What factors are most influential in increasing cervical cancer screening attendance? An online study of UK-based women.
ABSTRACT: Objective: Cervical cancer is the fourth most commonly occurring cancer in women worldwide. The UK has one of the highest cervical screening rates in Europe, yet attendance has been decreasing. This study aimed to identify barriers and facilitators to screening attendance and assess the perceived importance of these factors. Methods: 194 women living in the UK were recruited via an online research recruitment website to an online survey. Most participants (N = 128, 66.0%) were currently up-to-date with cervical screening, 66 participants (34.0%) had never been screened, or were overdue for screening. Participants identified barriers and facilitators to cervical screening attendance via free-text responses and were also asked to rate a list of factors as most to least influential over decision making. Results were analysed using thematic content analysis and ratings analysed using multivariable analyses. Results: The most commonly reported barriers were: Pain/discomfort; Embarrassment; and Time. These were also rated as most influential for decision making. The most commonly reported facilitators were: Ease of making appointments; Peace of mind; and Fear of cancer/preventing serious illness. While importance rating of barriers did not differ by previous screening behaviour, ratings of some facilitators significantly differed. Up-to-date women rated believing screening is potentially life-saving and part of personal responsibility as significantly more important than overdue/never screened women. Conclusion: This study confirmed that factors which encourage screening are key to the decision of whether to attend screening. Women suggested several improvements that might make attending easier and improve uptake, including flexibility of screening locations to fit around work hours and childcare arrangements. Psychological facilitators included the peace of mind that screening brings and the belief that cervical cancer screening is potentially life-saving. Public health interventions should target factors which facilitate screening and how these interplay with barriers in order to improve uptake.
Project description:<h4>Background</h4>Women from ethnic minority backgrounds are less likely to attend cervical screening, but further understanding of ethnic inequalities in cervical screening uptake is yet to be established. This study aimed to explore the socio-demographic and ethnicity-related predictors of cervical cancer knowledge, cervical screening attendance and reasons for non-attendance among Black women in London.<h4>Methods</h4>A questionnaire was completed by women attending Black and ethnic hair and beauty specialists in London between February and April 2013. A stratified sampling frame was used to identify Black hair specialists in London subdivisions with >10% Black population (including UK and foreign-born). Fifty-nine salons participated. Knowledge of cervical cancer risk factors and symptoms, self-reported screening attendance and reasons for non-attendance at cervical screening were assessed.<h4>Results</h4>Questionnaires were completed by 937 Black women aged 18-78, describing themselves as being predominantly from African or Caribbean backgrounds (response rate 26.5%). Higher educational qualifications (p?<?.001) and being born in the UK (p?=?.011) were associated with greater risk factor knowledge. Older age was associated with greater symptom knowledge (p?<?.001). Being younger, single, African (compared to Caribbean) and attending religious services more frequently were associated with being overdue for screening. Women who had migrated to the UK more than 10 years ago were less likely to be overdue than those born in the UK. Of those overdue for screening who endorsed a barrier (67/133), 'I meant to go but didn't get round to it' (28%), fear of the test procedure (18%) and low risk perception (18%) were the most common barriers.<h4>Conclusions</h4>Ethnicity, migration and religiosity play a role in predicting cervical screening attendance among women from Black backgrounds. African women, those born in the UK and those who regularly attend church are most likely to put off attending. Additional research is needed to explore the attitudes, experiences and beliefs that explain why these groups might differ.
Project description:Women from Black, Asian and Minority Ethnic (BAME) backgrounds are less likely to attend cervical screening than White British women. This study explored sociodemographic and attitudinal correlates of cervical screening non-attendance among BAME women.Women (30-60 years) were recruited from Indian, Pakistani, Bangladeshi, Caribbean, African and White British backgrounds (n=720). Participants completed structured interviews.BAME women were more likely to be non-attenders than white British women (44-71% vs 12%) and fell into two groups: the disengaged and the overdue. Migrating to the United Kingdom, speaking a language other than English and low education level were associated with being disengaged. Being overdue was associated with older age. Three attitudinal barriers were associated with being overdue for screening among BAME women: low perceived risk of cervical cancer due to sexual inactivity, belief that screening is unnecessary without symptoms and difficulty finding an appointment that fits in with other commitments.BAME non-attenders appear to fall into two groups, and interventions for these groups may need to be targeted and tailored accordingly. It is important to ensure that BAME women understand cancer screening is intended for asymptomatic women and those who have ceased sexual activity may still be at risk.
