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Dzobo M, Dzinamarira T, Murewanhema G, Chishapira T, Dube Mandishora RS, Fitzpatrick M, Mashamba-Thompson T. Co-creation of human papillomavirus self-sampling delivery strategies for cervical cancer screening in rural Zimbabwe: nominal group technique. Front Public Health 2023; 11:1275311. [PMID: 38035305 PMCID: PMC10687562 DOI: 10.3389/fpubh.2023.1275311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
Background Human papillomavirus (HPV) self-sampling is recommended for cervical cancer screening, particularly among women who do not participate in or have access to current screening methods offered in Zimbabwe. Key stakeholder involvement is critical in co-creating acceptable delivery strategies for implementing HPV self-sampling to ensure demand and facilitate uptake by the target population. The main objective of this study was to engage key stakeholders in co-creating acceptable HPV self-sampling delivery strategies for cervical cancer screening in rural Zimbabwe. Methods We invited key stakeholders and employed a nominal group technique (NGT) for data collection. We employed the NGT to (1) identify barriers to access and utilisation of available cervical cancer screening services and (2) co-create delivery strategies for HPV self-sampling. The workshop included 8 participants (women n = 4, health workers n = 2 and policymakers n = 2). Quantitative data was gathered by ranking ideas and qualitative data were collected from participant group discussions and analysed thematically. The results of the ranking exercise were fed back to the participants for comments. Results The most significant barriers to accessing and utilising current cervical cancer screening services by women were: Inadequate information and education on cervical cancer, lack of resources and funding for cervical cancer programmes, long distances to nearest health facilities, and low perceived personal risk of cervical cancer. Key stakeholders recommended enhanced education and awareness, results notification, linkage to care, community-based self-sampling, and the choice of sampling devices as potential HPV self-sampling delivery strategies. Conclusion Our study demonstrated the utility of the NGT for reaching a consensus. Using the NGT, we established priority delivery strategies for HPV self-sampling cervical cancer screening. Adequate education and awareness, early results notification, choice of sampling device and community-based self-sampling were crucial to HPV self-sampling screening in rural Zimbabwe. The proposed delivery strategies can guide the development of guidelines for designing and implementing an HPV self-sampling intervention. We recommend a study to determine women's most preferred HPV self-sampling delivery strategies before implementing the intervention.
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Affiliation(s)
- Mathias Dzobo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Centre for International Programmes Zimbabwe Trust, Harare, Zimbabwe
| | - Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Tatenda Chishapira
- Medical Microbiology Unit, Department of Laboratory Diagnostics and Investigative Sciences, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Racheal S. Dube Mandishora
- Medical Microbiology Unit, Department of Laboratory Diagnostics and Investigative Sciences, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
- Moffitt Cancer Center, Center for Immunization and Infection Research in Cancer (CIIRC), Tampa, FL, United States
| | - Megan Fitzpatrick
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Tivani Mashamba-Thompson
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Gosbell E, Panambalana A, Stephenson A, Vici C, Dutton T, Bailey J. Awareness and attitudes towards the revised National Cervical Screening Program amongst women in rural New South Wales: a cross-sectional study. Aust J Prim Health 2023; 29:471-479. [PMID: 37037661 DOI: 10.1071/py22267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/06/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Research exploring awareness and attitudes towards the revised National Cervical Screening Program (NCSP) amongst rural Australian women is limited. Given the increased incidence and mortality from cervical cancer in rural Australian women, this gap needs attention. This study examined awareness and attitudes of women in rural New South Wales (NSW) towards the revised NCSP. METHODS A cross-sectional survey was conducted with women aged 18-74years currently residing in the Western NSW Primary Health Network region. The anonymous survey was distributed online via social media and email to eligible women. RESULTS In total, 309 rural women participated. The majority were 30-39years old (35.9%) and had completed tertiary education (73.1%), figures which are higher than average for this rural region. Of these, 51.8% (160/309) were aware there had been a change to the NCSP. This information most commonly came from their healthcare provider (57.5%; 82/160). Three-quarters reported being happy or neutral with the change (76.1%; 235/309). Those who were aware of the revised NCSP were more likely to have a positive attitude toward it (P =0.02). Fewer participants reported that they were never/unlikely to participate in screening under the revised NCSP (4.8%, 9/309) as compared to the previous program (15.5%, 48/309) after being provided with information about the revised NCSP. Women who reported an abnormal result under the previous NCSP were more likely to be concerned about the revised NCSP (P =0.037), in particular the starting age of 25years (P =0.007) and the 5-yearly screening interval (P =0.008). CONCLUSION Awareness and knowledge levels play an important role in attitudes towards the revised NCSP in rural women. Strategies to increase participation rates should therefore target these areas. Healthcare professionals can take a central role in this information sharing process.
