expectations lessen their trust in the healthcare system. All of which underlines the need for new tailored CC preventive strategies for this group. Based on our findings we suggest that future studies develop and evaluate interventions aiming to improve HPVV and CCS, including user-involvement.

Effectiveness of motivational interviewing in enhancing cancer screening uptake amongst average-risk individuals: A systematic review

BACKGROUND

Although cancer is a worldwide public health problem, it can be detected early and prevented through cancer screening. Recommendations for screening methods and screening intervals are currently available for several types of cancer. However, not all average-risk individuals are motivated to undergo cancer screening.

OBJECTIVES

To examine the effectiveness of motivational interviewing that targets average-risk individuals regarding their cancer screening intention and uptake and to provide recommendations for the content and format of motivational interviewing based on the existing evidence.

METHODS

A systematic literature search was performed using four databases and a manual search. A combination of keywords including 'motivational interviewing', 'cancer screening', 'screening intention' and 'screening uptake' were used to identify relevant articles. Only randomised controlled trials that examined the effects of motivational interviewing amongst average-risk individuals were included in the review. The Cochrane Risk of Bias Tool was used to appraise the methodological quality of the selected articles. The findings were summarised in narrative and tabular formats.

RESULTS

Six randomised controlled trials that used motivational interviewing to enhance cancer screening uptake or intention were included in the review. The findings show that motivational interviewing that used a face-to-face and telephone-based approach or were used together with a tailored or reminder letter enhanced the participants' uptake of breast and cervical cancer screening and their intention to undergo future cervical cancer screening. Mixed results were observed in the effectiveness of single-contact motivational interviewing on colorectal cancer screening.

CONCLUSIONS

The use of motivational interviewing has demonstrated improvements in the uptake of breast and cervical cancer screening. However, more research is warranted in view of the inconclusive findings noted for colorectal cancer screening. Further studies with more rigorous methods are needed to identify the most effective interventions and to test the feasibility and efficiency of the use of Internet-based information communication technology to deliver motivational interviewing.

Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research

Background

Although Abnormal Uterine Bleeding (AUB) can have serious medical consequences and significantly impacts daily life, the overall trend is that most women do not seek care for these symptoms. The objective of this review was to synthesise factors impeding women’s access care for AUB.

Methods

Systematic literature review of qualitative studies (interview and focus group) regarding the lived in experiences of women with abnormal menstrual symptoms, followed by a thematic analysis of these studies. We screened CINAHL, SCOPUS, ProQuest, OVID and Pubmed for qualitative studies. Studies were assessed using the Clinical Appraisal Skills Programme checklist and thematic synthesis was used to develop themes from the findings of the studies.

Results

The review yielded 12 studies that satisfied the inclusion criteria. Three themes were developed that described barriers for women seeking care for AUB: health literacy (understanding of normal periods, role of cervical Pap smears and lack of access to appropriate information), taboo/normalisation (fear and embarrassment of symptoms, prioritising others) and health care provider (lack of accessible and trusted female GPs and poor experiences with GPs).

Conclusions

For 20 years women have consistently reported poor experiences in accessing care for AUB. The findings from our review indicate that drivers to impeding access are multiple; therefore any approaches to improve access will need to be multi-level – from comprising local sociocultural considerations to improved GP training.

Knowledge Level and Hand Hygiene Practice of Nepalese Immigrants and Their Host Country Population: A Comparative Study

Nepali people are one of the ethnic minority immigrants of Hong Kong. This epidemiological investigation aims to determine and compare the knowledge level and hand hygiene (HH) behaviour of the Nepali people and the population of their host country (i.e., native Chinese population of Hong Kong). A total of 1008 questionnaires were collected via an online platform. The overall knowledge level of the native population towards HH was considerably higher than that of the Nepali respondents. Lower levels of knowledge in young and older people were noted. Reduced HH knowledge was also observed in people with low educational level or with comorbid illness(es). Significant differences between groups were noted in the self-reported hand washing behaviours. Regarding hand drying, more Nepalese than native Chinese respondents always/sometimes dried their hands on their clothing irrespective whether after performing handwashing in public washrooms or at home. Misconceptions and suboptimal practices on HH were prevalent in the two populations. The findings of this comparative study offer valuable information for the development of culturally sensitive health educational programs to enhance HH practices for the ethnic minorities and native Chinese population.

