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Houpert R, Bendiane MK, Huiart L, Bouhnik AD, Alleaume C, Touzani R, Veronique-Baudin J, Mancini J, Joachim C, Chirpaz E. Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island. BMC Public Health 2024; 24:1125. [PMID: 38654197 DOI: 10.1186/s12889-024-18633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Réunion Island is a French overseas territory located in the southern Indian Ocean, with a challenging socioeconomic and multicultural context. Compared to mainland France, Réunion has an overincidence and overmortality of cervical cancer. In order to investigate these two issues, it is important to evaluate the barriers and potential levers to Pap smear screening among female inhabitants of the island. We aimed to identify the specific socio-demographic factors, cultural factors, and living conditions associated with Pap smear screening in Réunion, with a view to increasing uptake. METHODS We conducted a Knowledge Attitude Behavior and Practices (KABP) survey on cervical cancer screening practices among women aged between 25 and 65 years old living in Réunion Island, selected using random digit dialing sampling. Data were collected using Computer Assistant Telephone Interviews. Weighted chi-squared tests and Student's t-tests were used to compare women who had up-to-date Pap smear screening with women who did not. Weighted logistic models were used to identify the factors associated with not having up-to-date screening. RESULTS A total of 1000 women were included in the study. Of these, 88.1% had a Pap smear test during the previous three years. Factors independently associated with not being up to date were as follows: aged over 55 (AOR 2.3 [1.2-4.3]), no children (AOR 2.5 [1.4-4.3]), having free universal health coverage (AOR 1.7 [1.1-2.7]), an income per unit consumption lower than 1500€ per month (AOR 2.0 [1.1-3.7]), low health literacy (AOR 2.7 [1.7-4.1]), not consulting a general practitioner in the prior 12 months (AOR 3.6 [2.0-6.5]), and a BMI > 30 (AOR 2.6 [1.5-4.4]). CONCLUSIONS This is the first large-scale survey focusing on recommended Pap smear screening uptake in Réunion Island. Although self-reported screening incidence was higher than in mainland France, national screening policies must take into account the island's diverse social and cultural characteristics (e.g., an ageing population, low health literacy), while implementing actions to fight against poverty and increase general access to healthcare.
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Affiliation(s)
- Rémi Houpert
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Research & Development in Oncology (UF3596), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Marc-Karim Bendiane
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Laetitia Huiart
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Santé Publique France, Paris, France
| | - Anne-Deborah Bouhnik
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Caroline Alleaume
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Santé Publique France, Paris, France
| | - Rajae Touzani
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Jacqueline Veronique-Baudin
- Research & Development in Oncology (UF3596), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Julien Mancini
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- APHM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
| | - Clarisse Joachim
- General Cancer Registry (UF 1441), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Emmanuel Chirpaz
- Reunion cancer Registry - Clinical Investigation Center (INSERM CIC-1410), University Hospital FR, Saint Pierre Cedex, France
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Romli R, Abd Rahman R, Mohd Hashim S, Chew KT, Mohamad EMW, Mohammed Nawi A. Women's motivation towards Pap smear screening based on sexual and screening status: A cross-sectional study using protection motivation theory. J Educ Health Promot 2023; 12:357. [PMID: 38144028 PMCID: PMC10743857 DOI: 10.4103/jehp.jehp_1842_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/01/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Cervical cancer remains a reproductive health burden. Pap smear (PS) screening can detect cervical cancer early but is underused despite being subsidized. Motivational factors play a role in promoting PS screening. This study aimed to determine the women's motivation toward PS screening based on Protection Motivation Theory (PMT), which mainly focused on sexual and screening status. MATERIALS AND METHODS The study was conducted electronically throughout Malaysia from January to February 2022 by disseminating Google Form (https://forms.gle/cD7fkUKYR4Cq6kZC8) via multiple WhatsApp groups to reach 526 women aged 21-65 years. The questionnaire consists of 24 items based on seven PMT constructs [perceived vulnerability, perceived severity, self-efficacy, response efficacy, fear (threat appraisal), response costs (coping appraisal), and protection motivation]. The descriptive statistics and independent t-test was used to analyze data using IBM SPSS Statistics software, version 25. RESULTS Most respondents were sexually active [80.6% (n = 424)] and have heard of PS screening [95.8% (n = 504)]. More than half of respondents did not have PS screening in the last three years [59.3% (n = 312)]. Sexually active women have heard and have undergone PS screening feel less threatened with low coping appraisals. Undergoing PS screening made women perceived more response efficacy (P =. 011), more self-efficacy (P <. 001), and higher protection motivation (P <. 001) toward PS screening. CONCLUSIONS Women's motivation related to PS screening needs to be highlighted. Future development of health education strategy should include motivation focused in emphasizing the threat and coping appraisal into educational plan to ensure women come forward for screening.