Project description:OBJECTIVE:The attendance rate for cervical cancer screening in Norway is currently suboptimal at 69%, and an in-depth understanding of postponement of cervical cancer screening from the perspective of non-attenders is lacking. This study aims to generate knowledge about how non-attenders for cervical cancer screening reflect on booking a screening appointment. METHODS:Using the Norwegian cervical cancer screening registry, we identified and recruited women who were non-attenders to screening. Nine focus group interviews were carried out, with 41 women participating in the interviews. RESULTS:Four main themes were generated, which provide a comprehensive understanding of how women who are overdue for screening reflect on their hesitancy to book a screening appointment: 'It's easy to forget about it', 'Women have to arrange their own appointment', 'It has to be a 'must'' and 'It's a humiliating situation'. CONCLUSION:The degree to which women regard screening as important is affected by the nudging strategies employed in the screening programme and the facilitation of attendance provided by healthcare services. Dependence on one's personal initiative to schedule a screening appointment and perception of a lack of responsibility on the part of healthcare services to attend screening may undermine informed and shared decision-making about screening attendance.
Project description:OBJECTIVES:To explore community knowledge, facilitators and barriers to cervical cancer screening among women in rural Uganda so as to generate data to inform interventions. DESIGN:A qualitative study using focus group discussions and key informant interviews. SETTING:Discussions and interviews carried out in the community within two districts in Eastern Uganda. PARTICIPANTS:Ten (10) focus group discussions with 119 screening-eligible women aged between 25 and 49 years and 11 key informant interviews with healthcare providers and administrators. RESULTS:Study participants' knowledge about cervical cancer causes, signs and symptoms, testing methods and prevention was poor. Many participants attributed the cause of cervical cancer to use of contraception while key informants said that some believed it was due to witchcraft. Perceptions towards cervical cancer and screening were majorly positive with many participants stating that they were at risk of getting cervical cancer. The facilitators to accessing cervical cancer screening were: experiencing signs and symptoms of cervical cancer, family history of the disease and awareness of the disease/screening service. Lack of knowledge about cervical cancer and screening, health system challenges, fear of test outcome and consequences and financial constraints were barriers to cervical cancer screening. CONCLUSION:Whereas perceptions towards cervical cancer and screening were positive, knowledge of study participants on cervical cancer was poor. To improve cervical cancer screening, effort should be focused on reducing identified barriers and enhancing facilitators.
Project description:Cervical cancer is a major health concern in Tanzania, caused by poor attendance for cervical cancer screening and follow-up of women at risk. Mobile telephone health interventions are proven effective tools to improve health behaviour in African countries. So far, no knowledge exists on how such interventions may perform in relation to cervical cancer screening in low-income settings. This study aims to assess the degree to which a Short Message Service (SMS) intervention can increase attendance at appointments among women who have tested positive for high-risk (HR) Human Papillomavirus (HPV) during cervical cancer screening.Connected2Care is a non-blinded, multicentre, parallel-group, randomised controlled trial. Tanzanian women testing positive to HR HPV at inclusion are randomly assigned in an allocation ratio of 1:1 to the SMS intervention or the control group (standard care). In a period of 10 months, the intervention group will receive 15 one-directional health educative text messages and SMS reminders for their appointment. The total sample size will be 700 with 350 women in each study arm. Primary outcome is attendance rate for follow-up. Secondary objectives are cost-effectiveness, measured through incremental ratios, and knowledge of cervical cancer by a 16-item true/false scale questionnaire at baseline and follow-up. Barriers against implementing the intervention will be assessed in a mixed-methods sub-population study.This study may provide information on the potential effects, costs, and barriers in implementing an SMS intervention targeting a group of women who are followed up after testing positive for HR HPV and are, therefore, at increased risk of developing cervical cancer. This can guide decision-makers on the effective use of mobile technology in a low-income setting. Trial status: recruiting.ClinicalTrials.gov, ID: NCT02509702 . Registered on 15 June 2015.
Project description:<h4>Objectives</h4>Many women who do not attend screening intend to go, but do not get around to booking an appointment. Qualitative work suggests that these 'intenders' face more practical barriers to screening than women who are up-to-date ('maintainers'). This study explored practical barriers to booking a screening appointment and preferences for alternative invitation and booking methods that might overcome these barriers.<h4>Design</h4>A cross-sectional survey was employed.<h4>Setting</h4>Great Britain.<h4>Participants</h4>Women aged 25-64, living in Great Britain who intended to be screened but were overdue ('intenders', n=255) and women who were up-to-date with screening ('maintainers', n=359).<h4>Results</h4>'Intenders' reported slightly more barriers than 'maintainers' overall (mean=1.36 vs 1.06, t=3.03, p<0.01) and were more likely to think they might forget to book an appointment (OR=2.87, 95% CI: 2.01 to 4.09). Over half of women said they would book on a website using a smartphone (62%), a computer (58%) or via an app (52%). Older women and women from lower social grades were less likely to say they would use online booking methods (all ps <0.05). Women who reported two or more barriers were more likely to say they would use online booking than women who reported none (ps <0.01).<h4>Conclusions</h4>Women who are overdue for screening face practical barriers to booking appointments. Future interventions may assess the efficacy of changing the architecture of the invitation and booking system. This may help women overcome logistical barriers to participation and increase coverage for cervical screening.
