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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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Frempong SN, Shinkins B, Howdon D, Messenger M, Neal RD, Sagoo GS. Early economic evaluation of an intervention to improve uptake of the NHS England Diabetes Prevention Programme. Expert Rev Pharmacoecon Outcomes Res 2021; 22:417-427. [PMID: 33682555 DOI: 10.1080/14737167.2021.1895755] [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: 10/22/2022]
Abstract
BACKGROUND Despite reported increases in referral numbers, a large proportion of those with prediabetes still decline participation in the NHS England Diabetes Prevention Programme (NDPP). The aim of this study was to explore whether investment in interventions to improve uptake of the programme has the potential to be cost-effective. METHODS An early cost-utility analysis was conducted using a Markov model parameterized based on secondary data sources. We explored different uptake scenarios and the impact that this had on the maximum allowable intervention price based on cost-effectiveness at the UK NICE willingness to pay threshold of £20,000 (US$ 25,913). Value of information analyses were conducted to explore the potential value of further research to resolve uncertainty at each uptake level. RESULTS As uptake levels increase, the maximum allowable intervention price and overall expected value of removing decision uncertainty increases. For 5 percentage and 50 percentage points increase in uptake levels, the maximum allowable intervention price is £41.86 (US$ 54.23) and £418.59 (US$ 542.34) per person, and the overall expected value of removing decision uncertainty are £361,818,839 (US$ 468,786,625) and £1,468,712,316 (US$ 1,902,921,063) respectively. CONCLUSION There is headroom for investment in interventions that improve uptake to the NDPP, thereby allowing the programme itself to be delivered in a manner that remains cost-effective.
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Affiliation(s)
- Samuel N Frempong
- Test Evaluation Group, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds UK
| | - Bethany Shinkins
- Test Evaluation Group, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds UK.,NIHR Leeds in Vitro Diagnostics Co-operative, Leeds, UK
| | - Daniel Howdon
- Test Evaluation Group, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds UK
| | - Michael Messenger
- Cancer Research UK Centre, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds UK
| | - Richard D Neal
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds UK
| | - Gurdeep S Sagoo
- Test Evaluation Group, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds UK.,NIHR Leeds in Vitro Diagnostics Co-operative, Leeds, UK
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Tefera F, Mitiku I. Uptake of Cervical Cancer Screening and Associated Factors Among 15-49-Year-Old Women in Dessie Town, Northeast Ethiopia. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:901-907. [PMID: 27075197 DOI: 10.1007/s13187-016-1021-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cervical cancer screening is acknowledged as the most effective approach to reduce incidence and mortality rates from the disease. Nevertheless, there are limited data on the rate of uptake of cervical cancer screening and factors that are related to uptake of screening services in Ethiopia. The purpose of this study was to determine the level of uptake of screening and determine associated factors among women of age 15-49 years in Northeast Ethiopia. A community-based cross-sectional survey was conducted among 620 women residing in Dessie town, Northeast Ethiopia. The respondents were selected using a multistage sampling technique. Data were collected using interviewer-administered questionnaires. Binary and multiple logistic regressions were employed to determine factors associated with the uptake of cervical cancer screening service. Overall, 57.7 % of the women had ever heard of cervical cancer, and 51.9 % had sufficient knowledge about the disease. However, only 11 % underwent at least one cervical screening in their lifetime. After adjusting for covariates, knowledge of cervical cancer (adjusted odds ratio (AOR) 11.1; 95 % CI 5.0-24.8) and age (being 25-34 years (AOR 5.0; 95 % CI 1.5-16.7) and being within the age group of 34-49 years (AOR 6.0; 95 % CI 1.74-20.8)) were significantly associated with screening service uptake. In this study, uptake of cervical cancer screening service was found to be low. Increasing women's knowledge about cervical cancer, particularly targeting the younger ones, is crucial to enhance uptake of screening.
