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Rawl SM, Baltic R, Monahan PO, Stump TE, Hyer M, Ennis AC, Walunis J, Renick K, Hinshaw K, Paskett ED, Champion VL, Katz ML. Receipt, uptake, and satisfaction with tailored DVD and patient navigation interventions to promote cancer screening among rural women. Transl Behav Med 2023; 13:879-890. [PMID: 37708322 PMCID: PMC10724168 DOI: 10.1093/tbm/ibad054] [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] [Indexed: 09/16/2023] Open
Abstract
Process evaluation is essential to understanding and interpreting the results of randomized trials testing the effects of behavioral interventions. A process evaluation was conducted as part of a comparative effectiveness trial testing a mailed, tailored interactive digital video disc (DVD) with and without telephone-based patient navigation (PN) to promote breast, cervical and colorectal cancer screening among rural women who were not up-to-date (UTD) for at least one screening test. Data on receipt, uptake, and satisfaction with the interventions were collected via telephone interviews from 542 participants who received the tailored interactive DVD (n = 266) or the DVD plus telephone-based PN (n = 276). All participants reported receiving the DVD and 93.0% viewed it. The most viewed sections of the DVD were about colorectal, followed by breast, then cervical cancer screening. Most participants agreed the DVD was easy to understand, helpful, provided trustworthy information, and gave information needed to make a decision about screening. Most women in the DVD+PN group, 98.2% (n = 268), reported talking with the navigator. The most frequently discussed cancer screenings were colorectal (86.8%) and breast (71.3%); 57.5% discussed cervical cancer screening. The average combined length of PN encounters was 22.2 minutes with 21.7 additional minutes spent on coordinating activities. Barriers were similar across screening tests with the common ones related to the provider/health care system, lack of knowledge, forgetfulness/too much bother, and personal issues. This evaluation provided information about the implementation and delivery of behavioral interventions as well as challenges encountered that may impact trial results.
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Affiliation(s)
- Susan M Rawl
- Simon Comprehensive Cancer Center, School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Ryan Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Patrick O Monahan
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Timothy E Stump
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Madison Hyer
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alysha C Ennis
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jean Walunis
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - Karen Hinshaw
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Electra D Paskett
- College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Victoria L Champion
- School of Nursing, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Mira L Katz
- College of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Poon PKM, Tam KW, Lam T, Luk AKC, Chu WCW, Cheung P, Wong SYS, Sung JJY. Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk. Front Oncol 2023; 12:1053698. [PMID: 36686831 PMCID: PMC9850080 DOI: 10.3389/fonc.2022.1053698] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Background Low health literacy (HL) is negatively associated with mammography screening uptake. However, evidence of the links between poor HL and low mammography screening participation is scarce. Methods We conducted a cross-sectional questionnaire survey among participants of a cancer screening program. We measured HL using a validated Chinese instrument. We assessed breast cancer screening-related beliefs using the Health Belief Model and the accuracy of risk perception. We used multivariable regression models to estimate the relationship between HL and the outcomes. Results A total of 821 females were included. 264 (32.2%) had excellent or sufficient, 353 (43.0%) had problematic, and 204 (24.8%) had inadequate health literacy (IHL). Women with IHL were more likely to agree that high price (β = -0.211, 95% CI -0.354 to -0.069), lack of time (β = -0.219, 95% CI -0.351 to -0.088), inconvenient service time (β = -0.291, 95% CI -0.421 to -0.160), long waiting time (β = -0.305, 95% CI -0.447 to -0.164), fear of positive results (β = -0.200, 95% CI -0.342 to -0.058), embarrassment (β = -0.225, 95% CI -0.364 to -0.086), fear of pain (β = -0.154, 95% CI -0.298 to -0.010), fear of radiation (β = -0.177, 95% CI -0.298 to -0.056), lack of knowledge on service location (β = -0.475, 95% CI -0.615 to -0.335), and lack of knowledge on mammography (β = -0.360, 95% CI -0.492 to -0.228) were barriers. They were also less likely to have an accurate breast cancer risk perception (aOR 0.572, 95% CI 0.341 to 0.956). Conclusion Women with lower HL could have stronger perceived barriers to BC screening and an over-estimation of their breast cancer risk. Tackling emotional and knowledge barriers, financial and logistical assistance, and guidance on risk perception are needed to increase their breast cancer screening uptake.
