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Shpendi S, Norman P, Gibson-Miller J, Webster RK. Utilising the COM-B model to interpret barriers and facilitators to cervical cancer screening in young women. J Health Psychol 2024:13591053241281405. [PMID: 39340402 DOI: 10.1177/13591053241281405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2024] Open
Abstract
As most women now reaching the age for cervical cancer screening (24.5 years old) in the UK will be HPV vaccinated, their current perspectives on screening can inform effective interventions to increase screening uptake (and thus, early detection). Twenty-four interviews were conducted with women aged 24-30 years old to explore their views on cervical cancer screening (n = 12 attendees and n = 12 non-attendees). Reflexive thematic analysis generated six themes that were then mapped onto the COM-B model. Reflective motivations (e.g. reassurance) were key facilitators to screening attendance for both groups. Social opportunities (e.g. open communication) contrasted between the groups, with attendees more likely to have discussed screening with friends. Automatic motivations (e.g. embarrassment) were key barriers to attending screening in both groups. Notably, HPV vaccination did not factor into the decision to attend screening. Interventions to increase screening uptake may target motivational and social factors.
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Song G, Thomas-Purcell K, Sealy DA, Bailey A, Ragin C, Ashing K. Cultural shifts: an examination of cervical cancer stigma across age groups in the Caribbean. JNCI Cancer Spectr 2024; 8:pkae075. [PMID: 39235932 PMCID: PMC11412600 DOI: 10.1093/jncics/pkae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/29/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Cervical cancer-related stigma is common but understudied in the Caribbean. This study aims to describe the age difference of cervical cancer stigma and to evaluate the influence on the prevention practices among the Caribbean nonpatient population in Jamaica, Grenada, and Trinidad and Tobago. METHODS A cross-sectional study involving 1209 participants was conducted using a culturally trans-created Cancer Stigma Scale for the Caribbean context and supplemented with questions on cervical cancer and human papillomavirus (HPV) and HPV vaccine knowledge and beliefs. Descriptive analyses and χ2 tests were conducted. RESULTS The χ2 tests showed age is statistically significantly related to participants' response to stigma items such as "community members believe cervical cancer is viewed as shameful" (P = .0001); "women with cervical cancer are treated with less respect than usual by others" (P < .0001); "women with cervical cancer are rejected by family members" (P = .0007); "women with cervical cancer are rejected by intimate partners" (P < .0001); and "intimate partners blame women for having cervical cancer" (P = .0032). Additionally, age has statistically significant associations with endorsements of negative views of cervical cancer from the community (P < .0001) and family (P < .0001) as key barriers to cervical cancer care (item: "discourage women from seeking and obtaining screening and treatment"). Notably, younger respondents (18-25 years) are more sensitized to the unfair stigma and hold more stigma. CONCLUSIONS Among Caribbeans, age influences cervical cancer stigma. Younger persons acknowledged greater stigma within families and communities. This study can guide age-informed interventions and programs to reduce stigma and improve cervical cancer screening and care seeking to reduce cervical cancer burden and disparities.
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Affiliation(s)
- Gaole Song
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | | | - Althea Bailey
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center - Temple University Health System, Philadelphia, PA, USA
- African Caribbean Cancer Consortium, Philadelphia, PA, USA
| | - Kimlin Ashing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- African Caribbean Cancer Consortium, Philadelphia, PA, USA
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Temminghoff L, Russell C, Andersson T, Broun K, McGrath N, Wyatt K. Barriers and enablers to participation in the National Cervical Screening Program experienced by young women and people with a cervix aged between 25 and 35. Health Promot J Austr 2024; 35:376-384. [PMID: 37326914 DOI: 10.1002/hpja.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/10/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
ISSUE ADDRESSED Cervical screening rates for young women aged between 25 and 35 are lower than older Australian women, however, little research has been conducted to understand why. This study aimed to identify and explore the barriers and enablers faced by young Victorians with a cervix to regular cervical screening. METHODS This study used a mixed method exploratory design consisting of qualitative focus groups and a quantitative online survey. Four focus groups were conducted with 24 Victorians with a cervix aged between 25 and 35. Barriers, enablers and knowledge of cervical screening were explored. Focus groups were recorded and transcribed for thematic analysis of common themes. A supporting online survey was completed by 98 respondents. Summary statistics were analysed for differences in age. RESULTS Focus groups and the online survey revealed four main factors that influence young people's cervical screening behaviour. These include past negative screening experiences, practitioner factors, priority placed on cervical screening, and cervical screening knowledge. These factors differ to the opinions of people older than 35, with young people focusing more on the psychological elements of cervical screening compared with practical factors. CONCLUSIONS This research provides a unique insight into cervical screening barriers faced by women and people with a cervix aged between 25 and 35 as well as what factors motivate them to screen. SO WHAT?: These findings should be utilised to inform the design of public health campaign messaging targeting this age demographic. Findings can also assist practitioners to improve how they communicate with young people in a clinical setting.
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Affiliation(s)
- Lauren Temminghoff
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Claire Russell
- Prevention Division, Cancer Council Victoria, Melbourne, Australia
| | - Tove Andersson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Kate Broun
- Prevention Division, Cancer Council Victoria, Melbourne, Australia
| | - Nikki McGrath
- Department of Health, Public Health Division, Melbourne, Australia
| | - Kerryann Wyatt
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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Bønløkke S, Blaakær J, Steiniche T, Iachina M. Social factors and age play a significant role in cervical cancer and advanced-stage disease among Danish women. BMC Cancer 2024; 24:259. [PMID: 38395802 PMCID: PMC10893677 DOI: 10.1186/s12885-024-11994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND For cervical cancer (CC), the implementation of preventive strategies has the potential to make cervical cancer occurrence and death largely avoidable. To better understand the factors possibly responsible for cervical cancer, we aimed to examine possible differences in age and social parameters as well as screening status between women with low- or high-stage cervical cancer and matched controls. METHODS Through the Danish Cancer Registry (DCR), women diagnosed with cervical cancer in Denmark between 1987 and 2016 were included. These were age- and residence-matched in a 1:5 ratio with controls from the general female population. The study population was sub grouped into a low-stage subpopulation with women with early-stage cervical cancer and matched controls and a high-stage subpopulation with women with late-stage cervical cancer and matched controls. Age and social parameters were compared within the subpopulations as well as between low- and high-stage cases. For part of the study population, screening attendance was examined to compare differences in adherence. RESULTS Overall, we found that the risk of cervical cancer is significantly increased in socially disadvantaged women and not least non-attenders in screening. Interestingly, the high-stage subpopulation was significantly older than the low-stage subpopulation (p < 0.001), and when examining the impact of age further, we found that for cervical cancer cases, the risk of having low-stage disease decreases significantly with increasing age, whereas the risk of having high-stage disease increases significantly with increasing age. In the screening cohort, significantly less cases than controls were attenders in screening with the most pronounced differences seen in the old subpopulation (women aged 50-64 years) and in the high-stage subpopulation (p-values all < 0.001). Interestingly, when examining the risk of CC for attenders and non-attenders, we demonstrated that many social parameters continue to influence the risk of cervical cancer, even in women attending screening. CONCLUSIONS Older women, socially disadvantaged women, and non-attenders in screening are particularly vulnerable in terms of developing cervical cancer, especially high-stage disease. Therefore, improvements in the participating rate in screening as well as a revision of the current screening guidelines are needed.
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Affiliation(s)
- Sara Bønløkke
- Department of Clinical Medicine - Department of Pathology, Aarhus University, Aarhus N, Denmark.
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
| | - Jan Blaakær
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Torben Steiniche
- Department of Clinical Medicine - Department of Pathology, Aarhus University, Aarhus N, Denmark
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Maria Iachina
- Department of Clinical Epidemiology, Odense University Hospital, Odense C, Denmark
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Urwin S, Gillibrand S, Davies JC, Crosbie EJ. Factors associated with cervical screening coverage: a longitudinal analysis of English general practices from 2013 to 2022. J Public Health (Oxf) 2024; 46:e43-e50. [PMID: 38148290 PMCID: PMC10939411 DOI: 10.1093/pubmed/fdad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Cervical cancer remains an important global public health concern. Understanding the factors contributing to a decline in screening uptake in high-income countries is fundamental to improving screening rates. We aimed to identify general practice and patient characteristics related to cervical screening coverage in England between 2013 and 2022. METHODS We analyzed a panel of 59 271 General Practice (GP)-years from 7881 GP practices. We applied correlated random effects regression to examine the association between cervical screening uptake and a rich set of GP practice workforce, size, quality and patient characteristics. RESULTS Our results show a decline in overall screening rates from 2013/14 to 2021/22 from 77% to 72%. We find GP workforce and list size characteristics are strongly related to screening rates. An increase in 1 FTE Nurse per 1000 patients is related to a 1.94 percentage point increase in cervical screening rates. GP practices located in more deprived areas have lower screening rates. CONCLUSIONS GP workforce and patient characteristics need to be considered by decision-makers to increase screening rates. The implementation of self-sampling screening methods could help address some of the current barriers to screening, including lack of healthcare staff and facilities.
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Affiliation(s)
- Sean Urwin
- Health Organisation, Policy and Economics Group, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Stephanie Gillibrand
- Health Organisation, Policy and Economics Group, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Jennifer C Davies
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Emma J Crosbie
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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Wearn A, Shepherd L. Determinants of routine cervical screening participation in underserved women: a qualitative systematic review. Psychol Health 2024; 39:145-170. [PMID: 35296200 DOI: 10.1080/08870446.2022.2050230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Routine, population-wide cervical screening programmes reduce cervical cancer incidence and mortality. However, socioeconomically deprived communities and ethnic minority groups typically have lower uptake in comparison to the general population and thus are described as 'underserved.' A systematic qualitative literature review was conducted to identify relevant determinants of participation for these groups. METHODS Online databases were searched for relevant literature from countries with well-established, call-recall screening programmes. Overall, 24 articles were eligible for inclusion. Data was synthesized via Framework synthesis. Dahlgren & Whitehead's social model of health was used as a broad a priori coding framework. RESULTS Participation was influenced by determinants at multiple levels. Overall, patient-provider relationships and peer support facilitated engagement. Cultural disparities, past healthcare experience and practical barriers hindered service access and exacerbated negative thoughts, feelings and attitudes towards participation. Complex interrelationships between determinants suggest barriers have a cumulative effect on screening participation. CONCLUSIONS These findings present a framework of psychosocial determinants of cervical screening uptake in underserved women and emphasise the role of policy makers and practitioners in reducing structural barriers to screening services. Additional work, exploring the experience of those living within socioeconomically disadvantaged areas, is needed to strengthen understanding in this area.
