上海市虹口区离退休及低保妇女参与宫颈癌筛查相关因素研究

目的:了解影响社区妇女参与宫颈癌筛查的主要相关因素,为有效的干预提供基础。方法:采用自我效能量表和自行设计的知识态度及影响因素调查问卷,对上海市虹口区502例离退休及低保妇女进行问卷调查。问卷内容根据社会认知理论模型设计。结果:83.9%的调查对象曾经参与宫颈癌筛查,其中46.5%(所有调查对象中的39.0%)在3年内参加过宫颈癌筛查,多因素分析显示影响妇女曾经参与宫颈癌筛查的因素有:单位组织筛查、婚姻状况、医生推荐、周围人影响,且均为正向影响因素;而影响妇女3年内参与宫颈癌筛查的因素有:文化程度、社区组织筛查、离退休年数、医生推荐、宫颈癌及筛查相关知识、自我效能,这些影响除离退休年数为负向,其他均为正向相关因素。结论:上海市虹口区妇女3年内参与宫颈癌筛查率较低,应采取健康教育、提高妇女自我效能、提高医生对宫颈癌筛查的认识、提供免费筛查服务等多方面措施。在健康教育时应特别关注绝经后妇女,鼓励妇女家人同时参加。     

农村适龄妇女宫颈癌筛查服务利用行为现状及其影响因素分析

摘要:目的　调查农村适龄妇女宫颈癌筛查服务利用现状及其影响因素,为进一步完善农村宫颈癌筛查服务实施策略提供依据。方法　采用分层抽样方法,选取1 013名农村适龄妇女为研究对象,采用自制问卷进行入户调查获取宫颈癌筛查服务利用相关情况 结果　宫颈癌筛查服务利用率为28.8%;年龄、经济收入、医疗保障状况及宫颈癌筛查意识对宫颈癌筛查服务利用率有明显影响（P＜0.05）结论　农村宫颈癌筛查服务利用率较低;人口学因素及宫颈癌筛查意识是农村适龄妇女利用宫颈癌筛查服务的重要影响因素。     

城市社区妇女参加宫颈癌筛查行为意向结构方程模型分析

目的建构具有态度、主观行为准则等概念的"城市社区妇女接受宫颈癌筛查行为意向整合模型",探讨影响城市社区妇女接受宫颈癌筛查(宫颈涂片检查)行为的因素。方法用结构式问卷调查1591名上海某社区妇女参加宫颈癌筛查相关知识、态度和行为意向。验证性因子分析建立测量模型,再构建结构方程模型。最大似然法(ML)估计参数,通过评价修正来确定最佳结构模型。结果社区妇女既往参加过宫颈癌筛查的占42.1%,其中三年内参加过宫颈癌筛查的占56.7%。结构方程模型拟合较好,正向影响参加筛查行为意向的因素包括对象个体主观行为准则、对家庭社会责任的感知、对筛查促进因素的感知、参与筛查的自我效能和对宫颈涂片的态度。宫颈癌相关知识对行为意向无影响。对象对行为改变障碍的感知对参与筛查行为意向的作用是负向的。结论要提高社区妇女宫颈癌筛查项目的覆盖率,不能仅提供免费筛查服务和健康知识的培训,还需要构建筛查环境,包括家属的动员,社区妇女较易接受的女性筛查医师的配备、医师检查技能的提高等,同时筛查对象本身信念层面对筛查必要性的感知和改变也是重要的。     

