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Bøje RB, Bardou M, Mensah K, Rico Berrocal R, Giorgi Rossi P, Bonvicini L, Auzzi N, Taut D, Jiboc N, Tisler A, Reintamm K, Uusküla A, Teixeira M, Firmino-Machado J, Amorim M, Baia I, Lunet N, Michaylova R, Panayotova Y, Kotzeva T, Andersen B, Kirkegaard P. What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries. BMJ Open 2024; 14:e079921. [PMID: 38760040 PMCID: PMC11103196 DOI: 10.1136/bmjopen-2023-079921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/31/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES The aim of this study was to map and compare stakeholders' perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries. DESIGN In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening. SETTING The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. PARTICIPANTS Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers. METHODS Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis. RESULTS 120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers' lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women's fear, shame and lack of priority to preventive healthcare were identified as psychological barriers. CONCLUSION The study provides an overview of stakeholders' perceived barriers towards vulnerable women's cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women's psychological barriers had several similarities.
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Affiliation(s)
- Rikke Buus Bøje
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Marc Bardou
- CIC-P INSERM 1432, Institut national de la santé et de la recherche médicale, Paris, France
| | - Keitly Mensah
- Early Detection, Prevention and Infections Branch, IARC, Lyon, France
| | - Raquel Rico Berrocal
- Centre d'Etudes des Mouvements Sociaux, Ecole des Hautes Etudes en Sciences Sociales, Paris, France
| | - Paolo Giorgi Rossi
- Servizio Interaziendale Epidemiologia, Azienda Unita Sanitaria Locale della Romagna, Ravenna, Italy
| | - Laura Bonvicini
- Servizio Interaziendale Epidemiologia, Azienda Unita Sanitaria Locale della Romagna, Ravenna, Italy
| | - Noemi Auzzi
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Osservatorio Nazionale Screening, Florence, Italy
| | - Diana Taut
- Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Anna Tisler
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kerli Reintamm
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Margarida Teixeira
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | - Mariana Amorim
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Ines Baia
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Nuno Lunet
- EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal
| | | | | | | | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Kirkegaard
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Greenley R, Bell S, Rigby S, Legood R, Kirkby V, McKee M. Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature. Front Public Health 2023; 11:1144674. [PMID: 37304105 PMCID: PMC10247980 DOI: 10.3389/fpubh.2023.1144674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Cervical cancer is a preventable and inequitably distributed disease. Screening plays a vital role in prevention, but many women face barriers to participation. The aims of this scoping review, undertaken to inform the co-design of interventions to equitably increase screening uptake, were to: (1) identify barriers and facilitators to cervical cancer screening for underserved populations, and (2) identify and describe the effectiveness of interventions aimed at improving participation in cervical cancer screening among underserved groups in Europe. Methods Qualitative, quantitative, and mixed methods studies focusing on barriers and facilitators to cervical screening participation and interventions to improve uptake undertaken in Europe and published after 2000 were included. Four electronic databases were searched to identify relevant papers. Titles and abstracts were screened, full text reviewed, and key findings extracted. Data were extracted and analyzed according to different health system strata: system-wide (macro), service specific (meso) and individual/community specific (micro). Within these categories, themes were identified, and the population groups impacted were recorded. All findings are presented in accordance with (PRISMA) guidelines. Results 33 studies on barriers and facilitators and eight intervention studies met the inclusion criteria. Collectively, the findings of these studies presented a wide array of screening uptake barriers, facilitators, and interventions, predominantly related to screening service and individual/community factors. However, although diverse, certain core themes around information provision, prompts for participation and the need for inclusive spaces were apparent. Implementation of screening programs should focus on: (1) reducing identifiable barriers, (2) increasing public awareness, and (3) providing patient reminders and measures to promote engagement by healthcare providers. Conclusion There are many barriers to uptake of cervical cancer screening and this review, nested within a larger study, will inform work to devise a solution alongside groups identified in three European countries.
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Affiliation(s)
- Rachel Greenley
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sadie Bell
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Samuel Rigby
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosa Legood
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victoria Kirkby
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- Department of Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lemmo D, Martino ML, Vallone F, Donizzetti AR, Freda MF, Palumbo F, Lorenzo E, D'Argenzio A, Caso D. Clinical and psychosocial constructs for breast, cervical, and colorectal cancer screening participation: A systematic review. Int J Clin Health Psychol 2023; 23:100354. [PMID: 36415605 PMCID: PMC9677078 DOI: 10.1016/j.ijchp.2022.100354] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Research has identified a wide range of psychosocial factors associated to choosing to engage in ongoing cancer screenings. Nevertheless, a systematic review of the theoretical frameworks and constructs underpinning studies on breast, cervical, and colorectal cancer screening participation has yet to be conducted. As part of the action-research project “Miriade,” the present study aims to identifying the main theoretical frameworks and constructs adopted in the literature over the past five years to explain cancer screening participation. According to the PRISMA guidelines, a search of the MEDLINE/PubMed and PsycINFO databases was made. Empirical studies conducted from 2017 to 2021 were included. The following keywords were used: breast OR cervical OR colorectal screening AND adhesion OR participation OR engagement AND theoretical framework OR conceptual framework OR theory. Overall, 24 articles met the inclusion criteria. Each theoretical framework highlighted clinical and psychosocial constructs of cancer screening participation, focusing on the individuals (psycho-emotional functioning and skills plan) and/or the health services perspectives. Findings from the present study acknowledge the plurality of the theoretical frameworks and constructs adopted to predict or promote breast, cervical, and colorectal cancer screening adhesion and the need for new research efforts to improve the effectiveness of cancer screening promotion interventions.