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Affiliation(s)
- Angela Wearn
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Lee Shepherd
- Department of Psychology, Northumbria University, Northumberland Building, Newcastle Upon Tyne, UK
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Wilding S, O'Connor DB, Conner M. Social Norms in Cervical Cancer Screening. Psychol Rep 2023:332941231219943. [PMID: 38048215 DOI: 10.1177/00332941231219943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Cancer screening aims to check the body for cancer before symptoms develop. Social norms theory suggests people falsely perceive the attitudes and/or behaviours of similar others to be different from their own and correcting these perceptions can lead to behaviour change. Across two studies, we tested if women underestimate peer levels of cervical screening behaviour and whether a social norms manipulation increases intention to attend cervical cancer screening. In study 1, participants completed a survey on cervical cancer screening norms. In study 2, participants were randomised to receive no norm information, norm information, or norm information plus statement on value of norms in decision making. In study 1, participant estimates of peer level of cervical screening behaviour were significantly lower than nationally reported levels. In study 2, a social norm plus value statement intervention led to stronger intentions to attend screening. This effect was consistent across demographic factors and screening status. Participants significantly underestimate rates of cervical screening behaviour in their peers. A brief, online social norms plus values manipulation increased intentions to attend cervical cancer screening across all groups.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | | | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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Devotta K, Vahabi M, Prakash V, Lofters AK. Implementation of a Cervical Cancer Screening Intervention for Under- or Never-Screened Women in Ontario, Canada: Understanding the Acceptability of HPV Self-Sampling. Curr Oncol 2023; 30:6786-6804. [PMID: 37504357 PMCID: PMC10378307 DOI: 10.3390/curroncol30070497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
With appropriate screening, cervical cancer can be prevented. In Ontario, Canada, some groups of women have low screening rates. South Asian, Middle Eastern and North African women are particularly at risk of under-screening. Currently, cytology-based screening is used in Ontario, although the growing evidence and adoption of HPV testing for cervical screening has encouraged many jurisdictions around the world to move towards HPV testing, with the option of self-sampling. We conducted an intervention beginning in June 2018, where we recruited over 100 under- or never-screened (UNS) women who identify as South or West Asian, Middle Eastern or North African from the Greater Toronto Area, to understand the uptake and acceptability of HPV self-sampling as an alternative to a Pap test. Participants self-selected if they tried the kit or not and completed both quantitative and qualitative research activities. This paper focuses on the qualitative arm of the study, where follow-ups and five focus groups were conducted with those who tried the kit (three groups) and those who did not (two groups), as well as eight key informant interviews with community champions and others who were involved in our recruitment. We used the Consolidated Framework for Implementation Research (CFIR) to guide our data collection and analysis. Major themes around convenience, privacy and comfort came from the data as important drivers of the uptake of the intervention. The role of community champions and peers in engaging and educating UNS women, as well as having self-confidence to collect the sample, also came out as factors impacting uptake and plans for continued use. Overall, the intervention showed that HPV self-sampling is an acceptable alternative to a Pap test for some but not all UNS women in Ontario.
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Affiliation(s)
- Kimberly Devotta
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5, Canada
| | - Vijayshree Prakash
- WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5, Canada
| | - Aisha K Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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Gao X, Zhang W, Sun J, Adeloye D, Jin H, Rudan I, Song P, Jin M. Lifetime prevalence and adherence rate of cervical cancer screening among women living with HIV: a systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26090. [PMID: 37247380 DOI: 10.1002/jia2.26090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Women living with HIV (WLWH) are more likely to develop cervical cancer. Screening and available healthcare can effectively reduce its incidence and mortality rates. We aimed to summarize the lifetime prevalence and adherence rate of cervical cancer screening among WLWH across low- and middle-income countries (LMICs), and high-income countries (HICs). METHODS We systematically searched PubMed, Web of Science and Embase for studies published between database inception and 2 September 2022, without language or geographical restrictions. Those reporting the lifetime prevalence and/or adherence rate of cervical cancer screening among WLWH were included. Pooled estimates across LMICs and HICs were obtained using DerSimonian-Laird random-effects models. When the number of eligible studies was greater than 10, we further conducted stratified analyses by the World Health Organization (WHO) region, setting (rural vs. urban), investigation year, screening method, type of cervical cancer screening programme, age and education level. RESULTS Among the 63 included articles, 26 provided data on lifetime prevalence, 24 on adherence rate and 13 on both. The pooled lifetime prevalence in LMICs was 30.2% (95% confidence interval [CI]: 21.0-41.3), compared to 92.4% in HICs (95% CI: 89.6-94.6). The pooled adherence rate was 20.1% in LMICs (95% CI: 16.4-24.3) and 59.5% in HICs (95% CI: 51.2-67.2). DISCUSSION There was a large gap in cervical cancer screening among WLWH between LMICs and HICs. Further analysis found that those in LMICs had higher lifetime prevalence in subgroups with urban settings, with older age and with higher education levels; and those in HICs had higher adherence in subgroups with younger age and with higher education levels. CONCLUSIONS Cervical cancer screening among WLWH falls considerably short of the WHO's goal. There should be continuous efforts to further increase screening among these women, especially those residing in the rural areas of LMICs and with lower education levels.
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Affiliation(s)
- Xiangrong Gao
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wanting Zhang
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyi Sun
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Davies Adeloye
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Huyi Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Peige Song
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mingjuan Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wilding S, Wighton S, West R, Conner M, O'Connor DB. A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake. Soc Sci Med 2023; 322:115800. [PMID: 36858020 DOI: 10.1016/j.socscimed.2023.115800] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3-5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up. METHODS 14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks. RESULTS Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06). CONCLUSION The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Wighton
- NHS England and NHS Improvement (North East & Yorkshire), UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK.
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Devotta K, Vahabi M, Prakash V, Lofters A. Reach and effectiveness of an HPV self-sampling intervention for cervical screening amongst under- or never-screened women in Toronto, Ontario Canada. BMC Womens Health 2023; 23:36. [PMID: 36698140 PMCID: PMC9876406 DOI: 10.1186/s12905-023-02174-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cervical cancer is almost entirely preventable with appropriate and timely screening. In Ontario, Canada, South Asian, Middle Eastern and North African women have some of the lowest rates of screening and a suggested higher burden of cervical cancer. With increasing international evidence and adoption of HPV testing, many screening programs are making the move away from Pap tests and towards HPV testing with the option of HPV self-sampling seeming promising for under- or never-screened (UNS) women. Our study aimed to understand the uptake and acceptability of an HPV self-sampling intervention amongst these disproportionately UNS women in Peel region and surrounding areas in Ontario. METHODS A community -based mixed methods approach guided by the RE-AIM framework was used to recruit approximately 100 UNS racialized immigrant women aged 30-69, during the period of June 2018 to December 2019. The main recruitment strategy included community champions (i.e. trusted female members of communities) to engage people in our selected areas in Peel Region. Participants completed a study questionnaire about their knowledge, attitudes and practices around cervical cancer screening, self-selected whether to use the HPV self-sampling device and completed follow-up questions either about their experience with self-sampling or going to get a Pap test. RESULTS In total, 108 women participated in the study, with 69 opting to do self-sampling and 39 not. The majority of women followed through and used the device (n = 61) and found it 'user friendly.' The experience of some participants suggests that clearer instructions and/or more support once at home is needed. Survey and follow-up data suggest that privacy and comfort are common barriers for UNS women, and that self-sampling begins to address these concerns. Across both groups addressing misinformation and misconceptions is needed to convince some UNS women to be screened. Family, friends and peers also seemed to play a role in the decision-making process. CONCLUSIONS HPV self-sampling is viewed as an acceptable alternative to a Pap test for cervical screening, by some but not all UNS women. This method begins to address some of the barriers that often prevent women from being screened and is already being offered in some jurisdictions as an alternative to clinical cervical cancer screening.
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Affiliation(s)
- Kimberly Devotta
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - Mandana Vahabi
- grid.68312.3e0000 0004 1936 9422Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Vijayshree Prakash
- grid.68312.3e0000 0004 1936 9422WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Aisha Lofters
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7 Canada
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Shamaun S, Jaleel R, Gull Y, Shahid A, Iqbal M, Qazi TN. Knowledge and Attitude of Cervical Cancer Screening and Vaccination in Patients Attending Gynecology Outpatient Clinic at a Tertiary Care Hospital in Pakistan. South Asian J Cancer 2023; 12:17-22. [PMID: 36851927 PMCID: PMC9966166 DOI: 10.1055/s-0042-1751093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Shamaila ShamaunBackground Cervical cancer is the third most prevalent female cancer in Pakistan; nearly 70% present at a very advanced stage of malignancy due to lack of awareness, proper screening, and vaccination. Therefore, we aimed to assess the knowledge and attitude toward screening, vaccination, and risk factors of cervical cancer in sexually active women of Pakistan. Methods This cross-sectional study was conducted at the gynecology outpatient clinic of a public sector hospital in Karachi, Pakistan, from December 2021 to March 2022. We included sexually active women with exception of diagnosed cases of cervical cancer, pregnancy, vaginal bleeding, and psychological disorder. Collected data were regarding demographic characteristics, awareness regarding cervical cancer, screening, human papillomavirus (HPV) vaccine, and risk factors, history of cervical screening, and wiliness to opt-in for cervical screening. Results We included 226 women with a mean age of 41.25 ± 10.54 years. The mean parity level was observed to be 3.8 ± 1.95. A majority of women were housewives by profession (88.9%) and uneducated (61.9%). Only 41.2% (93) of women were aware of cervical cancer, 33.6% (76) were aware of cervical screening, and only 15.9% (36) had a history of cervical screening. Only four women (1.8%) were aware of the HPV vaccine and 31% (70) showed intention to opt-in for cervical screening. A vast majority of women (96.9%) were not aware of the risk factors of cervical cancer. Conclusion(s) We have observed poor awareness regarding cervical cancer, HPV vaccination, and cervical screening among women in our population. Lack of awareness was not restricted to a certain segment but it prevails all across the demographic in our population.
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Affiliation(s)
- Shamaila Shamaun
- Dow International Medical College (DIMC)/Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Riffat Jaleel
- Dow International Medical College (DIMC)/Dow University of Health Sciences (DUHS), Karachi, Pakistan.,Dr Ruth KM Pfau Civil Hospital, Karachi, Pakistan
| | - Yasmeen Gull
- Meer Jam Ghulam Qadir Hospital Hub District, Lasbella Balochistan, Pakistan
| | - Afshan Shahid
- Dow International Medical College (DIMC)/Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Mehreen Iqbal
- Dow International Medical College (DIMC)/Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Tabinda Naseer Qazi
- Dow International Medical College (DIMC)/Dow University of Health Sciences (DUHS), Karachi, Pakistan
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13
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Wilding S, Prudenzi A, Conner M, O'Connor DB. Do reasoned action approach variables mediate relationships between demographics and cervical cancer screening intentions or behaviour? An online study of women from the UK. Soc Sci Med 2022; 313:115354. [PMID: 36191387 DOI: 10.1016/j.socscimed.2022.115354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/05/2022] [Accepted: 09/03/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In the UK, approximately 3,200 women are diagnosed with cervical cancer each year. Regular screening is one of the best ways to prevent cervical cancer from developing, yet screening rates are declining and vary by sociodemographic variables. The present stratified online study aimed to investigate relationships between sociodemographic factors and screening intentions and past behaviour. Reasoned Action Approach (RAA) variables were assessed as potential mediators. METHODS In total, 500 women living in the UK were recruited via an online research recruitment website to an online cross-sectional survey. Participant recruitment was stratified by age, socioeconomic status and ethnicity to ensure adequate representation of each strata. Participants completed measures on RAA variables (affective attitudes, cognitive attitudes, injunctive norms, descriptive norms, capability, autonomy, and intention) as well as screening past behaviour. RESULTS Among the demographic variables, age, ethnicity and deprivation were significantly related to screening intention. Younger women, those from less deprived areas, along with white women were more likely to report higher intentions to attend screening. Past behaviour was significantly negatively predicted by deprivation only, indicating that individuals from less deprived areas were more likely to be up to date with their screening. Both intention and past behaviour were significantly positively correlated with all RAA variables. Capability and cognitive attitude partially mediated the relationship between age and intention and fully mediated the relationship between ethnicity and intention. Capability fully mediated the relationships between deprivation and intention and between deprivation and past behaviour. CONCLUSION Intentions toward attending cervical cancer screening are related to age, ethnicity, and level of deprivation, with older women and those from areas of greater deprivation and ethnic minority groups reporting lower intentions. Capability (confidence engaging in cervical screening) and cognitive attitudes (how useful/beneficial screening is seen to be) are key variables to target to promote cervical screening attendance and reduce potential inequalities.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Arianna Prudenzi
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Mark Conner
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK.
