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Prowse SR, Brazzelli M, Treweek S. What factors influence the uptake of bowel, breast and cervical cancer screening? An overview of international research. Eur J Public Health 2024:ckae073. [PMID: 38702983 DOI: 10.1093/eurpub/ckae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND For cancer screening programmes to be effective in early detection it is important that those invited can access screening services and understand the benefits of participation. A better understanding of the factors that matter to potential participants of cancer screening programmes can assist in developing strategies to increase current uptake. METHODS We conducted an overview of systematic reviews to answer the question: What factors influence the uptake of cancer screening services (breast, bowel and cervical) in high-income countries? A thematic approach supported by tabular summaries and qualitative heat maps was used to categorize factors, described as 'barriers' or 'facilitators'. RESULTS A total of 41 systematic reviews met the criteria for inclusion. The barrier with the greatest number of 'hot spots' across all three screening programmes was a fear of the unknown regarding a possible diagnosis of cancer or abnormal screening results, followed closely by a general lack of knowledge surrounding cancer screening programmes. The greatest collective facilitator to uptake was recommendation by a healthcare provider to attend screening. CONCLUSION Across all factors 'trust' and 'building trusted relationships' can be seen as integral to the success of cancer screening programmes and must be reflective of collaborative efforts to mitigate barriers and enhance facilitators to uptake. There is future scope to consider interventions that (i) increase demand for screening services, (ii) reduce barriers to uptake of services and/or (iii) are relevant to the healthcare system and those providing services.
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Affiliation(s)
- Sarah R Prowse
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
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Kim M, Güler A, Kim D, Lee RC. A qualitative study of ethnic Korean women and men's experiences of HPV and HPV vaccination in the United States. ETHNICITY & HEALTH 2024; 29:179-198. [PMID: 37970802 DOI: 10.1080/13557858.2023.2279933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Approximately 42.5% of adults aged 18-59 in the United States is estimated to be affected by human papillomavirus (HPV) infection. However, Asian Americans have the lowest HPV vaccination initiation rate compared to other racial groups. This study aims to explore the experiences of HPV and the HPV vaccination among ethnic Korean women and men in the United States. METHODS A total of 33 ethnic Korean and Korean Americans aged 27-45 years living in the U.S. were recruited via word-of-mouth and social media using a purposive sampling strategy. They participated in an online survey. Of the 33 participants, 29 (14 females and 15 males) participated in in-depth interviews via password-protected Zoom. A content analysis approach was used to analyze the interviews. RESULTS Only 32% of participants had received the HPV vaccine at least once (female: 35.3%, male: 12.5%). Six major themes emerged from data analysis: (1) awareness of HPV, HPV vaccine, and HPV-associated cancers; (2) attitudes toward the HPV vaccine; (3) barriers to HPV vaccination; (4) women's experiences and preferences for pap smear testing; (5) experiences with HPV diagnosis; and (6) HPV and HPV vaccination education preferences. CONCLUSION The findings highlight cultural factors that may impede the discussion about and uptake of HPV vaccination and HPV-associated cancer screening, which emphasize the need for culturally appropriate interventions to overcome stigma around HPV and enhance vaccination rates. Healthcare providers should consider ethnic and cross-cultural differences perceptions to effectively HPV-related health information. This study provides insight into the experiences and understanding of HPV and vaccination among ethnic Korean men and women, laying the groundwork for developing culturally-tailored programs that sim to increase HPV vaccination rates and mitigate the stigma and impact of HPV-related disease in this community.
