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McMahan KD, Olmstead SB. Disclosure of Sexually Transmitted Infections to Sexual Partners: A Systematic Critical Literature Review. JOURNAL OF SEX RESEARCH 2024:1-15. [PMID: 38840296 DOI: 10.1080/00224499.2024.2343927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
The purpose of this review was to systematically and critically evaluate the STI disclosure literature (excluding HIV disclosure literature), summarize limitations and omissions, and identify opportunities for future research. We used the Health Disclosure Decision-Making Model (DD-MM) as a guiding theoretical framework. Following PRISMA guidelines, database searches using key terms identified 387 possible articles, 32 of which ultimately met inclusion criteria for this review. Findings indicated that individuals with STIs experience a variety of negative feelings and emotions related to the prospect of disclosure. Reasons for disclosure included moral obligation, love for partner, and desire for support, whereas reasons to not disclose included fears about partner's reaction and response, fears of being rejected or broken up with, and beliefs about the lack of obligation. Disclosers used a variety of disclosure strategies, including priming messages, framing, and direct disclosure. Non-disclosers used strategies to pass as uninfected (i.e. passing), withdraw from relationships, and using outbreaks to time sexual activity. Among studies that examined disclosure timing, around half or fewer individuals disclosed or believed they should disclose prior to engaging in sexual activity. The findings indicated that relationship-related factors such as greater levels of commitment, relationship quality, length together, and feelings of closeness were important predictors of disclosure. Finally, some individuals experienced negative partner responses, whereas others experienced positive responses and relationship outcomes. Our review revealed that the experiences of receivers of STI disclosures are not well-represented in the literature. Implications for future research, education, and intervention are specified.
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Affiliation(s)
- Kayley D McMahan
- Center for Health Education & Wellness, The University of Tennessee
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Eppel-Meichlinger J, Mayer H, Steiner E, Kobleder A. From existential uncertainty to a new mindset promoting recovery: Exploring the development of uncertainty experience in women with vulvar neoplasia - A qualitative longitudinal study. BMC Womens Health 2024; 24:35. [PMID: 38218781 PMCID: PMC10788007 DOI: 10.1186/s12905-024-02889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/06/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Women with vulvar neoplasia continue to experience uncertainty up to six months post-surgery. Uncertainty in illness is considered a significant psychosocial stressor, that negatively influences symptom distress, self-management strategies and quality of life. According to the Reconceptualized Uncertainty in Illness Theory, the appraisal of uncertainty changes positively over time in chronic illness. We aimed at exploring whether and how the experience of uncertainty develops in women with vulvar neoplasia. METHODS We selected a purposive sample of seven women diagnosed with vulvar neoplasia in four Swiss and one Austrian women's clinic. By means of a qualitative longitudinal study, we conducted 30 individual interviews at five points of time during one year after diagnosis. We applied Saldaña's analytical questions for longitudinal qualitative research. RESULTS First, participants experienced uncertainty as an existential threat, then an inherent part of their illness, and finally a certainty. Women initially associated the existential threat with a high risk for suffering from severe health deteriorations. Participants that could reduce their individually assessed risk by adopting health promoting behaviors, accepted the remaining uncertainty. From now on they reframed uncertainty into a certainty. This new mindset was based on a belief of promoting recovery and reducing the risk of recurrence. CONCLUSIONS The long-lasting and oscillating nature of uncertainty should receive attention in supportive oncology care. Uncertainty concerning existential issues is of special importance since it can inhibit a positive development of uncertainty experience.
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Affiliation(s)
- Jasmin Eppel-Meichlinger
- Department of General Health Studies, Division Nursing Science with focus on Person-centred Care Research, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, Austria.
- Vienna Doctoral School of Social Sciences, University of Vienna, Vienna, Austria.