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Affiliation(s)
- Rodziah Romli
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Institut Latihan Kementerian Kesihatan Malaysia Alor Setar, Ministry of Health, Alor Setar, Kedah, Malaysia
| | - Rahana Abd Rahman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Syahnaz Mohd Hashim
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Kah Teik Chew
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Emma Mirza Wati Mohamad
- Centre for Research in Media and Communication (MENTION), Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Tom JJ, Vaz C, Nisha C. Screening for cervical dysplasia and reproductive tract infections in Kerala, India: A multicentric study. J Family Med Prim Care 2020; 9:4107-4111. [PMID: 33110817 PMCID: PMC7586590 DOI: 10.4103/jfmpc.jfmpc_514_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/25/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Cancer of the uterine cervix is estimated to the second most frequently occurring malignancy among females in India. Cancer mortality profile in India estimates that 20.7% of cancer deaths in females are cervical cancer. This well elucidates the fatal aspect of the disease and the need for early detection. Aims: To screen for cervical dysplasias and reproductive tract infections in various parts of Kerala, India, and determine its associated factors. Methods and Methodology: This was a descriptive cross-sectional study conducted in various parts of Kerala, India. This study included an interview schedule to collect data and the procedures included per speculum examination along with a Pap smear test. Results: A total of 199 women were screened with mean age of 45.87 ± 9.84 years. Of these, 13.5% showed inflammatory smears, 1% showed infective pathology and 1.5% showed pre-malignant lesions. Conclusion: The increased rates of inflammation and infection show its importance in public health. Similar community-based screening as well as routine screening by physicians/gynaecologists is recommended for early detection of cervical cancer and reproductive tract infections. Community education among the population proves to be an important factor; especially regarding HPV vaccination.
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Affiliation(s)
- Jeremiah Jacob Tom
- Department of Community Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Clint Vaz
- Department of Clinical Immunology and Rheumatology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.,Current status: Chief Medical Officer, St. Joseph's Hospital, Thrissur, Kerala, India
| | - Catherin Nisha
- Department of Community Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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Yunus NA, Mohamed Yusoff H, Draman N. Non-Adherence to recommended Pap smear screening guidelines and its associated factors among women attending health clinic in Malaysia. Malays Fam Physician 2018; 13:10-17. [PMID: 29796205 PMCID: PMC5962229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Cervical cancer ranks as the second most frequent cancer among women in Malaysia. Although a cervical screening program has been introduced since 1960s and is provided free of charge in all government health facilities, the coverage and adherence rate to recommendation among Malaysian women remains low. OBJECTIVES To determine the proportion of non-adherence to Pap smear screening guidelines and its associated factors among women attending a health clinic in Malaysia. METHOD A cross sectional study involving 316 women aged 20 to 65 years who had undergone a Pap smear. Universal sampling method was applied to select participants among women who attended the selected health clinic from January 2013 to May 2013. A self-administered questionnaire was used to obtain the socio-demographic characteristics, socio-health data and perceptions about cervical cancer and Pap smear screening. The data was analysed using descriptive statistics and multiple logistic regression. RESULT The proportion of non-adherence to Pap smear screening was 90.5%. Age, marital status, duration of marriage, education level, employment, household income and number of children were not significantly associated with non-adherence. Perceived severity, perceived susceptibility, perceived benefit, perceived barrier and cues to action did not show significant association with non-adherence to Pap smear screening. CONCLUSION Non-adherence to Pap smear screening was high among Malaysian women. Measures should be taken to increase Pap smear screening coverage in our country. Other factors beyond Health Belief Model that influence Pap smear screening practice among Malaysian women should be explored.
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Affiliation(s)
- N A Yunus
- MD, MMed (F Medicine), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia (USM), Kubang Kerian, Malaysia.
| | - H Mohamed Yusoff
- MD, MMed (F Medicine), Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA)
| | - N Draman
- MD, MMed (F Medicine), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia (USM), Kubang Kerian, Malaysia.