成都市608名社区妇女宫颈癌认知、态度、行为调查

目的了解成都市部分社区妇女对于宫颈癌知识的认知、态度、行为(KAP)及相关影响因素,为成都市社区妇女宫颈癌健康教育提供依据。方法抽取成都市6个社区妇女共计654例,采用自制问卷进行调查,有效问卷608例,应用SPSS13.0软件统计处理。结果 608例调查对象中仅有27.3%知晓HPV(人类乳头瘤病毒)感染是宫颈癌的高危因素,87.3%认为宫颈癌可以预防;85.2%认为有性生活的妇女应该每年做妇科检查;66.6%曾主动了解过宫颈癌相关知识;22.2%参加过宫颈癌筛查。调查对象宫颈癌知识得分偏低,为(13.82±3.401)(-8～10)分;单因素分析显示不同经济状况、文化程度、年龄、职业、单位体检是否包括宫颈癌筛查以及是否参加过宫颈癌筛查等组间得分差异有统计学意义(P﹤0.05);多元线性回归显示,对得分影响最大的变量从大到小依次为:单位体检中是否包括妇科检查、务农、经济状况、是否参加过宫颈癌筛查、文化程度、企事业单位员工及年龄。结论调查对象对宫颈癌的认知程度偏低,特别是对宫颈癌筛查相关知识、HPV与宫颈癌的关系了解不全面;有预防宫颈癌的意识,但缺乏实际行动。     

广州市妇女参加宫颈癌筛查影响因素的结构方程模型分析

目的 探讨影响城市社区妇女参加宫颈癌筛查的因素,为有效开展宫颈癌筛查提供依据.方法 采用整群随机抽样方法,自行设计宫颈癌认知、参与筛查的态度和行为调查问卷对广州市基层社区的813名妇女进行调查.采用结构方程模型对调查数据进行统计分析 结果 被调查的813名妇女近3年宫颈癌筛查率为48.3％.结构方程模型分析结果表明,“客观因素”、“危险因素认知”、“防治知识”及“筛查支持感知”等4个外生潜变量对内生潜变量“筛查积极态度”有正向影响作用,其标准化路径系数分别为0.21、0.13、0.21、0.22,均有统计学意义(均有P＜0.05);“筛查积极态度”进而影响妇女参加宫颈癌筛查的时间间隔,其标准化路径系数为0.16(P=0.001),即态度积极者参加筛查的时间间隔较短.外生潜变量“筛查支持感知”还直接影响筛查的时间间隔,是妇女参加宫颈癌筛查的重要促进因素.模型的拟合效果良好,其卡方自由度比(x2/df)为2.99、拟合优度指数(GFI)为0.914、近似误差均方根(RMSEA)为0.057.结论 提高妇女参加宫颈癌筛查的积极性,除了要加强对妇女自身的健康教育外,还要提高其对筛查支持的感知度,比如同时也对其家庭、所在社区或工作单位普及宫颈癌防治知识.     

广东省中山市3838例城区妇女宫颈癌筛查情况分析

目的:探讨在城市社区进行液基薄层细胞学制片技术(TCT)筛查早期宫颈癌的必要性。方法:对筛查妇女中TCT阳性(细胞学TBS分类为不典型鳞状细胞以上)者进行hc2-HPV检测、阴道镜及镜下多点活组织检查,分析城市社区人群的筛查比例、TCT检查阳性率及子宫颈癌前病变患病率。结果:中山市东区共有3 838例妇女参加筛查,筛查率为19.39%。共检出TCT阳性61例(1.59%),31～40岁36例,41～50岁25例;阴道镜检查结果显示异常27例(44.26%);活检结果 CINⅠ15例(24.60%),CINⅡ6例(9.84%),CINⅢ6例(9.84%)。结论:城市社区妇女宫颈癌筛查率较低,在城市社区开展宫颈癌防治的宣传教育及筛查有着巨大的社会需求。     

武汉市某高校社区适龄妇女两癌筛查结果分析

目的 通过对武汉某高校社区适龄妇女宫颈癌、乳腺癌筛查结果回顾分析,了解其发病情况,为推广筛查工作提供依据。方法 对居于校内30～65周岁的女职工及家属采用DNA倍体分析+液基薄层细胞学检测的方法进行宫颈癌筛查,乳腺彩超进行乳腺癌筛查。对初筛可疑病例转至定点医院复诊并随访。结果 参加宫颈癌筛查1 631人,筛查率30.72%,确诊癌前病变5例,检出率为0.31％;参加乳腺癌筛查1 605人,筛查率30.23%,确诊乳腺癌6例,检出率为0.37％。结论 此高校妇女筛查率不高,须加强定期检查,发现问题及早干预,提高生存率和生活质量。     