| | - Hanna Mayer
- Department of General Health Studies, Division Nursing Science with focus on Person-centred Care Research, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, Austria
| | - Enikö Steiner
- Department of Obstetrics and Gynecology, Vienna General University Hospital, Vienna, Austria
| | - Andrea Kobleder
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
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Aasbø G, Hansen BT, Waller J, Nygård M, Solbrække KN. Unpacking the Lay Epidemiology of Cervical Cancer: A Focus Group Study on the Perceptions of Cervical Cancer and Its Prevention among Women Late for Screening in Norway. Healthcare (Basel) 2023; 11:healthcare11101441. [PMID: 37239727 DOI: 10.3390/healthcare11101441] [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: 01/31/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Nonattendance for cervical cancer screening is often understood in terms of a lack of 'appropriate' or 'correct' knowledge about the risks and prevention of the disease. Few studies have explored how lay persons-the users themselves-interpret and contextualise scientific knowledge about cervical cancer. In this study, we address the following research question: How is the epidemiology of cervical cancer and its prevention discussed among women who are late for cervical cancer screening in Norway? We completed nine focus group interviews (FGIs) with 41 women who had postponed cervical screening. The analyses were both inductive and explorative, aiming to unpack the complexity of lay understandings of cervical cancer. Interactive associations expressed in the FGIs reflected multiple understandings of aetiology and risk factors, screening, and interpretations of responsibility for acquiring cervical cancer. The term 'candidacy' was employed to provide an enhanced understanding of lay reasoning about the explanations and predictions of cervical cancer, as reflected in the FGIs. Both interpretations of biomedical concepts and cultural values were used to negotiate acceptable and nuanced interpretations of candidacy for cervical cancer. Uncertainties about risk factors for acquiring cervical cancer was an important aspect of such negotiations. The study's findings provide an in-depth understanding of the contexts in which screening may be rendered less relevant or significant for maintaining health. Lay epidemiology should not be considered inappropriate knowledge but rather as a productive component when understanding health behaviours, such as screening attendance.
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Affiliation(s)
- Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
- Department of Interdisciplinary Health Science, Institute of Health and Society, University of Oslo, 0318 Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London WC2R 2LS, UK
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Kari N Solbrække
- Department of Interdisciplinary Health Science, Institute of Health and Society, University of Oslo, 0318 Oslo, Norway
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Santos BD, Moreira CS, Teixeira-Santos AC, Carvalho E, Pereira MG. HPV-related quality of life in diagnosed women: A longitudinal study. J Health Psychol 2022; 27:2982-2996. [PMID: 35176887 DOI: 10.1177/13591053211073642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper explored changes in the HPV-related quality of life (QoL) of 209 women diagnosed with human papillomavirus (HPV) during 1 year of medical monitoring, at three time points (6-month interval between them). Participants completed the HPV Impact Profile (HIP) questionnaire to assess HPV-related QoL. The relationship between HIP scores and time was moderated by the HPV risk type and infection duration: an HPV diagnosis had a stronger negative effect on patients with an HPV high-risk type and on those living with HPV for a long period of time. Age, condom use, motherhood, and type of family were significant predictors.
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Smith LW, Racey CS, Gondara L, Krajden M, Lee M, Martin RE, Stuart G, Peacock S, Coldman AJ, Franco EL, van Niekerk D, Ogilvie GS. Women's acceptability of and experience with primary human papillomavirus testing for cervix screening: HPV FOCAL trial cross-sectional online survey results. BMJ Open 2021; 11:e052084. [PMID: 34620663 PMCID: PMC8499254 DOI: 10.1136/bmjopen-2021-052084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To study participant's acceptability of and attitudes towards human papillomavirus (HPV) testing compared with cytology for cervical cancer screening and what impact having an HPV positive result may have in future acceptability of screening. DESIGN Cross-sectional online survey of clinical trial participants. SETTING Primary care, population-based Cervix Screening Program, British Columbia, Canada. PARTICIPANTS A total of 5532 participants from the HPV FOCAL trial, in which women received HPV and cytology testing at study exit, were included in the analysis. Median age was 54 years. The median time of survey completion was 3 years after trial exit. OUTCOME MEASURES Acceptability of HPV testing for primary cervical cancer screening (primary); attitudes and patient perceptions towards HPV testing and receipt of HPV positive screen results (secondary). RESULTS Most respondents (63%) were accepting of HPV testing, with the majority (69%) accepting screening to begin at age 30 years with HPV testing. Only half of participants (54%) were accepting of an extended screening interval of 4-5 years. In multivariable logistic regression, women who received an HPV positive screen test result during the trial (OR=1.41 95% CI 1.11 to 1.80) or were older (OR=1.01, 95% CI 1.00 to 1.02) were more likely to report HPV testing as acceptable. CONCLUSIONS In this evaluation of acceptability and attitudes regarding HPV testing for cervix screening, most are accepting of HPV testing for screening; however, findings indicate heterogeneity in concerns and experiences surrounding HPV testing and receipt of HPV positive results. These findings provide insights for the development of education, information and communication strategies during implementation of HPV-based cervical cancer screening. TRIAL REGISTRATION NUMBERS ISRCTN79347302 and NCT00461760.