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Affiliation(s)
- Elizabeth Gosbell
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Alisha Panambalana
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Annabelle Stephenson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Carissa Vici
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Tegan Dutton
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia
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Swai P, Mgongo M, Leyaro BJ, Mwaiselage J, Mchome BL, Kjaer SK, Rasch V, Manongi R, Msuya SE. Knowledge on human papilloma virus and experience of getting positive results: a qualitative study among women in Kilimanjaro, Tanzania. BMC Womens Health 2023; 23:61. [PMID: 36774477 PMCID: PMC9921604 DOI: 10.1186/s12905-023-02192-8] [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: 11/13/2021] [Accepted: 01/24/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Human papilloma virus (HPV) is a sexually transmitted infection causing more than 80% of cervical cancers. WHO recommends using of sensitive screening methods like HPV-testing to timely prevent future morbidity and mortality from cervical cancer. Pilot studies have shown that HPV-testing is feasible and can be scaled in developing country like Tanzania. However, there is limited information on women understanding, reactions and psychological challenges following diagnosis of high risk HPV (HR-HPV). This study explored the knowledge of women on HPV and their experience after HPV positive results in Kilimanjaro, Tanzania. METHODS The study was part of a larger study that assessed incidence and persistence of HR-HPV among women aged 18 years and above in Kilimanjaro. This was a cross sectional study conducted in Moshi municipal council among women who had HR-HPV positive results at enrollment. In-depth interviews were conducted with 13 randomly selected women who were attending for follow-up after enrollment. Interviews were conducted at the health facility and Atlas.ti.8 was used to analyze the data using thematic framework analysis. RESULTS Women had knowledge on HPV infection but they had different reactions following receiving positive HPV results. Reaction toward the positive HPV results had two extremes; some women had psychological effect (hopeless, death sentence, having cancer, being shocked, failure to disclose and psychosexual effects) while others women explained positive results is good as they are identified earlier, will be followed up and it has made them plan to continue with cervical cancer screening in future. CONCLUSION Women had knowledge on HPV, but positive results lead to negative and positive experiences by women. Clinicians and programs need to develop interventions and good strategies to minimize the psychological and social burden of testing positive for HPV.
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Affiliation(s)
- Patricia Swai
- grid.412898.e0000 0004 0648 0439Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania ,Department of Obstetrics and Gynaecology, KCMC Hospital, Moshi, Tanzania
| | - Melina Mgongo
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
| | - Beatrice J. Leyaro
- grid.412898.e0000 0004 0648 0439Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | | | - Bariki L. Mchome
- grid.412898.e0000 0004 0648 0439Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania ,Department of Obstetrics and Gynaecology, KCMC Hospital, Moshi, Tanzania
| | - Susanne K. Kjaer
- grid.4973.90000 0004 0646 7373Department of Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Rasch
- grid.7143.10000 0004 0512 5013Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rachel Manongi
- grid.412898.e0000 0004 0648 0439Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Sia E. Msuya
- grid.412898.e0000 0004 0648 0439Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania ,grid.412898.e0000 0004 0648 0439Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania ,grid.415218.b0000 0004 0648 072XDepartment of Community Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
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Galeshi M, Shirafkan H, Yazdani S, Motaghi Z. Reproductive health needs of Human papillomavirus (HPV) positive women: A systematic review. PLoS One 2022; 17:e0266819. [PMID: 36095006 PMCID: PMC9467316 DOI: 10.1371/journal.pone.0266819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Human papillomavirus is one of the most important causes of cervical cancer. Participating in an HPV test and receiving an HPV diagnosis can create questions about the needs and preferences. The present systematic review was conducted to determine the reproductive health needs of women with HPV. Methods We searched PubMed, Scopus, Web of Science, Google Scholar and Magiran, SID and Iranmedex. Without language restrictions and time constraints. We also searched the grey literature and carried out forward/backward citation searches. Results In the first, 1056 articles were retrieved, and, after removing them, 13 articles published were entered. The studies were qualitative (N = 9), quantitative (N = 3), and one was unclear. Most qualitative studies collected data using individual interviews (N = 7), two qualitative studies, narratives of HPV patients from a website of patient experiences and questions. Women wanted further information on different HPV viral types, transmission, implications for sexual partners, prevalence, latency and regression of HPV, their management options and the implications of infection for cancer risk and fertility. Women’s experience of searching the Internet for further information about HPV was reported as difficult, anxiety provoking and contributing to the stigma of the infection because information was often located in the context of other sexually transmitted infections, with multiple sexual partners highlighted as a risk factor for infection. Conclusion Surveys showed that the majority of women had unanswered questions about their HPV test results. The information that women thought was helpful in interpreting their test results included having a high-risk type of HPV, and cancer survival statistics for the virus. Women also needed information about sexual transmission, how HPV tested positive in a long-term relationship, and the potential consequences for their partners and the risk of re-infection. Younger women had questions about whether HPV could affect fertility.
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Affiliation(s)
- Mina Galeshi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shahla Yazdani
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Motaghi
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
- * E-mail:
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Sanchez Antelo V, Szwarc L, Paolino M, Saimovici D, Massaccesi S, Viswanath K, Arrossi S. A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina. JMIR Form Res 2022; 6:e32610. [PMID: 35023843 PMCID: PMC8796044 DOI: 10.2196/32610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 01/16/2023] Open
Abstract
Background Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective This study aims to understand HPV-tested women’s perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users’ needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions Providing information that meets women’s needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women.