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Liebermann EJ, VanDevanter N, Hammer MJ, Fu MR. Social and Cultural Barriers to Women's Participation in Pap Smear Screening Programs in Low- and Middle-Income Latin American and Caribbean Countries: An Integrative Review. J Transcult Nurs 2018; 29:591-602. [PMID: 29366369 DOI: 10.1177/1043659618755424] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Pap smear screening programs have been ineffective in reducing cervical cancer mortality in most Latin American and Caribbean countries, in part due to low screening rates. The purpose of this review was to analyze recent studies to identify demographic, social, and cultural factors influencing women's participation in Pap screening programs in Latin America and the Caribbean. DESIGN/METHOD For this integrative review, cervical cancer screening in Latin America and the Caribbean was searched using PubMed, CINAHL, EMBASE, and PsycINFO databases. Findings/Results: Demographic barriers to screening were socioeconomic status, education, race/ethnicity, and geography. Social barriers included lack of uniformity in screening guidelines, lack of knowledge regarding cervical cancer, and lack of preventive culture. Cultural barriers were fear/embarrassment and gender roles. CONCLUSIONS There are multilevel barriers to Pap smear utilization among women in Latin America and the Caribbean. IMPLICATIONS FOR PRACTICE Findings highlight a need for health system engagement, promotion of preventive care, and community-generated educational programs and solutions.
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Affiliation(s)
| | | | | | - Mei R Fu
- 1 New York University, New York, NY, USA
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Verloop J, van Leeuwen FE, Helmerhorst TJM, de Kok IMCM, van Erp EJM, van Boven HH, Rookus MA. Risk of cervical intra-epithelial neoplasia and invasive cancer of the cervix in DES daughters. Gynecol Oncol 2016; 144:305-311. [PMID: 27939984 DOI: 10.1016/j.ygyno.2016.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Women exposed to diethylstilbestrol in utero (DES) have an increased risk of clear cell adenocarcinoma (CCA) of the vagina and cervix, while their risk of non-CCA invasive cervical cancer is still unclear. METHODS We studied the risk of pre-cancerous (CIN) lesions and non-CCA invasive cervical cancer in a prospective cohort of 12,182 women with self-reported DES exposure followed from 2000 till 2008. We took screening behavior carefully into account. Incidence was obtained through linkage with the Netherlands Nationwide Pathology database (PALGA). General population data were also derived from PALGA. RESULTS The incidence of CIN1 was increased (Standardized Incidence Ratio (SIR)=2.8, 95% Confidence Interval (CI)=2.3 to 3.4), but no increased risk was observed for CIN2+ (CIN2, CIN3 or invasive cancer) compared to the screened general population (SIR=1.1, 95% CI=0.95 to1.4). Women with DES-related malformations had increased risks of both CIN1 and CIN2+ (SIR=4.1, 95%CI=3.0 to 5.3 and SIR=1.5, 95%CI=1.1 to 2.0, respectively). For CIN2+, this risk increase was largely restricted to women with malformations who were more intensively screened. CONCLUSIONS An increased risk of CIN1 among DES daughters was observed, especially in women with DES-related malformations, probably mainly due to screening. The risk of CIN2+ (including cancer) was not increased. However, among DES daughters with DES-related malformations a true small risk increase for non-CCA cervical cancer cannot be excluded.
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Affiliation(s)
- J Verloop
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Th J M Helmerhorst
- Department of Obstetrics and Gynaecology, Erasmus MC, University Hospital Rotterdam, The Netherlands
| | - I M C M de Kok
- Department of Public Health, Erasmus MC, The Netherlands
| | | | - H H van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M A Rookus