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14
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Waite F, Marlow LAV, Nemec M, Waller J. Do age-targeted messages increase cervical screening intentions in women aged 50-64 years with weak positive intentions? A randomised control trial in Great Britain. Prev Med 2022; 164:107322. [PMID: 36330870 DOI: 10.1016/j.ypmed.2022.107322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/27/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Over 20% of women aged 50-64 in Britain have not attended cervical screening within the recommended 5-year interval. The aim of the present study was to investigate the impact of five messages, informed using strategies from the Behaviour Change Wheel, on strength of intention to attend cervical screening in women aged 50-64 with weak positive intentions to be screened when next invited. Women were randomised (2:2:1), into one of two intervention groups or a control group. The control group saw basic information about cervical screening. Intervention group 1 saw a social norms message and an outcome expectancy message. Intervention group 2 saw a risk reduction message and a response efficacy message. There was further randomisation within the two intervention groups (1:1) to test the effectiveness of message framing and age-targeted information. Lastly, both intervention groups were randomised (1:1) to see a message acknowledging the possible discomfort associated with screening and offering support, or the support message only. Data were included from 475 women, collected using an online survey in March 2022. Adjusting for baseline intention, social norms (p = .84), outcome expectancy (p = .51), risk reduction (p = .19), response efficacy (p = .23) and discomfort acknowledgement messages (p = .71) had no effect on intention strength. However, there was a significant increase in intention after reading multiple messages. These results suggest that although no single message has a significant impact on intentions, when combined, they may act together to increase intention strength. Further research will understand the impact of these messages when combined in information materials.
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Affiliation(s)
- Frances Waite
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, Hodgkin Building, Guy's Campus, London SE1 1UL, UK
| | - Laura A V Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, Hodgkin Building, Guy's Campus, London SE1 1UL, UK
| | - Martin Nemec
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, Hodgkin Building, Guy's Campus, London SE1 1UL, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, Hodgkin Building, Guy's Campus, London SE1 1UL, UK.
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15
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Knowledge, attitudes, and practices among Indonesian urban communities regarding HPV infection, cervical cancer, and HPV vaccination. PLoS One 2022; 17:e0266139. [PMID: 35552546 PMCID: PMC9098048 DOI: 10.1371/journal.pone.0266139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Few studies explored Indonesian understanding of cervical cancer (CC) and the human papillomavirus (HPV) vaccination. We aimed to investigate the association between knowledge, attitudes, and practices (KAP) and socio-demographical influences related to HPV, CC, and vaccination among Indonesian urban citizens. Methods We conducted an online survey during March 2020-August 2021 using the Snowball sampling technique. The socio-demographic characteristic and KAP responses were collected via Google Forms from 400 respondents in Jakarta. The knowledge and attitudes were divided into HPV and CC (aspect 1) and HPV vaccination (aspect 2). Correlation between KAP scores was performed using Spearman’s test, and multiple logistic regression analyses were conducted to determine KAP predictors. Results Indonesian urban citizens in Jakarta were found to have poor knowledge in individual aspects of the inquiry but moderate knowledge overall, good attitude in inquiry both in each aspect and overall, and unsatisfying practices. Overall, in the general population, men, and women respectively: 50.8%, 32.4%, and 53.6% had good knowledge; 82.0%, 75.2%, and 84.4% expressed positive attitude; and 30.3%, 15.2%, and 35.6% applied favorable practice regarding questions inquired. Knowledge was weakly correlated towards attitude (ρ = 0.385) but moderately correlated with practice (ρ = 0.485); attitude was moderately correlated with practice (ρ = 0.577), all results: p<0.001. Significant odds ratio (OR) for predictors to good knowledge were female sex (OR = 2.99), higher education (OR = 2.91), and higher mother’s education (OR = 2.15). Factors related to positive attitudes were higher mother’s education (OR = 4.13), younger age (OR = 1.86), and better results in the knowledge inquiries (OR = 2.96). Factors that suggested better practices were female sex (OR = 2.33), being employed (OR = 1.68), excellent knowledge scores (OR = 4.56), and positive attitudes expressions (OR = 8.05). Having done one vaccination dose and intention to receive vaccines were significantly influenced by good KAP. Conclusions KAP had inter-association to successful CC and HPV prevention programs, and socio-demographical characteristics are critical to influencing better KAP.
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Bravington A, Chen H, Dyson J, Jones L, Dalgliesh C, Bryan A, Patnick J, Macleod U. Translating qualitative data into intervention content using the Theoretical Domains Framework and stakeholder co-design: a worked example from a study of cervical screening attendance in older women. BMC Health Serv Res 2022; 22:610. [PMID: 35524217 PMCID: PMC9074234 DOI: 10.1186/s12913-022-07926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous screening interventions have demonstrated a series of features related to social determinants which have increased uptake in targeted populations, including the assessment of health beliefs and barriers to screening attendance as part of intervention development. Many studies cite the use of theory to identify methods of behaviour change, but fail to describe in detail how theoretical constructs are transformed into intervention content. The aim of this study was to use data from a qualitative exploration of cervical screening in women over 50 in the UK as the basis of intervention co-design with stakeholders using behavioural change frameworks. We describe the identification of behavioural mechanisms from qualitative data, and how these were used to develop content for a service-user leaflet and a video animation for practitioner training. The interventions aimed to encourage sustained commitment to cervical screening among women over 50, and to increase sensitivity to age-related problems in screening among primary care practitioners. METHODS Secondary coding of a qualitative data set to extract barriers and facilitators of cervical screening attendance. Barrier and facilitator statements were categorised using the Theoretical Domains Framework (TDF) to identify relevant behaviour change techniques (BCTs). Key TDF domains and associated BCTs were presented in stakeholder focus groups to guide the design of intervention content and mode of delivery. RESULTS Behavioural determinants relating to attendance clustered under three domains: beliefs about consequences, emotion and social influences, which mapped to three BCTs respectively: (1) persuasive communication/information provision; (2) stress management; (3) role modelling and encouragement. Service-user stakeholders translated these into three pragmatic intervention components: (i) addressing unanswered questions, (ii) problem-solving practitioner challenges and (iii) peer group communication. Based on (ii), practitioner stakeholders developed a call to action in three areas - clinical networking, history-taking, and flexibility in screening processes. APEASE informed modes of delivery (a service-user leaflet and a cartoon animation for practitioners). CONCLUSION The application of the TDF to qualitative data can provide an auditable protocol for the translation of qualitative data into intervention content.
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Affiliation(s)
- Alison Bravington
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.
| | - Hong Chen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Judith Dyson
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - Lesley Jones
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | | | | | - Julietta Patnick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
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17
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Marlow LAV, Nemec M, Vlaev I, Waller J. Testing the content for a targeted age-relevant intervention to promote cervical screening uptake in women aged 50-64 years. Br J Health Psychol 2022; 27:623-644. [PMID: 34339562 DOI: 10.1111/bjhp.12552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/06/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Low uptake of cervical screening in women in their 50s and 60s leaves them at elevated risk of cancer in older age. An age-targeted intervention could be an effective way to motivate older women to attend cervical screening. Our primary objective was to test the impact of different candidate messages on cervical screening intention strength. DESIGN A cross-sectional online survey with randomized exposure to different candidate messages. METHODS Women aged 50-64 years who were not intending to be screened when next invited were recruited through an online panel. Those meeting the inclusion criteria (n = 825) were randomized to one of three groups: (1) control group, (2) intervention group 1, (3) intervention group 2. Each intervention group saw three candidate messages. These included a descriptive social norms message, a diagram illustrating the likelihood of each possible screening outcome, a response efficacy message, a risk reduction message and an acknowledgement of the potential for screening discomfort. We tested age-targeted versions (vs. generic) of some messages. The primary outcome was screening intention strength. RESULTS After adjusting for baseline intention, social norms (p = .425), outcome expectancy (p = .367), risk reduction (p = .090), response efficacy (p = .136) and discomfort acknowledgement messages (p = .181) had no effect on intention strength. Age-targeted messages did not result in greater intention than generic ones. CONCLUSIONS There was no evidence that a single message used to convey social norms, outcome expectancy, risk reduction or response efficacy had an impact on intention strength for older women who did not plan to be screened in future.
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Affiliation(s)
- Laura A V Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, UK
| | - Martin Nemec
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, UK
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, UK
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18
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Woodcock EW. Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review. J Med Internet Res 2022; 24:e28323. [PMID: 35014968 PMCID: PMC8790681 DOI: 10.2196/28323] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/25/2021] [Accepted: 11/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background Appointment management in the outpatient setting is important for health care organizations, as waits and delays lead to poor outcomes. Automated patient self-scheduling of outpatient appointments has demonstrable advantages in the form of patients’ arrival rates, labor savings, patient satisfaction, and more. Despite evidence of the potential benefits of self-scheduling, the organizational uptake of self-scheduling in health care has been limited. Objective The objective of this scoping review is to identify and to catalog existing evidence of the barriers to and facilitators of self-scheduling for health care organizations. Methods A scoping review was conducted by searching 4 databases (PubMed, CINAHL, Business Source Ultimate, and Scopus) and systematically reviewing peer-reviewed studies. The Consolidated Framework for Implementation Research was used to catalog the studies. Results In total, 30 full-text articles were included in this review. The results demonstrated that self-scheduling initiatives have increased over time, indicating the broadening appeal of self-scheduling. The body of literature regarding intervention characteristics is appreciable. Outer setting factors, including national policy, competition, and the response to patients’ needs and technology access, have played an increasing role in influencing implementation over time. Self-scheduling, compared with using the telephone to schedule an appointment, was most often cited as a relative advantage. Scholarly pursuit lacked recommendations related to the framework’s inner setting, characteristics of individuals, and processes as determinants of implementation. Future discoveries regarding these Consolidated Framework for Implementation Research domains may help detect, categorize, and appreciate organizational-level barriers to and facilitators of self-scheduling to advance knowledge regarding this solution. Conclusions This scoping review cataloged evidence of the existence, advantages, and intervention characteristics of patient self-scheduling. Automated self-scheduling may offer a solution to health care organizations striving to positively affect access. Gaps in knowledge regarding the uptake of self-scheduling by health care organizations were identified to inform future research.