基于健康信念模式的上海市社区妇女宫颈癌筛查行为影响因素研究

目的 基于健康信念模式,初步探索社区妇女宫颈癌筛查行为的影响因素,以期提出针对筛查需方角度的建议,为优化宫颈癌筛查工作提供参考。方法 对上海市2个区自愿参加宫颈癌筛查的社区女性487例进行问卷调查。应用x²检验与t检验进行不同筛查行为影响因素的比较,采用logistic回归评估各因素对筛查行为的影响。结果 41.7%（203例）的调查对象从未参加过宫颈癌筛查,不同年龄(t=2.332,P=0.020）、户籍（x²=41.120,P<0.001）、文化程度（x²=11.169,P=0.004）、居住状况（x²=27.529,P<0.001）及职业（x²=7.905,P=0.019）的女性筛查率有差异。曾参与筛查者对宫颈癌筛查的益处认知得分高于从未筛查者（t=2.358,P=0.019）,障碍认知得分低于从未筛查者(t=-7.443,P<0.001）,有行为线索的比例也高于从未筛查者（x²=80.181,P<0.001）。障碍认知（OR=1.884,95%CI:1.311~2.709）与行为线索（OR=2.606,95%CI:1.245~5.453）是宫颈癌筛查行为的影响因素。结论 障碍认知与行为线索对社区女性的宫颈癌筛查行为有影响,帮助改善障碍认知与行为线索是促进个体参与筛查的有效措施,并对不同特征人群开展针对性的宣教。     

石家庄市900例妇女宫颈癌认知及影响因素调查

目的调查河北省石家庄市妇女宫颈癌认知情况及影响因素,为当地宫颈癌的防治提供借鉴和参考。方法选取2012年1月-2014年12月河北省石家庄市进行健康体检的妇女900例为研究对象。调查问卷了解研究对象对宫颈癌防治知识的知晓情况,统计研究对象答对宫颈癌防治知识的数量,比较不同特征妇女对宫颈癌防治知识的知晓情况。Logistic回归分析影响妇女宫颈癌防治知识的影响因素,调查妇女未参加宫颈癌筛查的原因。结果 900例妇女对宫颈癌防治知识中的一般知识、危险因素及预防措施的知晓率普遍较低,9道宫颈癌防治知识中仅有10例(1.1%)全部答对,36.1%答对3～4题。单因素分析显示,妇女的年龄、居住区域、文化程度、家庭人均收入、生殖道病史、5年内参加宫颈癌筛查是影响妇女宫颈癌防治知识知晓率的因素。Logistic多因素回归分析显示,居住区域、文化程度、家庭人均收入、5年内参加宫颈癌筛查是影响妇女宫颈癌防治知识知晓率的因素。妇女未参加宫颈癌筛查的原因众多,未出现症状占53.6%;担心有心理负担占43.1%;做妇科检查难受占21.0%。结论河北省石家庄市妇女对宫颈癌防治知识的知晓率较低,针对宫颈癌高发人群展开有效的健康教育,定期展开宫颈癌的筛查工作,促进宫颈癌及宫颈癌癌前病变的早期诊治具有重要意义。     

北京市海淀区妇女两癌筛查情况分析

目的 了解北京市海淀区妇女生殖健康状况,筛查严重危害妇女健康的子宫颈癌和乳腺癌,为制定切实有效的妇女病防治措施提供依据.方法 采用妇科检查和国产液基薄层细胞学技术对海淀区户籍25-65岁妇女进行宫颈癌筛查,彩色多普勒超声对其中40-60岁的妇女进行乳腺癌筛查.结果 参加宫颈癌筛查的妇女有87 102人,筛查率为15.18%;妇科良性疾病患病率为24.67%,宫颈癌前病变患病率为9.07/万,宫颈癌患病率为4.59/10万.参加乳腺癌筛查的妇女有68 114例,筛查率为18.89%;乳腺良性疾病患病率为30.50%,乳腺癌患病率为80.75/10万.结论 开展妇女两癌筛查工作对降低宫颈癌和乳腺癌的发病率及死亡率具有重要的意义.应进一步加强健康教育工作,完善筛查制度,提高妇女两癌筛查率,保障妇女的生殖健康.     