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Affiliation(s)
- Paul K. M. Poon
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Paul K. M. Poon,
| | - King Wa Tam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Thomas Lam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Arthur K. C. Luk
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Polly Cheung
- Hong Kong Breast Cancer Foundation, Hong Kong, Hong Kong SAR, China
| | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Joseph J. Y. Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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HPV Testing Behaviors and Willingness to Use HPV Self-sampling at Home Among African American (AA) and Sub-Saharan African Immigrant (SAI) Women. J Racial Ethn Health Disparities 2022; 9:2485-2494. [PMID: 34780021 PMCID: PMC10060062 DOI: 10.1007/s40615-021-01184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND HPV self-sampling is an emerging HPV testing method that offers reliable identification of cervical precancer and cancer. To determine the feasibility of HPV self-sampling in the USA, information is needed regarding women's use of HPV test and willingness to use self-sampling, especially among disparate groups such as African American (AA) and sub-Saharan African immigrant (SAI) women. The purpose of this study was to examine factors associated with having had at least one HPV test and willingness to use HPV self-sampling among AA and SAI women. METHODS AA and SAI women (n = 91) recruited from community settings completed a survey in a cross-sectional study. Data included sociodemographics, HPV and HPV testing knowledge, and willingness to use a HPV self-sampling test at home. Logistic regressions were performed to evaluate associations with having had a HPV test and willingness to use self-sampling. RESULTS Respondents mean age was 38.2 years (SD = 12.6) and 65% were SAIs. The majority (84%) reported having had at least one Pap test and (36%) had at least one HPV test. Sixty-seven percent were willing to self-sample at home. Age, education, and HPV testing knowledge were associated with having had a HPV test. Being uninsured and likelihood to accept a Pap test if recommended were associated with willingness to use self-sampling at home for an HPV test. CONCLUSIONS Health care providers have an important role in recommending cervical cancer screening according to current guidelines. HPV self-sampling may be a promising strategy to reach older, less educated, uninsured, and underinsured Black women.
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Katz ML, Stump TE, Monahan PO, Emerson B, Baltic R, Young GS, Madison Hyer J, Paskett ED, Champion VL, Rawl SM. Factors associated with the accurate self-report of cancer screening behaviors among women living in the rural Midwest region of the United States. Prev Med Rep 2022; 30:102063. [PMID: 36531105 PMCID: PMC9747628 DOI: 10.1016/j.pmedr.2022.102063] [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: 06/13/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 11/22/2022] Open
Abstract
This study examines the accuracy of the self-report of up-to-date cancer screening behaviors (Mammography, Papanicolaou (Pap)/Human Papillomavirus (HPV) tests, Fecal Occult Blood Test (FOBT)/Fecal Immunochemical Test (FIT), Colonoscopy) compared to medical record documentation prior to eligibility determination and enrollment in a randomized controlled trial of an intervention to increase cancer screening among women living in rural counties of Indiana and Ohio. Women (n = 1,641) completed surveys and returned a medical record release form from November 2016-June 2019. We compared self-report to medical records for up-to-date cancer screening behaviors to determine the validity of self-report. Logistic regression models identified variables associated with accurate reporting. Women were up-to-date for mammography (75 %), Pap/HPV test (54 %), colonoscopy (53 %), and FOBT/FIT (6 %) by medical record. Although 39.6 % of women reported being up-to-date for all three anatomic sites (breast, cervix, and colon), only 31.8 % were up to date by medical records. Correlates of accurate reporting of up-to-date cancer screening varied by screening test. Approximately-one-third of women in rural counties in the Midwest are up-to-date for all three anatomic sites and correlates of the accurate reporting of screening varied by test. Although most investigators use medical records to verify completion of cancer screening behaviors as the primary outcome of intervention trials, they do not usually use medical records for the routine verification of study eligibility. Study results suggest that future research should use medical record documentation of cancer screening behaviors to determine eligibility for trials evaluating interventions to increase cancer screening.
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Affiliation(s)
- Mira L. Katz
- College of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Timothy E. Stump
- Department of Biostatistics, School of Medicine, Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, United States
| | - Patrick O. Monahan
- Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | - Brent Emerson
- College of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Ryan Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Gregory S. Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States
| | - J. Madison Hyer
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Electra D. Paskett
- College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Victoria L. Champion
- School of Nursing, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | - Susan M. Rawl
- School of Nursing, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
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Farr DE, Cofie LE, Brenner AT, Bell RA, Reuland DS. Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth. BMC Womens Health 2022; 22:125. [PMID: 35449050 PMCID: PMC9022316 DOI: 10.1186/s12905-022-01694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/31/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Colorectal cancer screening rates in the U.S. still fall short of national goals, while screening rates for other cancer sites, such as breast, remain high. Understanding characteristics associated with colorectal cancer screening among different groups of women adherent to breast cancer screening guidelines can shed light on the facilitators of colorectal cancer screening among those already engaged in cancer prevention behaviors. The purpose of this study was to explore which demographic characteristics, healthcare access factors, and cancer-related beliefs were associated with colorectal cancer screening completion among U.S. and foreign-born women adherent to mammography screening recommendations. Methods Analyses of the 2015 National Health Interview Survey were conducted in 2019. A sample of 1206 women aged 50–74 who had a mammogram in the past 2 years and were of average risk for colorectal cancer was examined. Logistic regression was used to determine demographic, health service, and health belief characteristics associated with colorectal cancer screening completion. Results Fifty-five percent of the sample were adherent to colorectal cancer screening recommendations. Women over the age of 65 (AOR = 1.76, 95% CI 1.06–2.91), with any type of health insurance, and who were bilingual (AOR = 3.84, 95% CI 1.83–8.09) were more likely to complete screening, while foreign-born women (AOR = 0.53, 95% CI 0.34–0.83) were less likely. Cancer-related beliefs did not influence adherence. Stratified analyses by nativity revealed additional associations. Conclusions Demographic and health service factors interact to influence colorectal cancer screening among women completing breast cancer screening. Colorectal cancer screening interventions targeting specific underserved groups and financing reforms may enhance women’s colorectal cancer screening rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01694-1.