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Affiliation(s)
- Elizabeth W Woodcock
- Department of Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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19
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Landy R, Hollingworth T, Waller J, Marlow LA, Rigney J, Round T, Sasieni PD, Lim AW. Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial. Br J Gen Pract 2022; 72:e26-e33. [PMID: 34972808 PMCID: PMC8714504 DOI: 10.3399/bjgp.2021.0350] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cervical cancer disproportionately affects women ≥65 years, especially those not screened regularly. Speculum use is a key barrier. AIM To assess if offering non-speculum clinician-taken sampling and self-sampling increases uptake for lapsed attenders aged 50-64 years. DESIGN AND SETTING Pragmatic randomised control trial conducted at 10 general practices in East London, UK. METHOD Participants were 784 women aged 50-64 years, last screened 6-15 years before randomisation. Intervention participants received a letter offering the choice of non-speculum clinician- or self-sampling. Control participants received usual care. The main outcome measure was uptake within 4 months. RESULTS Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4% (n = 80/393) versus 4.9% in the control arm (n = 19/391, absolute difference 15.5%, 95% confidence interval [CI] = 11.0% to 20.0%, P<0.001). This was maintained at 12 months: intervention 30.5% (n = 120/393) versus control 13.6% (n = 53/391) (absolute difference 17.0%, 95% CI = 11.3% to 22.7%, P<0.001). Conventional screening attendance within 12 months was very similar for both intervention 12.7% (n = 50/393) and control 13.6% (n = 53/391) arms. Ethnic differences were seen in screening modality preference. More White women opted for self-sampling (50.7%, n = 38/75), whereas most Asian and Black women and those from other ethnic backgrounds opted for conventional screening. CONCLUSION Offering non-speculum clinician-taken sampling and self-sampling substantially increases uptake in older lapsed attendee women. Non-speculum clinician sampling appeals to women who dislike the speculum but still prefer a clinician to take their sample. Providing a choice of screening modality may be important for optimising cervical screening uptake.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, US
| | | | - Jo Waller
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Laura Av Marlow
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Jane Rigney
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London and National Cancer Analysis and Registration Service, Public Health England
| | - Peter D Sasieni
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Anita Ww Lim
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
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20
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O'Donovan B, Mooney T, Rimmer B, Fitzpatrick P, Flannelly G, Doherty L, Martin C, O'Leary J, O'Connor M, Sharp L. Advancing understanding of influences on cervical screening (non)-participation among younger and older women: A qualitative study using the theoretical domains framework and the COM-B model. Health Expect 2021; 24:2023-2035. [PMID: 34476875 PMCID: PMC8628586 DOI: 10.1111/hex.13346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective screening can prevent cervical cancer, but many women choose not to attend their screening tests. OBJECTIVE This study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM-B models of behaviour change. DESIGN A qualitative study and semistructured phone interviews were conducted with women invited for routine screening tests within the national cervical screening programme in Ireland. SETTING AND PARTICIPANTS Forty-eight women aged 25-65 years were recruited from the national screening register. RESULTS Seven core themes were identified that mapped to three COM-B components and 11 TDF domains: (1) knowledge of cervical cancer and screening, (2) coping with smear tests, (3) competing motivational processes-automatic and reflective, (4) cognitive resources, (5) role of social support, (6) environmental influences and (7) perceputal and practical influences. A range of knowledge about screening, perceived risk of cervical cancer and human papillomavirus infection was evident. Factors that influenced screening behaviours may be hierarchical-some were assigned greater importance than others. Positive screening behaviours were linked to autonomous motivation. Deficits in physical and psychological capability (inadequate coping skills) were barriers to screening, while physical and social opportunity (e.g. healthcare professional 'champions') could facilitate participation. Older women raised age-related issues (e.g. screening no longer necessary) and had more negative attitudes to screening, while younger women identified practical barriers. CONCLUSIONS This study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake. PATIENT OR PUBLIC CONTRIBUTION Women invited for screening tests through the national screening programme were interviewed. A Public & Patient Involvement (PPI) Panel, established to provide input into all CERVIVA research projects, advised the research team on recruitment materials and were given the opportunity to review and comment on the interview topic guide. This panel is made up of six women with various cervical screening histories and experiences.
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Affiliation(s)
| | - Therese Mooney
- Programme Evaluation Unit, National Screening Service, Dublin, Ireland
| | - Ben Rimmer
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Patricia Fitzpatrick
- Programme Evaluation Unit, National Screening Service, Dublin, Ireland.,School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | | | | | - Cara Martin
- Department of Histopathology, Trinity College, University of Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - John O'Leary
- Department of Histopathology, Trinity College, University of Dublin, Dublin, Ireland.,Department of Pathology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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21
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Understanding the Acceptability and Uptake of HPV Self-Sampling Amongst Women Under- or Never-Screened for Cervical Cancer in Toronto (Ontario, Canada): An Intervention Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179114. [PMID: 34501703 PMCID: PMC8430523 DOI: 10.3390/ijerph18179114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022]
Abstract
Cervical cancer remains a global public health concern, even though scientific advancements have made the disease almost entirely preventable. With the link between human papillomavirus (HPV) and cervical cancer, and the subsequent improvement in screening technology, there is potential to improve access and coverage of cervical screening with the introduction of HPV self-sampling. In Ontario, Canada, a province with a cytology-based screening program (i.e., Pap test), women who identify as South Asian, West Asian, Middle Eastern and North African have some of the lowest rates of screening, and research suggests they have a higher burden of cervical cancer. In this study, we will use both quantitative and qualitative methods to understand the acceptability and uptake of a take-home HPV self-sampling kit. Working with community champions—people with pre-existing connections with local groups—we will recruit women from these groups who are under- or never-screened for cervical cancer. Women will self-select whether they are in the group that tries HPV self-sampling or in the group that does not. We will aim for 100 women in each group. All participants will provide feedback on the feasibility, acceptability and preferences for cervical screening through a survey and phone follow-up. Women who self-select the HPV self-sampling group, will be followed up to find out if they followed through with self-sampling and to understand their experience using the device. Women who do not want to try self-sampling will be followed up to see if they went on to get a Pap test. The qualitative phase of this study consists of five focus groups with participants and semi-structured interviews with key informants in the community.
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22
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Mortensen JH, Bigaard J, Kvernrød AB. Young Danish HPV vaccinated women's knowledge, barriers and facilitators towards cervical cancer screening: A qualitative study. Prev Med Rep 2021; 24:101507. [PMID: 34430190 PMCID: PMC8365507 DOI: 10.1016/j.pmedr.2021.101507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 10/26/2022] Open
Abstract
Cervical cancer occurs more often in under-screened women, and participation rates in cervical cancer screening among young women are worryingly low worldwide. In Denmark only about half the women in their twenties participate in cervical cancer screening. 64-80% of women between 20 and 29 have been HPV vaccinated with a vaccine protecting against 70% of all cervical cancers. Thus screening is still an important supplement to HPV vaccination for the next decades. The aim of this study was to investigate knowledge, facilitators and barriers towards cervical cancer screening among young HPV vaccinated women in Denmark. This qualitative study used an anthropological approach, and data was collected using semi structured focus group interviews as this is an effective method for promoting self-disclosure among participants. Eight focus groups were conducted with participation of 49 HPV vaccinated women aged 20-29 years. We identified five main themes providing an understanding of the women's barriers and facilitators towards cervical cancer screening: Lack of knowledge about HPV and cervical cancer, the screening invitation, the GP as gatekeeper, the gynaecological examination and perceived relevance of cervical cancer screening. Former vaccination did not impact the women's reflection about screening attendance. We argue that systematic information and the attitude and tone of the GP are the primary facilitators for filling the knowledge gap we found among young HPV vaccinated women. As an important gatekeeper, the GP can explain, motivate and remind young women about the importance of a regular Pap smear.
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Affiliation(s)
- Julie Hedegaard Mortensen
- Danish Cancer Society, Department of Cancer Prevention and Information, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Janne Bigaard
- Danish Cancer Society, Department of Cancer Prevention and Information, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Ann-Britt Kvernrød
- Danish Cancer Society, Department of Cancer Prevention and Information, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
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23
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Groves S, Brooks J. What do young women below national screening age in England think about cervical cancer and cervical screening? A qualitative study. J Clin Nurs 2021; 31:1588-1597. [PMID: 34418192 DOI: 10.1111/jocn.16012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore what women aged below the national screening age in the UK know and think about cervical cancer and cervical screening. BACKGROUND The efficacy of cervical cancer screening is well established. However, cervical screening attendance in the United Kingdom has decreased, with especially low rates at the first screening opportunity at age 25. Research has not yet explored knowledge and beliefs underpinning young women's intention to screen before first screening invitation. DESIGN Qualitative exploratory study. METHODS Qualitative email interviews were undertaken with 16 participants, using questions derived from the Health Belief Model. Data were analysed using template analysis. The COREQ were followed. RESULTS Analysis generated three themes; (1) Learning about cervical cancer and cervical screening: sources of information and (missed) opportunities; (2) Young women know screening is important - but they don't always know why; (3) Screening intentions: a cost/benefit analysis of the available information. CONCLUSIONS Young women had varied knowledge and beliefs about cervical cancer and screening which were underpinned by several sources of information available to them. Most women expressed an intention to attend screening when invited; however, some participants were unsure, with low screening-based knowledge and low perceived susceptibility of cervical cancer identified as key barriers. Social media, familial interactions and interventions within education were highlighted as being suited to interventions aimed at increasing cervical cancer- and screening-based knowledge in young women. RELEVANCE TO CLINICAL PRACTICE Findings suggest that women below screening age could be better informed about cervical cancer and screening. Tailored interventions addressing common concerns and misconceptions around screening may be acceptable to young women and could help to promote screening attendance at first invitation.
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Affiliation(s)
- Samantha Groves
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, England
| | - Joanna Brooks
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, England
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Jillapalli R, Radhakrishnan K. Cervical Cancer Screening Behaviors Among Asian Indians in the United States: A Systematic Review. J Immigr Minor Health 2021; 24:779-789. [PMID: 34273046 DOI: 10.1007/s10903-021-01237-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
While Asian Indians (AIs) are the third fastest-growing Asian minority population in the United States, they fall short of the Healthy People cervical cancer screening target goals, with rates averaging 70% compared to 83% among non-Hispanic Whites. The purpose of this systematic review is to examine factors influencing cervical cancer screening behaviors among AIs in the US. Medline, CINAHL, PubMed, PsychINFO, and ProQuest databases were searched for qualitative and quantitative studies conducted between 1990 and 2017 that focused on cervical cancer screening behaviors among AIs in the US. The seven selected quantitative cross-sectional descriptive studies show that acculturation, length of stay in the US, age, education level, employment, cultural beliefs, and language influence cervical cancer screening behaviors among AIs in the US. Results from this systematic review inform development of culturally sensitive interventions to raise awareness and engagement in cervical cancer screening among AIs.
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Affiliation(s)
- Regina Jillapalli
- St. David's School of Nursing, Texas State University, 100 Bobcat Way, Round Rock, TX, 78665, USA.
| | - Kavita Radhakrishnan
- School of Nursing, University of Texas - Austin, 1710 Red River Street, Austin, TX, 78701-1499, USA
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Cyr PR, Pedersen K, Iyer AL, Bundorf MK, Goldhaber-Fiebert JD, Gyrd-Hansen D, Kristiansen IS, Burger EA. Providing more balanced information on the harms and benefits of cervical cancer screening: A randomized survey among US and Norwegian women. Prev Med Rep 2021; 23:101452. [PMID: 34221852 PMCID: PMC8242055 DOI: 10.1016/j.pmedr.2021.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022] Open
Abstract
Additional information did not impact intentions to participate in CC screening. Additional information increased uncertainty to seek precancer treatment in Norway. Women reported strong system-specific preferences for sources of information. Having a prior Pap-test was an important predictor of intentions-to-participate. Socioeconomic factors influenced follow-up intentions in the U.S. but not in Norway.
We aimed to identify how additional information about benefits and harms of cervical cancer (CC) screening impacted intention to participate in screening, what type of information on harms women preferred receiving, from whom, and whether it differed between two national healthcare settings. We conducted a survey that randomized screen-eligible women in the United States (n = 1084) and Norway (n = 1060) into four groups according to the timing of introducing additional information. We found that additional information did not significantly impact stated intentions-to-participate in screening or follow-up testing in either country; however, the proportion of Norwegian women stating uncertainty about seeking precancer treatment increased from 7.9% to 14.3% (p = 0.012). Women reported strong system-specific preferences for sources of information: Norwegians (59%) preferred it come from a national public health agency while Americans (59%) preferred it come from a specialist care provider. Regression models revealed having a prior Pap-test was the most important predictor of intentions-to-participate in both countries, while having lower income reduced the probabilities of intentions-to-follow-up and seek precancer treatment among U.S. women. These results suggest that additional information on harms is unlikely to reduce participation in CC screening but could increase decision uncertainty to seek treatment. Providing unbiased information would improve on the ethical principle of respect for autonomy and self-determination. However, the clinical impact of additional information on women’s understanding of the trade-offs involved with CC screening should be investigated. Future studies should also consider country-specific socioeconomic barriers to screening if communication re-design initiatives aim to improve CC screening participation.