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Affiliation(s)
- Laurie W Smith
- Department of Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - C Sarai Racey
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Department of Data and Analytics, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Mel Krajden
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Public Health Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marette Lee
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Cervix Screening Program, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gavin Stuart
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Department of Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Andrew J Coldman
- Department of Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Eduardo L Franco
- Department of Oncology, McGill University, Montreal, Québec, Canada
| | - Dirk van Niekerk
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Cervix Screening Program, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Gina S Ogilvie
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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'Does HPV affect my fertility?' Reproductive concerns of HPV-positive women: a qualitative study. Reprod Health 2021; 18:72. [PMID: 33794938 PMCID: PMC8017806 DOI: 10.1186/s12978-021-01126-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/21/2021] [Indexed: 12/26/2022] Open
Abstract
Background Reproductive health changes can occur following infection with Human papillomavirus. HPV is the most prevalent sexually transmitted infection causing a variety of clinical manifestations ranging from warts to cancer. This study aimed to explore the reproductive concerns of women infected with HPV. Methods In this qualitative study, we used the conventional content analysis approach, with the aid of MAXQDA.10 software, to analyze data extracted from the face-to-face semi-structured interviews with 20 Iranian HPV-positive women (sampled by maximum variation purposive sampling). The accuracy of this research was ensured according to the four criteria proposed by Guba and Lincoln. Results Exploring participants' reproductive concerns, three main categories were identified from the interviews including concerns about fertility potential, pregnancy and non-pregnancy reproductive issues. HPV-positive women concerned about reduced female/ male fertility due to HPV, the impact of the HPV on the fetal health, adverse pregnancy outcomes such as miscarriage and preterm delivery, and mother-to-child transmission of HPV during breastfeeding. HPV-positive women with abnormal cytology results were anxious that becoming pregnant or taking hormonal contraception might worsen their abnormalities. Most married women were reluctant to use a condom. Participants requested further information about the potential reproductive risks of the HPV vaccine. They also wanted to know about the safety of HPV vaccine during pregnancy and breastfeeding. Conclusions HPV-positive women had some reproductive concerns that should be considered in the designing of educational-consulting interventions. Women need to be better understood and informed about the impact of HPV on their reproductive health. Health care providers may lack knowledge about these specific areas, and they could benefit from additional up-to-date information to address women's reproductive concerns.
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Qaderi K, Mirmolaei ST, Geranmayeh M, Sheikh Hasani S, Farnam F. Iranian women's psychological responses to positive HPV test result: a qualitative study. BMC WOMENS HEALTH 2021; 21:128. [PMID: 33771159 PMCID: PMC7995699 DOI: 10.1186/s12905-021-01272-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022]
Abstract
Background Human papillomavirus testing as an established screenings test allow for the early detection and treatment of cervical cancer. Testing positive for HPV may have adverse consequences for women. This study aimed to explore the psychological impacts of testing positive for HPV on women in a developing country with a distinct cultural and religious background. Methods Qualitative face-to-face semi-structured interviews were conducted with 40 Iranian women who received a positive high-risk HPV result. Content analysis approach was used to data analysis through MAXQDA10. Results Three main categories were emerged: initial confrontation; STD-related psychological burden; and rebuilding health. Initial reactions to positive HPV results were shock, unrealistic fear, confusion, distress, and financial concerns. Stigma was manifested in form of self-blame, fear of HPV-disclosure, negative body image, being stigmatized by healthcare providers, and receiving health care anonymously. Refusal to use insurance services showed how evident and powerful the stigma was. Most women reported lifestyles and sexual behaviors modifications to help their immune system to clear HPV; indicating that the screening can work as a valuable opportunity to improve women's physical and sexual health. Regular follow-up, safe sex and a focus on spirituality enable women infected with HPV to take control of the situation. Worrying about other HPV-linked cancers (oropharynx and anal) and fears of partner infection indicated that women consider HPV to be more than just a cause of cervical cancer. Conclusions The findings implied to the HPV-positive women's need to support and factual information. Designing and implementing interventions that mitigate the psychological effect of positive HPV test results can highlight the potential benefits of screening for women's health.
