Health‐care providers' perceptions,attitudes towards and recommendation practice of cervical cancer screening

In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health‐care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health‐care provider's perception around cervical cancer screening. In‐depth, face‐to‐face interviews were conducted with 16 health‐care providers, from both public and private sectors in Az‐Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health‐care providers did not provide sufficient information regarding cervical cancer screening for women who attend health‐care facilities. The results highlight the role played by health‐care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health‐care providers to offer a precious advice regarding the screening. On the other hand, health‐care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health‐care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women.     

Cervical Cancer Screening in Iranian Women: Healthcare Practitioner Perceptions and Views

Background: Although regular screening for cervical cancer with the Papanicolaou test is an important element for reducing the incidence and mortality of cervical cancer, the actual screening program in Iranian women is not sufficiently comprehensive at present. The purpose of this study was to explore healthcare provider perceptions of factors affecting cervical cancer screening in Iranian women. Methods: In this qualitative study performed from September 2015 to August 2016 in Hamadan, Iran, we conducted semi-structured in depth interviews with 14 healthcare providers selected purposefully. All interviews were recorded, transcribed and analyzed according to a conventional thematic analysis approach. MAXQDA10 software was employed for data analysis. Results: Four themes were extracted from data: "Inefficient management of cervical cancer screening process, Personal and professional characteristics of health care providers, Individual barriers and facilitators, Need for health system authorities to pay attention". Conclusion: Increased official attention to screening, and identifying challenges and providing strategies based on these challenges will help in achieving a successful screening program. It is necessary to attend to professional features of medical science students and increase the skills of interaction with clients in addition to academic training. Efforts should be made to increase trust in healthcare providers regarding the Pap test and receptiveness of society to this screening modality through informing the public, with encouragement through the media.     

Factors Associated with Decisions to Attend Cervical Cancer Screening among Women Aged 30-60 Years in Chatapadung Contracting Medical Unit,Thailand

Background: This study aimed to identify factors associated with women’s decisions to attend cervical cancer screening and to explore those linked with intention to attend in the coming year and to continue regular screening. Materials and Methods: A community based case-control study was conducted among woman 30-60 years of age in catchment area of Chatapadung Contracting Medical Unit (CCMU), networking of Khon Kaen Center Hospital, Thailand. Self-administered questionnaires were used to collect data, and in-depth interviews were then performed to explore in greater detail. Results: There were 195 participants. Only one third (32.3 %) had been screened for cervical cancer within the past 5 years. Some 67.7% reported that they had not been screened becausethey had no abnormal symptoms, single marital status, and no children. Only 10.6% of those never had screening intent to be screened within the next 12 months. High family income (adjusted OR=2.16, 95%CI=1.13-4.14), good attitude towards a Pap test (OR=1.87, 95%CI=1.09-4.23), and having received a  recommendation from health care providers were important factors associated with decisions to attend cervical cancer screening (OR=1.73, 95%CI=1.01-4.63). From in-depth interviews, there were five reasons of their decisions to attend cervical cancer screening including yearly check-up, postpartum check-up, having abnormal symptom, encouragement by health care providers, and request from workplace. Conclusions: High family income, good attitude towards a Paptest, and receiving proper recommendation by health care providers, were important factors associated with decision to have cervical cancer screening among women 30-60 years old. Trying to enhance these factors and reduce barriers regarding screening, may increase the coverage rate for cervical cancer screening in Thailand.     

Enhancement of the Cervical Cancer Screening Program in Malaysia: A Qualitative Study

Introduction: Cervical cancer has long been known as a preventable disease. Yet it still is a prime women’shealth issue globally. In Malaysia, the current cervical cancer screening program, introduced in the 1960s, hasbeen found to be unsuccessful in terms of Pap smear coverage. The aim of this study is to determine providersperceptives on the program and the feasibility of practicing an organized cervical screening program in Malaysia.Methods: 11 key informant interviews were conducted with policy makers and health care providers from theMinistry of Health in Malaysia from October 2009 to May 2010. Interviewees’ perceptions were explored oncurrent and organized cervical screening program based on their expertise and experience. Results: The resultshighlighted that the existing cervical screening program in Malaysia faced flaws at all levels that failed to reducecervical cancer morbidity and mortality. The identified weaknesses were poor acceptance by women, lack ofcommitment by health care providers, nature of the program, an improper follow-up system, limited resourcesand other competing needs. Complementarily, all interviewees perceived an organized cervical screening programas an alternative approach both feasible and acceptable by women and government to practice in Malaysia.Conclusion: Better screening coverage depends on an effective screening program that incorporates a behaviourbasedstrategy. A new program should be focused in the policy-making context to improve screening coverageand to effectively combat cervical cancer.     