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Affiliation(s)
- P R Cyr
- Department of Global Health and Community Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - K Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - A L Iyer
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - M K Bundorf
- Stanford School of Public Policy, Duke University, Durham, NC 27708 and NBER, United States
| | - J D Goldhaber-Fiebert
- Centers for Health Policy and Primary Care and Outcomes Research, Stanford Health Policy, Stanford University, Stanford, CA, United States
| | - D Gyrd-Hansen
- Danish Centre for Health Economic, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 1 Floor, 5000, Odense C, Denmark
| | - I S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
| | - E A Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1039 Blindern, 0318 Oslo, Norway
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Stuart G, D'Lima D. Perceived barriers and facilitators to attendance for cervical cancer screening in EU member states: a systematic review and synthesis using the Theoretical Domains Framework. Psychol Health 2021; 37:279-330. [PMID: 34121540 DOI: 10.1080/08870446.2021.1918690] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To identify and synthesise peer-reviewed, published literature reporting perceived barriers and facilitators associated with cervical cancer screening attendance in EU member states with organised population-based screening programmes. METHODS Quantitative and qualitative studies reporting perceived barriers/facilitators to attendance for cervical cancer screening were searched for in databases Embase, HMIC, Medline and PsycInfo. Data were extracted and deductively coded to the Theoretical Domains Framework domains and inductive thematic analysis within domains was employed to identify specific barriers or facilitators to attendance for cervical cancer screening. RESULTS 38 studies were included for data extraction. Five theoretical domains ['Emotion' (89% of the included studies), 'Social influences' (79%), 'Knowledge' (76%), 'Environmental Context and Resources' (74%) and 'Beliefs about Consequences' (68%)] were identified as key domains influencing cervical cancer screening attendance. CONCLUSION Five theoretical domains were identified as prominent influences on cervical cancer screening attendance in EU member states with organised population-based screening programmes. Further research is needed to identify the relative importance of different influences for different sub-populations and to identify the influences that are most appropriate and feasible to address in future interventions.
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Affiliation(s)
- Gabriella Stuart
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Ravindran R, Cotton S, Cruickshank M. Women's preferences for communication with the cervical screening programme: A qualitative study. Cytopathology 2021; 31:47-52. [PMID: 31677212 DOI: 10.1111/cyt.12783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Scotland, invitations and results for cervical screening are sent by post. We ask the question: is this an effective means of communication in the 21st century? Consideration of other ways of communicating with women may help to increase acceptability of the cervical screening programme. OBJECTIVE To explore perspectives of screening-eligible women, regarding methods for communication of invitations and results from the cervical screening programme to improve acceptability. METHODS A qualitative study design using semi-structured face-to-face or telephone interviews with women aged 25-65 years. Thirty interviews were directed using visual cues to generate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis of the data was conducted using a Framework approach. RESULTS The main advantage of the postal system is its perceived formality; however, its lack of speed was a concern. Advantages of e-communication included speed and convenience; however, concerns such as lack of confidentiality and access were mentioned. Telephone communication was deemed impractical, while face-to-face communication was highly regarded. Furthermore, the majority of participants felt screening appointments set at a specific date and time may improve uptake. Overall, participants believed there is no universal solution regarding the issue of communication. CONCLUSION At present, the postal system may be an appropriate method for invitation and results for cervical screening; however, there may be greater scope for preference of communication to improve the acceptability of the screening programme to women.
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Kirubarajan A, Leung S, Li X, Yau M, Sobel M. Barriers and facilitators for cervical cancer screening among adolescents and young people: a systematic review. BMC Womens Health 2021; 21:122. [PMID: 33757512 PMCID: PMC7989022 DOI: 10.1186/s12905-021-01264-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening as this population has historically been under-screened. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening (CCS) among adolescents and young people globally. METHODS We conducted a systematic review following PRISMA guidelines of three key databases: Medline-OVID, EMBASE, and CINAHL. Supplementary searches were done through ClinicialTrials.Gov and Scopus. Databases were examined from 1946 until the date of our literature searches on March 12th 2020. We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss CCS, were not specific to individuals under the age of 35, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. RESULTS Of the 2177 original database citations, we included 36 studies that met inclusion criteria. The 36 studies included a total of 14,362 participants, and around half (17/36, 47.2%) of studies specifically targeted students. The majority of studies (31/36, 86.1%) discussed barriers and facilitators to Pap testing specifically, while one study analyzed self-sampling (1/36, 2.8%), one study targeted HPV DNA testing (1/36, 2.8%), and the remainder (4/36, 11.1%) were not specified. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and systemic barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. CONCLUSION There are unique barriers and facilitators that affect CCS rates in adolescents and young people. Health systems and healthcare providers worldwide should address the challenges for this unique population.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Shannon Leung
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Xinglin Li
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Matthew Yau
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mara Sobel
- Department of Obstetrics and Gynecology, Sinai Health System, Toronto, ON, Canada
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Mao B, Kim S, Peng W. The Interplay between Message Framing and Message Recipients' Regulatory Focus in Promoting HPV Prevention Strategies. JOURNAL OF HEALTH COMMUNICATION 2021; 26:92-103. [PMID: 33709870 DOI: 10.1080/10810730.2021.1895918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Limited awareness and low uptake rate of Human papillomavirus (HPV) prevention strategies among females require the development of more effective educational interventions. Regulatory focus theory posits the matching of framing valence with the recipients' regulatory focus increases persuasiveness. Following regulatory focus theory, we examined how individual regulatory focus changed the effects of gain- and loss-framed messages on promoting consistent condom use and HPV DNA testing for HPV prevention. We also explored whether this interaction effect impacts the influences of target individuals' initial attitudes about condom use and HPV DNA testing on post attitudes and intentions. Results of Study 1 showed that, in general, the gain-framed message fit with regulatory focus (i.e., promotion focus) promoted more positive attitudes about consistent condom use than the gain-framed message nonfit with their regulatory focus (i.e., prevention focus).Nevertheless, the gain-framed message nonfit with regulatory focus (i.e., prevention focus) strengthened the negative relationship between initial attitudes and intentions, which promoted the intentions to use condom consistently among people who initially held negative attitudes toward consistent condom use. In Study 2, we did not observe a significant interaction effect of message framing and regulatory focus in the HPV DNA testing context. However, we observed that the gain-framed message nonfit with regulatory focus (i.e., prevention focus) led to the changes in the significance of the initial attitudes - post attitudes relationship from significant to non-significant. Thus, the reliance on initial negative attitudes about HPV DNA testing in decision-making decreased. Theoretical and practical implications of our research were discussed.
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Affiliation(s)
- Bingjing Mao
- Department of Communication Studies, University of Miami, Coral Gables, Florida, USA
| | - Soyoon Kim
- Department of Communication Studies, University of Miami, Coral Gables, Florida, USA
| | - Wei Peng
- Edward R. Murrow College of Communication, Washington State University, Pullman, Washington, USA
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Clark M, Jembere N, Wang L, Kupets R. Survival of Older Women With Cervical Cancer Based on Screening History. J Low Genit Tract Dis 2021; 25:9-14. [PMID: 33347044 DOI: 10.1097/lgt.0000000000000582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A population-level retrospective cohort study was conducted to determine the influence of cervical screening history on the survival from cervical cancer in women 50 years or older. METHODS The study included women diagnosed with invasive cervical cancer in Ontario, Canada, between 2005 and 2012, who were followed for at least 4 years. Screening history was observed for the 5 years before diagnosis. Health care administrative databases were linked to determine demographic, affiliation with primary care physicians, stage (available 2010-2012), treatment, and survival data. Kaplan-Meier and multivariate analyses were carried out to evaluate the impact of cervical screening on overall survival (OS). RESULTS There were eligible 1,422 women diagnosed with invasive cervical cancer between 2005 and 2012 of whom 566 had been screened within the 5 years before diagnosis. There were 856 women who did not undergo screening within the 5 years before diagnosis. Unscreened women were more likely to present with locally advanced disease (69.3%) compared with the screened women (42.9%). Four-year OS was significantly greater in the screened group (79.9% vs 58.2%). In our univariate analysis, screening was significantly related to survival (hazard ratio = 2.1, p < .01). In our multivariate analysis after adjusting for age, treatment, affiliation with a primary care physician, and income, screening was still significantly associated with improved survival (hazard ratio = 1.5, p < .01). CONCLUSIONS Our results demonstrate a survival benefit to screening in women 50 years or older who are diagnosed with cervical cancer. Screening participation must be encouraged in women older than 50 years as rates decline in this age group.
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Affiliation(s)
- Mitchell Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | | | - Li Wang
- Cancer Care Ontario, Toronto, Ontario, Canada
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Zodzika J, Krumina K, Jermakova I, Kojalo U, Plisko O, Santare D, Rezeberga D, Lazdane G. Post-reproductive aged women: a lost generation in the cervical cancer screening programme. EUR J CONTRACEP REPR 2020; 26:23-28. [PMID: 33124491 DOI: 10.1080/13625187.2020.1824269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aims of the study were to find out why some post-reproductive aged women did not participate in the organised cervical cancer screening programme in Latvia and to clarify factors that would motivate them to take part. METHODS A cross-sectional study was carried out between January and July 2017 among female patients in three general practitioner (GP) practices. GP practice nurses used the Latvian national health service database to identify women aged 25-70 who had not participated in the organised programme for the last 3 years. Participants were asked to complete a specially developed questionnaire. The results were then compared between three age groups: 25-34, 35-49 and 50-70 years. RESULTS Included in the study were 523 out of 992 women who had not attended screening; 41% were in the age group 50-70 years. Post-reproductive aged women statistically significantly more often did not take part in the programme because of lack of time (26.4%), too great a distance to the gynaecology screening clinic (10.4%), lengthy appointment waiting time (8.5%) and a belief that a smear test was unnecessary for them (8.5%); 32.1% of women in this age group indicated that if the cervical screen could be carried out by their GP it would facilitate their participation in the programme. CONCLUSION Post-reproductive aged women in Latvia often do not attend cervical cancer screening. Analysis of personal and organisational barriers confirmed that the involvement of GPs would encourage older women to participate in the organised screening programme.