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Affiliation(s)
- Kowsar Qaderi
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat St. Tohid Sq., 141973317, Tehran, Iran
| | - Seyedeh Tahereh Mirmolaei
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat St. Tohid Sq., 141973317, Tehran, Iran.
| | - Mehrnaz Geranmayeh
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat St. Tohid Sq., 141973317, Tehran, Iran
| | - Shahrzad Sheikh Hasani
- Gynecology Oncology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farnaz Farnam
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat St. Tohid Sq., 141973317, Tehran, Iran
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Natipagon-Shah B, Lee E, Lee SY. Knowledge, Beliefs, and Practices Among U. S. College Students Concerning Papillomavirus Vaccination. J Community Health 2020; 46:380-388. [PMID: 32939677 DOI: 10.1007/s10900-020-00922-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted disease in the U.S. Data on knowledge, attitudes, and beliefs related to HPV vaccination among college students are limited. The purpose of this study was to provide a comprehensive description of the variables influencing HPV vaccination uptake and intention among college students. This study employed a cross sectional descriptive quantitative design. Survey data were collected online from the 181 college students, aged 18-25 years. The data were analyzed to identify the students' attitudes toward HPV vaccine (perceived potential harm, effectiveness, barriers, and uncertainty), knowledge of HPV and HPV vaccine, and their intention of receiving the vaccine in the next 6 months. Descriptive statistics, Chi-square tests, ANOVA, and logistic regressions were conducted to examine the correlates of vaccination intention and uptake. Among 181 participants, 101 (55.8%) were had received at least one dose of HPV vaccine, 52 (28.7%) intended to receive HPV vaccine, and 28 (15.5%) did not intend to receive HPV vaccine. On average, participants responded correctly to less than half of the questions on the HPV knowledge and HPV vaccine knowledge scales, and those who were vaccinated were significantly more knowledgeable than their counterparts. Multivariate logistic regression showed HPV vaccine knowledge and uncertainty were significant factors associated with HPV vaccine uptake. Providing education designed to improve HPV and HPV vaccination knowledge and decrease feelings of uncertainty could improve college students' HPV vaccination uptake.
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Affiliation(s)
- Bulaporn Natipagon-Shah
- School of Nursing, California State University, San Marcos, 333 S. Twin Oaks Valley Rd., San Marcos, CA, 92096, USA
| | - Eunice Lee
- School of Nursing, University of California, Los Angeles, 700 Tiverton Ave., #-4-258, Los Angeles, CA, 90095, USA
| | - Shin-Young Lee
- Department of Nursing, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-759, Republic of Korea.
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McBride E, Tatar O, Rosberger Z, Rockliffe L, Marlow LAV, Moss-Morris R, Kaur N, Wade K, Waller J. Emotional response to testing positive for human papillomavirus at cervical cancer screening: a mixed method systematic review with meta-analysis. Health Psychol Rev 2020; 15:395-429. [PMID: 32449477 DOI: 10.1080/17437199.2020.1762106] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tens-of-millions of women every year test positive for human papillomavirus (HPV) at routine cervical screening. We performed a mixed-methods systematic review using a results-based convergent design to provide the first comprehensive overview of emotional response to testing positive for HPV (HPV+). We mapped our findings using the cognitive behavioural framework. Six electronic databases were searched from inception to 09-Nov-2019 and 33 papers were included. Random-effects meta-analyses revealed that HPV+ women with abnormal or normal cytology displayed higher short-term anxiety than those with normal results (MD on State-Trait Anxiety Inventory = 7.6, 95% CI: 4.59-10.60 and MD = 6.33, CI: 1.31-11.35, respectively); there were no long-term differences. Psychological distress (general/sexual/test-specific) was higher in HPV+ women with abnormal cytology in the short-term and long-term (SMD = 0.68, CI: 0.32-1.03 and SMD = 0.42, CI: 0.05-0.80, respectively). Testing HPV+ was also related to disgust/shame, surprise and fear about cancer. Broadly, adverse response related to eight cognitive constructs (low control, confusion, cancer-related concerns, relationship concerns, sexual concerns, uncertainty, stigma, low trust) and six behavioural constructs (relationship problems, social impact, non-disclosure of results, idiosyncratic prevention, indirect clinical interaction, changes to sexual practice). Almost exclusive use of observational and qualitative designs limited inferences of causality and conclusions regarding clinical significance.