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Affiliation(s)
- Victoria Sanchez Antelo
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucila Szwarc
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Autónoma de Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Autónoma de Buenos Aires, Argentina
| | - Diana Saimovici
- Centro de Estudios de Estado y Sociedad, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvia Massaccesi
- Secretaria de Salud de Ituzaingó, Instituto Provincial del Cáncer, Ministerio de Salud de la Provincia de Buenos Aires, Ituzaingo, Argentina
| | - Kasisomayajula Viswanath
- McGraw-Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Ciudad Autónoma de Buenos Aires, Argentina
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Ciavattini A, Delli Carpini G, Giannella L, Del Fabro A, Banerji V, Hall G, Barbero M, Sopracordevole F. An online survey on emotions, impact on everyday life, and educational needs of women with HPV positivity or abnormal Pap smear result. Medicine (Baltimore) 2021; 100:e27177. [PMID: 34766557 PMCID: PMC8589238 DOI: 10.1097/md.0000000000027177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/20/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the emotional path, impact on everyday life, and adequacy of patient education throughout the diagnostic and therapeutic journey of women who received a positive human papillomavirus (HPV) test or Pap smear result.An online survey was designed to determine the demographic characteristics, dominant feelings throughout the diagnostic and therapeutic procedures, major lifestyle changes, impact on social life, and perceived adequacy of patient information in Italian women with a positive HPV test or abnormal cervical cytology result. In this study, the phases of the "patient's journey" included the initial test, waiting for colposcopy or biopsy, waiting for surgery, and follow-up.Anxiety, worry, and fear were the most frequently cited emotions during the initial tests and intervals between procedures. Anxiety and fear gradually decreased during the journey until surgery, and higher levels of optimism were observed postsurgery. The most frequently reported lifestyle changes were attempts to boost the immune system, increased precautions in sexual practices, and dietary changes. Social life is affected by changes in sexual and intimate relationships with partners. Women reported receiving insufficient patient education on the diagnosis and its implications, progression, management, personal care, and resolution.Significant attention should be given to the psychosocial aspects of the entire patient journey after receiving a positive HPV test or an abnormal Pap smear result. It is essential to establish a good rapport between patients and healthcare professionals, and to educate women regarding the condition by minimizing the gap between the perceived and desired adequacy of information.
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Affiliation(s)
- Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Giannella
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Anna Del Fabro
- Centro di Riferimento Oncologico di Aviano-IRCCS, SOC Chirurgia Oncologica Ginecologica, Aviano, Italy
| | - Vivek Banerji
- Insight Dojo, Studio 206, The Print Rooms, 164-180 Union Street, London, UK
| | - Genevieve Hall
- Insight Dojo, Studio 206, The Print Rooms, 164-180 Union Street, London, UK
| | - Maggiorino Barbero
- Azienda Sanitaria Locale di Asti, SOC Ostetricia e Ginecologia, Asti, Italy
| | - Francesco Sopracordevole
- Centro di Riferimento Oncologico di Aviano-IRCCS, SOC Chirurgia Oncologica Ginecologica, Aviano, Italy
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O'Connor M, McSherry LA, Dombrowski SU, Francis JJ, Martin CM, O'Leary JJ, Sharp L. Identifying ways to maximise cervical screening uptake: a qualitative study of GPs' and practice nurses' cervical cancer screening-related behaviours. HRB Open Res 2021; 4:44. [PMID: 34458677 PMCID: PMC8370130 DOI: 10.12688/hrbopenres.13246.1] [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] [Accepted: 04/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Cervical screening uptake is declining in several countries. Primary care practitioners could play a greater role in maximising uptake, but better understanding is needed of practitioners’ cervical screening-related behaviours. Among general practitioners (GPs) and practice nurses, we aimed to identify cervical screening-related clinical behaviours; clarify practitioners’ roles/responsibilities; and determine factors likely to influence clinical behaviours.
Methods: Telephone interviews were conducted with GPs and practice nurses in Ireland. Interview transcripts were analysed using the Theoretical Domains Framework (TDF), a comprehensive psychological framework of factors influencing clinical behaviour. Results: 14 GPs and 19 practice nurses participated. Key clinical behaviours identified were offering smears and encouraging women to attend for smears. Smeartaking responsibility was considered a predominantly female role. Of 12 possible theoretical domains, 11 were identified in relation to these behaviours. Those judged to be the most important were beliefs about capabilities; environmental context and resources; social influences; and behavioural regulation. Difficulties in obtaining smears from certain subgroups of women and inexperience of some GPs in smeartaking arose in relation to beliefs about capabilities. The need for public health education and reluctance of male practitioners to discuss cervical screening with female patients emerged in relation to social influences. Conclusions: We identified - for the first time - primary care practitioners’ cervical-screening related clinical behaviours, their perceived roles and responsibilities, and factors likely to influence behaviours. The results could inform initiatives to enable practitioners to encourage women to have smear tests which in turn, may help increase cervical screening uptake.