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Affiliation(s)
- Jana Zodzika
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia.,Department of Gynaecology, Riga East University Hospital, Riga, Latvia
| | - Krista Krumina
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia.,Department of Gynaecology, Riga East University Hospital, Riga, Latvia
| | - Irina Jermakova
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia.,Department of Gynaecology, Riga East University Hospital, Riga, Latvia
| | - Una Kojalo
- Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Olga Plisko
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia
| | - Daiga Santare
- Science Division, Riga East University Hospital, Riga, Latvia.,Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Dace Rezeberga
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia.,Department of Gynaecology, Riga East University Hospital, Riga, Latvia
| | - Gunta Lazdane
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia.,Institute of Public Health, Riga Stradins University, Riga, Latvia
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Jolidon V, De Prez V, Willems B, Bracke P, Cullati S, Burton-Jeangros C. Never and under cervical cancer screening in Switzerland and Belgium: trends and inequalities. BMC Public Health 2020; 20:1517. [PMID: 33028278 PMCID: PMC7542418 DOI: 10.1186/s12889-020-09619-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background Research on inequalities in cervical cancer screening (CCS) participation has overlooked the distinction between ‘never-’ and ‘under-screeners’ while different socioeconomic and demographic determinants may underlie ‘non-’ and ‘under-’ screening participation. This study examines socioeconomic and demographic inequalities in never and under CCS participation. We compare cross-national prevalence and trends among these two groups in Switzerland and Belgium, two countries with similar opportunistic CCS strategy but different healthcare systems. Methods Data on 38,806 women aged 20–70 from the Swiss Health Interview Survey (1992–2012) and 19,019 women aged 25–64 from the Belgian Health Interview Survey (1997–2013), both population-based cross-sectional nationally representative surveys, was analysed. Weighted adjusted prevalence ratios were estimated with multivariate Poisson regressions. Results Over the studied period, never screening prevalence was about 15% in both Switzerland and Belgium and under screening prevalence about 14.0%. Socioeconomic gradients were found among both never- and under-screeners. Higher income women had lower never and under screening prevalence in Switzerland and a similar gradient in education was observed in Belgium. Importantly, distinct socioeconomic and demographic determinants were found to underlie never and under screening participation. Never screening was significantly higher among foreign nationals in both countries and this association was not observed in under screening. Never screening prevalence was lower among older age groups, while under screening increased with older age. Over time, age inequalities diminished among never- and under- screeners in Switzerland while educational inequalities increased among never-screeners in Belgium. Conclusion Findings revealed that determinants of screening inequalities differed among never- and under-screeners and hence these should be addressed with different public health strategies. Crucially, socioeconomic and demographic inequalities were more pronounced among never-screeners who appeared to face more structural and persistent inequalities. Differences between the two countries should also be noted. The more liberal-type Swiss healthcare systems appeared to shape income-related screening inequalities, while education appeared to be a stronger determinant of never- and under-screening in Belgium.
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Affiliation(s)
- Vladimir Jolidon
- Institute of Sociological Research, University of Geneva, 40 Bd du Pont-d'Arve, 1211, Genève 4, Switzerland.
| | - Vincent De Prez
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Barbara Willems
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Stéphane Cullati
- Institute of Sociological Research, University of Geneva, 40 Bd du Pont-d'Arve, 1211, Genève 4, Switzerland.,Population Health Laboratory, University of Fribourg, Rte des Arsenaux 41, 1700, Fribourg, Switzerland
| | - Claudine Burton-Jeangros
- Institute of Sociological Research, University of Geneva, 40 Bd du Pont-d'Arve, 1211, Genève 4, Switzerland
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Ryan M, Marlow L, Forster A, Ruwende J, Waller J. Offering an app to book cervical screening appointments: A service evaluation. J Med Screen 2020; 27:85-89. [PMID: 31500520 PMCID: PMC7222961 DOI: 10.1177/0969141319871312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the feasibility of offering women who are overdue for cervical screening the use of a smartphone app to book their appointment. METHODS Women who were at least six months overdue for cervical screening in three general practice surgeries in a deprived East London borough were identified from practice records. Staff sent batches of text messages informing women that they were overdue for screening, and inviting them to download an app to book their appointment. RESULTS Across the three practices, 2632 eligible women were identified. Valid mobile phone numbers were available for 1465 women. One woman had opted out of receiving text messages, so messages were sent to 1464 women. Of these, 158 (11%) booked a screening appointment within five months. The majority of these women booked without using the app (72%; 113/158); just over a quarter booked via the app (28%; 45/158). CONCLUSIONS Just over 10% of cervical screening non-attenders booked an appointment in response to a text message with a link to a downloadable app; however, only one in four of these women booked using the app. This suggests that the text message reminder was likely to have been the key 'active ingredient' for most women, rather than the app itself. Future research could explore the optimal message for a text reminder in this context and evaluate the inclusion of a link to existing online booking systems.
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Affiliation(s)
- Mairead Ryan
- Department of Behavioural Science and Health, UCL, London, UK
| | - Laura Marlow
- Department of Behavioural Science and Health, UCL, London, UK
| | - Alice Forster
- Department of Behavioural Science and Health, UCL, London, UK
| | | | - Jo Waller
- Department of Behavioural Science and Health, UCL, London, UK
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Mohd Suan MA, Tan WL, Ismail I, Abu Hassan MR. Perceived Deterrence Towards Colonoscopy for Colorectal Cancer Screening among Northern Malaysia Population: A Qualitative Study. Asian Pac J Cancer Prev 2020; 21:1253-1258. [PMID: 32458630 PMCID: PMC7541869 DOI: 10.31557/apjcp.2020.21.5.1253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with positive immunochemical faecal occult blood test results were found to have poor compliance for a subsequent colonoscopy procedure. This study was conducted to explore patients' perceived deterrence for colonoscopy following a positive stool test. METHODS Using qualitative study method, a phone interview was conducted with 16 patients to elicit their views on the reasons for failure to attend the colonoscopy procedure following a positive stool test. The interviews were audio recorded, transcribed verbatim and translated before proceeded with the data analysis. Content analysis was made on the translated interview, followed by systematic classification of data by major themes. RESULTS Reasons for nonattendance were categorized under five main themes; unnecessary test, fear of the procedure, logistic obstacles (subthemes; time constraint, transportation problem), social influences, and having other health priority. Lacking in information about the procedure during the referral process was identified to cause misperception and unnecessary worry towards colonoscopy. Fear of the procedure was commonly cited by female respondents while logistic issues pertaining to time constraint were raised by working respondents. CONCLUSIONS More effective communication between patients and health care providers are warranted to avoid misconception regarding colonoscopy procedure. Support from primary care doctors, customer-friendly appointment system, use of educational aids and better involvement from family members were among the strategies to increase colonoscopy compliance.
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Affiliation(s)
- Mohd Azri Mohd Suan
- Clinical Research Center, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Wei Leong Tan
- Kedah State Health Department, Alor etar, Kedah, Malaysia
| | - Ibtisam Ismail
- Clinical Research Center, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Center, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.,3Medical Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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Marlow LAV, Ryan M, Waller J. Increasing the perceived relevance of cervical screening in older women who do not plan to attend screening. Sex Transm Infect 2020; 96:20-25. [PMID: 31395750 PMCID: PMC7029243 DOI: 10.1136/sextrans-2019-054120] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/08/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Uptake of cervical screening among women aged 50-64 years is declining. Not feeling at risk because of current sexual behaviour is a reason some older women give for not being screened. We hypothesised that explaining the long interval between acquiring human papillomavirus (HPV) and developing cervical cancer would increase the relevance of screening in older women. METHODS Women aged 50-64 years (n=597) who did not intend to go for screening were recruited through an online panel and randomised to one of three information conditions: cause only (basic information about HPV and cervical cancer), cause with basic timeline (also read a sentence describing the long interval between acquiring HPV and developing cervical cancer) and cause with explicit timeline (read the same as the timeline group alongside an explanation of what this means for older women). Perceived risk of cervical cancer, screening intention strength and understanding of HPV were assessed preinformation and postinformation exposure. RESULTS Information condition was significantly associated with risk perceptions and intention strength postintervention (F(2,593)=6.26, p=0.002 and F(2,593)=4.98, p=0.007 respectively). Women in the cause with explicit timeline condition were more likely to increase their risk perceptions and intention strength compared with cause only (24% vs 9% and 25% vs 13% for risk perceptions and intention, respectively). In the cause with explicit timeline group, women with 4-10 lifetime partners had higher odds of increasing their perceived risk and intention strength postintervention compared with those with 0-1 partners (OR=2.27, 95% CI 1.01 to 5.12 and OR=3.20, 95% CI 1.34 to 7.67, respectively). CONCLUSIONS Providing a clear explanation that decouples women's perceived cervical cancer risk from their current sexual behaviour has the potential to increase perceived risk of cervical cancer and intentions to be screened among older women. Providing women with a clear cognitive representation of the aetiology of cervical cancer may be one approach to increasing screening uptake.
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Affiliation(s)
- Laura A V Marlow
- Department of Behavioural Science and Health, University College London, London, UK
| | - Mairead Ryan
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
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Campbell HE, Gray AM, Watson J, Jackson C, Moseley C, Cruickshank ME, Kitchener HC, Rivero-Arias O. Preferences for interventions designed to increase cervical screening uptake in non-attending young women: How findings from a discrete choice experiment compare with observed behaviours in a trial. Health Expect 2019; 23:202-211. [PMID: 31659850 PMCID: PMC6978852 DOI: 10.1111/hex.12992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Young women's attendance at cervical screening in the UK is continuing to fall, and the incidence of invasive cervical cancer is rising. OBJECTIVES We assessed the preferences of non-attending young women for alternative ways of delivering cervical screening. DESIGN Postal discrete choice experiment (DCE) conducted during the STRATEGIC study of interventions for increasing cervical screening uptake. Attributes included action required to arrange a test, location of the test, availability of a nurse navigator and cost to the National Health Service. SETTING AND PARTICIPANTS Non-attending young women in two UK regions. MAIN OUTCOME MEASURES Responses were analysed using a mixed multinomial logit model. A predictive analysis identified the most preferable strategy compared to current screening. Preferences from the DCE were compared with observed behaviours during the STRATEGIC trial. RESULTS The DCE response rate was 5.5% (222/4000), and 94% of respondents agreed screening is important. Preference heterogeneity existed around attributes with strong evidence for test location. Relative to current screening, unsolicited self-sampling kits for home use appeared most preferable. The STRATEGIC trial showed this same intervention to be most effective although many women who received it and were screened, attended for conventional cytology instead. CONCLUSIONS The DCE and trial identified the unsolicited self-sampling kit as the most preferred/effective intervention. The DCE suggested that the decision of some women receiving the kit in the trial to attend for conventional cytology may be due to anxieties around home testing coupled with a knowledge that ignoring the kit could potentially have life-changing consequences.
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Affiliation(s)
- Helen E Campbell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Judith Watson
- Department of Health Sciences, University of York, York, UK
| | - Cath Jackson
- Department of Health Sciences, University of York, York, UK
| | - Carly Moseley
- Institute of Cancer Sciences, The University of Manchester, St Mary's Hospital, Manchester, UK
| | | | - Henry C Kitchener
- Institute of Cancer Sciences, The University of Manchester, St Mary's Hospital, Manchester, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Lorenzi NPC, Termini L, Longatto Filho A, Tacla M, de Aguiar LM, Beldi MC, Ferreira-Filho ES, Baracat EC, Soares-Júnior JM. Age-related acceptability of vaginal self-sampling in cervical cancer screening at two university hospitals: a pilot cross-sectional study. BMC Public Health 2019; 19:963. [PMID: 31319838 PMCID: PMC6637504 DOI: 10.1186/s12889-019-7292-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether age is a barrier against acceptability of cervicovaginal self-sampling in screening for cervical cancer at two gynecology outpatient clinics. METHODS This is a cross-sectional study involving 116 women over 21 years of age with an abnormal Pap smear. Clinical and laboratorial data were recorded in electronic files. Women received detailed self-collection instructions. After the self-sampling procedure (Evalyn Brush®), women were instructed to answer a questionnaire about vaginal self-sampling acceptability that consisted of seven multiple-choice items. The participants were divided into three age brackets: 21 to 29 years, 30 to 49 years, and 50 years and over. Chi-square, Fischer exact, Kolmogorov-Smirnov and Kruskal-Wallis tests were used. RESULTS The analysis of the participants' perception of the procedure stratified according to age groups showed a decline in the fear of hurting oneself during the procedure as age increased. Most participants reported that it was very easy to understand how to use the self-sampling brush and that it was easy to use it. Most of them were neither embarrassed nor afraid of getting hurt during the procedure. The majority preferred self-sampling to collection by a healthcare professional. The main reason was practicality: the possibility of choosing the place and time for sampling. CONCLUSIONS The participating women found self-collection simple to understand and easy to accept regardless of age. The younger women indicated more fear and discomfort in self-sampling, which points to the need for attraction strategies that are more appealing to the younger generations.