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Affiliation(s)
- Emily McBride
- Department of Behavioural Science and Health, University College London (UCL), London, UK
| | - Ovidiu Tatar
- Research Center-Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, QC, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Psychology, Psychiatry and Oncology, McGill University, Montreal, Canada
| | - Lauren Rockliffe
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Laura A V Marlow
- School of Cancer and Pharmaceutical Sciences, King's College London (KCL), London, UK
| | - Rona Moss-Morris
- Department of Psychology, King's College London (KCL), London, UK
| | - Navdeep Kaur
- Research Center-Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London (KCL), London, UK
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Dauphin S, Van Wolputte S, Jansen L, De Burghgraeve T, Buntinx F, van den Akker M. Using Liminality and Subjunctivity to Better Understand How Patients With Cancer Experience Uncertainty Throughout Their Illness Trajectory. QUALITATIVE HEALTH RESEARCH 2020; 30:356-365. [PMID: 31617448 DOI: 10.1177/1049732319880542] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Uncertainty is a central theme in the illness experiences of older cancer patients throughout their illness trajectory. Mishel's popular theory on uncertainty during illness approaches uncertainty as an outcome and is characterized by the patient's inability to find meaning in illness events. This study used the concepts of liminality and subjunctivity to explore uncertainty throughout the illness trajectory of cancer patients. We interviewed 18 older (age range = 57-92 years) patients with breast cancer or gastro-intestinal cancer 3 to 4 years post diagnosis. Our analysis is based on the QUAGOL guide that draws on elements of grounded theory such as constant comparison. We found that liminality and subjunctivity provide a useful frame for understanding uncertainty with a specific focus on its productive potential and meaning making. Health care professionals should be open to acquiring a complete picture of patients' diverse and dynamic experiences of uncertainty in the different stages of their illness trajectory.
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Affiliation(s)
| | | | | | | | - Frank Buntinx
- KU Leuven, Leuven, Belgium
- Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- KU Leuven, Leuven, Belgium
- Maastricht University, Maastricht, The Netherlands
- Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Bennett KF, Waller J, Ryan M, Bailey JV, Marlow LAV. Concerns about disclosing a high-risk cervical human papillomavirus (HPV) infection to a sexual partner: a systematic review and thematic synthesis. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 47:bmjsrh-2019-200503. [PMID: 31915190 PMCID: PMC7815639 DOI: 10.1136/bmjsrh-2019-200503] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Human papillomavirus (HPV)-based cervical screening is now replacing cytology-based screening in several countries and many women in screening programmes will consequently receive HPV-positive results. Because of the sexually transmitted nature of HPV, receiving an HPV-positive result may raise questions about disclosing the infection to a sexual partner. OBJECTIVE To review the quantitative and qualitative literature exploring women's concerns about disclosing a high-risk cervical HPV infection to a sexual partner. METHODS We searched MEDLINE, PsycINFO, CINAHL Plus, Web of Science and EMBASE for studies reporting at least one disclosure-related outcome among women with high-risk HPV. We also searched the grey literature and carried out forward/backward citation searches. A narrative synthesis for quantitative studies and a thematic synthesis for qualitative studies were conducted. RESULTS Thirteen articles met the inclusion criteria (12 qualitative, 1 quantitative). In the quantitative study, 60% of HPV-positive women felt disclosing an HPV result was 'risky'. Concerns about disclosing HPV to a sexual partner were influenced by the stigma that is associated with having an STI and uncertainty about how their partner would respond. Women questioned how, when and to whom they should disclose their HPV-positive status. CONCLUSIONS The studies included in this review provide rich information about the range of concerns women have, the reasons for these concerns, and the questions women have about disclosing HPV to sexual partners. As studies were predominantly qualitative, the prevalence of concerns is unclear.