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Affiliation(s)
| | - Lisa A McSherry
- National Cancer Registry of Ireland, Kinsale Road, Cork, Ireland, Ireland
| | | | - Jill J Francis
- School of Health Sciences, City University London, London,, UK
| | | | | | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle, UK
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Asymmetric Power Relations in Gynaecological Consultations for Cervical Cancer Prevention: Biomedical and Gender Issues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157850. [PMID: 34360140 PMCID: PMC8345629 DOI: 10.3390/ijerph18157850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
A generic qualitative research, using a poststructuralist feminist perspective, was conducted in a Spanish gynaecology unit with the following aims: (a) to analyse how asymmetric power relations in relation to biomedical knowledge and gender shape the medical encounters between gynaecologists and women diagnosed with cervical intraepithelial neoplasia and (b) to explore the cognitive, moral, and emotional responses expressed by patients. A total of 21 women diagnosed with cervical intraepithelial neoplasia were recruited through purposive sampling. Semi-structured interviews were recorded and transcribed, and a thematic analysis was carried out. Two major themes were identified: (a) gendered relations in cervical intraepithelial neoplasia medical encounters are based on hidden, judgmental moral assumptions, making women feel irresponsible and blamed for contracting the human papillomavirus infection; (b) biomedical power is based on the positivist assumption of a single truth (scientific knowledge), creating asymmetric relations rendering women ignorant and infantilised. Women reacted vehemently during the interviews, revealing a nexus of cognitive, moral, and emotional reactions. In medical encounters for management of cervical intraepithelial neoplasia, patients feel they are being morally judged and given limited information, generating emotional distress. Healthcare professionals should question whether their practices are based on stereotypical gender assumptions which lead to power asymmetries during encounters.
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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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Borrull-Guardeño J, Sebastiá-Laguarda C, Donat-Colomer F, Sánchez-Martínez V. Women's knowledge and attitudes towards cervical cancer prevention: A qualitative study in the Spanish context. J Clin Nurs 2021; 30:1383-1393. [PMID: 33528874 DOI: 10.1111/jocn.15687] [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: 07/28/2020] [Revised: 12/19/2020] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the knowledge, attitudes and practices related to cervical cancer and its prevention in Spain. BACKGROUND Worldwide, women's knowledge about cervical cancer is low, and their attitudes towards its prevention are good, but they do not correlate with the screening uptake. Although the rates of Spanish women performing cervical cancer screening are mostly acceptable, their knowledge and attitudes about it have not been explored. DESIGN Qualitative descriptive study. METHODS Three focus groups were conducted, with 21 women aged 25 to 65 years. Participants were recruited through convenience sampling. For intragroup homogeneity, women participated in age groups. The COREQ reporting guidelines were used. RESULTS Women expressed their knowledge about cervical cancer was low. None of the participants identified the human papillomavirus as a cause of cervical cancer, nor did they mention the vaccine as a preventive measure. They all knew about the screening existence, but not about its frequency nor target population. About the attitudes and practice, 18 women had an appropriate screening, and they were favourable to this health check, claiming an increase in its frequency. Nineteen women claimed they had not received enough information from the healthcare system and a lack of social awareness in comparison with breast cancer. They demanded from the professionals more health education, a reminder of their appointments and a report of the Pap test results. CONCLUSIONS There was a self-perceived low level of knowledge about cervical cancer risk factors and its prevention in the participants. However, they expressed favourable attitudes towards screening, and they demanded more information about cervical cancer and its prevention measures, and they regretted its low social awareness. RELEVANCE TO CLINICAL PRACTICE Midwives, general nurses and other nurse specialists may have a leading position in health education for cervical cancer prevention in different population levels.
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Affiliation(s)
- Jessica Borrull-Guardeño
- Arnau de Vilanova- Llíria Health Department, Ministry of Universal Healthcare and Public Health, Valencia, Spain.,Department of Nursing, University of Valencia, Valencia, Spain
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Abstract
BACKGROUND Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection. OBJECTIVES The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women. METHODS A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015-2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose-response associations were estimated based on p-trend. RESULTS Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified "promiscuity" as a risk factor of HPV infection and "the use of condoms" as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose-response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine. DISCUSSION In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine.
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O'Connor M, Waller J, Gallagher P, O'Donovan B, Clarke N, Keogh I, MacCarthy D, O'Sullivan E, Timon C, Martin C, O'Leary J, Sharp L. Barriers and facilitators to discussing HPV with head and neck cancer patients: A qualitative study using the theoretical domains framework. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30318-9. [PMID: 32565003 DOI: 10.1016/j.pec.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The incidence of human papillomavirus-associated head and neck cancers (HPV-HNC) is increasing worldwide. Research in other clinical contexts has shown that healthcare professionals (HCPs) can find discussing HPV with patients challenging. However, limited research has been conducted in HNC. This study aimed to investigate barriers and facilitators to, discussing HPV among HCPs caring for patients with HNC in Ireland. METHODS Semi-structured telephone/face-to-face interviews were conducted with HCPs. Barriers and facilitators to discussing HPV with patients were identified using the Theoretical Domains Framework (TDF). RESULTS 20 HCPs (8 clinicians, 3 nurses, 9 allied healthcare professionals) were interviewed. Barriers to discussing HPV included professionals' lack of HPV knowledge, difficulties in talking about sexual issues with patients and lack of privacy to discuss HPV in busy clinic settings. Facilitators included increasing public and patient awareness of the link between HPV and HNC and professional education and skills development. CONCLUSIONS This is the first theoretically informed study to identify barriers and facilitators to discussing HPV with HNC patients. HCPs consider HPV discussions to be an essential part of HNC patient care. PRACTICE IMPLICATIONS Understanding the issues associated with patient-provider HPV communication will help develop effective interventions to support HCPs in their HPV discussions.