Variation in Cervical Cancer Screening Preferences among Medically Underserved Individuals in the United States: A Systematic Review

Underutilization of effective screening is one driver of disparities in cervical cancer incidence and mortality. Consideration of patient preferences could help to improve screening rates in populations facing substantial barriers to preventive care. We conducted a systematic review of the literature on cervical cancer screening preferences among medically underserved patients in the United States. We searched six electronic databases (PubMed, Web of Science, EMBASE, Scopus, CINAHL, and PsycINFO) for articles published through February 2019 (Prospero ID: CRD42019125431). Among the 43 articles included, 23 reported screening modality preferences, 11 reported preferences related to provider demographics and attributes, six reported screening scheduling and results delivery preferences, and nine reported preferences related to health education and communication. This review demonstrates the wide variety of medically underserved patient preferences related to cervical cancer screening. It also draws attention to two key preference trends that emerged despite heterogeneity in study design, populations, and preference assessment. Consistent preferences for human papillomavirus self-testing over traditional Pap testing highlight a key potential mechanism for increasing cervical cancer screening uptake among medically underserved populations. In addition, preferences for gender- and language-concordant providers underscore the need for continued efforts toward expanding diversity among medical professionals.

A cross-sectional study of barriers to cervical cancer screening uptake in Ghana: An application of the health belief model

Background

The high incidence (32.9, age-standardized per 100,000) and mortality (23.0, age-standardized per 100,000) of cervical cancer (CC) in Ghana have been largely attributed to low screening uptake (0.8%). Although the low cost (Visual inspection with acetic acid) screening services available at various local health facilities screening uptake is meager.

Objective

The purpose of the study is to determine the barriers influencing CC screening among women in the Ashanti Region of Ghana using the health belief model.

Methods

A analytical cross-sectional study design was conducted between January and March 2019 at Kenyase, the Ashanti Region of Ghana. The study employed self-administered questionnaires were used to collect data from 200 women. Descriptive statistics were used to examine the differences in interest and non-interest in participating in CC screening on barriers affecting CC screening. Multivariable logistic regression was used to determine factors affecting CC screening at a significance level of p<0.05.

Results

Unemployed women were less likely to have an interest in CC screening than those who were employed (adjustes odds ratio (aOR) = 0.005, 95%CI:0.001–0.041, p = 0.005). Women who were highly educated were 122 times very likely to be interested in CC screening than those with no or low formal education (aOR = 121.915 95%CI: 14.096–1054.469, p<0.001) and those who were unmarried were less likely to be interested in CC screening than those with those who were married (aOR = 0.124, 95%CI: 0.024–0.647, p = 0.013). Also, perceived threat, perceived benefits, perceived barriers and cues for action showed significant differences with interest in participating in screening with a P-values <0.003. The association was different for long waiting time, prioritizing early morning and late evening screening which showed no significant difference (P-value > 0.003).

Conclusions

Married women, unemployed and those with no formal education are less likely to participate in CC screening. The study details significant barriers to cervical cancer screening uptake in Ghana. It is recommended that the Ghana health services should develop appropriate, culturally tailored educational materials to inform individuals with no formal education through health campaigns in schools, churches and communities to enhance CC screening uptake.

Low attendance by non-native women to human papillomavirus vaccination and cervical cancer screening - A Danish nationwide register-based cohort study

Background

Cervical cancer is preventable through human papillomavirus vaccination and cervical cancer screening. However, possibly due to systemic, individual (e.g. low socio-economic staus) and socio-cultural barriers, it is likely that non-natives, especially non-westerns, are more prone to attend neither vaccination nor screening (combined non-attendance). This is disturbing as the non-native population in Denmark is predicted to rise to 21% by 2060. We aimed to investigate differences in combined non-attendance by nativity and region of origin, and to analyse the association between country of origin and combined non-attendance adjusted for socio-economic status.

Setting

1.6.2007–31.12.2016 Denmark.

Methods

Logistic regression was performed to estimate crude and adjusted odds ratios with 95% confidence intervals for combined non-attendance.

Results

170,158 women were included. Overall combined non-attendance was 11.8% [11.7–12.0]; 10.0% [9.8–10.1] for native women and 27.1% [26.4–27.7] for non-native women, with highest degrees among Middle-Eastern and North-Africans (30.1% [29.2–30.9]). Even when adjusted for socio-economics, women from Middle-East and North-Africa had substantially higher odds of combined non-attendance than natives (adj. OR = 7.5 [6.3–8.9] for Somali women).

Conclusion

Denmark has a relatively low degree of combined non-attendance. However, cervical cancer preventive programmes seem to be better tailored to the needs of native women and do not appear to cater sufficiently to the needs of the fast-growing non-native populations, particularly not to the needs of Middle-Eastern and North African women. In order to secure more just cervical cancer prevention, future studies are recommended to develop tailored intervention sensitive to the need of non-native women.