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Affiliation(s)
- Kirsty F Bennett
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Mairead Ryan
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
| | - Julia V Bailey
- e-Health Unit, Department of Primary Care and Population Health, University College London, London, UK
| | - Laura A V Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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12
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Bennett KF, Waller J, Ryan M, Bailey JV, Marlow LAV. The psychosexual impact of testing positive for high-risk cervical human papillomavirus (HPV): A systematic review. Psychooncology 2019; 28:1959-1970. [PMID: 31411787 PMCID: PMC6851776 DOI: 10.1002/pon.5198] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
Abstract
Objectives Many countries are implementing human papillomavirus (HPV)‐based cervical screening due to the higher sensitivity of the test compared with cytology. As HPV is sexually transmitted, there may be psychosexual consequences of testing positive for the virus. We aimed to review the literature exploring the psychosexual impact of testing positive for high‐risk cervical HPV. Methods MEDLINE, PsycINFO, CINAHL Plus, Web of Science, and EMBASE were searched with no date limits. We also searched the grey literature, reference lists of included articles and carried out forward citation searching. Eligible studies reported at least one psychosexual outcome among HPV‐positive women. Qualitative and quantitative papers were included. We extracted data using a standardised form and carried out a quality assessment for each article. We conducted a narrative synthesis for quantitative studies and a thematic synthesis for qualitative studies. Results Twenty‐five articles were included. Quantitative study designs were diverse making it difficult to determine the impact that an HPV positive result would have in the context of routine screening. The qualitative literature suggested that psychosexual concerns cover a broad range of aspects relating to women's current and past relationships, both interpersonal and sexual. Conclusions The psychosexual impact of testing positive for high‐risk cervical HPV is unclear. This review highlights the need for further research in the context of HPV‐based cervical screening. As primary HPV testing is introduced more widely, it is important to understand women's responses to testing HPV positive in the cancer screening context to minimise any adverse psychosexual impact.
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Affiliation(s)
- Kirsty F Bennett
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
| | - Mairead Ryan
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
| | - Julia V Bailey
- e-Health Unit, Department of Primary Care and Population Health, University College London, London, UK
| | - Laura A V Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, University College London, London, UK
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Kelly-Hanku A, Ase S, Fiya V, Toliman P, Aeno H, Mola GM, Kaldor JM, Vallely LM, Vallely AJ. Ambiguous bodies, uncertain diseases: knowledge of cervical cancer in Papua New Guinea. ETHNICITY & HEALTH 2018; 23:659-681. [PMID: 28158947 DOI: 10.1080/13557858.2017.1283393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Within their local realities, people experience and interpret disease in diverse ways that do not necessarily correlate or converge with Western biomedical interventions. In the high cervical cancer burden setting of Papua New Guinea, understanding how people experience and interpret cervical cancer is necessary for effective intervention. Drawing on work by Street on the production of unstable biomedical knowledge, we explored how ambiguity and uncertainty, coupled with cultural taboos and linguistic limitations, affect what and how people 'know' about women's reproductive organs and their associated disease. DESIGN A qualitative research approach was used to explore and understand how people in PNG articulate matters of health and disease as they relate to cervical cancer and HPV infection. Specifically, how unstable biomedical knowledge is produced and sustained. We employed a mixed-methods approach in collecting data from 208 (147 women) participants between 2011 and 2012 across 3 provinces in PNG. RESULTS We found that knowledge and awareness about cervical cancer were poor. Five thematic areas emerged in our analysis, which included the gendered knowledge of women's reproductive health, the burden of cervical cancer in the community and the role (or limitation) of language. We further identified four ways in which ambiguity and uncertainty operate on both sociocultural and biological levels, and in the intersection between to produce unstable biomedical knowledge. These included poor knowledge of where the cervix is located and the uncertainty or unreliability of (lay) diagnoses of disease. CONCLUSION Local understandings of cervical cancer reflected the limitations of Tok Pisin as a lingua franca as well as the wider uncertain biomedical environment where diagnoses are assembled and shared. There is a clear need to improve understanding of the female reproductive organs in order that people, women in particular, can be better informed about cervical cancer and ultimately better receptive to intervention strategies.