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Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA.
| | - Leslie E Cofie
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA
| | - Alison T Brenner
- Department of Medicine, Department of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Daniel S Reuland
- Department of Medicine, Department of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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6
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Patterson JG, Borger TN, Burris JL, Conaway M, Klesges R, Ashcraft A, Hauser L, Clark C, Wright L, Cooper S, Smith MC, Dignan M, Kennedy-Rea S, Paskett ED, Anderson R, Ferketich AK. A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the "Break Free" program. Addict Sci Clin Pract 2022; 17:11. [PMID: 35164857 PMCID: PMC8842942 DOI: 10.1186/s13722-022-00295-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program. METHODS The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness. DISCUSSION Addressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer. Trial registration NCT04340531 (April 9, 2020).
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Affiliation(s)
- Joanne G Patterson
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Mark Conaway
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Robert Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Lindsay Hauser
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Connie Clark
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | | | - Sarah Cooper
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Merry C Smith
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Stephenie Kennedy-Rea
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Electra D Paskett
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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7
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Li T, Yoon J, Luck J, Bui LN, Harvey M. The Impact of Continuity of Care on Cervical Cancer Screening: How Visit Pattern Affects Guideline Concordance. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:30-36. [PMID: 32542438 DOI: 10.1007/s13187-020-01777-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cervical cancer can be prevented and highly curable if detected early. Current guidelines recommend women to receive cervical cancer screening starting at age 21. Our study aims to investigate how improving continuity of care (COC) may influence guideline concordance of cervical cancer screening. Using the eligibility and claims data, we created a person-month panel data set for women who were enrolled in Oregon Medicaid for at least 80% of the period from 2008 to 2015. We then selected our study cohort following the cervical cancer screening guidelines. Our dependent variable is whether a woman received cervical cancer screening concordant with guidelines in a given month, when she did not receive Pap test in the past 36 months and did not receive co-testing of HPV test plus Pap test in the past 60 months. We used both population-averaged logit model and conditional fixed-effect logit model to estimate the association between the guideline concordance and the COC index, after controlling for high risk, pregnancy, age, race, and ethnicity. A total of 466,526 person-month observations were included in our main models. A 0.1 unit increase of the COC score was significantly associated with a decrease in the odds of receiving guideline-concordant cervical cancer screening (population-averaged logit model: OR = 0.988, p < .001; conditional fixed-effect logit model: OR = 0.966, p < .001). Our findings remain robust to a series of sensitivity analyses. A better COC may not be necessarily beneficial to improving cervical cancer prevention. Educations for both physicians and patients should be supplemented to assure quality of preventive care.
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Affiliation(s)
- Tao Li
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA.
| | - Jangho Yoon
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA
| | - Jeff Luck
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA
| | - Linh N Bui
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA
- School of Pubic Health, University of California, Berkeley & Sutter Health Center for Health Systems Research, Berkeley, CA, USA
| | - Marie Harvey
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 458 Waldo Hall, 2250 SW Jefferson Way, Corvallis, OR, USA
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MacDonald M, Mirza AS, Mhaskar R, Ewing A, Chen L, Robinson K, Lu Y, Ayoubi N, Gonzalez E, Guerra L, Roetzheim R, Woodard L, Pabbathi S. Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors. Cancer Control 2022; 29:10732748211072983. [PMID: 35245986 PMCID: PMC8902193 DOI: 10.1177/10732748211072983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background There is limited research on screening rates among uninsured cancer
survivors. Uninsured cancer survivors are at higher risk of poorer health
outcomes than the insured due to limited access to preventative screening
for secondary cancers. This study examines the rates of surveillance and
screening of uninsured cancer survivors and compares to uninsured patients
without a cancer history seen in free clinics. Methods Data were collected retrospectively from electronic medical records and paper
charts of patients from 10 free clinics between January 2016 and December
2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics,
cancer diagnoses, and screening practices were compared for cancer survivors
and free clinic patients without a history of cancer. Study participants
were determined to be eligible for cancer screenings based on the United
States Preventive Services Task Force guidelines. Results Out of 13 982 uninsured patients frequenting free clinics between 2016 and
2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible
cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer
screening. Among the 170 female cancer survivors, 75 (44.1%) had completed
breast cancer screenings, and only 5.9% (59/246) had completed cervical
cancer screenings. After adjusting for age, gender, race, salary, employment
status, and household size, cancer survivors were more likely to undergo
colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer
screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer
history. This difference was not seen for cervical cancer screening (OR:
0.99, 95% CI: .62–1.58). Conclusions Uninsured cancer survivors frequenting free clinics represent a unique
population that is underrepresented in the medical literature. Our results
suggest that uninsured survivors use screening services at higher rates when
compared to uninsured patients without a reported cancer diagnosis. However,
these rates are suboptimal when compared to national screening rates of
insured cancer survivors.