Effect of an Intervention in General Practice to Increase the Participation of Immigrants in Cervical Cancer Screening: A Cluster Randomized Clinical Trial

IMPORTANCE

Immigrant women have lower participation in cervical cancer screening (CCS) programs. At the same time, some groups of immigrants have higher prevalence of cervical cancer. Targeted interventions are therefore necessary.

OBJECTIVE

To determine whether an intervention among general practitioners (GPs) could influence immigrant women's participation in the Norwegian CCS program.

DESIGN, SETTING, AND PARTICIPANTS

Cluster-randomized clinical trial using the 20 subdistricts of the Bergen, Norway, municipality as clusters. The clusters were matched in 10 pairs according to the number of immigrant women living in them and randomized thereafter. The intervention was implemented between January and June 2017 among urban, primary care, general practices in Bergen. Follow-up ended in January 2018. General practices belonging to the control areas continued treatment as usual. A total of 10 360 women who attended 73 general practices in the 20 subdistricts were included as participants.

INTERVENTION

The intervention consisted of 3 elements: an educational session for GPs at lunch describing the importance of CCS among immigrants and giving advice about how to invite them to participate, a mouse pad as a reminder, and a poster placed in waiting rooms. In the educational session, we elaborated the need for GPs to ask every immigrant woman about CCS, regardless of their reason for contacting their GP.

MAIN OUTCOMES AND MEASURES

The main outcome, screening status of immigrant women by January 1, 2018, was obtained from the Norwegian Cancer Registry. The effect of the intervention was measured as odds ratio (OR) for CCS status as of January 1, 2018, for the intervention group vs the control group, with 3 levels of adjustments: baseline CCS status at January 1, 2017 (model 1), additional adjustment for women's age, marital status, income level, and region of origin (model 2), and further adjustment for the GP's sex, age, and region of origin (model 3). Two subgroup analyses, screening status at baseline and women's country of origin, were conducted to assess whether these factors had any influence on the effect of the intervention. Data were analyzed as intention to treat.

RESULTS

A total of 10 360 immigrant women, 5227 (50.4%; mean [SD] age, 44.0 [12.0] years) in the intervention group and 5133 (49.6%; mean [SD] age, 44.5 [11.6] years) in the control group, belonging to 39 general practices in the intervention area and 34 in the control area, were included in the study. The proportion of immigrant women screened increased by 2.6% in the intervention group and 0.6% in the control group. After adjustment for screening status at baseline, women in the intervention group were more likely to have participated in CCS (OR, 1.24 [95% CI, 1.11-1.38]). This statistically significant effect remained unchanged after adjustment for women's characteristics (OR, 1.24 [95% CI, 1.11-1.38]) and was reduced, but still significant, after further adjustment for GP characteristics (OR, 1.19 [95% CI, 1.06-1.34]). In subgroup analyses, the intervention particularly increased participation among women who were not previously screened at baseline (OR, 1.35 [95% CI, 1.16-1.56]), and those from Poland, Pakistan, and Somalia (OR, 1.74 [95% CI, 1.17-2.61]) when adjusting for baseline screening status.

CONCLUSIONS AND RELEVANCE

Our intervention targeting general practices significantly increased CCS participation among immigrants, although the absolute effect size of 2% in the fully adjusted model was small. Engaging other primary health professionals such as midwives to perform CCS could further contribute to increasing participation.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03155581.

Racial and Ethnic Differences in Acceptability of Urine and Cervico-Vaginal Sample Self-Collection for HPV-Based Cervical Cancer Screening

Background: We compared women's acceptability of urine and cervico-vaginal sample self-collection for high-risk (oncogenic) human papillomavirus (hrHPV) testing and assessed whether acceptability varied across racial/ethnic groups. Methods: As part of a test accuracy study of urine-based hrHPV testing, we recruited a convenience sample of women 25-65 years of age at two colposcopy clinics in North Carolina between November 2016 and January 2019. After self-collection of urine and cervico-vaginal samples, women completed a questionnaire on the acceptability of the sample collection methods. We coded open-ended questions inductively. All results are presented stratified by racial/ethnic group. Results: We included 410 women (119 Hispanic, 115 non-Hispanic Black, 154 non-Hispanic White, and 22 women with other racial identities). Most women (79%, 95% confidence interval [CI] = 76%-83%) had positive feelings about urine-based hrHPV testing. Women generally preferred urine (78%, 95% CI = 74%-82%) over cervico-vaginal self-collection (18%, 95% CI = 14%-22%), but the degree differed by racial/ethnic group, increasing from 75% in non-Hispanic Black to 82% in Hispanic women (p = 0.011). Most women reported at least one positive aspect of urine (89%) and cervico-vaginal self-collection (85%) for hrHPV testing with the most common positive aspect being easy sample collection, although 16% of women were concerned about performing the cervico-vaginal self-collection correctly. Conclusions: Self-collection for hrHPV-based cervical cancer screening is highly acceptable to women across different racial/ethnic groups in the United States, and most women in our study would be more likely to attend future cervical cancer screening appointments if screening were urine based. Urine-based hrHPV testing is a promising approach to improve cervical cancer screening coverage.