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Troisi R, Hatch EE, Palmer JR, Titus L, Robboy SJ, Strohsnitter WC, Herbst AL, Adam E, Hyer M, Hoover RN. Prenatal diethylstilbestrol exposure and high-grade squamous cell neoplasia of the lower genital tract. Am J Obstet Gynecol 2016; 215:322.e1-8. [PMID: 26979629 DOI: 10.1016/j.ajog.2016.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/23/2016] [Accepted: 03/07/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prenatal diethylstilbestrol (DES) exposure is associated with an excess risk of clear-cell adenocarcinoma of the vagina and cervix, and of high-grade squamous neoplasia. OBJECTIVE We explored whether neoplasia risk remains elevated among DES-exposed women as they age. STUDY DESIGN In all, 4062 DES-exposed and 1837 unexposed daughters were followed for approximately 30 years (1982 through 2013) for pathology-confirmed diagnoses of cervical intraepithelial neoplasia grade ≥2 (CIN2+) of the lower genital tract (n = 178). Hazard ratios (HR) and 95% confidence intervals (CI) were estimated adjusting for birth year and individual study cohort. RESULTS The cumulative incidence of CIN2+ in the DES-exposed group was 5.3% (95% CI, 4.1-6.5%) and in the unexposed group was 2.6% (95% CI, 1.5-3.7%). The HR for DES and CIN2+ was 1.98 (95% CI, 1.33-2.94), and was similar with further adjustment for frequency of cervical cancer screening (HR, 1.97; 95% CI, 1.33-2.93). The HR was 2.10 (95% CI, 1.41-3.13) with additional adjustment for other potential confounders. The HR for DES exposure was elevated through age 44 years (age <45 years HR, 2.47; 95% CI, 1.55-3.94), but not in women age ≥45 years (HR, 0.91; 95% CI, 0.39-2.10). In exposed women, HRs for DES were 1.74 (95% CI, 1.09-2.79) among those who had earlier evidence of vaginal epithelial changes (VEC), presumably reflecting glandular epithelium undergoing transformation to normal, adult-type squamous epithelium, and 1.24 (95% CI, 0.75-2.06) among those without VEC, compared with unexposed women. The HRs for DES and CIN2+ were higher among women with earlier intrauterine exposure (HR, 2.64; 95% CI, 1.64-4.25 for <8 weeks' gestation and HR, 1.41; 0.88-2.25 for ≥8 weeks' gestation), and lowest when exposure began >15th week (HR, 1.14; 95% CI, 0.59-2.20). CONCLUSION CIN2+ incidence was higher among the DES exposed, particularly those with early gestational exposure and VEC. The HR for DES and CIN2+ remained positive and significant until the mid-40s, confirming that the recommendation of annual cytological screening among these women is appropriate. Whether those ≥45 years of age continue to require increased screening is unclear, and would require a careful weighing of possible risks and benefits.
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Fang WH, Yen CF, Hu J, Lin JD, Loh CH. The utilization and barriers of Pap smear among women with visual impairment. Int J Equity Health 2016; 15:65. [PMID: 27068132 PMCID: PMC4828796 DOI: 10.1186/s12939-016-0354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 04/04/2016] [Indexed: 01/08/2023] Open
Abstract
Background Many evidences illustrate that the Pap smear screening successfully reduces if the cervical cancer could be detected and treated sufficiently early. People with disability were higher comorbidity prevalence, and less likely to use preventive health care and health promotion activities. There were also to demonstrate that people with visual impairment has less access to appropriate healthcare services and is less likely to receive screening examinations. In Taiwan, there was no study to explore utilization of Pap smear, associated factors and use barriers about Pap smear screening test among women with visual impairment. The purpose is to explore the utilization and barriers of using Pap smear for women with visual impairment in Taiwan. To identify the barriers of women with visual from process of receiving Pap smear screening test. Methods The cross-sectional study was conducted and the totally 316 participators were selected by stratified proportional and random sampling from 15 to 64 year old women with visual impairment who lived in Taipei County during December 2009 to January 2010. The data was been collected by phone interview and the interviewers were well trained before interview. Results The mean age was 47.1 years old and the highest percentage of disabled severity was mile (40.2 %). Totally, 66.5 % of participators were ever using Pap smear and 38.9 % used it during pass 1 year. Their first time to accept Pap smear was 38.8 year old. There was near 50 % of them not to be explained by professionals before accepting the Pap smear. For non-using cases, the top two percentage of barriers were “feel still younger” (22.3 %), the second was “there’s no sexual experience” (21.4 %). We found the gynecology experiences was key factor for women with visual impairment to use Pap smear, especially the experiences was during 1 year (OR = 4). Conclusions Associated factors and barriers to receive Pap smear screening test for women with visual impairment can be addressed through interventions aimed at improving on cognitions and attitudes for cervical cancer risk factors. Our study would be as a reference resource for erasing the barriers and inequality among the visually disabled women.