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Affiliation(s)
- Madeline MacDonald
- 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Abu-Sayeef Mirza
- Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA
| | - Aldenise Ewing
- Health Outcomes and Behavior, 5301H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Liwei Chen
- Department of Medical Education, 7831University of South Florida, Tampa, FL, USA
| | - Katherine Robinson
- Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA
| | - Yuanyuan Lu
- College of Public Health, 7831University of South Florida, Tampa, FL, USA
| | - Noura Ayoubi
- 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Eduardo Gonzalez
- Department of Family Medicine, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Lucy Guerra
- Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA
| | - Richard Roetzheim
- Department of Medical Education, 7831University of South Florida, Tampa, FL, USA.,Department of Family Medicine, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Laurie Woodard
- Department of Medical Education, 7831University of South Florida, Tampa, FL, USA.,Department of Family Medicine, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Smitha Pabbathi
- Survivorship Clinic, 25301H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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9
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Robinson JK, Brown Z, Spring B. Melanoma Skin Self-Examination Education During Mammography: Health Burden of Women Impairs Implementation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:858-864. [PMID: 32090289 PMCID: PMC7483150 DOI: 10.1007/s13187-020-01714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Identification of barriers to seeking health care for a concerning mole found during skin self-examination (SSE) by women educated during screening mammography. In this sequential mixed methods research, interviews with women who found a concerning mole and did not have health-care follow-up were analyzed and a survey was created. One year after SSE education, barriers to having health care for a self-identified concerning mole were assessed. The electronic medical records for all participants, who received education, were reviewed to ascertain who received health care related to a concerning mole or a screening mammogram. Among the 280 women who performed SSE, 85 found a concerning mole. Nine months later 51 women did not receive health care for the mole. Barriers were the burden of other medical concerns, fear of what the doctor will find, feeling like nothing is wrong, and being too busy. A positive screening mammogram (Fisher's two-sided exact test, p < 0.001) and a history of indoor tanning (Fisher's two-sided exact test, p = 0.011) were significantly associated with lack of follow-up for a concerning mole. Targeted melanoma self-identification with SSE relies upon participants initiating performance and seeking medical care for a concerning mole. The burden of a positive screening mammogram reported to women at about the same time as they identified the concerning mole was associated with failing to seek care for their concerning mole. Reminders to check moles for change 4 months after identifying a concerning mole may benefit women. Clinicaltrials.gov NCT03512457.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 1050, Chicago, IL, 60611, USA.
| | - Zoe Brown
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 1050, Chicago, IL, 60611, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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10
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Unanue-Arza S, Solís-Ibinagagoitia M, Díaz-Seoane M, Mosquera-Metcalfe I, Idigoras I, Bilbao I, Portillo I. Inequalities and risk factors related to non-participation in colorectal cancer screening programmes: a systematic review. Eur J Public Health 2021; 31:346-355. [PMID: 33313657 PMCID: PMC8071594 DOI: 10.1093/eurpub/ckaa203] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Colorectal cancer (CRC) screening programmes require high levels of participation in order to reduce mortality. To improve participation rates, it is necessary to identify the health risk factors and social inequalities associated with non-participation. Methods A systematic review was conducted between June and September of 2019 in six databases: CINHAL, Medline, Scopus, Social Sciences Citation Index, Embase and PsycINFO. Studies assessing the relationship between health risk factors, participation in preventive activities and participation in CRC screening were included. Methodological assessment was carried out according to the Quality Assessment Tools of the National Heart, Lung and Blood Institute. Results A total of nine studies that analyze participation in both organized and opportunistic screening programmes using any type of screening method were finally selected. Data were mainly self-reported although in two studies medical records were also studied. We identified several variables: gender, body mass index, consultation with a doctor or a specialist, educational level, employment, health insurance, residence, ethnicity, age, marital status, income, other preventive activities, obesity, physical activity, smoking, family history of CRC and general health status. Conclusion The scarcity of studies linking risk factors, social inequalities and participation in preventive activities for participation in screening in the same study makes it difficult to reach definitive patterns related to non-participation in CRC screening programmes. Nevertheless, being under 60, obese, smoker and sedentary have shown an association with non-participation as well as not visiting a doctor.