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Affiliation(s)
- Minjin Kim
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Ayse Güler
- Center for Research on Violence Against Women, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Deogwoon Kim
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rebecca C Lee
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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Moss JL, Entenman J, Stoltzfus K, Liao J, Onega T, Reiter PL, Klesges LM, Garrow G, Ruffin MT. Self-sampling tools to increase cancer screening among underserved patients: a pilot randomized controlled trial. JNCI Cancer Spectr 2024; 8:pkad103. [PMID: 38060284 PMCID: PMC10868381 DOI: 10.1093/jncics/pkad103] [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: 08/02/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Screening can reduce cancer mortality, but uptake is suboptimal and characterized by disparities. Home-based self-sampling can facilitate screening for colorectal cancer (with stool tests, eg, fecal immunochemical tests) and for cervical cancer (with self-collected human papillomavirus tests), especially among patients who face barriers to accessing health care. Additional data are needed on feasibility and potential effects of self-sampling tools for cancer screening among underserved patients. METHODS We conducted a pilot randomized controlled trial with patients (female, ages 50-65 years, out of date with colorectal and cervical cancer screening) recruited from federally qualified health centers in rural and racially segregated counties in Pennsylvania. Participants in the standard-of-care arm (n = 24) received screening reminder letters. Participants in the self-sampling arm (n = 24) received self-sampling tools for fecal immunochemical tests and human papillomavirus testing. We assessed uptake of screening (10-week follow-up), self-sampling screening outcomes, and psychosocial variables. Analyses used Fisher exact tests to assess the effect of study arm on outcomes. RESULTS Cancer screening was higher in the self-sampling arm than the standard-of-care arm (colorectal: 75% vs 13%, respectively, odds ratio = 31.32, 95% confidence interval = 5.20 to 289.33; cervical: 79% vs 8%, odds ratio = 72.03, 95% confidence interval = 9.15 to 1141.41). Among participants who returned the self-sampling tools, the prevalence of abnormal findings was 24% for colorectal and 18% for cervical cancer screening. Cancer screening knowledge was positively associated with uptake (P < .05). CONCLUSIONS Self-sampling tools can increase colorectal and cervical cancer screening among unscreened, underserved patients. Increasing the use of self-sampling tools can improve primary care and cancer detection among underserved patients. CLINICAL TRIALS REGISTRATION NUMBER STUDY00015480.
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Affiliation(s)
- Jennifer L Moss
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Juliette Entenman
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Kelsey Stoltzfus
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Jiangang Liao
- Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Tracy Onega
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Paul L Reiter
- Department of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Lisa M Klesges
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | | | - Mack T Ruffin
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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Christensen K, Bauer AG, Burgin T, Williams J, McDowd J, Sutkin G, Bennett K, Bowe Thompson C, Berkley-Patton JY. "Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:137-150. [PMID: 36125430 DOI: 10.1177/0272684x221115494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3 years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.
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Affiliation(s)
- Kelsey Christensen
- Department of Family and Community Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Alexandria G Bauer
- Center for Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
| | - Tacia Burgin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joah Williams
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joan McDowd
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Gary Sutkin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kymberly Bennett
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jannette Y Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
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Asare M, Lanning BA, Montealegre JR, Akowuah E, Adunlin G, Rose T. Determinants of Low-Income Women's Participation in Self-Collected Samples for Cervical Cancer Detection: Application of the Theory of Planned Behavior. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:65-76. [PMID: 37724032 DOI: 10.1177/0272684x221090060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Low-income women (LIW) are underrepresented in physician-provided cervical cancer screening. Providing women with an option for Human Papillomavirus (HPV) self-sampling would increase cervical cancer screening. However, little is known about LIW's attitude towards self-sampling for cervical cancer. We determined the associations between the Theory of Planned Behavior (TPB) constructs and LIW intention for participation in the HPV self-sampling. METHODS A 44-item survey was administered among women receiving food from a food pantry in central Texas. Independent variables included TPB constructs (i.e., attitudes, subjective norms, and perceived control). The outcome variables were intentions and preference for self-sampling. Both variables were measured on a 5-point scale. Hierarchical linear regression models were used to analyze the data. RESULTS A sample of 241 participants (age 50.13 ± 9.60 years) comprising non-Hispanic White (40%), Black/African American (27%), and Hispanic (30%) participated in the study. The participants were current with a pap test (54.8%) and preferred self-sampling (42%). The participant's attitudes and subjective norms were significantly associated with their intention for self-sampling, accounting for 38.7% of the variance (p < .001). Women who were overdue for pap testing versus current with pap testing had increased odds of preferring self-sampling (OR = 1.72, 95% CI: 1.27, 6.04). CONCLUSIONS The key predictors for LIW's intention for self-sampling included attitudes and subjective norms. Future research should use the TPB as a framework to examine whether intention predicts self-sampling behavior among LIW.