Factors Associated with Breast and Cervical Cancer Screening Behavior Among African Immigrant Women in Minnesota

Immigrant populations in the United States (US) have lower cancer screening rates compared to none immigrant populations. The purpose of this study was to assess the rates of cancer screening and examine factors associated with cancer screening behavior among African immigrant women in Minnesota. A cross sectional survey of a community based sample was conducted among African immigrants in the Twin Cities. Cancer screening outcome measures were mammography and Papanicolau smear test. The revised theoretical model of health care access and utilization and the behavioral model for vulnerable populations were utilized to assess factors associated with cancer screening. Only 61 and 52 % of the age eligible women in the sample had ever been screened for breast and cervical cancer respectively. Among these women, duration of residence in the US and ethnicity were significant determinants associated with non-screening. Programs to enhance screening rates among this population must begin to address barriers identified by the community.     

Visual Inspection with Acetic Acid (VIA) Screening Program: 7 Years Experience in Early Detection of Cervical Cancer and Pre-Cancers in Rural South India

Cervical cancer continues to be a major public health problem in India in the absence of wide spread organised cervical screening programs. Visual inspection of the cervix with acetic acid (VIA) is an effective, inexpensive screening test that can be combined with simple treatment procedures for early cervical lesions, provided by trained health workers. We report 7 years experience in early detection of cervical cancer and pre-cancers using the VIA test in a community-based program in rural Andhra Pradesh, India where there are no existing organised cervical screening programs.

Materials and Methods:

Eligible women aged between 26 and 60 were opportunistically screened by trained health wor kers using the VIA test. Women who tested positive were further evaluated and those with cervical lesions were treated either by cryotherapy in the screening clinic or referred to a higher center.

Results:

A total of 18,869 women were screened by a single round of VIA testing with a positive rate of 10.75%. Biopsy proven high-grade squamous intraepithelials (HSILs) were 90 (0.48%) and low-grade squamous intraepithelials (LSILs) were 43 (0.28%). The overall prevalence of cervical intraepithelial neoplasia (CIN) 2+ lesion rate is 1.05%. A total of 312 (1.65%) cryotherapies were done and 49 women underwent hysterectomy.

Conclusions:

VIA by trained female health workers is a safe, acceptable, and effective test that can save lives from cervical cancer even in remote areas with few resources. These results have important implications for efficient service delivery in cervical screening programs in low-resourced settings.     

Uptake of cervical cancer screening in The Netherlands is mainly influenced by women's beliefs about the screening and by the inviting organization

BACKGROUND: This study aims to examine the impact of women's characteristics (demographics, risk behaviour, and beliefs) on the uptake of cervical cancer screening, taking practice characteristics (demographic and organizational) into account. METHODS: Routinely collected data of screening status were sampled from electronic medical records of 32 Dutch general practices. Additionally, a questionnaire was sent to a sample of 2224 listed women-1204 screened, 1020 unscreened. We used a step-by-step, logistic, multilevel approach to examine determinants of the screening uptake. RESULTS: Analyses of data for 1392 women (968 screened and 424 unscreened) showed that women's beliefs about cervical screening and attendance are the best predictors of screening uptake, even when demographic and organizational aspects are taken into account. Women aged 40-50 years who felt high personal moral obligation, who had only one sexual partner ever, and who were invited and reminded by their own general practice had the greatest likelihood of screening uptake. A non-response study was performed; the non-responders to the questionnaire (mainly unscreened) thought they had less risk of cervical cancer, were less motivated, less often intended to get future screening, and were more convinced that cervical cancer cannot be cured. CONCLUSION: To improve the uptake rate, we should focus on the personal moral obligation of eligible women, beliefs about the risks of cervical cancer, and available cures. Invitations and reminders within general practices enhance the uptake rate.     

