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Chua B, Ma V, Asjes C, Lim A, Mohseni M, Wee HL. Barriers to and Facilitators of Cervical Cancer Screening among Women in Southeast Asia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4586. [PMID: 33926019 PMCID: PMC8123618 DOI: 10.3390/ijerph18094586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/24/2021] [Accepted: 04/24/2021] [Indexed: 01/27/2023]
Abstract
In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection and treatment. Existing reviews on CCS have limited insights into the barriers and facilitators for SEA. Hence, this study aims to identify key barriers and facilitators among women living in SEA. A systematic literature review was conducted on Pubmed, Embase, PsycINFO, CINAHL, and SCOPUS. Primary qualitative and quantitative studies published in English that reported barriers and facilitators to CCS were included. The Mix Methods Appraisal Tool was used for the quality assessment of the included studies. Among the 93 included studies, pap smears (73.1%) were the most common screening modality. A majority of the studies were from Malaysia (35.5%). No studies were from Timor-Leste and the Philippines. The most common barriers were embarrassment (number of articles, n = 33), time constraints (n = 27), and poor knowledge of screening (n = 27). The most common facilitators were related to age (n = 21), receiving advice from healthcare workers (n = 17), and education status (n = 11). Findings from this review may inform health policy makers in developing effective cervical cancer screening programs in SEA countries.
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Affiliation(s)
- Brandon Chua
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore; (B.C.); (M.M.)
- Health Economics and Outcomes Research Centre of Excellence (Greater Asia), Becton, Dickinson and Company, 2 International Business Park Road, Singapore 609930, Singapore;
| | - Viva Ma
- Health Economics and Outcomes Research Centre of Excellence (Greater Asia), Becton, Dickinson and Company, 2 International Business Park Road, Singapore 609930, Singapore;
| | - Caitlin Asjes
- Government and Public Affairs, Becton, Dickinson and Company, 2 International Business Park Road, Singapore 609930, Singapore;
| | - Ashley Lim
- Department of Pharmacy, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;
| | - Mahsa Mohseni
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore; (B.C.); (M.M.)
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore; (B.C.); (M.M.)
- Faculty of Science, Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore
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Cervical Cancer Screening Behaviors Among Post-Menopausal Women. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.80026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yeo C, Fang H, Thilagamangai, Koh SSL, Shorey S. Factors affecting Pap smear uptake in a maternity hospital: A descriptive cross-sectional study. J Adv Nurs 2018; 74:2533-2543. [PMID: 29920737 DOI: 10.1111/jan.13769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022]
Abstract
AIM To understand factors that influence women's decisions to go for Pap smears. BACKGROUND Globally, cervical cancer is the fourth most common cancer among women. In Singapore, cervical cancer is on the rise and has been found to be the eighth highest cause of death among women. Research has shown that regular screening for cervical cancer with Pap smear reduces cervical cancer-related mortality. However, Pap smear awareness is still limited and its uptake in Singapore is highly opportunistic, requiring the need for a deeper understanding of the factors that influence Pap smear uptake among women in Singapore. DESIGN A descriptive cross-sectional study design was used. METHODS Convenience sampling was used to recruit 350 participants (postnatal women of at least 21 years old) from a local maternity hospital. Data were collected using validated questionnaires. Logistic regression was used to analyse the data. RESULTS Demographic factors, such as age, ethnicity and religion, as well as women's beliefs about the effectiveness of Pap smear in detecting cervical cancer, the desire to discover health problems early and considering Pap smear to be painful, were found to be factors significantly influencing Pap smear uptake. Healthcare professionals need to be mindful of these factors to address women's needs to encourage women to go for Pap smears. CONCLUSION Various factors were found to influence Pap smear uptake. Future interventions can take these factors into account for increasing Pap smear awareness.
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Affiliation(s)
- Celestine Yeo
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Huang Fang
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Thilagamangai
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Serena Siew Lin Koh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
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Hou SI. Subjective and Objective Cancer Screening Knowledge Among White- and Blue-Collar Chinese Midlife Adults. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:167-173. [PMID: 27565165 DOI: 10.1007/s13187-016-1104-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cancer is the leading cause of death among Chinese, yet little is known about cancer knowledge among this population. The study described the subjective and objective cancer screening knowledge among white- versus blue-collar Chinese midlife adults. A convenient sample of white-collar adults age 40+ years was recruited from government and academic agencies; and blue-collar adults age 40+ years were recruited from manufactory companies in Taiwan. An eight-item cancer screening knowledge test (CSKT) was used to measure objective knowledge and one five-point Likert scale item for assessing subjective (perceived) cancer screening knowledge. A total of 208 white- and 533 blue-collar workers completed the survey during 2008-2011. Mean ages between groups were comparable (41.1 versus 46.3 years), as well as family cancer history (41.5 %). About 76 % of the white-collar and 43 % of the blue-collar adults had college education. The mean score of the CSKT was lower in the blue-collar versus white-collar workers, 5.4 (SD = 1.76) versus 6.1 (SD = 1.40), indicating on average, 68 versus 76 % of the participants answered the cancer knowledge correctly. The subjective knowledge levels were, however, higher among the blue-collar workers (mean rating of 3.22 versus 2.78). The CSKT showed a good mix of relatively easy and moderately difficult items in both groups. Study showed that overall cancer screening knowledge was low among Chinese midlife adults. Although blue-collar workers scored lower on CSKT, the perceived knowledge level was higher. Results also suggest attention to communicating cancer screening information among Chinese blue-collar midlife workers in particular.