Knowledge,Attitudes, and Practices Regarding Cervical Cancer Screening among HIV-infected Women at Srinagarind Hospital: A Cross-Sectional Study

Introduction: In recent years, the lives of HIV-infected patients in Thailand have improved significantly due to continuous advances in treatment. However, the rate of cancer related to HIV infection (especially cervical cancer) is likely to increase. Although the World Health Organization (WHO) recommends Papanicolaou testing in all HIV-infected women, few of these patients receive this kind of screening in Thailand. Therefore, we conducted this study to evaluate the knowledge, attitudes, and practices of these patients with regard to cervical cancer screening. Materials and Methods: This cross-sectional study was conducted in HIV-infected women aged 18-65 years from April to November 2019 via a self-administered cervical cancer screening questionnaire, which consisted of four parts: demographic data, knowledge, attitudes, and practices. Results: Three hundred HIV-infected women were recruited. Most of the participants had good attitudes toward screening and practiced adequate screening (75.3% and 71.3%, respectively). However, only 62 participants (20.7%) demonstrated adequate knowledge. The crucial factors that were associated with adequate screening practice were age 40-49 years-old (AOR =3.26, 95%CI=1.02-10.37), CD4 cell count (AOR = 3.41, 95%CI = 1.29-8.99), having been advised about cervical cancer screening (AOR= 6.23, 95%CI 1.84-21.07), and attitude toward screening (AOR= 5.7, 95%CI = 2.23-14.55). The major reasons for not undergoing screening were embarrassment (41.86%), lack of symptoms (41.86%), fear of the results (36.04%), and fear of pain (36.04%). Conclusion: The reasons for inadequate testing were disregard and misconceptions about the procedure. To prevent invasive cervical lesions in HIV-infected women, health care providers should inform these patients about the importance of regular cervical cancer screening.     

Human Papillomavirus and Cervical Cancer Knowledge,Perceptions, and Screening Behavior: A Cross-Sectional Community-Based Survey in Rural Philippines

Background: Cervical cancer is the second most common cancer among women in the Philippines. Cervical cancer screening is an effective method to reduce incidence. However, screening utilization is limited. This study aims to assess human papillomavirus (HPV) and cervical cancer knowledge, perceptions, and screening utilization, and to investigate factors influencing screening utilization among rural women in the Philippines. Methods: This cross-sectional community-based study was conducted among 338 rural women aged 20–50 years, with a child under 5 years old registered in one of four public rural health centers in Tacao Island, Masbate Province in October 2017. A questionnaire administered via face-to-face interviews elicited information about demographic characteristics, knowledge, perceived susceptibility and perceived severity of HPV and cervical cancer, and cervical cancer screening utilization. Results: Mean age of participants was 32.5 years. Only 13.9% of participants had ever had cervical cancer screening. Although most women had heard of cervical cancer screening, their knowledge about the cause, risk factors, and preventive measures of HPV and cervical cancer was limited. Older age and higher education status were significantly associated with screening utilization. However, knowledge and perceived susceptibility and severity showed no association. The main reason for having screening was due to a health professional’s request or recommendation, and the reasons for not having screening were cost, not having symptoms, and fear of pain or discomfort and/or embarrassment during the procedure.  Conclusions: Health education must increase knowledge about HPV and cervical cancer and screening among women, including the nature and progression of cervical cancer, benefits of screening, screening cost, and screening procedure. Health care providers have an important role in educating and motivating women to undergo screening.     