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Affiliation(s)
- A Kelly-Hanku
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
- b Kirby , UNSW , Sydney , Australia
| | - S Ase
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - V Fiya
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - P Toliman
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - H Aeno
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - G M Mola
- c School of Medical Sciences , University of Papua New Guinea , Goroka , Papua New Guinea
| | | | | | - A J Vallely
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
- b Kirby , UNSW , Sydney , Australia
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Wilson KL, Cowart CJ, Rosen BL, Pulczinski JC, Solari KD, Ory MG, Smith ML. Characteristics Associated with HPV Diagnosis and Perceived Risk for Cervical Cancer Among Unmarried, Sexually Active College Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:404-416. [PMID: 27896666 DOI: 10.1007/s13187-016-1131-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Human papillomavirus (HPV) has been identified as the leading cause of cervical cancer. While HPV risk factors have been well studied, less is known about those with HPV and their perceptions about health ramifications. The purposes of this study were to examine unmarried college student women's (1) HPV diagnosis status and (2) perceived risk of getting cervical cancer in the next 5 years. Data were analyzed from 1106 unmarried, sexually active college women aged 18 to 26. Binary logistic regression compared HPV-related knowledge, vaccination-related perceptions, mandate support, healthcare utilization, sexual behaviors, and personal characteristics. Multinomial logistic regression was performed to assess the degree to which these factors were associated with perceived risk of cervical cancer diagnosis. Relative to those not diagnosed with HPV, participants who had more lifetime sex partners (P < 0.001), unprotected sex during last intercourse (P = 0.003), Pap test in the past year (P < 0.001), and perceived themselves to be at higher risk for cervical cancer (P < 0.001) were significantly more likely to be diagnosed with HPV. Those with HPV were more likely to support HPV vaccination mandates (P = 0.036) and have fewer friends vaccinated (P = 0.002). Participants who were uninsured (P = 0.011), diagnosed with HPV (P < 0.001), and had a family member (P < 0.001) or friend (P < 0.001) with cervical cancer were more likely to perceive themselves at risk for developing cervical cancer in the next 5 years. Findings indicate women with HPV, despite engaging in risky sexual behaviors, acknowledge their cervical cancer risk and may be strong advocates for HPV vaccination mandates to protect youth against this preventable virus.
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Affiliation(s)
- Kelly L Wilson
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA.
| | - Clayton J Cowart
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | - Brittany L Rosen
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Jairus C Pulczinski
- Department of Occupational and Environmental Health, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Kayce D Solari
- Department of Psychological Health and Learning Sciences, University of Houston, Houston, TX, USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
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A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany. Eur J Obstet Gynecol Reprod Biol 2017; 212:132-139. [PMID: 28363186 DOI: 10.1016/j.ejogrb.2017.03.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We modelled human papilloma virus (HPV) primary screening scenarios compared with Pap cytology to evaluate clinical effectiveness and projected annual costs in Germany. STUDY DESIGN A Markov cohort model was built to compare the budget impact of annual Pap cytology with different 5-yearly HPV screening scenarios: (1) a positive HPV test followed by Pap cytology; (2) a positive HPV test followed by p16/Ki-67 dual-stained cytology; (3) a positive HPV test followed by colposcopy if HPV-16/18-positive or p16/Ki-67 dual-stained cytology if positive for other subtypes; (4) co-testing with HPV and Pap. Screening scenarios were based on a 10-year horizon. RESULTS All HPV screening scenarios in the model were associated with fewer deaths from missed diagnosis of cervical cancer compared with Pap screening; 10-year totals n=172-344 (1.5-3 per 100,000) versus n=477 (4.1 per 100,000), respectively. Total annual costs were lower with HPV screening than Pap cytology. The projected average annual cost for HPV screening ranged from €117 million to €136 million compared with €177 million for Pap screening, representing annual savings of €41-60 million. The greatest clinical impact was achieved with primary HPV screening (with genotyping) followed by colposcopy for HPV 16/18-positive women or p16/Ki-67 dual-stained cytology for women positive for other HPV subtypes. CONCLUSION Screening strategies including primary HPV testing for high-risk subtypes (HPV-16/18) in conjunction with p16/Ki-67 dual-stained cytology can improve the detection of cervical cancer at a lower total annual cost than conventional Pap cytology screening.
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"I have human papillomavirus": An analysis of illness narratives from the Experience Project. Appl Nurs Res 2015; 30:137-41. [PMID: 27091268 DOI: 10.1016/j.apnr.2015.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 01/24/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is the most common sexually transmitted virus worldwide. Our purpose was to examine people's experiences with HPV using narratives posted on a website entitled, Experience Project. METHOD We conducted a content analysis of 127 HPV narratives to identify stigma, emotion-focused and problem-focused coping, and misinformation. RESULTS Negative self-image was the most commonly identified type of stigma. There were more instances of problem-focused than emotion-focused coping. Sources of confusion were mostly about HPV treatment and side effects/symptoms. CONCLUSIONS These findings have implications for how nurses and other health professionals can care for individuals living with HPV. Based on these findings, it would be beneficial for clinics/providers to implement on-line forums where myths about HPV can be debunked and accurate information provided. Both patients and the public need to be better informed about HPV, in order to decrease the negative stigma that can create a mental burden for individuals with HPV.
