对门诊女性患者宫颈癌筛查知信行的调查

目的了解门诊女性患者对宫颈癌筛查知识的认知以及相关的态度和行为,为提高宫颈癌筛查参与率的护理干预方案提供理论依据。方法采取随机抽样法,使用宫颈癌筛查知识的认知以及相关的态度和行为的调查问卷,对门诊就诊的1116例女性患者进行调查。结果本研究显示,不同年龄、文化程度、经济收入妇女对宫颈癌筛查相关知识认知度不同,差异均有统计学意义（X2=42．377,138．7,32．519,P〈0．01）,学历较高者、经济情况较好者对宫颈癌筛查知识知晓率较高。76．3％赞成“早期发现宫颈癌可提高生存率”这一观点,47．5％赞成“筛查可以早期发现宫颈癌”,45．3％的妇女愿意接受宫颈癌筛查。43．8％的妇女曾经做过宫颈癌筛查,定期每年做1次的有4．9％。不同年龄、受教育程度、经济收入妇女宫颈癌筛查率的比较差异均有统计学意义（X2=16．155,9．052,28．801,P〈0．01）。结论女性患者对宫颈癌筛查知识了解不足,文化程度低、经济条件差的患者对宫颈癌筛查的认知度低,实际参加宫颈癌筛查率低。护理人员应帮助患者树立积极态度,提高对宫颈癌筛查的认知,根据患者不同情况采取不同形式和渠道进行宫颈癌筛查健康教育,从而改善宫颈癌筛查率低的现状。     

Nurse practitioners and preventive screening in the hospital

The purpose of this study was to investigate a reminder to discuss cervical cancer screening with hospitalized females. A quasi-experimental design was used to compare the association of a reminder intervention for nurse practitioners with two outcomes: prevalence of cervical cancer screening as documented in patients' charts and patients' self-report of cervical cancer screening 4 months after discharge. Data were collected by chart review and phone survey. The sample consisted of nurse practitioners caring for eligible female patients at a university teaching hospital. Chi-square was used to test all research questions. The rate of documentation of cervical cancer screening increased from 2% to 69% after implementation of the reminder intervention. The reminder intervention did not impact patients actually receiving Pap smears after discharge. The significant increase in documentation of screening associated with the use of the single reminder in the patients' charts support the use of this low-cost intervention.     

健康教育对已婚妇女早期宫颈癌筛查的效果分析

目的:了解已婚妇女对宫颈癌早期筛查认知情况,为正确开展宫颈癌早期筛查患者的健康教育提供依据。方法:对在我院妇产科门诊就诊接受宫颈癌筛查的患者同时进行宫颈癌相关知识宣传教育,应用自行设计的问卷评估干预效果。结果:已婚妇女对宫颈癌筛查认知程度较低。干预后患者宫颈癌相关性知识综合掌握情况和愿意接受官颈癌筛查的患者明显提高。结论:开展多元素、多种形式的官颈癌筛查,有利于提高已婚妇女对宫颈癌筛查重要性的认识和宫颈癌筛查率,对早发现和早治疗宫颈癌具有重要意义。     

Cervical cancer screening--"For better or worse...": women's experience of screening

In Sweden, the population-based cervical cancer screening program has been in progress since the 1970s and is directed toward women between 23 and 60 years of age. The aim of this study was to explore women's experience of cervical screening after being diagnosed with cancer. A qualitative study inspired by Grounded Theory was used. Eleven women were interviewed. The interviews were analyzed using the constant comparative method. "Screening-For Better or Worse..." was identified as the core category, around which the categories "Unawareness," "Trust," "Search for Understanding," and "Making the Invisible Visible" were integrated and on which the conceptual model was built. The experience of screening had both a positive and a negative dimension for the women stricken by cervical cancer. The women had a positive experience of screening as such and they believed in its benefits. However, many women felt deceived and, because of their unawareness, questions arose for which they searched for understanding. The women requested adequate and understandable information. Their trust remained because the contact with healthcare professionals involved in screening and in the follow-up program had been reassuring.     

Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies.