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Affiliation(s)
| | - Lara Termini
- Center for Translational Investigation in Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Adhemar Longatto Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital/Pio XII Foundation, Barretos, SP, Brazil.,Department of Pathology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Research Institute of Life and Health Sciences (ICVS), University of Minho, Braga, Portugal.,8ICVS / 3B's - Associated Laboratory to the Government of Portugal, Braga / Guimarães, Portugal
| | - Maricy Tacla
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lana Maria de Aguiar
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana Carmezim Beldi
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Edson Santos Ferreira-Filho
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José Maria Soares-Júnior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Ryan M, Waller J, Marlow LA. Could changing invitation and booking processes help women translate their cervical screening intentions into action? A population-based survey of women's preferences in Great Britain. BMJ Open 2019; 9:e028134. [PMID: 31300499 PMCID: PMC6629419 DOI: 10.1136/bmjopen-2018-028134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/28/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Many women who do not attend screening intend to go, but do not get around to booking an appointment. Qualitative work suggests that these 'intenders' face more practical barriers to screening than women who are up-to-date ('maintainers'). This study explored practical barriers to booking a screening appointment and preferences for alternative invitation and booking methods that might overcome these barriers. DESIGN A cross-sectional survey was employed. SETTING Great Britain. PARTICIPANTS Women aged 25-64, living in Great Britain who intended to be screened but were overdue ('intenders', n=255) and women who were up-to-date with screening ('maintainers', n=359). RESULTS 'Intenders' reported slightly more barriers than 'maintainers' overall (mean=1.36 vs 1.06, t=3.03, p<0.01) and were more likely to think they might forget to book an appointment (OR=2.87, 95% CI: 2.01 to 4.09). Over half of women said they would book on a website using a smartphone (62%), a computer (58%) or via an app (52%). Older women and women from lower social grades were less likely to say they would use online booking methods (all ps <0.05). Women who reported two or more barriers were more likely to say they would use online booking than women who reported none (ps <0.01). CONCLUSIONS Women who are overdue for screening face practical barriers to booking appointments. Future interventions may assess the efficacy of changing the architecture of the invitation and booking system. This may help women overcome logistical barriers to participation and increase coverage for cervical screening.
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Affiliation(s)
- Mairead Ryan
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Laura Av Marlow
- Department of Behavioural Science and Health, University College London, London, UK
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Jalili F, O'Conaill C, Templeton K, Lotocki R, Fischer G, Manning L, Cormier K, Decker K. Assessing the impact of mailing self-sampling kits for human papillomavirus testing to unscreened non-responder women in Manitoba. ACTA ACUST UNITED AC 2019; 26:167-172. [PMID: 31285661 DOI: 10.3747/co.26.4575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background CervixCheck, Manitoba's cervical cancer screening program, conducted a pilot study to assess whether screening participation could be improved in unscreened women by offering a mailed self-sampling kit for human papillomavirus (hpv) testing instead of a Pap test. Methods In a prospective cohort study design, a sample of unscreened women (n = 1052) who had been sent an invitation letter from CervixCheck in the past but who did not respond were randomized to either an intervention group or a control group. The intervention group received a mailed hpv self-sampling kit; the control group received no additional communication. Returned hpv self-sampling swabs were analyzed by a provincial laboratory. After 6 months, screening participation in the two study groups was compared using a logistic regression model adjusted for age and area of residence (urban or rural). Secondary outcomes included hpv positivity, specimen inadequacy, compliance with follow-up, and time to colposcopy. Results Screening participation was significantly higher in the intervention group than in the control group (n = 51, 9.6%, vs. n = 13, 2.5%; odds ratio: 4.7; 95% confidence interval: 2.56 to 8.77). Geographic area of residence (urban or rural) and age were not statistically significant. Conclusions The study demonstrated that hpv self-sampling kits can enhance screening participation in unscreened non-responder women in the setting of an organized screening program. Next steps should include additional research to determine the best implementation strategy for hpv self-sampling in Manitoba.
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Affiliation(s)
- F Jalili
- CervixCheck, CancerCare Manitoba, MB
| | | | | | - R Lotocki
- CervixCheck, CancerCare Manitoba, MB
| | - G Fischer
- Diagnostic Services, Shared Health Manitoba, MB
| | - L Manning
- Diagnostic Services, Shared Health Manitoba, MB
| | - K Cormier
- Diagnostic Services, Shared Health Manitoba, MB
| | - K Decker
- Department of Community Health Sciences, University of Manitoba, MB.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB
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Marlow L, McBride E, Varnes L, Waller J. Barriers to cervical screening among older women from hard-to-reach groups: a qualitative study in England. BMC Womens Health 2019; 19:38. [PMID: 30808349 PMCID: PMC6390581 DOI: 10.1186/s12905-019-0736-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical screening attendance among 50-64 year-olds is suboptimal. Understanding attitudes to screening and reasons for non-attendance in older women will help to identify the content of interventions for this age group. This study aimed to explore barriers to cervical screening among women aged 50-64 years from hard-to-reach groups whose perspectives are often absent from research on cervical screening but are critical to developing appropriate interventions to increase engagement with the screening offer. METHODS Qualitative methodology was used. Six focus groups were carried out with women aged 50-64 years from lower socio-economic and ethnic minority backgrounds (n = 38). Focus group discussions were recorded, transcribed verbatim and translated where necessary. Data were analysed using the Framework Approach, a type of thematic analysis. RESULTS All women had heard of cervical screening, but many felt they had poor knowledge. Women's reasons for non-attendance were wide-ranging and included discomfort and embarrassment, negative perceptions of health professionals, worry and trust in the results, concern about the procedure, idiosyncratic beliefs, and extreme negative experiences. Some women reported not receiving letters or prompts to be screened. CONCLUSIONS Information designed specifically for older women should ensure they understand the purpose of screening and its relevance to them. Emphasising changes to the programme that have made the experience less uncomfortable, and improved sample taker awareness of how women feel, may help to allay concerns related to previous negative experiences.
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Affiliation(s)
- Laura Marlow
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Emily McBride
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Laura Varnes
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Jo Waller
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
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Freeman M, Waller J, Sasieni P, Lim AWW, Marlow LAV. Acceptability of non-speculum clinician sampling for cervical screening in older women: A qualitative study. J Med Screen 2018; 25:205-210. [PMID: 29439604 PMCID: PMC6262594 DOI: 10.1177/0969141318756452] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES One reason that women over age 50 report avoiding cervical screening is increased discomfort postmenopause. This study aimed to explore the acceptability of human papillomavirus testing on clinician-collected vaginal samples without a speculum ('non-speculum') for cervical screening among older women. METHODS Thirty-eight women in England aged 50-64 with a range of cervical screening experience ('up-to-date' n = 17, 'overdue screening' n = 18, 'never screened' n = 3) were identified via a recruitment agency. Women participated in focus groups or interviews about the potential for using clinician-collected samples without a speculum. Discussions were analysed using Framework Analysis. RESULTS The two main themes identified were women's perceptions of the speculum and attitudes towards non-speculum screening. Many women reported negative experiences with the speculum, including increased pain after the menopause. Women generally had positive attitudes towards non-speculum clinician sampling and felt it would be a less intrusive option, but expressed concern that it could be less accurate than screening with a speculum. Women who were 'up-to-date' preferred conventional screening, while overdue and never screened women welcomed the option to be screened without a speculum. CONCLUSIONS Human papillomavirus testing on non-speculum clinician-collected vaginal samples could be an acceptable alternative cervical screening method for older women. Offering this approach could increase screening uptake in older women who find conventional cervical screening to be less acceptable with ageing or the menopause.
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Affiliation(s)
- Madeleine Freeman
- Research Department of Behavioural Science and Health,
University College London, London, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health,
University College London, London, UK
| | - Peter Sasieni
- Barts & The London School of Medicine and Dentistry, Queen
Mary University of London, London, UK
| | - Anita WW Lim
- Barts & The London School of Medicine and Dentistry, Queen
Mary University of London, London, UK
| | - Laura AV Marlow
- Research Department of Behavioural Science and Health,
University College London, London, UK
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42
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Jradi H, Bawazir A. Knowledge, attitudes, and practices among Saudi women regarding cervical cancer, human papillomavirus (HPV) and corresponding vaccine. Vaccine 2018; 37:530-537. [PMID: 30503079 DOI: 10.1016/j.vaccine.2018.11.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/13/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
AIM To our knowledge there are no studies exploring Saudi women's understanding of the importance of the human papillomavirus (HPV) vaccine. In the present study, we examined the awareness of HPV and women's attitudes toward the HPV vaccine. METHOD Nine focus groups were formed in Riyadh City, Saudi Arabia, including 77 women between the ages of 18 and 45 years old. Face-to-face interviews were conducted in 58 female healthcare providers to examine women's awareness of cervical cancer, HPV, barriers, acceptance, beliefs, and attitudes towards the HPV vaccine. RESULTS Focus group discussions revealed a lack of knowledge and awareness of cervical cancer, HPV, and the HPV vaccine. Cultural concerns regarding screening and vaccinating for a conventionally known sexually transmitted infection were an emerging theme in addition to not perceiving cervical cancer screening as necessary because women with no signs and symptoms considered themselves not at risk for developing cervical cancer. Approximately 30% of healthcare providers other than physicians were unaware of prevention methods, and 63.3% did not practice any screening methods for cervical cancer and attributed the lack of screening to "no specific reasons at all". CONCLUSION Because of the unfavorable knowledge and attitude of HPV infection and the associated vaccine from the women in the present study, emphasis should be directed to educate and promote awareness of women to the risk factors of cervical cancer and to the need for screening programs and the administration of the vaccine.
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Affiliation(s)
- Hoda Jradi
- Public and Environmental Health, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Amen Bawazir
- Public and Environmental Health, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, National Guard Health Affairs, Riyadh, Saudi Arabia.
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O'Connor M, O'Leary E, Waller J, Gallagher P, Martin CM, O'Leary JJ, Sharp L. Socio-economic variations in anticipated adverse reactions to testing HPV positive: Implications for the introduction of primary HPV-based cervical screening. Prev Med 2018; 115:90-96. [PMID: 30144488 DOI: 10.1016/j.ypmed.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022]
Abstract
Some cervical cancer screening programmes are replacing cytology with human papillomavirus (HPV) DNA testing as the primary screening test. Concerns have been previously raised around the potential psychosocial impact of testing positive for HPV. We analysed socio-economic variations in anticipated adverse reactions to testing positive for HPV in women of screening age in the general population. A questionnaire was mailed to a random sample of 5553 women aged 20-64 in 2010, selected through primary care in Ireland. This included questions on: socio-economics; HPV knowledge; and women's anticipated adverse psychosocial responses to testing HPV positive (shame, anxiety, stigma and worry). Multivariable linear regression was used to identify socio-economic factors significantly associated with each anticipated adverse reaction. The response rate was 62% (n = 3470). In multivariate analyses, having only attained primary level education were significantly associated with higher mean scores for all four adverse outcomes. Religion was significantly associated with all four adverse outcomes. Age was associated with anxiety and worry; younger women (<30 years) had the highest mean scores. Being married/cohabiting was significantly associated with significantly lower shame and worry scores. Not working was significantly associated with higher mean anxiety and worry scores. Our large population-based survey found significant socio-economic variations in anticipated adverse reactions to testing HPV positive. In order to minimise possible negative impacts on screening uptake and alleviate potential adverse psychological effects of HPV-based screening on women, screening programmes may need to develop specific messages around HPV infection and HPV screening that target certain subgroups of women.