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Affiliation(s)
- Fasika Tefera
- Family Guidance Association Ethiopia, Addis Ababa, Ethiopia
| | - Israel Mitiku
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
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Acharya Pandey R, Karmacharya E. Cervical cancer screening behavior and associated factors among women of Ugrachandi Nala, Kavre, Nepal. Eur J Med Res 2017; 22:32. [PMID: 28927464 PMCID: PMC5606016 DOI: 10.1186/s40001-017-0274-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer in Nepal ranks as the first most frequent cancer among women. Primary prevention measures, such as prophylactic vaccines against high risk HPV, are now available. Over time, vaccination will decrease the prevalence of the disease among younger women; however, screening will still be needed. The objective of the study was to assess the cervical cancer screening behavior and its associated factors among women of Nala Village Development Committee (VDC), Kavre. Methods A descriptive cross-sectional study was done to assess the cervical cancer screening behavior among women in 2014. Systematic Random sampling was used to collect the data from a sample of 180 women residing in Nala VDC. A structured interview questionnaire and health belief model scale was used to collect data. Descriptive and inferential statistics (Chi-square test) was used for data analysis using SPSS version 16 program. Results Minority (18.3%) of the respondents had cervical cancer screening behavior. Education level of the respondents was significantly associated with cervical cancer screening behavior (p < 0.05). Age, parity, perceived susceptibility, perceived benefits, and perceived barriers had no significant association with cervical cancer screening behavior. Conclusion This study shows that cervical cancer screening behavior was satisfactory. The findings of the study indicate a significant association between cervical cancer screening behavior and education level of the participants. Awareness campaigns targeting illiterate groups can be conducted in community so that they become motivated towards cervical cancer screening.
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Affiliation(s)
- Radha Acharya Pandey
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
| | - Era Karmacharya
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
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Jahani P, Ghahramani S, Abdollahifard G. Knowledge, Attitude and Practice of University Faculty Members and High School Teachers About Cervical Cancer Screening in Shiraz, Iran. WOMEN’S HEALTH BULLETIN 2015. [DOI: 10.17795/whb-24462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Determinants of cervical screening services uptake among 18-49 year old women seeking services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. BMC Health Serv Res 2014; 14:335. [PMID: 25100298 PMCID: PMC4271847 DOI: 10.1186/1472-6963-14-335] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/30/2014] [Indexed: 11/30/2022] Open
Abstract
Background Kenyan women aged ≥15 years are at risk of developing cervical cancer. Currently, cervical cytology reduces cervical cancer incidence, since it allows for early diagnosis and treatment. Uptake of cervical screening services is a priority research area in Kenya. Central to the success of any screening programme is its ability to identify, reach out and screen the defined target population. Cervical screening coverage in Kenya is currently at 3.2%. In Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Nyanza, the number screened for cervical cancer is low (averagely 3/day). Thus the current study sought to identify factors influencing uptake of cervical screening services at the facility. Methods In a cross-sectional study, knowledge, perceptions and cues for action associated with self-reported cervical screening uptake were explored. The targeted population (n = 424), purposively selected were women of child-bearing age (18–49 years) visiting JOOTRH. Data on socio-demographic status (age, level of education, marital status, job status, income level), knowledge of cervical cancer, perceptions on severity and susceptibility to the disease were collected using self-administered structured questionnaires. Statistical significance of differences in proportions were determined by chi-square analyses while logistic regression analyses were used to identify determinants of self-reported uptake of the service. Results Self-reported screening uptake was 17.5%. There was a strong positive association between age (P < 0.0001), level of education (P < 0.0001) and income levels (P = 0.005) with the uptake of the service. Knowledge level on the signs and symptoms of cervical cancer was an important determinant for being screened for cervical cancer (P < 0.0001). Furthermore, those who said they didn’t know about the disease (OR, 26.84, 95% CI, 6.07-118.61, P < 0.0001) or were not aware about susceptibility to it (OR, 2.37, 95% CI, 1.10-5.08, P = 0.02) had a higher likelihood of not being screened. On cues for action, those who attended the child welfare clinic were more likely to be screened (OR, 2.31, 95% CI, 1.17-3.93, P = 0.03). Conclusion Knowledge, perception of higher susceptibility and attending child welfare clinic are key determinants of self-reported uptake of cervical screening. Increasing knowledge, enhancing health education and providing free services may increase uptake among women population in such settings. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-335) contains supplementary material, which is available to authorized users.