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Affiliation(s)
- Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
- Corresponding author.
| | - Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Federica Vallone
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Anna Rosa Donizzetti
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | | | - Francesco Palumbo
- Department of Political Science, University of Naples Federico II, Naples, Italy
| | - Elvira Lorenzo
- Directorate General for Health Protection and Coordination of the Regional Health System, Campania Region, Italy
| | - Angelo D'Argenzio
- Directorate General for Health Protection and Coordination of the Regional Health System, Campania Region, Italy
| | - Daniela Caso
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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Marques P, Geraldes M, Gama A, Heleno B, Dias S. What is the role of attitudinal barriers on cervical cancer screening non-attendance? Findings from a cross-sectional study with migrant women in Portugal. BMC Womens Health 2023; 23:52. [PMID: 36759781 PMCID: PMC9909634 DOI: 10.1186/s12905-023-02198-2] [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: 07/19/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Cervical cancer is a common disease which can be effectively and timely detected by cervical cancer screening. However, access to cervical cancer screening is unequal, and it is known that migrant women have a lower attendance to cervical cancer screening. These inequalities are associated with several factors, including attitudes and beliefs of the women regarding screening practices, which prevents them from participating. This study aims to explore the attitudinal barriers to cervical cancer screening among migrant women in Portugal. METHODS A web-based cross-sectional survey was conducted with 1100 migrant women residing in Portugal. Women were recruited through social media platforms. The survey included items on socioeconomic characteristics, cervical cancer screening history and an 11-item attitudinal questionnaire to assess attitudinal barriers. Logistic regression models were used for statistical analysis. RESULTS The attitudinal barriers to CCS most often reported by participants were fear of the test result (25.3%), worry about seeing a male health professional (23.8%), perceiving the test as painful (23.1%), embarrassment (18.5%), difficulties scheduling the test (14.3%), and having a negative experience in screening (12.4%). Low perceived need in absence of symptoms and lack of motivation to be screened were reported by less than 5% of the women. However, the results suggest that most of the attitudinal barriers with higher agreement percentage have no association with cervical cancer screening attendance. Among all the attitudinal barriers, low perceived need of screening and lack of motivation were associated with CCS non-attendance. CONCLUSIONS Based on the findings, out of all the factors analyzed, low perceived need of screening and lack of motivation are the most relevant factors associated with non-attendance among migrants in Portugal. Promoting health literacy and empowering women with knowledge about benefits of screening may help overcoming these barriers. Therefore, this study provides a foundation for stakeholders on which areas should be prioritized when developing strategies aiming to reduced cervical cancer screening non-attendance among migrant women.
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Affiliation(s)
- Patrícia Marques
- grid.10772.330000000121511713NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Mariana Geraldes
- grid.10772.330000000121511713NOVA Nacional School of Public Health, Public Health Research Centre, NOVA University Lisbon, 1600-560 Lisbon, Portugal
| | - Ana Gama
- grid.10772.330000000121511713NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Bruno Heleno
- grid.10772.330000000121511713CHRC, NOVA Medical School, NOVA University Lisbon, 1169-056 Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.
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Marques P, Nunes M, Antunes MDL, Heleno B, Dias S. Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review. Int J Equity Health 2020; 19:160. [PMID: 32917224 PMCID: PMC7488650 DOI: 10.1186/s12939-020-01275-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/02/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical cancer screening has been effective in reducing incidence and mortality of cervical cancer, leading European countries to implement screening programs. However, migrant women show lower screening participation compared to nationals. This scoping review aims to provide a synthesis of the growing evidence on factors associated with participation in cervical cancer screening among migrant women in Europe. METHODS Electronic peer-reviewed databases were searched in November 2019 for studies on factors related to the participation of migrants in cervical cancer screening conducted in EU/EFTA countries, using comprehensive search expressions. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Factors were classified in barriers and facilitators and were divided into further categories. RESULTS Twenty out of 96 articles were selected and analyzed. Factors associated with participation in cervical cancer screening were classified in categories related to sociodemographic, healthcare-system, psychological, migration, knowledge, language, and cultural factors. Lack of information, lack of female healthcare providers, poor language skills, and emotional responses to the test (especially fear, embarrassment and discomfort) were the most reported barriers to cervical cancer screening. Encouragement from healthcare providers and information available in migrants' languages were frequently stated as facilitators. Results on the role of sociodemographic factors, such as age, education, employment and marital status, are the most conflicting, highlighting the complexity of the issue and the possibility of interactions between factors, resulting in different effects on cervical cancer screening participation among migrant women. Several identified barriers to screening are like those to access to healthcare services in general. CONCLUSIONS Efforts to increase migrant women's participation in CCS must target barriers to access to healthcare services in general but also specific barriers, including cultural differences about sexuality and gender, past traumatic personal experiences, and the gender and competences of healthcare professionals performing CCS. Healthcare services should strengthen resources to meet migrants' needs, including having CCS information translated and culturally adapted, as well as healthcare providers with skills to deal with cultural background. These findings can contribute to improve CCS programs among migrant women, reducing health disparities and enhancing their overall health and well-being.
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Affiliation(s)
- Patrícia Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Mariana Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria da Luz Antunes
- ESTeSL (Instituto Politécnico de Lisboa), Lisbon, Portugal
- APPsyCI - Applied Psychology Research Center Capabilities & Inclusion, ISPA, Lisbon, Portugal
| | - Bruno Heleno
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
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