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Affiliation(s)
- M O'Connor
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - J Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - P Gallagher
- School of Psychology, Dublin City University, Dublin, Ireland
| | - B O'Donovan
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland.
| | - N Clarke
- School of Psychology, Dublin City University, Dublin, Ireland
| | - I Keogh
- College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Ireland
| | - D MacCarthy
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Dublin, Ireland
| | - E O'Sullivan
- Cork University Dental School and Hospital, Cork, Ireland
| | - C Timon
- St. James's Hospital, James's Street, Dublin, Ireland
| | - C Martin
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland
| | - J O'Leary
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland
| | - L Sharp
- Institute of Health & Society, Newcastle University, UK
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Nagendiram A, Bidgood R, Banks J, Heal C. Knowledge and perspectives of the new National Cervical Screening Program: a qualitative interview study of North Queensland women-'I could be that one percent'. BMJ Open 2020; 10:e034483. [PMID: 32156766 PMCID: PMC7064076 DOI: 10.1136/bmjopen-2019-034483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate women's understanding and attitudes towards the National Cervical Screening Program (NCSP) and to explore methods to improve screening participation. DESIGN Semi-structured face-to-face interviews were conducted through convenience and snowball sampling. Thematic analysis occurred using the interpretivist framework. SETTING A private general practice in North Queensland. PARTICIPANTS Women between the ages of 18 and 74 who attended the general practice were eligible to participate. Fourteen women between 20 and 58 years old were interviewed. RESULTS Participants were concerned that the new NCSP would miss cancer due to longer screening intervals and reliance on primary human papilloma virus (HPV) testing. They believed that young women are at increased risk of cervical cancer, due to perceived HPV vaccine ineffectiveness and parent objection to vaccination. Most participants were not agreeable to self-sampling and preferred their doctor to perform screening. Personal and practitioner beliefs influenced a woman's screening participation. Personal factors include being healthy for themselves and their family, previous abnormal smears and family history of cancer. Emphasis was placed on feeling 'comfortable' with their practitioner which included patient rapport and gender preference. Proposed methods to improve cervical screening included education programmes, advertising campaigns, general practitioner interventions and improving accessibility. CONCLUSIONS It is apparent that women are hesitant about the new NCSP. However, when provided with additional information they were more amenable to the changes. This highlights the need to improve awareness of cervical screening and the new NCSP.
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Affiliation(s)
- Archana Nagendiram
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | | | - Jennifer Banks
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Clare Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
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Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla-Fernández MJ. When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance. PLoS One 2019; 14:e0226261. [PMID: 31841543 PMCID: PMC6913976 DOI: 10.1371/journal.pone.0226261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/23/2019] [Indexed: 11/19/2022] Open
Abstract
Background After the early detection of cervical intraepithelial neoplasia (CIN), medical surveillance of the precancerous lesions is carried out to control risk factors to avoid the development of cervical cancer. Objective To explore the effects of medical surveillance on the personal and social lives of women undergoing CIN follow-up and treatment. Methodology A generic qualitative study using a poststructuralist perspective of risk management was carried out in a gynecology clinic in a public hospital of the Galician Health Care System (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed, and a thematic analysis was carried out, including researcher triangulation to verify the results of the analysis. Findings Two main themes emerged from the participants’ experiences: CIN medical surveillance encounters and risk management strategies are shaped by the biomedical discourse, and the effects of “risk treatment” for patients include (a) profound changes expected of patients, (b) increased patient risk management, and (c) resistance to risk management. While doctors’ surveillance aimed to prevent the development of cervical cancer, women felt they were sick because they had to follow strict recommendations over an unspecified period of time and live with the possibility of a life-threatening disease. Clinical risk management resulted in the medicalization of women’s personal and social lives and produced great uncertainty. Conclusions This study is the first to conceptualize CIN medical surveillance as an illness experience for patients. It also problematizes the effects of preventative practices in women’s lives. Patients deal with great uncertainty, as CIN medical surveillance performed by gynecologists simultaneously trivializes the changes expected of patients and underestimates the effects of medical recommendations on patients’ personal wellbeing and social relations.