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Affiliation(s)
- Matthew Asare
- Department of Public Health, Baylor University, Waco, TX, USA
| | - Beth A Lanning
- Department of Public Health, Baylor University, Waco, TX, USA
| | - Jane R Montealegre
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX USA
| | | | - Georges Adunlin
- Department of Pharmaceutical, Social and Administrative Sciences, Samford University, Birmingham, AL, USA
| | - Tiffany Rose
- Department of Public Health, Baylor University, Waco, TX, USA
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Adekunle TB, Arreola A, Sembian S, Castro R, Claure L, Balian L, Rodriguez NM. Feasibility and anticipated acceptability of community health worker-facilitated HPV self-sampling for cervical cancer screening around Lake County, Indiana. J Clin Transl Sci 2023; 7:e157. [PMID: 37528945 PMCID: PMC10388433 DOI: 10.1017/cts.2023.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Indexed: 08/03/2023] Open
Abstract
Background/Objective In light of calls to engage community health workers (CHWs) in the delivery of cervical cancer screening innovations, this study explores CHW perspectives on i) barriers to cervical cancer screening in a predominantly Hispanic community in Lake County, Indiana, the county with the highest cervical mortality in the state; and ii) the acceptability and feasibility of CHW-facilitated human papillomavirus (HPV) self-sampling as a means of reducing screening disparities. Methods In 2021, in-depth interviews were conducted with 15 CHWs employed by Lake County community-based organizations including clinics, schools, and faith-based organizations. Results Harnessing CHWs' voices as insiders with knowledge of their communities' health landscape, our analysis identified multilevel barriers to screening that spanned individual, interpersonal, and community levels of the socio-ecological model. CHW-facilitated HPV self-sampling shows promise of mitigating several barriers to cervical cancer screening. Privacy, time saved, and comfort were perceived to be facilitators for acceptability, with concerns about the novelty of this approach and trust in provider (as opposed to CHW) expertise emerging as key barriers. In terms of feasibility, synergies with existing CHW work, and some community members' prior experience with self-sampling were found to be facilitators, while CHW's time limitations and self-efficacy in providing adequate medical support were areas of concern. Considerations for adoption included CHW training, gender concordance, safety, and respect, among others. Conclusion This study provides critical insights from CHWs as key stakeholders on a screening model that directly engages them, which can inform implementation to increase screening in medically-underserved communities in the US.
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Affiliation(s)
| | - Alyssa Arreola
- College of Science, Purdue University, West Lafayette, IN, USA
| | - Sathveka Sembian
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Raquel Castro
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Layla Claure
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Lara Balian
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Natalia M. Rodriguez
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- Department of Public Health, Purdue University, West Lafayette, IN, USA
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Mamo L, Pérez AE, Rios L. Human papillomavirus self-sampling: A tool in cancer prevention and sexual health promotion. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:218-235. [PMID: 34904724 DOI: 10.1111/1467-9566.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
Abstract
This article examines human papillomavirus (HPV) self-sampling as an approach to cervical cancer prevention and the ways self-sampling kits are promoted directly to consumers in the United States. Public health, biomedicine and health tech have increasingly imagined self-sampling, which allows individuals to collect their own vaginal specimen, mail to a laboratory for testing and receive delivered results, as a component of cervical cancer prevention and sexual health promotion. This article examines the scientific and biomedical claims used to configure the problem in need of this solution and the ways persons, publics and markets are established. We analyse scientific literature, interviews with clinicians and other key actors, and websites of directly to consumers (DTC) companies. HPV self-sampling is constructed as both a solution to inequities and gaps in cervical cancer screening and a solution to the wants and needs of those already engaged in self-projects of body monitoring and risk reduction. These multidirectional biomedical tendencies also reveal how sexuality and sexual health and cervical cancer prevention and sexual health promotion are entangled objects. While we do not want to undermine the potential of HPV self-sampling, we encourage a focus on equity and care and not commodified markets that reinforce notions of 'good' patients monitoring their health.
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Affiliation(s)
- Laura Mamo
- Department of Public Health, San Francisco State University, San Francisco, California, USA
- Health Equity Institute, San Francisco State University, San Francisco, California, USA
| | - Ashley E Pérez
- Health Equity Institute, San Francisco State University, San Francisco, California, USA
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lucy Rios
- Public Health Sciences, University of California, Davis, California, USA
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Desai S, Zhu MJ, Lapidos-Salaiz I. Cervical cancer prevention: Human papillomavirus testing as primary screening. Cancer 2021; 128:939-943. [PMID: 34767263 DOI: 10.1002/cncr.34006] [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: 09/13/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022]
Abstract
Low- and middle-income countries carry a high burden of preventable cervical cancer cases and deaths. Because human papillomavirus DNA-based testing is increasingly becoming the preferred method of screening for cervical cancer prevention, this commentary discusses next steps and key considerations for its expansion.
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Affiliation(s)
- Shreya Desai
- US Agency for International Development, Washington, DC
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