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Affiliation(s)
- Su-I Hou
- Doctoral Program in Public Affairs/Health Management & Informatics, College of Health & Public Affairs, University of Central Florida, HPA I, Room 217, 12805, Orlando, FL, 32816-1600, USA.
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Hou SI, Liu LJ. Objective and Subjective Cancer Knowledge Among Faith-Based Chinese Adults. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2018; 38:47-56. [PMID: 29298633 DOI: 10.1177/0272684x17749567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined cancer knowledge between church-going younger versus older Chinese adults. Hou's 8-item validated cancer screening knowledge test (CSKT) and a new 14-item cancer warning signs test (CWST) were used to assess objective knowledge. Subjective knowledge was measured by one overall 5-point Likert scale item. A total of 372 Taiwanese and Chinese Americans from nine churches participated. Although there were no significant differences by age on either the CSKT scores (younger = 5.89 vs. older = 5.71; p = .297) or the CWST (younger = 6.27 vs. older = 5.86; p = .245), subjective knowledge was higher among older Chinese adults (younger = 2.44 vs. older = 3.05, p < .001). Older Chinese adults were also more likely to identify cancer warning signs correctly, while younger adults were more likely to identify false warning signs correctly. Results have implication on tailoring cancer knowledge type (subjective vs. objective) and content domain (screening vs. warning signs). Findings can help health educators better understand cancer education needs among Chinese adults.
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Affiliation(s)
- Su-I Hou
- 1 50616 College of Health and Public Affairs, University of Central Florida , Orlando, FL, USA
| | - Ling Jie Liu
- 2 Department of Health Promotion and Behavior, College of Public Health, 1355 University of Georgia , Athens, GA, USA
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Kang KA, Kim SJ, Kaneko N. Factors influencing behavioral intention to undergo Papanicolaou testing in early adulthood: Comparison of Japanese and Korean women. Nurs Health Sci 2017; 19:475-484. [PMID: 28833987 DOI: 10.1111/nhs.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 11/29/2022]
Abstract
In this study, we identified the factors influencing behavioral intention to undergo Papanicolaou testing among Japanese and Korean women in early adulthood. Their behavioral intentions were compared in this cross-sectional descriptive study. In total, 887 women (Japanese = 498, Korean = 389) aged 20-39 years participated in this study. Using a self-report questionnaire, knowledge, attitudes, subjective norm, perceived behavioral control, and behavioral intention were surveyed. There were significant differences between Japanese and Korean women's scores on all main variables. For Japanese women, all the variables moderately correlated with behavioral intention. In comparison, for Korean women, all independent variables, except for knowledge, moderately correlated with behavioral intention. Through a multiple regression analysis, age, undergoing Papanicolaou testing, attitudes, subjective norm, and perceived behavioral control were identified as significant predictors of behavioral intention among Japanese women. Among Korean women, job status, undergoing a Papanicolaou test, attitudes, subjective norm, and perceived behavioral control were demonstrated as significant predictors of behavioral intention. Health professionals should consider these factors to encourage Papanicolaou testing in women in early adulthood.
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Affiliation(s)
- Kyung-Ah Kang
- Department of Nursing, Sahmyook University, Seoul, South Korea
| | - Shin-Jeong Kim
- Department of Nursing, Hallym University, Chuncheon, South Korea
| | - Noriyo Kaneko
- School of Nursing, Nagoya City University, Nagoya, Japan
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Bai Y, Liu Q, Chen X, Gao Y, Gong H, Tan X, Zhang M, Tuo J, Zhang Y, Xiang Q, Deng F, Liu G. Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women. Psychooncology 2017; 27:442-449. [PMID: 28749603 DOI: 10.1002/pon.4510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/14/2017] [Accepted: 07/21/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yang Bai
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Qing Liu
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Xinguang Chen
- School of Health Sciences; Wuhan University; Wuhan Hubei China
- Department of Epidemiology; University of Florida; Gainesville FL USA
| | - Yanduo Gao
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Huiyun Gong
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Xiaodong Tan
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Min Zhang
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Jiyu Tuo
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Yuling Zhang
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Qunying Xiang
- Maternal and Child Health Care Hospital; Wufeng Hubei China
| | - Fenghua Deng
- Maternal and Child Health Care Hospital; Wufeng Hubei China
| | - Guiling Liu
- Maternal and Child Health Care Hospital; Wufeng Hubei China
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Chan CWH, Choi KC, Wong RS, Chow KM, So WKW, Leung DYP, Lam WWT, Goggins W. Examining the Cervical Screening Behaviour of Women Aged 50 or above and Its Predicting Factors: A Population-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121195. [PMID: 27918456 PMCID: PMC5201336 DOI: 10.3390/ijerph13121195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/11/2016] [Accepted: 11/23/2016] [Indexed: 11/16/2022]
Abstract
Under-screening may increase the risk of cervical cancer in middle-aged women. This study aimed to investigate cervical cancer screening behaviour and its predictors among women aged 50 years or above. A population-based sample of 959 women was recruited by telephone from domestic households in Hong Kong, using random methods, and a structured questionnaire developed to survey participants. Multivariable logistic regressions were performed to examine the factors independently associated with cervical screening behaviour. Nearly half the sample (48%) had never had a cervical smear test. Multivariable analyses showed that age, educational level, marital status, family history of cancer, smoking status, use of complementary therapy, recommendation from health professionals, and believing that regular visits to a doctor or a Chinese herbalist were good for their health were predictors of cervical screening behaviour. Misconceptions concerned with menopause may reduce women's perceived susceptibility to cervical cancer, especially if they are 50 or above, and exert a negative effect on their screening behaviour. Healthcare professionals should actively approach these high-risk groups-older unmarried women, smokers, those less educated and who are generally not much concerned with their health.