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Affiliation(s)
- Saloa Unanue-Arza
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Bizkaia, Spain
- Correspondence: Saloa Unanue-Arza., Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Barrio Sarriena s/n 48940 Leioa, Bizkaia, Spain, Tel: +34 946 01 5610, e-mail:
| | | | - Marta Díaz-Seoane
- Department of Preventive Medicine and Public Health, University Clinical Hospital of Valladolid, Valladolid, Spain
| | | | - Isabel Idigoras
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Isabel Bilbao
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Isabel Portillo
- BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Basque Country Colorectal Cancer Screening Programme, Osakidetza, Basque Health Service, Bilbao, Spain
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11
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Changes in colorectal cancer knowledge and screening intention among Ohio African American and Appalachian participants: The screen to save initiative. Cancer Causes Control 2021; 32:1149-1159. [PMID: 34165662 PMCID: PMC8417011 DOI: 10.1007/s10552-021-01462-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/13/2021] [Indexed: 01/08/2023]
Abstract
African Americans and Appalachians experience greater incidence and mortality rates of colorectal cancer due to factors, such as reduced prevalence of screening. An educational session (the Screen to Save Initiative) was conducted to increase intent to screen for colorectal cancer among African Americans and Appalachians in Ohio. Using a community-based approach, from April to September 2017, 85 eligible participants were recruited in Franklin County and Appalachia Ohio. Participants completed a knowledge assessment on colorectal cancer before and after participating in either an educational PowerPoint session or a guided tour through an Inflatable Colon. Logistic regression models were used to determine what factors were associated with changes in colorectal cancer knowledge and intent to screen for colorectal cancer. The majority (71.79%) of participants gained knowledge about colorectal cancer after the intervention. Multivariate results showed that race (OR = 0.30; 95% CI: 0.11–0.80 for African Americans versus White participants) and intervention type (OR = 5.97; 95% CI: 1.94–18.43 for PowerPoint versus Inflatable Colon) were associated with a change in knowledge. The association between education and intent to screen was marginally statistically significant (OR = 0.42; 95% CI: 0.16–1.13 for college graduate versus not a college graduate). A change in colorectal cancer knowledge was not associated with intent to screen. Future educational interventions should be modified to increase intent to screen and screening for colorectal cancer. Further research with these modified interventions should aim to reduce disparities in CRC among underserved populations while listening to the voices of the communities.
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12
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Sung JJY, Luk AKC, Ng SSM, Ng ACF, Chiu PKF, Chan EYY, Cheung PSY, Chu WCW, Wong SH, Lam TYT, Wong SYS. Effectiveness of One-Stop Screening for Colorectal, Breast, and Prostate Cancers: A Population-Based Feasibility Study. Front Oncol 2021; 11:631666. [PMID: 33718212 PMCID: PMC7948441 DOI: 10.3389/fonc.2021.631666] [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: 11/20/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC), prostate cancer (PC) and breast cancer (BC) are among the most common cancers worldwide with well-established screening strategies. We aim to investigate the effectiveness and compliance of a one-stop screening service for CRC, PC and BC. Asymptomatic subjects aged 50–75 years were invited. Eligible subjects were offered fecal immunochemical test (FIT) for CRC screening. Serum prostate specific antigen (PSA) and Prostate Health Index (PHI) were offered for male PC screening and mammogram (MMG) for female BC screening as a one-stop service. Colonoscopy was offered to FIT+ subjects, prostate biopsy to PSA/PHI+ (PSA>10/PHI≥35) males and breast biopsy to MMG+ (Breast Imaging-Reporting and Data System, BI-RADS≥4) females. From August 2018 to April 2020, 3165 subjects were recruited. All participants (1372 men and 1793 women) were willing to accept FIT for CRC screening, and PSA/PHI test or MMG as second cancer screening. 102 subjects diagnosed advanced neoplasms after colonoscopy. Thirty-three males diagnosed PC after prostate biopsy and 15 females diagnosed BC after breast biopsy. No major complication reported in first tier screening tests. Subjects who were willing to undergo CRC screening were highly likely to accept other cancer screening when offered in a one-stop program. In conclusion, the effectiveness and compliance of a one-stop service for CRC, PC, and BC screening among asymptomatic subjects were high. Future studies should be conducted to test various ways of integrating cancer screening programs.