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Albrow R, Blomberg K, Kitchener H, Brabin L, Patnick J, Tishelman C, Törnberg S, Sparén P, Widmark C. Interventions to improve cervical cancer screening uptake amongst young women: a systematic review. Acta Oncol 2014; 53:445-51. [PMID: 24660768 DOI: 10.3109/0284186x.2013.869618] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In view of declining screening uptake in young women, this review aims to summarise the available evidence relating to interventions designed to increase cervical screening uptake amongst women aged ≤ 35 years. METHODS Electronic databases were searched and further articles located by manual searches. Study designs employing a valid comparison group and including women aged ≤ 35 years published through 2012 were considered. Data was extracted on the uptake from either screening programme statistics or as reported by the study subjects. A narrative synthesis was undertaken for each category of interventions identified. RESULTS Ninety-two records were screened with 36 articles retrieved for further assessment. Four studies met the inclusion criteria, two of which evaluated more than one intervention. One of the studies evaluated the use of a modified invitation letter and reported no significant increase in uptake compared to a standard invitation. Three studies investigated the use of a reminder letter, with two reporting a positive effect on screening uptake in women aged 24-34. Three studies were included which supported the use of physician and telephone reminders. One study on HPV self-sampling reported a positive effect when compared with a reminder letter. CONCLUSIONS There is a lack of randomised controlled trials designed to specifically address falling cervical screening uptake in amongst young women. Cervical screening programmes need to look beyond the use of invitation/reminders letters in this group of women to develop interventions which attempt to overcome as many barriers to uptake as possible.
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Affiliation(s)
- Rebecca Albrow
- School of Cancer and Enabling Sciences, The University of Manchester,
Manchester, UK
| | - Karin Blomberg
- School of Health and Medical Sciences, Örebro University,
Örebro, Sweden
| | - Henry Kitchener
- School of Cancer and Enabling Sciences, The University of Manchester,
Manchester, UK
| | - Loretta Brabin
- School of Cancer and Enabling Sciences, The University of Manchester,
Manchester, UK
| | | | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet,
Stockholm, Sweden
| | - Sven Törnberg
- Department of Cancer Screening, Regional Cancer Centre,
Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet,
Stockholm, Sweden
| | - Catarina Widmark
- Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet,
Stockholm, Sweden
- Department of Quality and Patient Safety, Karolinska University Hospital,
Stockholm, Sweden
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Bryant E. The impact of policy and screening on cervical cancer in England. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2012; 21:S4-S10. [PMID: 22470899 DOI: 10.12968/bjon.2012.21.sup4.s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There has been a significant statistical decrease in the incidence of cervical cancer since screening programmes have been introduced. This article will explore and evaluate the impact of the Cancer Reform Strategy on cervical screening in England, which preceded the Government's policy for cancer care announced in January 2011. The Strategy raised the initial age of screening from 20 to 25 years of age. This left a group of the population who could not access screening while also not being eligible for vaccines against cervical cancer. Although this caused concern for many people, the media coverage and reaction to the human papilloma virus (HPV) vaccine and the death of Jade Goody, for example, encouraged women to consider cervical screening. The barriers to screening have been identified but overall the Cancer Reform Strategy was found have a positive impact both economically and socially. The Strategy has led the way for the Government's policy for cancer care, which needs to continue achieving the same positive outcomes.
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Bedford S. Cervical cancer: physiology, risk factors, vaccination and treatment. ACTA ACUST UNITED AC 2009; 18:80-4. [DOI: 10.12968/bjon.2009.18.2.37874] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simone Bedford
- School of Health Science, Swansea University, Carmarthenshire
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