Barriers to Cervical Screening among Pacific Women in a New Zealand Urban Population

Background: In Aotearoa/New Zealand cervical screening programmes have reduced cervical cancer;however, half of cervical cancer cases among Pacific women are found among clients who had not attendedcervical screening. Hence, we set out to determine health provider perspectives on barriers that prevent theirservices reaching Pacific women within Aotearoa/New Zealand. Materials and Methods: Twenty semi-structuredinterviews were conducted with health care providers, Pap smear takers and community workers in the Wellingtonregion. Participants were asked their views on factors that enabled and/or constrained the participation of Pacificwomen in their cervical screening services. Results: Six interrelated themes influencing participation in cervicalscreening among Pacific women in the Wellington region were apparent: the funding and practice of servicedelivery; family always coming first; the cost of screening services; type of employment; the appropriateness ofinformation; and attitudes to self and screening. Conclusions: Determining specific ethnic group actual healthneeds and meeting them contributes to overall improvement in New Zealand’s health status. The results identifiedthe need for improvements to the delivery of screening services including adapting cervical screening services tothe requirements of Pacific women through more outreach services at alternate clinic hours; culturally appropriatepractitioners; the ability to take up opportunities for health checks and foster long-term relationships; as wellas appropriate monitoring and evaluation of approaches. Funding and reporting relationships also need to becompatible with the goal of improving outcomes for Pacific women. Further research into client voices for theirparticular needs to compliment the service provider perspective as well as minority groups is called for.     

健康教育对女性两癌认知水平及筛查行为的影响

目的：探讨健康教育对女性两癌认知水平及筛查行为的影响。方法选取136例女性为调查对象,采用自拟“两癌认知水平及筛查行为”调查表进行调查分析,根据调查结果制定具有针对性的健康教育干预方案,经过2年的调查研究,比较健康教育前后女性健康知识知晓情况及乳腺癌、宫颈癌筛查行为改善情况。结果健康教育前后,136例调查对象的癌症预防一般知识、乳腺癌相关知识及宫颈癌相关知识知晓率均高于健康教育前（χ2=3.866～6.259,P﹤0.05）;癌症预防一般知识,日常乳腺自我检查,乳腺癌筛查次数,阴道分泌物自我观察,宫颈癌筛查频率均优于健康教育前（t=7.264~12.183,P﹤0.05）。结论健康教育能提高女性两癌认知水平和保健意识,增加筛查行为,有利于两癌筛查工作的开展。     

Evaluation of an outreach intervention to promote cervical cancer screening among Cambodian American women

INTRODUCTION: Southeast Asian women have low levels of Papanicolaou (Pap) testing participation. We conducted a group-randomized controlled trial to evaluate a cervical cancer screening intervention program targeting Seattle's Cambodian refugee community. METHODS: Women who completed a baseline, community-based survey were eligible for the trial. Neighborhoods were the unit of randomization. Three hundred and seventy survey participants living in 17 neighborhoods were randomized to intervention or control status. Intervention group women received home visits by outreach workers and were invited to group meetings in neighborhood settings. The primary outcome measure was self-reported Pap testing in the year prior to completing a follow-up survey. RESULTS: The proportion of women in the intervention group reporting recent cervical cancer screening increased from 44% at baseline to 61% at follow-up (+17%). The corresponding proportions among the control group were 51 and 62% (+11%). These temporal increases were statistically significant in both the intervention (P < 0.001) and control (P = 0.027) groups. DISCUSSION: This study was unable to document an increase in Pap testing use specifically in the neighborhood-based outreach intervention group; rather, we found an increase in both intervention and control groups. A general awareness of the project among women and their health care providers as well as other ongoing cervical cancer screening promotional efforts may all have contributed to increases in Pap testing rates.     