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Abstract
Purpose
– The purpose of this paper is to present a three-part framework of information engagement for situated gynecological cancers. These particular cancers intertwine with medicalization of sexuality and gender power dynamics, situating information behaviors and interactions in women’s socio-health perceptions. Using Kavanagh and Broom’s feminist risk framework, the framework establishes functional and temporal parameters for sense-making and information engagement.
Design/methodology/approach
– This paper employs a structured, reiterative literature review with emergent thematic analysis. Nine indices from medicine, information studies, and sociology were searched using combinations of five terms on cervical cancer (CC) and 14 terms on information engagement in the title, abstract, and subject fields. Results were examined on a reiterative basis to identify emergent themes pertaining to knowledge development and information interactions.
Findings
– Environmentally, social stigma and gender roles inhibit information seeking; normalizing CC helps integrate medical, moral, and sexual information. Internally, living with the dichotomy between “having” a body and “being” a body requires high-trust information resources that are presented gradually. Actively, choosing to make or cede medical decision-making requires personally relevant information delivered in the form of concrete facts and explanations.
Research limitations/implications
– The study covers only one country.
Originality/value
– This study’s information framework and suggestions for future research encourage consideration of gender power dynamics, medicalization of sexuality, and autonomy in women’s health information interactions.
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Abstract
This study looks at media portrayals of sexual health through the popular HBO television show Girls. This rhetorical criticism of Girls delineates two emergent narrative themes. First, the show repeatedly discusses human papillomavirus (HPV) in terms of its severity, but it oscillates in terms of representing the degree of significance. Second, the show frames the source of infection as more important than other concerns related to HPV. Ultimately, this analysis demonstrates that Girls perpetuates a problematic narrative plot structure related to issues of HPV transmission; it also provides a largely scientifically accurate portrayal of HPV and promotes open and frank discussions of sexual health. It is argued that mediated narratives, such as Girls, might have the potential to transform social attitudes and actions and should thereby garner attention from health communication scholars and public health advocates.
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Affiliation(s)
- Brian Rogers
- a Department of Communication , University of Utah
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Smith RA, Hernandez R, Catona D. Investigating Initial Disclosures and Reactions to Unexpected, Positive HPV Diagnosis. WESTERN JOURNAL OF COMMUNICATION 2014; 78:426-440. [PMID: 25642121 PMCID: PMC4309010 DOI: 10.1080/10570314.2013.786120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Initial disclosures of health conditions are critical communication moments. Existing research focuses on disclosers; integrating confidants into studies of initial disclosures is needed. Guided by the disclosure decision-making model (DD-MM; Greene, 2009), this study examined what diagnosed persons and confidants may say when faced with unexpected test results and unexpected disclosures, respectively. Participants (N = 151) recorded an audio-visual message for another person, after imagining that they or the other person had just received unexpected, positive HPV test results. The qualitative analysis revealed four themes: (1) impression management and social distance, (2) invisible symptoms and advice regarding future disclosures, (3) expressing and acknowledging emotional reactions, and (4) misunderstandings and lacking knowledge about HPV. These findings suggested that DD-MM may be a relevant framework for understanding not only when disclosers share, but what disclosers and confidants say in early conversations about new diagnoses. While disclosers' and confidants' messages showed marked similarities, important differences appeared. For example, confidants focused on assuaging disclosers' fear about the consequences, whereas disclosers expressed distress related to their uncertainty about the prognosis of an HPV infection and how to prepare for next steps. The discussion highlighted implications for the DD-MM, HPV disclosures, and future interventions.
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Kosenko KA, Harvey-Knowles J, Hurley RJ. The information management processes of women living with HPV. JOURNAL OF HEALTH COMMUNICATION 2014; 19:813-824. [PMID: 24580554 DOI: 10.1080/10810730.2013.864728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The human papillomavirus (HPV) represents a significant public health burden because of its widespread prevalence, its links to genital warts and cancers, and the negative psychosocial impact of HPV infection and diagnosis. Scholars have attributed some of these negative effects to insufficient knowledge and information about HPV, prompting research on women's HPV information preferences; however, little is known about how women obtain, avoid, and use this information. To address this lacuna, we designed a study to trace the information management processes of women with HPV. Our analysis of interviews with 25 women living with HPV revealed a common sequence of emotional, cognitive, and behavioral responses to the HPV diagnosis. The authors review these findings and articulate their relevance and importance to research, theory, and practice in the discussion.
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Affiliation(s)
- Kami A Kosenko
- a Department of Communication , North Carolina State University , Raleigh , North Carolina , USA
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