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Affiliation(s)
- Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Arthur K C Luk
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Simon S M Ng
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony C F Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Peter K F Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Emily Y Y Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Winnie C W Chu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny H Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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13
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Paolino M, Gago J, Pera AL, Cinto O, Thouyaret L, Arrossi S. Adherence to triage among women with HPV-positive self-collection: a study in a middle-low income population in Argentina. Ecancermedicalscience 2020; 14:1138. [PMID: 33281930 PMCID: PMC7685770 DOI: 10.3332/ecancer.2020.1138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Screening for cervical cancer (CC) prevention has substantially changed with the introduction of human papillomavirus (HPV) tests. This technology compared to cytology has increased the detection of pre-malignant and malignant cervical lesions in real-world programmes in different settings. Very importantly, through self-collection, HPV testing can reduce barriers to screening and increase coverage. However, when using HPV self-collection, triage tests are a key step in the CC prevention process, and high adherence to triage has been difficult to obtain in low-middle income settings. The aim of this study was to measure adherence to triage among women with HPV+ self-collection and analysed factors associated with this adherence in a middle-low resource setting in Argentina. We also evaluated key indicators related to the implementation of the HPV self-collection strategy. Methods We analysed data on screening/triage/diagnosis/treatment from women aged 30+ who performed self-collection between 2015 and 2017 (n = 15,763), in the public health system in Tucuman, Argentina. We analysed secondary data from the national screening information system. The primary outcomes were: 1) adherence to cytology triage within the recommended timeframe (120 days) and 2) overall adherence to cytology triage including data at 18 months after screening. Multivariable regression was used to examine the association between age group, year of the screening test, record of the previous Pap-based screening and health insurance status with adherence to triage test as a primary outcome. We reported odds ratios, 95% confidence intervals and p-value of 0.05, which was considered the threshold for p-values). Results We analysed data of 2,389 HPV+ women. The overall adherence to triage at 18 months was 42.9%. The percentage of women completing cytology triage within the recommended timeframe of 120 days was lower (25.2%). Women with the record of a previous Pap-based screening had 1.86 times the odds of having a triage compared to women without a record of a previous Pap-based screening (95% CI: 1.64–2.64, p <0.001). Furthermore, the probability of having triage at the recommended timeframe was higher among women who were older and women with public health insurance. Conclusions Our results showed that adherence to triage in the recommended timeframe was low. In addition, the probability of having triage at the recommended timeframe was higher among women with a record of a previous Pap-based screening, a proxy of the use of health services. Our results showed that adherence to triage in the context of the HPV-self-collection strategy is challenging. The implementation of alternative approaches that might facilitate adherence to triage should be further investigated.
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Affiliation(s)
- Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina.,https://orcid.org/0000-0002-8649-1570
| | - Juan Gago
- Department of Population Health, School of Medicine, New York University (NYU), 550 1st Avenue, New York, NY 10016, USA
| | - Anabella Le Pera
- Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Oscar Cinto
- Ministerio de Salud Pública de Tucumán, Av. República del Líbano 956, San Miguel de Tucumán, Tucumán, Argentina.,Retired
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Julio A, Roca 781, Piso 9, Buenos Aires 1067, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina.,https://orcid.org/0000-0002-5071-0938
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14
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Cox DAL, Heiney SP, Baliko B. Use of a Paper Checklist to Increase Clinician Adherence to Mammography Screening Guidelines. Nurs Womens Health 2020; 24:277-282. [PMID: 32663442 DOI: 10.1016/j.nwh.2020.05.003] [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] [Received: 05/06/2019] [Revised: 04/08/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To increase clinician adherence to mammography screening guidelines. DESIGN Quality improvement initiative. SETTING/LOCAL PROBLEM At a nurse practitioner-led primary care practice, a chart audit of adherence to American Cancer Society mammography screening guidelines indicated a 12% adherence rate for clinicians writing mammography orders. PARTICIPANTS Nurse practitioners providing care to women ages 40 years and older. INTERVENTION/MEASUREMENTS The intervention was a screening checklist that was completed by the woman at registration and given to the clinician during the examination. The pre- and postintervention measurement was the percentage of mammogram orders. A Fisher exact test was used to examine changes from pre- to postintervention rates of adherence. RESULTS After the intervention, the percentage of women for whom a mammogram was recommended and ordered was 69.6%, compared to 12% from the original chart audit. This change was statistically significant (p = .01). CONCLUSION Clinicians must find efficient approaches to improve processes within their practice settings to ensure that preventive care recommendations are made during visits. Although the screening checklist was deemed useful, improvement in adherence rates is still needed, and a paperless system should be initiated.