Relationship between Health Literacy and Adherence to Recommendations to Undergo Cancer Screening and Health-Related Behaviors among Insured Women in Japan

Background: Health literacy serves as a major barrier to effective preventive health behaviors, such as cancerscreening, and this relationship has not been studied among insured women in Japan. We examined the relationshipbetween health literacy and adherence to recommendations to undergo cancer screening, and health-related behaviors,among Japanese women who were insured by a health insurance society. Methods: We conducted a cross-sectionalobservation study of 670 insured Japanese women. For this, we used a self-administered questionnaire to assessenvironments, self-rated health status, cancer screening behavior, health-related behaviors (dietary behavior, exercisefrequency, alcohol consumption and smoking behavior), and health literacy. Results: Among the participants, 206completed the questionnaire (response rate, 30.7%). Fifty-seven had undergone breast and/or cervical cancer screening.The mean health literacy score was 3.44 (standard deviation = 0.68). In logistic regression models adjusted for age,self-rated economic status, and having a primary care physician, there was no statistically significant relationship betweenhealth literacy and adherence to recommendations to undergo cancer screening, and health-related behaviors. However,age and having a primary care physician were significantly associated with cancer screening and health-related behaviors.Health literacy was not found significantly associated with effective preventive health behaviors. Conclusions: Thepresent study found no statistically significant relationship between health literacy and adherence to recommendationsto undergo cancer screening and health-related behaviors. Rather, cancer screening and health-related behaviors werefound related to medical support from physicians and those their own age. Further study is needed for exploring theseassociations among insured women in Japan.     

Apsáalooke women's experiences with Pap test screening.

BACKGROUND: Cervical cancer mortality rates are among the highest in the United States for Northern Plains Native American women compared with white and other Native American women. The aims of Messengers for Health, a community-based participatory research project based on the Apsáalooke (Crow Indian) Reservation, are to decrease cervical cancer screening barriers, improve knowledge regarding screening and prevention, and increase the proportion of women receiving Pap tests. This paper presents results from a survey assessing women's perceptions of the level of comfort and care received by health care providers in their most recent Pap test appointment. METHODS: A survey assessing patient communication and satisfaction with their health care providers was conducted with a random sample of 101 Apsáalooke women. Qualitative and quantitative methods were utilized to analyze the survey data. RESULTS: Women reported both positive and negative experiences with their provider regarding their Pap test appointments. They noted positive experiences when trust was established and when the provider offered information, reassured or encouraged them, was personable, was familiar or consistent, maintained confidentiality, and was a woman. The women reported negative experiences when the examination was too short, when they did not have a consistent or female provider, and when they did not feel comfortable with the provider's nonverbal communication. CONCLUSIONS: Continued work with both providers and patients is necessary to decrease communication barriers and increase satisfaction with Pap test appointments.     

Cervical cancer screening among Cambodian-American women.

Southeast Asian women have higher invasive cervical cancer incidence rates and lower Pap testing frequencies than most other racial/ethnic groups in the United States. However, there is little information about the cervical cancer screening behavior of Cambodian-American women. Cambodian residents of Seattle were surveyed in person during late 1997 and early 1998. The PRECEDE model was used to guide the development of items that assessed predisposing, reinforcing, and enabling factors associated with cervical cancer screening participation. The estimated overall survey response was 72%. Four hundred thirteen women completed our questionnaire. Approximately one-quarter (24%) of the respondents had never had a Pap test, and over one-half (53%) had not been screened recently. The following variables were positively associated with a history of at least one Pap smear: younger age, greater number of years since immigration, belief about Pap testing for postmenopausal women, prenatal care in the United States, and physician recommendation. Women who believed in karma were less likely to have ever been screened for cervical cancer than those who did not. Six variables independently predicted recent screening: age; beliefs about regular checkups, cervical cancer screening for sexually inactive women, and the prolongation of life; having a female doctor; and a previous physician recommendation for Pap testing. The study findings indicate that culturally specific approaches might be effective in modifying the cervical cancer screening behavior of immigrant women. Programs targeting Cambodian-Americans are likely to be more effective if they are multifaceted and simultaneously address predisposing, reinforcing, and enabling factors.     

Quality of non-breast cancer health maintenance among elderly breast cancer survivors.