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Affiliation(s)
- Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Rosa S Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Wendy W T Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China.
| | - William Goggins
- School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
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Knowledge of Cervical Cancer Screening among Women across Different Socio-Economic Regions of China. PLoS One 2015; 10:e0144819. [PMID: 26657110 PMCID: PMC4682831 DOI: 10.1371/journal.pone.0144819] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Background and Objective China has a high burden of cervical cancer (CC) and wide disparities in CC burden exist among different socio-economic regions. In order to reduce these disparities, China’s government launched the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in 2009. Understanding the factors associated with underutilization of CC screening among target populations is important to improve the screening participation rate, and a high participation rate is key to achieving the goals of a screening program. However, data on the knowledge of CC among target populations in program areas is lacking in China. This study will investigate the knowledge of CC prevention and control among women in specific project counties to develop a better understanding of factors that might influence CC screening participation in order to improve the implementation of the NCCSPRA. Materials and Methods A cross-sectional survey was conducted and face-to-face interview questionnaires were completed by 308 women who received CC screening services in 6 project counties of NCCSPRA across different socio-economic regions of China. ANOVA and Chi-square tests were used to compare the knowledge rates and scores across the different subgroups. Logistic regression was conducted to examine factors associated with knowledge level. Results The overall CC knowledge rate of the target population was only 19.5%. Regional socio-economic level, advice from doctors, age, and educational status were strong predictors of knowledge level of CC screening. Significantly lower knowledge rates and scores were identified in older women (55–64 years old), less educated women (with primary school or illiterate), women in less developed regions and women who did not receive any advice about screening results from doctors. Conclusion The knowledge of CC screening among women in the project counties of NCCSPRA was found to be very poor. Given the importance of knowledge in encouraging women to participate in screening is key to reducing CC burden in rural women in China, it is urgent that a targeted health promotion intervention is developed and implemented in project counties, especially targeting older women, women with less education and women in less developed regions, and focus on improving their CC knowledge and encouraging them to communicate with health care providers. The health promotion intervention targeting health care providers is also important to improve their knowledge of CC and provide best advice to women.
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Tay K, Tay SK, Tesalona KC, Rashid NMR, Tai EYS, Najib SJM. Factors affecting the uptake of cervical cancer screening among nurses in Singapore. Int J Gynaecol Obstet 2015; 130:230-4. [PMID: 26032624 DOI: 10.1016/j.ijgo.2015.03.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/03/2015] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify factors other than socioeconomic status that influence participation in cervical cancer screening. METHODS A prospective, questionnaire-based, cross-sectional study was conducted among all female nurses working at Singapore General Hospital, Singapore, between November 1 and December 15, 2013. Characteristics assessed included age, knowledge score (0-10, on the basis of 10 true-or-false statements), perceived risk of cervical cancer, and health facility use. RESULTS Among 2000 nurses, 1622 (81.1%) responded. The mean knowledge score was 4.70±1.76. Among 1593 nurses who reported on self-perception of risk, 97 (6.1%) reported high risk, 675 (42.4%) reported low risk, and 821 (51.5%) reported uncertainty. Of the 815 nurses reporting on their history of screening, 344 (42.2%) were screened regularly, 103 (12.6%) underwent opportunistic screening, and 368 (45.2%) had never undergone screening. The likelihood of screening was increased among women aged 35-4years, those who had recent experience of medical screening, those who had recently had a specialist consultation, or those who had recently had a consultation with a gynecologist (P<0.001 for all). Nurses undergoing regular screening reported positive effects of a doctor's recommendation, husband's encouragement, people talking about screening, and people close to the respondent undergoing screening. CONCLUSION Advocacy and herd signaling positively influenced the cervical cancer screening rate.
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Affiliation(s)
- Kaijun Tay
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Sun K Tay
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore.
| | | | - Nadia M R Rashid
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Esther Y S Tai
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Sitti J M Najib
- Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
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