In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation incentives (bus passes/parking permits). The three interventions were evaluated using a 2 x 2 x 2 factorial design. Results of this study confirm a high rate of loss to screening follow-up (i.e., no return visits) among women with abnormal pap smears (29% overall), with substantial variability among the 12 participating clinics (13% to 42/%). For the sample as a whole, both transportation incentives and the combined intervention condition of personalized follow-up and slide-tape program had a significant positive impact on screening follow-up. However, transportation incentives emerged as the dominant intervention condition among patient subgroups that can be characterized as more disadvantaged socioeconomically and at higher risk of developing cervical cancer, including patients receiving care from the county health department (odds ratio (OR) = 1.51; P less than .05); patients without health insurance (OR = 1.77; P less than .01); and patients with more severe pap smear results (OR = 1.71; P less than .05). In contrast, among patient subgroups that can be characterized as relatively more advantaged and at lower risk of developing cervical cancer, only the combined intervention condition of personalized follow-up and slide-tape program was associated with a higher patient return rate. Subgroups reflecting this pattern included patients seen in noncounty clinics (OR = 4.54; P less than .05) and patients with less severe pap smear results (OR = 5.16; P less than .01). The implications of these findings are discussed in terms of designing clinic-based interventions to improve screening follow-up.     

Access to cervical screening for women with learning disabilities

Evidence shows that the uptake of cervical screening is much lower in women with learning disabilities compared to other women. A literature review was conducted, including published and unpublished international empirical research, discussion articles and reports written in English from 1990 to October 2007, to identify what factors are preventing women with learning disabilities from accessing cervical screening, and what can be done to encourage uptake. From the literature reviewed, factors that prevent women with learning disabilities from accessing cervical screening fell into the following categories: administration errors; access to a GP; assumptions made by healthcare professionals about women with learning disabilities; perceived difficulties obtaining consent; attitudes of carers; the beliefs and experiences of women themselves; lack of accessible information; and physical difficulties. Findings on how cervical screening uptake can be improved in women with learning disabilities were categorized into: preparation with the women; working in partnership; and encouraging good practice. The literature review showed that there are many factors that may be preventing women with learning disabilities from accessing cervical screening, many of which can be overcome by healthcare professionals adhering to good practice guidelines, thus ensuring that women with learning disabilities have their right to access cervical screening services acknowledged.     

Effectiveness and efficiency of opportunistic cervical cancer screening: comparison with organized screening

BACKGROUND: Several countries have adopted nationally organized cervical screening programs, but many continue with opportunistic screening. Comparison of the effectiveness and efficiency of the 2 systems is important for informing policy. OBJECTIVES: The objectives of this study were to assess the effectiveness and efficiency of an opportunistic cervical screening system, and to compare this with what could be achieved through an organized program. RESEARCH DESIGN: We propose a model for estimating the effectiveness and efficiency of opportunistic screening systems and demonstrate it using data from a cross-sectional study of 1826 women in Hong Kong. We estimated the coverage and frequency of screening and used this to estimate effectiveness (number of cases of invasive cervical cancer potentially prevented) and efficiency (tests per case prevented) of the current system. Similar estimates were made for various organized programs with different screening intervals and coverage. RESULTS: Ever screening coverage in this opportunistic system was 44%, resulting in 26% to 31% reduction in potential new cases (n = 144-183). Compared with this, a 3-yearly or 5-yearly screening policy aiming for 80% coverage would prevent an additional 46% (equivalent to 254 new cases out of a population of 2.3 million women per year) and 41% (222 per year), respectively. This could be achieved with more efficient use of resources, reducing the number of tests per case prevented from 2018 to 1545 and 1007, respectively. CONCLUSIONS: At best, the effectiveness of this opportunistic system is equivalent to an organized program with 10-yearly screening and 50% coverage but at much greater cost. Poor coverage and over screening of a minority of women contributes to its inefficiency.     

Reasons for non-attendance at cervical screening

Many women are anxious about cervical screening. The receipt of an abnormal result causes high levels of distress. Cervical screening uptake can be improved by the provision of information, sensitive communication and consideration of a woman's health beliefs. This article discusses the barriers that prevent some women from attending cervical screening. By informing nurses of the possible reasons why women do not have cervical smears it is hoped that they will be able to provide women with better health education in this area of practice.     

女性宫颈癌早期筛查认知程度的调查分析

目的 了解妇科门诊就诊女性对宫颈癌早期筛查的认知程度.方法 选取1 590例门诊就诊女性,采用自设问卷进行认知程度调查.结果 知道宫颈癌的占96.60％.城市女性对宫颈癌知识的认知程度高于农村;文化程度越高的女性对宫颈癌知识的认知程度越高,差异均具有统计学意义(P＜0.01).结论 女性对宫颈癌早期筛查重要性的认知程度...     