PURPOSE: To assess the quality of preventive health care, the role of health care participation, and the patient and provider characteristics associated with high-quality care for breast cancer survivors. METHODS: We analyzed the 1997 to 1998 Medicare data of elderly women who were diagnosed with nonmetastatic breast cancer in 1991 or 1992 while living in a Survival, Epidemiology, and End Results (SEER) tumor registry area and who survived to the end of 1998 without evidence of cancer recurrence. Controls were matched for age, race, and geographic location. RESULTS: The 5,965 breast cancer survivors received more preventive services (influenza vaccination, lipid testing, cervical and colon screening, and bone densitometry) than matched controls. Among both groups, those who were younger, non-African-American, of higher socioeconomic status, living in urban areas, and receiving care in a teaching center were most likely to receive high-quality health maintenance. Those survivors who continued to see oncology specialists were more likely to receive appropriate follow-up mammography for their cancer, but those who were monitored by primary care physicians were more likely to receive all other non-cancer-related preventive services. Those who saw both types of practitioners received more of both types of services. When the control group was restricted only to women actively undergoing mammographic screening before the study period, receipt of preventive services was similar. CONCLUSION: Breast cancer survivors receive high-quality preventive services, but disparities on the basis of nonmedical factors still exist. Cancer follow-up may provide regular contact with the health system, maximizing the likelihood of receiving appropriate general medical care.     

Personal and Socio-Cultural Barriers to Cervical Cancer Screening in Iran,Patient and Provider Perceptions: a Qualitative Study

Background: Although cervical cancer is preventable and early screening might decrease the associatedmortality, challenges faced by the women and health care providers can postpone early detection. This qualitativestudy aimed to establish patient and provider perceptions about personal and socio-cultural barriers for cervicalcancer screening in Mashhad, Iran. Materials and Methods: In the present study, which was conducted in 2012,eighteen participants, who were selected purposefully, participated in individual in-depth, semi-structuredinterviews, which were recorded, transcribed verbatim, and analyzed using conventional content analysis andAtlas-Ti software. Results: One theme and two categories were derived from data including: cognitive/behavioralfactors (lack of a community-based approach to cervical cancer, lack of awareness, wrong attitude and lackof health seeking behaviors) and socio/cultural issues (socio-cultural invasion, mismatch between tradition,modernity and religious, extra marital relationships and cultural taboos). Conclusions: Providing communitybased approach education programs and employing social policy are needed for preventing of cervical cancerin Iran.     

Experiences of Cervical Cancer Survivors in Rural Eastern North Carolina: a Qualitative Assessment

Little qualitative research has been conducted with cervical cancer survivors. We sought to understand the experiences of survivors in rural Eastern North Carolina and identify any barriers which may have kept women from receiving preventive Papanicolaou screenings or follow-up care. We conducted semi-structured in-depth interviews with 15 low-income and underserved cervical cancer survivors living in Eastern North Carolina. Participants included English-speaking women who attended a large cancer center for care between March 2012 and March 2013. Participants ranged from being recently diagnosed with cervical cancer to being 15 years post-diagnosis. Interviews lasted approximately 1 h and were audio-tape-recorded. On average, women were 55 years old (range 35–85) and were diagnosed with cervical cancer 3 years prior to the interview (range 0.2 to 180 months). A good proportion was uninsured or Medicaid-insured (60 %). Half reported an annual household income of less than $20,000, and 13 % reported having a college degree. The majority of survivors had limited understanding of cervical cancer, experienced persistent symptoms related to their cancer before seeking care, and were nonadherent to Papanicolaou screening recommendations. The main barriers to care reported by participants was lack of money and health insurance, followed by the perception of overall health (which equated to the belief that medical care was not needed), transportation issues, and discomfort with provider. Health professionals should focus educational efforts on the benefits of Papanicolaou screenings, the symptoms sometimes associated with cervical cancer, and the free or low-cost services available to low-income women.     