Correlates of cervical cancer screening among underserved Hispanic and African-American women

BACKGROUND: Substantial subgroups of American women, specifically those of ethnic minorities, have not been screened for cervical cancer or are not screened at regular intervals. The rates for receipt of female-related cancer screening tests remain far below the goals set forth in Healthy People 2010. OBJECTIVE: This study applied a well-known, recently revised theoretical model of health care access and utilization, the Behavioral Model for Vulnerable Populations, to examine the correlates of the adherence to cervical cancer screening guidelines among publicly housed Hispanic and African-American women, two of the most vulnerable segments of our population. METHODS: This study conducted a cross-sectional survey of a community-based random sample of 230 African-American and Latino female heads of household, from a geographically defined area, the three urban public housing communities in Los Angeles County, CA. RESULTS: Only 62% of our sample had received a screening for cervical cancer within the past year. Yet, 29% of the sample claimed that no health care provider had ever told them that they needed a screening test for cervical cancer. Hispanic and older women are by far less likely to adhere to screening guidelines; in this study, 51% of Hispanics and 22% of African-Americans reported no screening within the last year. Multivariate analysis shows that affordability, continuity of care, and receiving advice from health care providers regarding a Papanicolaou (Pap) smear were significant predictors of up-to-date to cervical cancer screening. CONCLUSION: This study documents a significant disparity in screening for cervical cancer among underserved minorities, particularly Hispanic, uninsured, and older women. The continuity of obtaining medical services and receiving recommendations from physicians remain the core factors that are significantly associated with obtaining cervical cancer screening. These results underscore the need for continued efforts to ensure that medically underserved minority women have access to cancer screening services.     

基于健康信念模型的济南市妇女宫颈癌筛查行为影响因素研究

目的 以健康信念模型（health belief model,HBM）为理论基础,探索济南市妇女宫颈癌筛查行为的影响因素。 方法 基于济南市“两癌筛查”项目,对济南市9个区进行方便抽样,使用基于HBM理论的宫颈癌筛查问卷进行调查,对曾做过宫颈癌筛查和从未做过此筛查的人群进行对比,分析济南市妇女宫颈癌筛查行为的影响因素。 结果 共收回有效问卷1441份,有效率为79.0 %,其中942（65.5%）份为曾筛查组问卷,499（34.5 %）份为未筛查组问卷。曾筛查组在筛查自我效能、筛查益处、筛查障碍等维度的平均得分均高于未筛查组但在宫颈癌易感性和严重性的平均得分低于未筛查组（P＜0.05）。Logistic回归分析显示居住地（OR=1.327, 95%CI:1.007~1.749）、文化程度（OR=1.414, 95%CI:1.079~1.853）、筛查益处认知（OR=2.061, 95%CI:1.56 ~2.72）和筛查障碍认知（OR=1.466, 95%CI:1.22~1.763）是济南市妇女宫颈筛查的独立影响因素。结论 济南市女性宫颈癌筛查信念较好。优化农村贫困人群筛查策略、加强宫颈癌筛查科普、减少筛查障碍是提高济南妇女筛查率的可行措施。     

The influence of marital status on the use of breast,cervical, and colorectal cancer screening