Psychometric properties of the Persian version of the Cancer attitude inventory

BACKGROUND

The Cancer Attitude inventory (CAI) was developed to measure attitudes toward cancer. The aim of the present study was to describe the development of the Persian version of the CAI and to evaluate its psychometric properties in an Iranian sample.

METHODS

The forward-backward method was used to translate the CAI scale from English into Persian. After linguistic validation and a pilot check, a cross-sectional study was performed and psychometric properties of the Iranian version of the questionnaire were assessed. The scale validation was conducted with a convenience sample of 820 laypeople. Construct validity was assessed through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed through Cronbach's alpha analysis and test-retest analysis.

RESULTS

Five factors were identified in CAI: isolation, helplessness, fear of consequence, belief of control and independence, and fear of death. The results achieved from the CFA displayed that the data fit the model: the relative chi-square (× 2/df) = 2.98 (p < .001), and the root mean square error of approximation (RMSEA) = .07 (90% CI = .06-.07). All comparative indices of the model had scores greater than .80, demonstrating a good fit to the data. Cronbach's Alpha and the intra-class correlation coefficient (ICC) were .97, which is well above the acceptable threshold.

CONCLUSIONS

The results indicate that the Persian version of the CAI is practical, reliable and valid. Consequently, the instrument could be used in plans to create positive attitudes about cancer control and treatment among Persian people.

Development of an explanatory model to explore cervical cancer screening behaviour among South Asian women: The influence of multilevel factors

PURPOSE

To develop an explanatory model, built on an ecological basis, and examine the relational effects of multilevel factors on screening behaviour among South Asian immigrant women.

METHODS

This is a cross-sectional, exploratory correlational study using path analysis. 776 South Asian immigrant women were recruited from community in Hong Kong. A self-administered survey with eight sections covering socio-demographics, recommendations received from others, previous screening experience, knowledge of the disease and screening, attitudes and perceptions, level of acculturation, cultural barriers to screening and perception of cancer fatalism was used to collect data. Path analysis was done to test the hypothesised model.

FINDINGS

The final model obtained an acceptable model fit with x²/df = 2.52, RMSEA = 0.044, CFI = 0.95 and TLI = 0.93. A total of 15 factors, ranging from intra-personal to community level, were identified as being associated with South Asian immigrant women's cervical cancer screening behaviour. Three factors at the community level (language use, modesty and crisis orientation) had an inter-relationship with three intra-personal factors (perceived barriers to screening, cancer fatalism and perceived benefits of screening) and hence affected screening uptake.

CONCLUSIONS

South Asian women's cervical cancer screening behaviour is affected by multi-level factors. Efforts should be made to change the current health-promoting strategies and attract more involvement from appropriate stakeholders, incorporating cultural and socio-environmental components in future interventions.

The effect of Medicare's Annual Wellness Visit on preventive care for the elderly

The study aim was to assess the effect of receiving an Annual Wellness Visit (AWV) between 2011 and 2013 on the annual rate of eight preventive services recommended for the Medicare population following the AWV. We used retrospective Medicare claims from 2009 to 2014 for a 5% national sample of fee-for-service beneficiaries in the United States. Propensity score-adjusted logistic regressions were performed to estimate the log odds of the probability of receiving the preventive services between beneficiaries who received AWVs during 2011-13 and those who did not during the same period. The average marginal effect was also reported. Among 845,318 patients who met the inclusion and exclusion criteria, 23% had an AWV in 2011-2013. In a propensity-matched sample of 381,934 patients, AWV participants are more likely to undergo subsequent preventive services within a year (adjusted odds ratio ranges from 1.46 (95% CI, 1.44, 1.49) to 2.43 (95% CI, 2.38, 2.49). The findings are consistent using secondary outcomes or with subgroups defined by baseline primary care provider visits or baseline preventive services. These analyses showed that AWV is associated with a significant increase in all the preventive services examined. As Healthy People 2020 has established a target goal to increase the proportion of older adults who receive a core set of clinical preventive services by 10%, AWV represents a promising opportunity to facilitate the delivery of preventive care for the elderly and to advance our knowledge about effective strategies for healthy aging.