综合性干预对改善社区颈椎病患者知信行状态的效果观察

目的探讨综合性干预对改善社区颈椎病患者知识-态度-行为状态的影响。方法由社区颈椎病综合干预团队对200例社区颈椎病患者实施为期6个月的包括健康教育、心理疏导、饮食干预、行为干预等内容的综合性干预措施,采用自行设计的社区颈椎病患者知信行评估问卷对干预前后患者的知识-态度-行为情况进行调查。结果实施综合性干预后社区颈椎病患者知信行总分及患者对颈椎病知识的知晓率、态度和行为较干预前有明显提高(P<0.01)。结论通过对社区颈椎病患者进行系统的综合性干预,使社区颈椎病患者能正确认识颈椎病,采用健康的行为方式,有效改善社区颈椎病患者的知识-态度-行为状态。     

Factors related to health practices: cervical cancer screening among Filipino women

This correlational study developed and tested theory to better understand health practices, including cervical cancer screening, among young Filipino women. It tested theoretical relationships postulated among (a) positive health practices, (b) cervical cancer screening, (c) social support, (d) acculturation, and (e) optimism. A convenience sample of 89 young Filipino women in an urban setting was obtained. Participants completed a demographic sheet and five instruments. Significant positive correlations were found between PHP and social support (r = .169, p <.05) and previous cervical cancer screening behavior (r = .285, p <.01) and cervical cancer screening frequency (r = .33, p <.01). Social support was not significantly related to cervical cancer screening. Previous cervical cancer screening behavior was significantly related to optimism (r = .285, p <.01) and screening frequency (r = .924, p <.01). Optimism was significantly related to positive health practices (r = .209, p <.05) and cervical cancer screening knowledge (r = .224, p <.05) but not significantly related to previous cervical cancer screening behavior or screening frequency. Findings contribute to a more comprehensive knowledge base regarding positive health practices, including cervical cancer screenings, among young Filipino women.     

Characteristics of participation in cervical cancer screening

Although Papanicolaou test screening rates are reportedly high, a significant proportion of women remain unscreened. With recent revision of Papanicolaou test guidelines, it is critical that interventions and programs for cervical cancer directed toward low participating groups or individuals be developed. The purpose of the study was to examine factors that influence participation in cervical cancer screening by quantifying characteristics of women who engage in Papanicolaou test screening in a 12-month period. Using the 2000 National Health Interview Survey and Cancer Topical Module, the sample (N = 18,388) consisted of women who were older than 18 years. The dependent variable was nominally identified as whether a woman had had a Papanicolaou test in the last 12 months. Independent variables examined were insurance, level of education, place for care, age, race, employment, place of residence, and income level. Using logistic regression, all variables except race and income level were found to be significant for participation in cervical cancer screening (P < .000). Each variable is discussed within the framework of the Institute of Medicine model of access to personal healthcare services. Study findings provide insight and guidance for the development and implementation of methods for accessing women who have lower participation rates.     

Understanding the cervical screening behaviour of Chinese women: The role of health care system and health professions

BackgroundIn China, cervical cancer cases are increasing, making an impact on the worldwide burden of cervical cancer. Despite the initiatives undertaken by the Chinese government, the current coverage of cervical screening in China remains suboptimal. There is an urgent need to identify the facilitators and barriers associated with the uptake of cervical cancer screening among the Chinese population.PurposeThe study aimed to explore the experiences and perceptions of cervical cancer screening of mainland Chinese women in relation to their screening behaviour, particularly in the aspects of health care system and health profession roles.MethodsA qualitative research was conducted using semi-structured interviews. A total of 27 Chinese women aged 25 to 50 (both screened and non-screened women) completed the interviews. The analysis of the interview data was undertaken inductively using latent content analysis.Discussion and conclusionResults showed that organised health examination programmes provide a good basis for integrating cervical screening into broader checks on the health of women, and utilising different networks of social support facilitate the utilisation of the screening service. However, education on cervical cancer and screening must be made more generally available. More importantly, there is a need for a more participatory and empowering exchange in the encounter between health professions and these women. Appropriate training program is strongly recommended for health professions about communicate skills with patients. Future work should focus on identifying strategies to overcome the barriers to cervical screening related to health care system and medical professions among this population.     

Cervical cancer screening knowledge and practices among Korean-American women.

Cervical cancer is one of the most common cancers of American women. The Papanicolaou (Pap) smear test for cervical screening is a widely used and effective means to reduce the morbidity and mortality rate from cervical cancer through early detection. Despite these benefits, many women have never been screened or are not screened at regular intervals. The purpose of this study was to examine cervical cancer screening knowledge and practices of Korean-American women. The sample consisted of 159 Korean-American women, 40 to 69 years of age. The 1987 Cancer Control Supplement questionnaire was translated into Korean and used to collect data. Twenty-six percent of the respondents never heard of the Pap smear test. Only 34% of respondents reported having had a Pap smear test for screening. The most frequently cited reason for not having had a Pap smear test was absence of disease symptoms. Results indicate that education and usual sources of health care were significant factors related to having heard of or having had a Pap smear test. The findings from this study have important implications for health practitioners and policy makers who serve this ethnic population.     