Mobile Screening Unit (MSU) for the Implementation of the ‘Screen and Treat’ Programme for Cervical Cancer Prevention In Pune,India

Objectives: We are reporting the evaluation of an opportunistic point of care cervical cancer screening initiative in Pune, India using a mobile screening unit (MSU). Methods: We conducted 290 cervical cancer screening outreach clinics in the MSU. Screening was performed by trained nurses/ health care providers using visual inspection with 5% acetic acid (VIA). Screen positive women when eligible were treated by thermal ablation during the same sitting. Women with large lesions not eligible for treatment with thermal ablation were referred for colposcopy and treatment. Results: A total of 10, 925 women were screened between Nov 2016 and June 2019 in 290 outreach clinics in the MSU. The overall screen positivity was 6.6% (95% CI 6.1, 7.0) with a declining trend over time. A total of 304/717 (42.4%, 95% CI 38.7, 46.1) women received treatment with thermal ablation. About 3.6% (11/304) reported minor side effects and 1.6% (5/304) reported lower abdominal pain and all of them subsided after treatment.  Among the 413 women who were advised colposcopy, only 84 (20.33%) women underwent the procedure. Of these 84 women, 64 (76.19%) had normal colposcopy/ histopathology, 7 (8.33%) had CIN1, 2 (2.38%) had CIN 2, 9 (10.71%) had CIN 3 disease and 2 (2.38%) women were diagnosed with invasive cancer. Conclusion: MSUs are useful for providing cervical cancer screening services, using the ‘screen and treat’ strategy.  Thermal ablation is safe in the field clinics. Additional efforts are needed to improve the compliance for referral of those with large lesions requiring additional visits.     

Access to Cancer Screening for Women with Mobility Disabilities

Women with mobility disabilities are less likely to access cancer screening, even when they have a primary care provider. The Gateways to Cancer Screening project was initiated to document the challenges for women with disabilities in their access and experiences of screening for breast, cervical and colorectal cancer. The study followed the tenets of participatory action research. Five peer-led focus groups were held with 24 women with mobility disabilities. Study participants identified multiple and interacting institutional barriers to cancer screening. Their discussions highlighted the complex work of (1) arranging and attending health-related appointments, (2) confronting normative assumptions about women's bodies and (3) securing reliable health care and information. These overlapping, mutually reinforcing issues interact to shape how women with disabilities access and experience cancer screening. We explore implications for redesign of cancer screening services and education of health providers, providing specific recommendations suggested by our participants and the findings.     

Exploring women's knowledge, experiences and perceptions of cervical cancer screening in an area of social deprivation

Despite the strong evidence that cervical screening does save lives, evidence suggests that the uptake for cervical screening for women from socially deprived areas still remains low. A qualitative approach using four focus groups was undertaken with 48 women living in socially deprived areas who had accessed a mobile screening unit to receive cervical screening. Analysis of the data was undertaken using thematic content analysis. The women's knowledge of cervical cancer including associated risks, and preventative factors were extremely limited. The women expressed a negative attitude towards their experiences of cervical screening, describing negative feelings of 'fear', 'embarrassment' and feeling 'stigmatised'. Practical issues such as the timing of the appointments, issues of time and having to find child care were identified as the main barriers to screening for this group. This study highlights that practices and beliefs about screening are variable and access to health care is poorly tailored to meet the needs of the socially deprived. There is a need for accessible targeted information and strategies in order to enhance knowledge and awareness of cervical cancer and screening for women living in socially deprived areas.     

Factors Influencing Breast Cancer Screening Behavior among Iranian Women

Background: Early detection of breast cancer is of great importance to improve women’s health and to decreasethe cost related to cancer death. Therefore, recognition of variables related to breast cancer screening behaviorsis necessary. Objectives of this study were to identify the rates of breast self-examination (BSE) performance andmammography use in Iranian women, and to characterize the demographic and cognitive factors associated withtheir breast cancer screening behavior. Method: Data were collected from a convenience sample of 388 females,using an adapted version of Champion’s revised Health Belief Model Scale. Results: The results showed that7.5% of the participants performed BSE on a regular monthly basis, and among the women aged 40 and older,14.3% reported having had at least one mammography in their lifetime. Perceived self-efficacy and perceivedbarriers to BSE were significant predictors for BSE performance. For having mammography, health motivationwas the main predictor. Conclusion: Eliminating barriers and increasing perceived self-efficacy with an emphasisto make the women acquainted with BSE performance; as well as increasing health motivation of women andpersuading of physicians for clinical breast examination (CBE) performance with low cost and free access tom ammography, are important to promote BSE and mammography.