Cervical cancer screening among incarcerated women

BACKGROUND

Women with a history of incarceration bear a disproportionate burden of cervical disease and have special characteristics that affect their intent and/or ability to adhere to cervical screening and follow-up recommendations. The goal of this study was to identify factors associated with cervical cancer screening and screening outcomes among incarcerated women.

METHODS

We applied a framework of predisposing factors, enabling factors and population-specific characteristics that could impact screening behaviors and outcomes for this population. We used bivariate chi-square tests and Wilcoxon signed-rank tests to analyze data previously collected from 290 incarcerated women.

RESULTS

Cervical cancer screening belief score, as a predisposing factor, was associated with women who had an up-to-date Pap test and who had a cervical cancer diagnosis ever in their life. Both a sexual history containing high-risk behaviors and a history of abuse, population-specific factors, were each associated with having had an abnormal pap; mental health, incarceration, and substance use histories were each associated with having a diagnosis of cervical cancer.

CONCLUSIONS

The significant differences in outcomes for these population-specific factors suggest the need for a health services approach that addresses the challenges to the cervical cancer preventive health needs of incarcerated women.

IMPLICATIONS FOR PRACTICE

Providers working with vulnerable populations such as women who have been incarcerated should be aware that their risk histories have an influence on their follow-up behaviors. These women will need extra support for cervical cancer screening and follow-up care.

Prevalence and determinants in cytology testing for cervical cancer screening in Spain (2006-14)

Background

Cervical cancer has decreased in developed countries thanks to cytology screening programmes. The aims of this study were To analyse the frequency and evolution of performing cytology tests and to determine the variables that influence their use.

Methods

Cross-sectional study of non-institutionalized women who participated in the national health survey (2006, 2011/12) and the European Health Survey in Spain (2009, 2014). Study variables: cytology-testing, time since last cytology-test, reason for performing the test, age, nationality, marital status, social status, education level and place of residence.

Results

The study evaluated 53 628 women in Spain over 15 years old, with a mean age of 52.68 (SD ± 19.12). About 94.1% were Spanish, 49.2% were married and 77.2% lived with a partner. In 2014, 72% had a cytology test, a number that increased significantly. Women aged 25-65 were 5.13 times more likely to undergo a cytology test than those aged 15-24 years old (odds ratio (OR): 5.13; P < 0.001); women with university educations were 9.23 times more likely to undergo a cytology test than those without university educations (P > 0.001); those of social classes I and II (high) were 1.2 more likely to undergo a cytology test than those of low social class (P = 0.026); and Spanish women were 1.74 times more likely to undergo a cytology test than foreigners living in Spain (P < 0.001).

Conclusion

Frequency of cytology testing has increased in the last few years. Screening for cervical cancer is associated with higher social status, education level, age, and not being foreign.

Design of a Culturally-Informed Virtual Human for Educating Hispanic Women about Cervical Cancer

Significant health disparities exist between Hispanics and the general US population, complicated in part by communication, literacy, and linguistic factors. There are few available Spanish-language interactive, technology-driven health education programs that engage patients who have a range of health literacy levels. We describe the development of an interactive virtual patient educator for educating and counseling Hispanic women about cervical cancer and human papillomavirus. Specifically, we describe the iterative design methodology and rationale, usability evaluation, and pilot testing of the system with Hispanic women in a rural community in Florida. The pilot study findings provide preliminary evidence of the feasibility of the proposed patient education approach. The proposed application and the lessons learned will prove beneficial for future work targeted towards different cultural populations.

Translation and validation of translation in cross-cultural research: Strategies used in a study of cervical cancer screening among ethnic minorities

AIMS

A discussion of the challenges encountered during instrument translation and validation while researching cervical cancer screening among ethnic minorities and the strategies used to overcome them.

BACKGROUND

Given the increasing ethnic and cultural diversity of populations in different countries, culturally sensitive instruments are needed to evaluate people's attitudes, perceptions, and health practices. Often, such instruments are lacking in the study population's language.

DESIGN

Discussion paper.

DATA SOURCES

The discussion is based on our previous experience including the challenges encountered in the translation process and in the semantic and content validation and the strategies used to overcome them.

IMPLICATION FOR NURSING

Seeking help from community centres or translation agencies to use translators with a health care background and of the same cultural origins as the target participants is effective. Actively contacting potential experts through email addresses obtained from published research articles is another effective way to find suitable experts. Field testing of the study questionnaire is important in validation, as it uncovers difficulties that go beyond translation.

CONCLUSION

Good planning and preparation before the translation and validation work begins is always required. Working closely with translators and experts through discussion is the key to success.