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Mkuu RS, Staras SA, Chakrabarti C, Hall J, Harvey I, Salloum RG, Barrow S, Ortega S, Woodard J, Seals K, Rawls A, Meduri Y, Donahoo WT, Goede DL, Shenkman EA. Acceptability of HPV self-collection: A qualitative study of Black women living with type II diabetes and social vulnerability. J Clin Transl Endocrinol 2024; 35:100331. [PMID: 38444842 PMCID: PMC10912756 DOI: 10.1016/j.jcte.2024.100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Human papillomavirus (HPV) causes 99.7% of cervical cancer cases. Cervical cancer is preventable through early detection via HPV testing. However, the number of women screened for cervical cancer has not increased in the last several years. Lower screening rates among women living in high poverty and social vulnerability areas, Black women, and women with chronic co-morbidities (e.g., type 2 diabetes (T2D)) are associated with their higher cervical cancer mortality rates. When screened, Black women are more likely to be diagnosed at later stages and die from cervical cancer. HPV self-collection decreases barriers to cervical cancer screening and can help lessen disparities among underserved women. This study aimed to examine the acceptability of HPV self-collection among Black women with T2D living in socially vulnerable communities. Methods Qualitative semi-structured interviews were conducted with 29 Black women with T2D living in communities with high social vulnerability. The Health Belief Model informed the development of the interview guide to gather data on the acceptability of HPV self-collection. Results Three main themes aligned with the Health Belief Model were identified: (1) HPV self-collection provides a comfortable alternative to in-clinic HPV testing (perceived benefits); (2) HPV self-collection would result in awareness of current HPV status (health motivation); and (3) Women were concerned about collecting their sample accurately (perceived barriers). Discussion/Conclusion Black women with T2D living in communities with high social vulnerability identified multiple benefits of cervical cancer screening through HPV self-collection. Women are concerned about their ability to collect these samples correctly. Our findings call for future studies focusing on increasing self-efficacy and skills to collect HPV samples among Black women with chronic conditions like T2D who reside in underserved communities with high social vulnerability.
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Affiliation(s)
- Rahma S Mkuu
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Stephanie A Staras
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Choeeta Chakrabarti
- Department of Anthropology, Florida State University, 909 Antarctic Way, Tallahassee, FL 32304, USA
| | - Jaclyn Hall
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Idethia Harvey
- College of Health Sciences, University of Missouri, 313 Clark Hall, Columbia, MO 65211, USA
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Sable Barrow
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Selena Ortega
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Jennifer Woodard
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Kayla Seals
- Department of Health Science, University of Alabama, 108 Russell Hall, Tuscaloosa, AL 35487, USA
| | - Audrey Rawls
- Department of Health Science, University of Alabama, 108 Russell Hall, Tuscaloosa, AL 35487, USA
| | - Yashaswini Meduri
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - William T Donahoo
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Florida, P.O. Box 100226, Gainesville, FL 32610, USA
| | - Dianne L Goede
- Internal Medicine, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4th Floor, Suite 4592, Gainesville, FL 32610-3008, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
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Emerson A, Dogan M, Hawes E, Wilson K, Chana SM, Kelly PJ, Comfort M, Ramaswamy M. Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use. HEALTH & JUSTICE 2024; 12:9. [PMID: 38407688 PMCID: PMC10895855 DOI: 10.1186/s40352-024-00262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The wide availability of routine screening with Papanicolaou (Pap) tests and vaccinations against human papillomavirus has resulted in a decline in rates of cervical cancer. As with other diseases, however, disparities in incidence and mortality persist. Cervical cancer, is found more often, at later stages, and has worse outcomes in people who live in rural areas, identify as Black or Hispanic, and in people who are incarcerated. Studies report 4-5 times higher rates of cervical cancer incidence in people detained in jails and prisons than in community-based samples. Studies to explain cervical cancer differences have been inconclusive, though there is broad consensus that issues of access play a role. In this study, we sought to learn more from people who have a history of criminal-legal system involvement and substance use about what barriers and facilitators they perceive in accessing cervical cancer preventive health and other support services in the community. RESULTS We conducted semi-structured interviews with open-ended questions by telephone with 20 self-identified women, ages 22-58, in Birmingham, Alabama. Interviews were audio recorded and transcribed and the transcripts analyzed using immersion-crystallization techniques. Our team identified two main themes, making connections: the importance of interpersonal communication, which stressed barriers and facilitators related to what makes for effective and humanistic interactions in cervical health prevention and other services, and getting it done: the logistics of access and availability, which highlighted elements of cost and payment; scheduling; transportation; and clinic policies. CONCLUSIONS People with a history of criminal-legal system involvement and substance abuse meet with a variety of enabling and impeding factors at personal and interpersonal as well as systemic levels in obtaining cervical health services. To better ensure that women in this high-risk group have equitable access to cervical cancer prevention and treatment-and thus better cancer outcomes-will require multilevel efforts that include an emphasis on improving the human connection in health care encounters and improving the nuts-and-bolts logistics related to accessing that care.