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Affiliation(s)
- Carla Freijomil-Vázquez
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Ferrol, Spain
- Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
- * E-mail:
| | - Denise Gastaldo
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Canada
| | - Carmen Coronado
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Ferrol, Spain
- Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Ferrol, Spain
- Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
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Schröer-Günther M, Fechtelpeter D, Zschorlich B, Wegmann M, Keller S, Schürmann C, Lampert U, Seidl A, Janßen I, Koch K. [Development of Decision Aids for Organized Cervical Carcinoma Screening in Germany]. DAS GESUNDHEITSWESEN 2019; 83:128-134. [PMID: 31830768 DOI: 10.1055/a-1028-7283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM OF THE STUDY The Federal Joint Committee has decided to introduce organized cervical carcinoma screening in 2020. The present work describes the development of decision aids that will be sent to women in this program. METHODS A systematic search for qualitative studies and surveys was conducted to gather information on experiences, attitudes and information needs. Furthermore, we searched for systematic reviews on advantages and disadvantages of screening. An existing decision analysis for cervical carcinoma screening in Germany was used. The designs were subjected to a qualitative test (focus groups with 26 women and 8 expert interviews), to a quantitative user test (online survey n=2,014 women) and to a public hearing. RESULTS Most women found the decision aids informative and helpful. The majority would recommend the use of these materials to others. For many women, part of the information was new, although they had been involved in cervical cancer screening for some time. The presentation of the advantages and disadvantages was judged to be balanced. However, 10% changed their attitude towards participation and 70% of women would attend screening. CONCLUSION The decision aids found a high acceptance among the users. They can help to reduce knowledge deficits on cervical carcinoma screening and support a informed decision making.
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Affiliation(s)
| | | | - Beate Zschorlich
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | | | - Sabine Keller
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | | | - Ulrike Lampert
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | - Astrid Seidl
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | - Inger Janßen
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
| | - Klaus Koch
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln
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Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla-Fernández MJ. Health care informational challenges for women diagnosed with cervical intraepithelial neoplasia: a qualitative study. BMC WOMENS HEALTH 2019; 19:112. [PMID: 31477083 PMCID: PMC6720084 DOI: 10.1186/s12905-019-0811-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/23/2019] [Indexed: 12/01/2022]
Abstract
Background Internationally, women with cervical intraepithelial neoplasia (CIN) lack knowledge about their disease, which limits their ability to take responsibility for self-care and creates negative psychosocial effects, including marital problems. Normally, screening is performed in primary care, and in case of abnormal results, the patient is referred to specialized care for follow-up and treatment. Given the lack of international literature regarding patients’ experiences in primary and specialized healthcare, our study aims to: (a) investigate how women with CIN perceive the communication and management of information by healthcare providers at different moments of their healthcare and (b) identify these women’s informational needs. Methods A qualitative exploratory study was carried out in a gynecology unit of a public hospital of the Galician Health Care Service (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women aged 21 to 52 years old with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed. A thematic analysis was carried out, including triangulation of researchers for analysis verification. Results Two analytical themes were identified. The first was communication gaps in the diagnosis and management of information in primary and specialized healthcare. These gaps occurred in the following moments of the healthcare process: (a) cervical cancer screening in primary care, (b) waiting time until referral to specialized care, (c) first consultation in specialized care, and (d) after consultation in specialized care. The second theme was participants’ unmatched informational needs. The doubts and informational needs of women during their healthcare process related to the following subthemes: (a) HPV transmission, (b) HPV infection symptoms and consequences, and (c) CIN treatment and follow-up. Conclusions This study shows that women who have a diagnosis of CIN experience important healthcare informational challenges when accessing primary and specialized care that have several implications for their wellbeing. The information given is limited, which makes it difficult for women to understand and participate in the decision making regarding the prevention and treatment of CIN. Service coordination among different levels of care and the availability of educational materials at any given time would improve the patients’ healthcare experience.
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Affiliation(s)
- Carla Freijomil-Vázquez
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain. .,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain.
| | - Denise Gastaldo
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Centre for Critical Qualitative Health Research (CQ), University of Toronto, Toronto, Canada
| | - Carmen Coronado
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain.,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Facultade de Enfermaría e Podoloxía, Universidade da Coruña, Campus de Esteiro, CP: 15403, Ferrol, Spain.,Laboratorio de Investigación Cualitativa en Ciencias da Saúde (CCSS), Grupo de Investigación Cardiovascular (GRINCAR), Universidade da Coruña, Ferrol, Spain
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17
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Dodd RH, Obermair HM, McCaffery KJ. A Thematic Analysis of Attitudes Toward Changes to Cervical Screening in Australia. JMIR Cancer 2019; 5:e12307. [PMID: 30973340 PMCID: PMC6482401 DOI: 10.2196/12307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/05/2019] [Accepted: 02/24/2019] [Indexed: 12/24/2022] Open
Abstract
Background In December 2017, the Australian National Cervical Screening Program (NCSP) was changed to encompass a 5-yearly human papillomavirus (HPV) primary test for women aged 25 to 74 years. Public concerns about changes to screening programs has been demonstrated in other countries previously. Objective The aim of the study was to explore in depth women’s understanding of and concerns about the specific changes to the Australian NCSP implemented in December 2017. Methods A Web-based petition (Change.org) opposing the changes received over 70,000 signatures and nearly 20,000 comments from February to March 2017. Of 19,633 comments, a random sample of 10% (2000/19,633) were analyzed using content analysis (reported elsewhere). Comments relating directly to the specific changes to the program were further analyzed using qualitative thematic analysis. Results Around one-third (34.55%; 691/2000) of the total comments were related to concerns about specific changes to the program. The greatest concern was that screening intervals would be too long and that cancer may not be detected in time for successful treatment. Missing cancer in younger women (aged <25 years) was also an important concern, perceiving younger women to remain at significant risk. Notably, concern was rarely expressed about the new test (the HPV test). Conclusions Gaps in knowledge and understanding about changes to the program and the rationale behind these have caused health concerns among women. Worry about the extended screening interval indicates little understanding of the slow progression of the HPV infection to cervical cancer or the high rates of regression. Identification of these knowledge gaps can inform both deintensification of other cancer screening programs and practitioners, so that they are able to address these concerns with their patients.