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15
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O'Connor EA, Vollmer WM, Petrik AF, Green BB, Coronado GD. Moderators of the effectiveness of an intervention to increase colorectal cancer screening through mailed fecal immunochemical test kits: results from a pragmatic randomized trial. Trials 2020; 21:91. [PMID: 31941527 PMCID: PMC6964086 DOI: 10.1186/s13063-019-4027-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background Colorectal cancer (CRC) screening rates remain suboptimal, particularly in low-income and underserved populations. Mailed fecal immunochemical testing (FIT) may overcome common barriers to screening; however, the effect of mailed FIT kits may differ across important subpopulations. The goal of the current study was to examine sociodemographic and health-related factors that moderate the effect of an intervention of automated direct mail of FIT kits at health clinics serving low-income populations. Methods This study is a secondary analysis of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) study, a cluster-randomized pragmatic trial to increase uptake of CRC screening in patients seen at federally qualified health centers. The intervention involved tools embedded in the electronic medical records to enable participating clinics to mail FIT kits and related materials to eligible participants. We examined the rate of FIT completion by potential moderating characteristics using electronic health record data supplemented by the American Community Survey and the Centers for Medicare & Medicaid Services Geographic Variation datasets, linked via geocoding to patients’ addresses. All patients aged 50–75 seen in participating health clinics who were eligible for CRC screening were included. Results Although not always statistically significant, we saw a consistent pattern of increased FIT return rates among intervention participants compared to control participants across all subgroups studied, with incidence rate ratios (IRRs) generally ranging from 1.25 to 1.50. FIT completion in the intervention group ranged from 15 and 20% across subpopulations, typically three to six percentage points higher than the control group participants. The only moderator with a statistically significant interaction was race: persons of Asian descent showed a twofold response to the intervention (adjusted incidence rate ratio [aIRR] = 2.06, 95% confidence interval 1.41 to 3.00). Conclusions Response to a mailed FIT intervention was generally consistent across a wide range of individual and neighborhood-level patient characteristics, including typically underserved patients and those in low-resource communities. Trial registration ClinicalTrials.gov, NCT01742065. Registered on 5 December 2012.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | - William M Vollmer
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
| | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite, Seattle, WA, 1600, USA
| | - Gloria D Coronado
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
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16
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Vanderpool RC, Huang B, Deng Y, Bear TM, Chen Q, Johnson MF, Paskett ED, Robertson LB, Young GS, Iachan R. Cancer-Related Beliefs and Perceptions in Appalachia: Findings from 3 States. J Rural Health 2019; 35:176-188. [PMID: 30830984 DOI: 10.1111/jrh.12359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Appalachians experience increased rates of cancer incidence and mortality compared to non-Appalachians. Many factors may contribute to the elevated cancer burden, including lack of knowledge and negative beliefs about the disease. METHODS Three National Cancer Institute (NCI)-designated cancer centers with Appalachian counties in their respective population-based geographic service areas-Kentucky, Ohio, and Pennsylvania-surveyed their communities to better understand their health profiles, including 5 items assessing cancer beliefs. Weighted univariate and bivariate statistics were calculated for each of the 3 state's Appalachian population and for a combined Appalachian sample. Weighted multiple linear regression was used to identify factors associated with a cancer beliefs composite score. Data from the combined Appalachian sample were compared to NCI's Health Information National Trends Survey (HINTS). RESULTS Data from 1,891 Appalachian respondents were included in the analysis (Kentucky = 798, Ohio = 112, Pennsylvania = 981). Significant differences were observed across the 3 Appalachian populations related to income, education, marital status, rurality, perceptions of present income, and body mass index (BMI). Four of 5 cancer beliefs were significantly different across the 3 states. Education, BMI, perceptions of financial security, and Kentucky residence were significantly associated with a lower composite score of cancer beliefs. When comparing the combined Appalachian population to HINTS, 3 of 5 cancer belief measures were significantly different. CONCLUSIONS Variations in cancer beliefs were observed across the 3 states' Appalachian populations. Interventions should be tailored to specific communities to improve cancer knowledge and beliefs and, ultimately, prevention and screening behaviors.
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Affiliation(s)
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | | | - Todd M Bear
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Meghan F Johnson
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Linda B Robertson
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gregory S Young
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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17
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Smalls BL, Aroh A, McQuerry K, Adegboyega A, Schoenberg N, Hatcher J. Social support and breast cancer screening in rural Appalachia. Psychooncology 2018; 27:2281-2288. [PMID: 29956391 PMCID: PMC8015397 DOI: 10.1002/pon.4828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Women in the Appalachian region have a high mortality rate attributable to cancer in spite of lower incidence of cancer compared with the general US population. Empirical evidence suggests that social support influences cancer outcomes, including adherence to screening guidelines and treatment recommendations. The purpose of this study is to examine the impact of social support on breast cancer screening patterns in a sample of rural Appalachian women. METHODS This paper reports the results of analyses of baseline cross-sectional data on breast cancer screening collected during a community-based group-randomized trial. We used the 2010 National Health Institute Survey questionnaires and the Medical Outcomes Study Social Support Survey to assess screening behavior and perceived social support, respectively. Data were analyzed using ANCOVA and ANOVA to assess the mean social support on breast cancer screening patterns (frequently, irregularly, and rarely/never) and relevant sociodemographic variables. FINDINGS Of the eligible participant records analyzed (N = 289), 50% were married, 36% were employed, 20% attended college, 40% had no mammogram in 6 years, and 20% never had mammograms. Overall social support score was high at 73.1 (SD = 18.2). Association between breast cancer screening patterns and social support scores was not statistically significant at α < 0.05 (P value = 0.09). CONCLUSIONS Although social support as it measured in this study does not show significant associations with screening patterns, it is important to understand how social network structures may influence screening patterns. Familial and social roles/responsibilities that result in reported social support may also be the barrier to cancer screening and other prevention health behaviors.