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Affiliation(s)
- Wen-Hui Fang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu-Chi University, Hualien, Taiwan.
| | - Jung Hu
- Medical Quality Department, E-DA Hospital, Kaohsiung, Taiwan
| | - Jin-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Hui Loh
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Fletcher FE, Buchberg M, Schover LR, Basen-Engquist K, Kempf MC, Arduino RC, Vidrine DJ. Perceptions of barriers and facilitators to cervical cancer screening among low-income, HIV-infected women from an integrated HIV clinic. AIDS Care 2014; 26:1229-35. [PMID: 24635664 DOI: 10.1080/09540121.2014.894617] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Significantly elevated rates of cervical cancer and low rates of Papanicolaou (Pap) smear screening have been documented among HIV-infected women. However, little is known about women's perceptions of cervical cancer screening utilization. Hence, this study describes barriers and facilitators related to cervical cancer screening in a sample of HIV-infected women seeking care at an integrated HIV clinic in Houston, Texas. Using an inductive qualitative methodological approach, data were obtained from five focus group discussions with a total of 33, HIV-infected women. The majority of the study sample consisted of women who self-identified as Black (69.7%), and reported heterosexual contact as the mode of HIV acquisition (75.8%). Barriers to cervical cancer screening were described as pain and discomfort associated with receiving Pap smears and subsequent procedures; lack of awareness of cervical cancer as a preventable disease; limited transportation access; and systemic issues as it relates to scheduling gynecological appointments. Facilitators were described as awareness of HIV-infected women's increased risk of cervical cancer and strong provider-patient relationships. To address disparities in cervical cancer screening among low-income HIV-infected women, programs should capitalize on the identified facilitators and alleviate modifiable barriers using multilevel strategies.
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Affiliation(s)
- Faith E Fletcher
- a Division of Community Health Sciences , University of Illinois at Chicago School of Public Health , Chicago , IL , USA
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Oussaid N, Lutringer-Magnin D, Barone G, Haesebaert J, Lasset C. Factors associated with Pap smear screening among French women visiting a general practitioner in the Rhône-Alpes region. Rev Epidemiol Sante Publique 2013; 61:437-45. [PMID: 24012357 DOI: 10.1016/j.respe.2013.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/30/2013] [Accepted: 04/04/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To help prevent cervical cancer, three yearly opportunistic Pap smear screening is recommended in France for women aged 25-65 years. Pap smear screening coverage varies with age and socioeconomic level. The aim of this cross-sectional study was to identify factors associated with a low uptake of Pap smear screening among women with no limited access to healthcare. METHODS We analyzed data from women aged 25-65 living in the Rhône-Alpes region who completed a self-administered questionnaire given to them by general practitioners between June and August 2008. The questionnaire covered knowledge about cervical cancer and its prevention as well as the women's history of Pap smear screening and other health-related behaviors. The relationship between low uptake of Pap smear screening--defined as not having had the test within the past 3 years--and a range of possible contributing factors was investigated using logistic regression. RESULTS Of 1186 women with an intact uterus who completed the questionnaire, 89.1% said they had had a Pap smear within the past 3 years. On multivariate analysis, the 10.9% who had not were significantly more likely to live alone (1.76 [1.13-2.74]), to have no children (2.17 [1.31-3.62]), to have never used contraception (5.35 [2.98-9.62]), to have less knowledge about Pap smear screening (3.40 [1.55-7.49]), and to be unvaccinated against hepatitis B (0.55 [0.35-0.87]). CONCLUSION Despite high overall compliance with Pap smear screening recommendations among women who consulted general practitioners, several factors were significantly associated with a low uptake of the service. Considering these factors may help to refine messages aimed at cervical cancer prevention.
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Affiliation(s)
- N Oussaid
- Département de santé publique, centre Léon-Bérard, 69373 Lyon cedex 08, France
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Prabha Devi K, Bindhu Priya N. Conventional Pap Smear Screening in HIV Seropositive Women in South India. J Obstet Gynaecol India 2013; 63:55-8. [PMID: 24431601 DOI: 10.1007/s13224-012-0204-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 05/26/2012] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To assess the prevalence of Pap smear abnormalities and to characterize the associated risk factors in HIV seropositive women. MATERIAL AND METHODS We conducted a cross-sectional study on 252 HIV seropositive women in and around Krishna district, Andhra Pradesh, India by screening them for cervical cytological abnormalities by means of conventional Pap smear screening and the abnormalities reported as per modified Bethesda system. RESULTS The prevalence of Pap smear abnormalities in HIV seropositive women was found to be 7.17 % which was a twofold increased risk as compared to the general population. On analysis of the risk factors like younger age for abnormal pap smears, mean CD4 count, duration of disease, and ART/HAART therapy the difference between the two groups of HIV seropositive women with normal pap smears and seropositive women with abnormal pap smears was found to be not statistically significant. CONCLUSION HIV/AIDS is associated with a twofold increased risk for cervical cytological abnormalities, and hence the need for periodic pap smear screening in this high risk group to reduce the global burden of cervical cancer.
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