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Affiliation(s)
- Rachael H Dodd
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Helena M Obermair
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten J McCaffery
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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18
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Malagón T, Louvanto K, Wissing M, Burchell AN, Tellier PP, El-Zein M, Coutlée F, Franco EL. Hand-to-genital and genital-to-genital transmission of human papillomaviruses between male and female sexual partners (HITCH): a prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2019; 19:317-326. [PMID: 30745276 DOI: 10.1016/s1473-3099(18)30655-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hand-to-genital contact is hypothesised to be a transmission mode of human papillomavirus (HPV) of the Alphapapillomavirus genus. We compared the relative importance of hand-to-genital and genital-to-genital HPV transmission between sexual partners. METHODS In this prospective cohort study, we recruited and followed up female university students aged 18-24 years and their male sexual partners in Montreal, QC, Canada (2005-11). Participants were eligible if they had initiated sexual activity within the past 6 months. Women were examined at clinic visits at baseline and every 4-6 months for up to 24 months. Men had a baseline visit and a single follow-up visit approximately 4 months later. Partners provided hand and genital swab samples, which we tested for DNA of 36 HPV types using PCR. We assessed predictors of incident type-specific HPV detections using Cox proportional hazards models. FINDINGS Participants were recruited between June 5, 2006, and April 4, 2013. 264 women and 291 men had valid hand samples. The hazard ratio (HR) of incident detection of HPV in genital samples from women was 5·0 (95% CI 1·5-16·4) when her partner was positive for the same HPV type on his hand versus negative, but adjustment for his genital HPV status reduced the HR to 0·5 (0·1-1·8). Similarly, the HR of incident detection of HPV on men's genitals was 17·4 (95% CI 7·9-38·5) when his partner was positive for the same HPV type on her hand versus negative, but adjustment for her genital HPV status reduced the HR to 2·3 (0·9-6·2). Conversely, the HR of type-specific incident detection of HPV in genital samples associated with partner genital HPV positivity was 19·3 (95% CI 11·8-31·8) for women and 28·4 (15·4-52·1) for men after adjustment for their hand HPV status. INTERPRETATION Clinicians can reassure their patients that HPV transmission is unlikely to occur through hand-to-genital contact. The majority of genital HPV infections are likely to be caused by genital-to-genital sexual transmission. FUNDING Canadian Institutes for Health Research, National Institutes of Health, Fonds de la Recherche en Santé du Québec, and Merck & Co.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.
| | - Karolina Louvanto
- Department of Obstetrics and Gynaecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Michel Wissing
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Mariam El-Zein
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - François Coutlée
- Département de Microbiologie et Infectiologie, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Département de Microbiologie et Immunologie, Université de Montréal, Montreal, QC, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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O'Connor M, O'Leary E, Waller J, Gallagher P, Martin CM, O'Leary JJ, Sharp L. Socio-economic variations in anticipated adverse reactions to testing HPV positive: Implications for the introduction of primary HPV-based cervical screening. Prev Med 2018; 115:90-96. [PMID: 30144488 DOI: 10.1016/j.ypmed.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022]
Abstract
Some cervical cancer screening programmes are replacing cytology with human papillomavirus (HPV) DNA testing as the primary screening test. Concerns have been previously raised around the potential psychosocial impact of testing positive for HPV. We analysed socio-economic variations in anticipated adverse reactions to testing positive for HPV in women of screening age in the general population. A questionnaire was mailed to a random sample of 5553 women aged 20-64 in 2010, selected through primary care in Ireland. This included questions on: socio-economics; HPV knowledge; and women's anticipated adverse psychosocial responses to testing HPV positive (shame, anxiety, stigma and worry). Multivariable linear regression was used to identify socio-economic factors significantly associated with each anticipated adverse reaction. The response rate was 62% (n = 3470). In multivariate analyses, having only attained primary level education were significantly associated with higher mean scores for all four adverse outcomes. Religion was significantly associated with all four adverse outcomes. Age was associated with anxiety and worry; younger women (<30 years) had the highest mean scores. Being married/cohabiting was significantly associated with significantly lower shame and worry scores. Not working was significantly associated with higher mean anxiety and worry scores. Our large population-based survey found significant socio-economic variations in anticipated adverse reactions to testing HPV positive. In order to minimise possible negative impacts on screening uptake and alleviate potential adverse psychological effects of HPV-based screening on women, screening programmes may need to develop specific messages around HPV infection and HPV screening that target certain subgroups of women.