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Affiliation(s)
- Brittany L. Smalls
- Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Adaeze Aroh
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Kristen McQuerry
- Department of Statistics, University of Kentucky, Lexington, Kentucky
| | | | - Nancy Schoenberg
- College of Public Health, University of Kentucky, Lexington, Kentucky
- Department of Behavioral and Social Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
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18
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Luque JS, Tarasenko YN, Chen C. Correlates of Cervical Cancer Screening Adherence Among Women in the U.S.: Findings from HINTS 2013-2014. J Prim Prev 2018; 39:329-344. [PMID: 29876723 PMCID: PMC10878428 DOI: 10.1007/s10935-018-0513-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Following the latest update of cervical cancer screening guidelines in 2012, we estimate the prevalence of guideline adherent cervical cancer screening and examine its associated factors among a nationally representative sample of US women aged 21-65 years. Our study was based on cross-sectional data from Cycles 3 (2013) and 4 (2014) of the Health Information National Trends Survey. The final analytic sample consisted of 2822 women. Guideline adherent cervical cancer screening was defined as having a Pap test within the last 3 years. Correlates of guideline adherent cervical cancer screening included socio-demographic and health-related characteristics and HPV/cervical cancer-related beliefs and knowledge items. Multivariable logistic regression analyses were used to estimate prevalence of guideline adherent screening. An estimated 81.3% of women aged 21-65 years reported being screened for cervical cancer within the last 3 years. Controlling for sociodemographic and health-related characteristics and survey year, women aged 46-65 years were less likely to be guideline adherent than those aged 21-30 years (aPR = 0.89; 95% CI 0.82-0.97). The adjusted prevalence of adherence was significantly higher among married/partnered than among not married women (aPR = 1.13; 95% CI 1.05-1.22), and those with one to three medical visits (aPR = 1.30; 95% CI 1.14-1.48), and four or more visits in the past year (aPR = 1.26; 95% CI 1.09-1.45) compared to those with no medical visits. Differences in unadjusted prevalence of guideline adherent screening depending on women's beliefs and knowledge about HPV and cervical cancer were not significant in adjusted analyses. Lack of interaction with a healthcare provider, being not married/partnered and increasing age continue to be risk factors of foregoing guideline adherent cervical cancer screening.
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Affiliation(s)
- John S Luque
- Institute of Public Health, Florida A&M University, 1515 South MLK Blvd., Ste. 207B, Tallahassee, FL, 32307, USA.
| | - Yelena N Tarasenko
- Department of Health Policy and Management, Georgia Southern University, Statesboro, GA, USA
- Department of Epidemiology, Georgia Southern University, Statesboro, GA, USA
| | - Chen Chen
- College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN, USA
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19
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Katz ML, Zimmermann BJ, Moore D, Paskett ED, Reiter PL. Perspectives from health-care providers and women about completing human papillomavirus (HPV) self-testing at home. Women Health 2016; 57:1161-1177. [PMID: 27700693 DOI: 10.1080/03630242.2016.1243608] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cervical cancer (CC) incidence and mortality rates are increased, and CC screening rates are low among Appalachian Ohio women. Mailing human papillomavirus (HPV) self-tests to women to complete at home is a potential new strategy to engage women in CC screening. The authors aimed to gain insights into the perceived acceptability of mailed HPV self-tests. Focus groups were conducted (August 2014-January 2015) among providers (physicians, nurse practitioners, nurses) and women in Appalachian Ohio. Providers (n = 28) and women (n = 15; age range: 32-62 years) reported general acceptance of HPV self-tests, however, for different reasons. Providers thought HPV self-testing would increase the proportion of under-screened women returning to the health-care system, while women thought self-testing would eliminate logistical and reduce psychological CC screening barriers. Findings provide insights into facilitators and barriers of completing an HPV self-test at home, returning it, reporting results, and providing needed follow-up care. To the authors' knowledge, no systematic research exists addressing providers' views regarding women's use of HPV self-tests and the relation of such use to fostering subsequent Pap testing. This information will be useful in developing CC screening programs that include mailed HPV self-tests, as well as encouragement of follow-up Pap testing to meet existing CC screening guidelines.
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Affiliation(s)
- Mira L Katz
- a Division of Health Behavior and Health Promotion, College of Public Health , The Ohio State University , Columbus , Ohio , USA.,b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Barret J Zimmermann
- c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Deborah Moore
- d Valley View Health Centers , Waverlys , Ohio , USA
| | - Electra D Paskett
- b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
| | - Paul L Reiter
- b Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.,c Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA
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