Women's lay knowledge of cervical cancer/cervical screening: accounting for non-attendance at cervical screening clinics

An assessment of women’s knowledge of cervical screening and cervical cancer was considered important as up to 92% of those dying from this form of cancer had never been tested. What were the reasons which determined their non-attendance? Issues to be addressed were reactions to invitation, women’s knowledge of screening, and the possible factors which they envisaged as being associated with cervical cancer. Other issues to be considered were practical problems associated with attendance, and preference for the sex and professional status of the health professionals involved; 187 women in a general practitioner practice in Lothian, Scotland were targeted by questionnaire. As with other studies in this field 50% of those contacted were ineligible for a variety of reasons. Seventy-two women completed the questionnaire, providing a mix of qualitative and quantitative data. Although the majority of women felt the invitation to attend screening was clear and easy to understand, there was a lack of knowledge with regard to both the screening itself and the possible causes of cervical cancer. The main ‘causes’ were seen as higher sexual activity among those aged under 37 and smoking and a virus by those over 37. The majority of women showed preference for a female professional to take the smear. Practical problems of time and venue were not considered insurmountable. The main reasons cited for non-compliance were the fear and dislike of the test itself.     

Promoting breast health: older women's perceptions of an innovative intervention to enhance screening

Aims and objectives. This study is a continuation of prior funded research in which we tested the use of age and ethnically sensitive video breast health kits to increase knowledge about breast cancer and enhance the screening practices of breast self‐examination and mammography among older Caucasian and African‐American women. Background. Breast cancer is the most frequent cancer in women worldwide and accounts for 23% of all cancers. Mammography is currently the best procedure available for mass screening of breast cancer. However, underutilization of mammography is a problem among older women in the United States. Elders are at the greatest risk for developing and dying from breast cancer but they are the least likely group to be screened routinely with mammograms or to practice breast self‐examination, particularly if they are African‐American. Design. Participatory qualitative evaluation focus groups were used to assess the overall impact of the video kit intervention programme and to elucidate the quantitative findings of the original study. Methods. Four focus groups were conducted in two diverse settings with a purposive sample of 23 participants (N = 23). The overall sample was predominantly African‐American (87%) with mean age of 71 ± 7.9 years and mean education completed of 12 ± 3.4 years. Results. Five major themes emerged from group discussions: usability and appeal of the intervention, fear and empowerment, personal relevance and intergenerational sharing, impact on screening behaviours, and story telling. Conclusions. Analyses suggest that customized media materials constructed especially for older African‐American women empowered participants in this sample to action regarding their own breast health. Relevance to clinical practice. These findings may translate to global populations where risk is increasing but screening programmes are not widely available. Given that older women are historically difficult to access and impact, further design and evaluation of innovative and sensitive educational programmes such as the one described here are recommended.     

Challenges in providing breast and cervical cancer screening services to Vietnamese Canadian women: the healthcare providers' perspective

Breast cancer and cervical cancer are major contributors to morbidity and mortality among Vietnamese Canadian women. Vietnamese women are at risk because of their low participation rate in cancer-preventative screening programmes. Drawing from the results of a larger qualitative study, this paper reports factors that influence Vietnamese women's participation in breast and cervical cancer screening from the healthcare providers' perspectives. The women participants' perspective was reported elsewhere.
Semistructured interviews were conducted with six healthcare providers. Analysis of these interviews reveals several challenges which healthcare providers encountered in their clinical practice. These include the physicians' cultural awareness about the private body, patient's low socioeconomic status, the healthcare provider–patient relationship, and limited institutional support.
This is the first Canadian study to identify the healthcare providers' perspective on giving breast and cervical cancer preventive care to the Vietnamese immigrant women. The insight gained from these healthcare providers' experiences are valuable and might be helpful to healthcare professionals caring for immigrant women of similar ethno-cultural backgrounds. Recommendations for the promotion of breast cancer and cervical cancer screening among Vietnamese women include: (i) effort should be made to recruit Vietnamese-speaking female healthcare professionals for breast and cervical health-promotion programmes; (ii) reduce woman–physicians hierarchical relationship and foster effective doctor–patient communication; (iii) healthcare providers must be aware of their own cultural beliefs, values and attitudes that they bring to their practice; and (iv) more institutional support and resources should be given to both Vietnamese Canadian women and their healthcare providers.