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Affiliation(s)
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Cara M Martin
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland, Ireland
| | - John J O'Leary
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, UK
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Ejegod DM, Pedersen H, Alzua GP, Pedersen C, Bonde J. Time and temperature dependent analytical stability of dry-collected Evalyn HPV self-sampling brush for cervical cancer screening. PAPILLOMAVIRUS RESEARCH 2018; 5:192-200. [PMID: 29689311 PMCID: PMC6026099 DOI: 10.1016/j.pvr.2018.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 12/20/2022]
Abstract
As a new initiative, HPV self-sampling to non-attenders using the dry Evalyn self-sampling brush is offered in the Capital Region of Denmark. The use of a dry brush is largely uncharted territory in terms of analytical stability. In this study we aim to provide evidence on the analytical quality of dry HPV self-sampling brushes as a function of time and temperature. We assessed the analytical stability of dry stored Evalyn brushes at three different temperatures, (4 °C, room temperature, 30 °C) and five different storage time points; T = 0 (baseline), 2, 4, 8, 16, and 32 weeks prior to HPV analysis using the BD Onclarity HPV assay. Mean Ct value of the Onclarity internal control was used as comparator of cellularity across time and temperatures, with no or only borderline statistical differences observed. HPV detection was stable throughout the five time points. In addition, analytically amplifiable DNA copy numbers and DNA fragmentation was assessed using the Agena iPLEX Exome QC assay, with no or only borderline statistical differences observed. In conclusion, the Evalyn brush is analytically stable with respect to human genomic material and HPV detection for up to 32 weeks at temperatures ranging from 4 °C to 30 °C. The Capital Region of Denmark is implementing HPV self-sampling using a dry brush. But how analytically stable is a dry collected self-sampling device? Stability was established for both human DNA (all, N = 637) and HPV (positives, N = 41). We found the Evalyn Self-sampling brush stable up to 6 month. Neither 4 °C nor 30 °C changed the analytical stability of the dry brush.
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Affiliation(s)
- Ditte Møller Ejegod
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
| | - Helle Pedersen
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Garazi Peña Alzua
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Camilla Pedersen
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark
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The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study. PLoS Med 2018; 15:e1002517. [PMID: 29509767 PMCID: PMC5839536 DOI: 10.1371/journal.pmed.1002517] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/25/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation. METHODS AND FINDINGS We developed a microsimulation model to estimate the health benefits (incident ischaemic heart disease, stroke, dementia, and lung cancer) of the NHS Health Check programme in England. We simulated a population of adults in England aged 40-45 years and followed until age 100 years, using data from the Health Survey of England (2009-2012) and the English Longitudinal Study of Aging (1998-2012), to simulate changes in risk factors for simulated individuals over time. We used recent programme data to describe uptake of NHS Health Checks and of 4 associated interventions (statin medication, antihypertensive medication, smoking cessation, and weight management). Estimates of treatment efficacy and adherence were based on trial data. We estimated the benefits of the current NHS Health Check programme compared to a healthcare system without systematic health checks. This counterfactual scenario models the detection and treatment of risk factors that occur within 'routine' primary care. We also explored the impact of making feasible changes to implementation of the programme concerning eligibility, uptake of NHS Health Checks, and uptake of treatments offered through the programme. We estimate that the NHS Health Check programme prevents 390 (95% credible interval 290 to 500) premature deaths before 80 years of age and results in an additional 1,370 (95% credible interval 1,100 to 1,690) people being free of disease (ischaemic heart disease, stroke, dementia, and lung cancer) at age 80 years per million people aged 40-45 years at baseline. Over the life of the cohort (i.e., followed from 40-45 years to 100 years), the changes result in an additional 10,000 (95% credible interval 8,200 to 13,000) quality-adjusted life years (QALYs) and an additional 9,000 (6,900 to 11,300) years of life. This equates to approximately 300 fewer premature deaths and 1,000 more people living free of these diseases each year in England. We estimate that the current programme is increasing QALYs by 3.8 days (95% credible interval 3.0-4.7) per head of population and increasing survival by 3.3 days (2.5-4.1) per head of population over the 60 years of follow-up. The current programme has a greater absolute impact on health for those living in the most deprived areas compared to those living in the least deprived areas (4.4 [2.7-6.5] days of additional quality-adjusted life per head of population versus 2.8 [1.7-4.0] days; 5.1 [3.4-7.1] additional days lived per head of population versus 3.3 [2.1-4.5] days). Making feasible changes to the delivery of the existing programme could result in a sizable increase in the benefit. For example, a strategy that combines extending eligibility to those with preexisting hypertension, extending the upper age of eligibility to 79 years, increasing uptake of health checks by 30%, and increasing treatment rates 2.5-fold amongst eligible patients (i.e., 'maximum potential' scenario) results in at least a 3-fold increase in benefits compared to the current programme (1,360 premature deaths versus 390; 5,100 people free of 1 of the 4 diseases versus 1,370; 37,000 additional QALYs versus 10,000; 33,000 additional years of life versus 9,000). Ensuring those who are assessed and eligible for statins receive statins is a particularly important strategy to increase benefits. Estimates of overall benefit are based on current incidence and management, and future declines in disease incidence or improvements in treatment could alter the actual benefits observed in the long run. We have focused on the cardiovascular element of the NHS Health Check programme. Some important noncardiovascular health outcomes (e.g., chronic obstructive pulmonary disease [COPD] prevention from smoking cessation and cancer prevention from weight loss) and other parts of the programme (e.g., brief interventions to reduce harmful alcohol consumption) have not been modelled. CONCLUSIONS Our model indicates that the current NHS Health Check programme is contributing to improvements in health and reducing health inequalities. Feasible changes in the organisation of the programme could result in more than a 3-fold increase in health benefits.
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Petkeviciene J, Ivanauskiene R, Klumbiene J. Sociodemographic and lifestyle determinants of non-attendance for cervical cancer screening in Lithuania, 2006–2014. Public Health 2018; 156:79-86. [DOI: 10.1016/j.puhe.2017.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/29/2017] [Accepted: 12/16/2017] [Indexed: 01/21/2023]
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Pedersen HN, Smith LW, Racey CS, Cook D, Krajden M, van Niekerk D, Ogilvie GS. Implementation considerations using HPV self-collection to reach women under-screened for cervical cancer in high-income settings. ACTA ACUST UNITED AC 2018; 25:e4-e7. [PMID: 29507489 DOI: 10.3747/co.25.3827] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The success of cytology (Pap screening) programs is undeniable and has drastically reduced cervical cancer rates in high-income settings where it has been implemented [...]
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Affiliation(s)
- H N Pedersen
- University of British Columbia, Vancouver, BC.,Women's Health Research Institute, Vancouver, BC
| | - L W Smith
- Women's Health Research Institute, Vancouver, BC.,BC Cancer Agency, Vancouver, BC; and
| | | | - D Cook
- BC Centre for Disease Control, Vancouver, BC
| | - M Krajden
- BC Centre for Disease Control, Vancouver, BC
| | | | - G S Ogilvie
- University of British Columbia, Vancouver, BC.,Women's Health Research Institute, Vancouver, BC
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Vahabi M, Lofters A. HPV self-sampling: A promising approach to reduce cervical cancer screening disparities in Canada. ACTA ACUST UNITED AC 2018; 25:13-18. [PMID: 29507479 DOI: 10.3747/co.25.3845] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Human papillomavirus (HPV) is the primary cause of cervical, anal, and other genital cancers, which are preventable through screening and early treatment. [...]
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Affiliation(s)
- M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Co- Director, Ryerson Centre for Global Health and Health Equity, Graduate Program in Immigration and Settlement Studies, Ryerson University, Toronto, ON
| | - A Lofters
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, and Department of Family and Community Medicine, University of Toronto, Toronto, ON
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Kitchener HC, Gittins M, Rivero-Arias O, Tsiachristas A, Cruickshank M, Gray A, Brabin L, Torgerson D, Crosbie EJ, Sargent A, Roberts C. A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC). Health Technol Assess 2018; 20:1-138. [PMID: 27632816 DOI: 10.3310/hta20680] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Falling participation by young women in cervical screening has been observed at a time that has seen an increase in the incidence of cervical cancer in the UK in women aged < 35 years. Various barriers to screening have been documented, including fear, embarrassment and inconvenience. OBJECTIVES To measure the feasibility, clinical effectiveness and cost-effectiveness of a range of interventions to increase the uptake of cervical screening among young women. DESIGN A cluster randomised trial based on general practices performed in two phases. SETTING Primary care in Greater Manchester and the Grampian region in Scotland. PARTICIPANTS Phase 1: 20,879 women receiving their first invitation for cervical screening. Phase 2: 10,126 women who had not attended by 6 months. INTERVENTIONS Phase 1: pre-invitation leaflet or not, and access to online booking (Manchester only). Phase 2: (1) vaginal self-sampling kits (SSKs) sent unrequested (n = 1141); or (2) offered on request (n = 1290); (3) provided with a timed appointment (n = 1629); (4) offered access to a nurse navigator (NN) (n = 1007); or (5) offered a choice between a NN or a SSK (n = 1277); and 3782 women in control practices. MAIN OUTCOME MEASURES Uplift in screening compared with control practices, cost-effectiveness of interventions, and the women's preferences explored in a discrete choice experiment. RESULTS The pre-invitation leaflet and offer of online booking were ineffective when compared with control practices at 3 months, 18.8% versus 19.2% [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.88 to 1.06; p = 0.485] and 17.8% versus 17.2% (OR 1.02, 95% CI 0.87 to 1.20; p = 0.802), respectively. The uptake of screening at 3 months was higher among previously human papillomavirus (HPV)-vaccinated women than unvaccinated women, 23.7% versus 11% (OR 2.07, 95% CI 1.69 to 2.53; p < 0.001). Among non-attenders, the SSK sent intervention showed a statistically significant increase in uptake at 12 months post invitation, 21.3% versus 16.2% (OR 1.51, 95% CI 1.20 to 1.91; p = 0.001), as did timed appointments, 19.8% versus 16.2% (OR 1.41, 95% CI 1.14 to 1.74; p = 0.001). The offer of a NN, a SSK on request, and a choice between timed appointments and NN were ineffective. Overall, there was a gradual rather than prompt response, as demonstrated by uptake among control practices. A discrete choice experiment indicated that women invited who had not yet attended valued the attributes inherent in self-sampling. The health economic analysis showed that both timed appointments and unsolicited SSK sent were likely to be cost-effective at a cost per quality-adjusted life-year (QALY) gained of £7593 and £8434, respectively, if extended across the national 25-year-old cohort throughout the duration of screening. The certainty of these being cost-effective at a ceiling ratio of £20,000 per QALY gained was > 90%. CONCLUSION Women receiving their initial screening invitation frequently delay taking up the offer and the net impact of interventions was small. Timed appointments and SSKs sent to non-attenders at 6 months are likely to be a cost-effective means of increasing uptake and should be considered further. HPV vaccination in the catch-up programme was associated with an increased uptake of cervical screening. Future work should focus on optimising self-sampling in terms of age range, timing of offer for non-attenders and use of urine testing instead of vaginal samples. TRIAL REGISTRATION Current Controlled Trials ISRCTN52303479. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 68. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Henry C Kitchener
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Matthew Gittins
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Margaret Cruickshank
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Loretta Brabin
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | | | - Emma J Crosbie
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Alexandra Sargent
- Virology Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Chris Roberts
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
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Tavasoli SM, Kane E, Chiarelli AM, Kupets R. Women's Behaviors Toward Mammogram and Pap Test: Opportunities to Increase Cervical Cancer Screening Participation Rates among Older Women. Womens Health Issues 2018; 28:42-50. [DOI: 10.1016/j.whi.2017.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/13/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022]
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