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Affiliation(s)
- Amanda Emerson
- KU School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66180, USA.
| | - Marissa Dogan
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Elizabeth Hawes
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Kiana Wilson
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Sofía Mildrum Chana
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Patricia J Kelly
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA
| | | | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66106, USA
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Mkuu RS, Hall JM, Galochkina Z, Cho HD, Staras SAS, Lee JH, Guo Y, Chakrabarti C, Barrow SB, Ortega S, Avery DM, Higginbotham J, Lockhart J, Shenkman EA. Does the Intersectionality of Race/Ethnicity and Type 2 Diabetes Increase the Odds of a Cervical Cancer Diagnosis? A Nested Case-Control Study of a Florida Statewide Multisite EHR Database. Healthcare (Basel) 2023; 11:1863. [PMID: 37444697 DOI: 10.3390/healthcare11131863] [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: 05/30/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Cervical cancer and Type 2 Diabetes (T2D) share common demographic risk factors. Despite this, scarce research has examined the relationship between race/ethnicity, having T2D, and cervical cancer incidence. We analyzed statewide electronic health records data between 2012 and 2019 from the OneFlorida+ Data Trust. We created a 1:4 nested case-control dataset. Each case (patient with cervical cancer) was matched with four controls (patients without cervical cancer) without replacement by year of encounter, diagnosis, and age. We used conditional logistic regression to estimate the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between race/ethnicity, T2D, and cervical cancer incidence. A total of 100,739 cases and 402,956 matched controls were identified. After adjusting for sociodemographic characteristics, non-Hispanic Black women with T2D had higher odds of cervical cancer compared with non-Hispanic White women with T2D (OR: 1.58, 95% CI 1.41-1.77). Living in a rural area, having Medicaid/Medicare insurance, and having high social vulnerability were associated with higher odds of having a cervical cancer diagnosis. Our findings imply the need to address the higher burden of cervical cancer diagnosis among non-Hispanic Black women with T2D and in underserved populations.
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Affiliation(s)
- Rahma S Mkuu
- Department of Health Science, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Jaclyn M Hall
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Zhanna Galochkina
- Division of Quantitative Sciences, University of Florida Health Cancer Center, The University of Florida, 2033 Mowry Road, Gainesville, FL 32610, USA
| | - Hee Deok Cho
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, The University of Florida, 2004 Mowry Road, Gainesville, FL 32603, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Choeeta Chakrabarti
- Department of Anthropology, Florida State University, 2035 E Paul Dirac Drive Suite 206, Tallahassee, FL 32310, USA
| | - Sable Bowman Barrow
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Selena Ortega
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
| | - Daniel M Avery
- College of Community Health Sciences, The University of Alabama, 211 Peter Bryce Boulevard, Tuscaloosa, AL 35401, USA
| | - John Higginbotham
- College of Community Health Sciences, The University of Alabama, 211 Peter Bryce Boulevard, Tuscaloosa, AL 35401, USA
| | - Jala Lockhart
- Department of Health Science, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, The University of Florida, 2199 Mowry Road, Gainesville, FL 32611, USA
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