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Affiliation(s)
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Kinsale Road, Cork, Ireland
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Cara M Martin
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland, Ireland
| | - John J O'Leary
- Department of Histopathology, University of Dublin, Trinity College, Ireland; Department of Pathology, Coombe Women and Infants University Hospital, Ireland, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, UK
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20
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Patel H, Moss EL, Sherman SM. HPV primary cervical screening in England: Women's awareness and attitudes. Psychooncology 2018. [PMID: 29521462 DOI: 10.1002/pon.4694] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Primary human papillomavirus (HPV) cervical screening is due to be implemented in England within the next 2 years; however, the acceptability of HPV testing as the primary screening test is unclear. This study explores women's awareness and attitudes toward HPV testing/screening. METHODS Qualitative interviews (semistructured and focus group) were conducted with 46 women (aged 25-65 years) from community and secondary care settings. Data were analyzed by using the inductive-framework method. RESULTS Women were unaware that cervical screening currently includes HPV testing and lacked HPV-related knowledge. Emotions of shock, fear, and anxiety were reported upon receiving a positive HPV result. For women in long-term relationships, the realization that HPV is a sexually transmitted infection was seen as a barrier to primary HPV testing. Knowledge that HPV testing is a screening test to prevent cervical cancer did not change their attitudes. Women debated the need for continued screening following a negative result. Women feared judgment by the community if they participated with primary HPV screening because they were being tested for a sexually transmitted infection, with the possible attendant perception that they had adopted a high-risk lifestyle in comparison to nonattenders. CONCLUSIONS The acceptability of HPV testing may be a limiting factor in encouraging participation with screening in the future.
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Affiliation(s)
- Hersha Patel
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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21
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Larasati L, Afiyanti Y, Rahmah H, Milanti A. Women’s knowledge, beliefs, and behaviors toward the prevention of human papillomavirus transmission. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30065-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Swedish translation and cross-cultural adaptation of the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia (FACIT-CD): linguistic validity and reliability of the Swedish version. BMC Womens Health 2017; 17:24. [PMID: 28372548 PMCID: PMC5379725 DOI: 10.1186/s12905-017-0381-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/16/2017] [Indexed: 11/29/2022] Open
Abstract
Background Cervical dysplasia is a precancerous condition, which has been shown to create anxiety in women. To be able to investigate these women’s health-related quality of life, a disease-specific instrument is required. There does not seem to be a Swedish version of an instrument to screen for this specific disease. Therefore, this study aims to translate and cross-culturally adapt the Functional Assessment of Chronic Illness Therapy – Cervical Dysplasia (FACIT-CD) into a Swedish context and evaluate its linguistic validity and reliability. Methods The Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology was used, which consists of several steps including pilot testing of the FACIT-CD instrument through cognitive debriefing interviews. Ten women diagnosed with cervical dysplasia participated in the cognitive debriefing interviews. The internal consistency reliability of the Swedish FACIT-CD was estimated by Cronbach’s alpha coefficient. Homogeneity of the items was evaluated by corrected item-total correlations. The sample consists of 34 women who were diagnosed with cervical dysplasia. Results The translation and cross-cultural adaptation went smoothly without any problems for the majority of the items. The cognitive debriefing interviews indicated that the Swedish FACIT-CD consists of relevant items, is easy to understand and complete, and has unambiguous and comprehensive response categories. The translation and cross-cultural adaptation resulted in a Swedish FACIT-CD, which is conceptually and semantically equivalent to the English version and linguistically valid. The total scale of the Swedish FACIT-CD exhibited good internal consistency reliability with a Cronbach’s alpha coefficient of 0.84, and all of the subscales exhibited acceptable value between 0.71 and 0.81 except the Relationships subscale, which had a value of 0.67. Finally, all but four items exceeded the acceptable level for the corrected item-total correlations of ≥ 0.20. Conclusions The Swedish FACIT-CD is conceptually and semantically equivalent to the English version and linguistically valid; further, it exhibits good internal consistency reliability.
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Rask M, Swahnberg K, Lindell G, Oscarsson M. Women's experiences of abnormal Pap smear results - A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 12:3-8. [PMID: 28477928 DOI: 10.1016/j.srhc.2017.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe women's experiences of abnormal Pap smear result. METHODS Ten women were recruited from a women's health clinic. Qualitative interviews based on six open-ended questions were conducted, transcribed verbatim, and analyzed by content analysis. RESULTS The women believed that their abnormal Pap smear result was indicative of having cancer. This created anxiety in the women, which resulted in the need for emotional support and information. Testing positive with human papillomavirus (HPV) also meant consequences for the relatives as well as concerns about the sexually transmitted nature of the virus. Finally, the women had a need to be treated with respect by the healthcare professionals in order to reduce feelings of being abused. CONCLUSIONS In general, women have a low level of awareness of HPV and its relation to abnormal Pap smear results. Women who receive abnormal Pap smear results need oral information, based on the individual women's situation, and delivered at the time the women receive the test result. It is also essential that a good emotional contact be established between the women and the healthcare professionals.
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Affiliation(s)
- Marie Rask
- Department of Health and Caring Sciences, Linnaeus University, Sweden.
| | | | - Gunnel Lindell
- Department of Women's and Children's Health, Karolinska Institute, Sweden; Kalmar County Hospital, Kalmar, Sweden.
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Sweden.
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Recommendations for Implementing Human Papillomavirus-Based Cervical Cancer Screening: Lessons Learned from the HPV FOCAL Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:723-6. [DOI: 10.1016/j.jogc.2016.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/22/2016] [Indexed: 11/21/2022]
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