PurposeTo examine the impact of marital status on the use of screening for breast, cervical, and colorectal cancer.MethodsWe relied on 2012 Behavioral Risk Factor Surveillance System Survey age-appropriate screening cohorts. Appropriate screening for breast, cervical, and colorectal cancer was determined according to United States Preventive Services Task Force recommendations in effect at the time of the 2012 survey. Complex samples logistic regression models were performed to examine the effect of marital status on cancer screening.ResultsOverall, 81.6, 83.9, and 68.9% of married participants underwent breast, cervical, and colorectal cancer, respectively, relative to 74.2, 75.1, and 60.9% for divorced/widowed/separated, individuals, and 74.7, 78.7, and 53.4% for never married individuals. Marital status (married vs. never married) was an independent predictor of screening for all cancers examined: breast cancer, odds ratio (OR): 1.42 (95% confidence interval [CI]: 1.25–1.61); cervical cancer, OR: 1.29 (95% CI: 1.16–1.43); colorectal cancer, OR: 1.63 (95% CI: 1.51–1.77). Gender-specific subgroup analyses for colorectal cancer suggests that marital status may exert a greater effect in men, relative to women (married men: OR 1.75, 95% CI: 1.56–1.96; married women: OR: 1.52, 95% CI: 1.35–1.70).ConclusionBeing married is associated with increased utilization of breast, cervical, and colorectal cancer screening. The influence of marital status was greater in men relative to women eligible for colorectal cancer screening. Our results emphasize the importance of social determinants of health-seeking behaviors.     

Women's knowledge about cervical cancer, Pap smear and human papillomavirus and its relation to screening in Argentina

The purpose of this study was to evaluate women's knowledge about cervical cancer, Pap smears, and human papilloma virus in relation to their cervical cancer screening behavior. This hospital-based study was conducted with a sample of 200 women: 100 women screened in the last three years and 100 non-screened women who attended a hospital located in the metropolitan area of Buenos Aires, between September 2008 and February 2009. Women at the hospital were surveyed using a structured questionnaire. Multiple logistic regression models were used to evaluate the relation of women's knowledge about Pap smears to screening behavior, controlling for socio-demographic characteristics. Of the women who had been screened, 49% compared to 73% of those not screened had inadequate knowledge about Pap smears (P = 0.001), and 47% of screened and 30% of non-screened women reported that they had ever heard about human papilloma virus (P = 0.013). In multivariate analysis, having adequate knowledge about Pap smears (odds ratio: 2.6 or 95%, confidence interval: 1.4-4.8) having health insurance (odds ratio: 2.6 or 95%, confidence interval: 1.1-6.4) and being married (odds ratio: 1.8 or 95%, confidence interval: 1.1-3.4) were the factors related to being screened in the previous three years. Knowledge was related to screening. Comprehensive educational approaches may enhance screening for cervical cancer prevention.     

Decomposing income-related inequality in cervical screening in 67 countries

Objectives  

The development of successful policies to reduce income-related inequalities in cervical cancer screening rates requires an understanding of the reasons why low-income women are less likely to be screened. We sought to identify important determinants contributing to inequality in cervical screening rates.     

Women's Knowledge About Cervical Cancer,Pap Smear and Human Papillomavirus and Its Relation to Screening in Argentina

The purpose of this study was to evaluate women's knowledge about cervical cancer, Pap smears, and human papilloma virus in relation to their cervical cancer screening behavior. This hospital-based study was conducted with a sample of 200 women: 100 women screened in the last three years and 100 non-screened women who attended a hospital located in the metropolitan area of Buenos Aires, between September 2008 and February 2009. Women at the hospital were surveyed using a structured questionnaire. Multiple logistic regression models were used to evaluate the relation of women's knowledge about Pap smears to screening behavior, controlling for socio-demographic characteristics. Of the women who had been screened, 49% compared to 73% of those not screened had inadequate knowledge about Pap smears (P = 0.001), and 47% of screened and 30% of non-screened women reported that they had ever heard about human papilloma virus (P = 0.013). In multivariate analysis, having adequate knowledge about Pap smears (odds ratio: 2.6 or 95%, confidence interval: 1.4–4.8) having health insurance (odds ratio: 2.6 or 95%, confidence interval: 1.1–6.4) and being married (odds ratio: 1.8 or 95%, confidence interval: 1.1–3.4) were the factors related to being screened in the previous three years. Knowledge was related to screening. Comprehensive educational approaches may enhance screening for cervical cancer prevention.