Project description:<h4>Objectives</h4>To explore self-reported cervical screening history and barriers to attendance among women who have been sexually abused and to identify measures to improve the experience of cervical screening for these women.<h4>Methods</h4>Women visiting the website of the National Association for People Abused in Childhood (NAPAC), who had been sexually abused, were invited to complete a survey of their views and experiences of cervical screening. This included closed questions on demographic characteristics and cervical screening attendance, open questions on barriers to screening, and the opportunity to submit suggestions to improve this experience for women who have been sexually abused. Content analysis was used to code responses to the open questions. Four women also participated in a discussion group.<h4>Results</h4>Overall, 135 women completed the closed questions and 124 provided open-ended responses. 77.5% of responding women who were eligible for cervical screening in England had ever attended, 48.5% at least once in the previous 5 years, but 42.1% of women aged 25-49 within 3 years. A total of nine higher order themes were identified related to barriers to screening, one related to intention to attend screening and five related to suggestions to improve screening.<h4>Conclusions</h4>This study supports the idea that women who have experienced sexual abuse are less likely to attend for regular cervical screening, with under half screened in the last 5 years compared to the National Health Service Cervical Screening Programme figure of 78.6%. Suggestions to improve the experience for abused women focused on communication, safety, trust and sharing control. Further research in this area is warranted to ensure that this at-risk population is appropriately served by cervical screening.
Project description:<h4>Importance</h4>Women who experience imprisonment have higher rates of cervical cancer. Lack of access to cervical cancer screening in the community or in prison may contribute to increased cervical cancer incidence.<h4>Objectives</h4>To determine cervical cancer screening rates for women in provincial prison in Ontario, Canada, and to compare these data with data for the general population.<h4>Design, setting, and participants</h4>This retrospective cohort study used correctional and health administrative data from January 1, 2006, to December 31, 2013. Participants included Ontario women aged 21 to 69 years during the follow-up period with no history of cervical cancer or hysterectomy. Analyses were conducted between July 2017 and September 2018.<h4>Exposures</h4>Women admitted to Ontario provincial prison in 2009 or 2010 and released in 2010 were considered exposed, and women in the general population of Ontario were considered unexposed.<h4>Main outcomes and measures</h4>Whether women were overdue for cervical cancer screening at the time of admission to prison or on July 1, 2010, for the general population, defined as not having been screened in the previous 3 years, and whether women who were overdue were still overdue after 3 years.<h4>Results</h4>There were 4553 women in the prison group and 3?647?936 women in the general population group. The median (interquartile range) age was 36 (29-43) years in the prison group and 43 (34-53) years in the general population. Women in the prison group had 2.20 times (95% CI, 2.08-2.33) the odds of being overdue for cervical cancer screening compared with women in the general population after adjusting for neighborhood income quintile, at 53.9% (95% CI, 51.8%-56.1%) compared with 32.9% (95% CI, 32.8%-33.0%) (P?<?.001). Women in the prison group also had nearly twice the odds of still being overdue at 3 years, with an odds ratio of 1.87 (95% CI, 1.76-1.99) after adjusting for neighborhood income quintile, and rates of still being overdue of 36.2% (95% CI, 34.5%-38.0%) compared with 21.9% (95% CI, 21.8%-21.9%) (P?<?.001).<h4>Conclusions and relevance</h4>Women who experience imprisonment have worse cervical cancer screening access than women in the general population. Work should be done to promote cervical cancer screening awareness and to improve access to acceptable screening in prison and in the community after prison release.
Project description:Cervical cancer mortality is high among Peruvian women of reproductive age. Understanding barriers and facilitators of cervical cancer screening and treatment could facilitate development of contextually-relevant interventions to reduce cervical cancer incidence and mortality. From April to October 2019, we conducted a cross-sectional survey with 22 medical personnel and administrative staff from Liga Contra el Cancer, in Lima, Peru. The survey included structured and open-ended questions about participants' roles in cervical cancer prevention and treatment, perceptions of women's barriers and facilitators for getting screened and/or treated for cervical cancer, as well as attitudes towards adopting new cervical cancer interventions. For structured questions, the frequency of responses for each question was calculated. For responses to open-ended questions, content analysis was used to summarize common themes. Our data suggest that the relative importance and nature of barriers that Peruvian women face are different for cervical cancer screening compared to treatment. In particular, participants mentioned financial concerns as the primary barrier to treatment and a lack of knowledge or awareness of human papillomavirus and/or cervical cancer as the primary barrier to screening uptake among women. Participants reported high willingness to adopt new interventions or strategies related to cervical cancer. Building greater awareness about benefits of cervical cancer screening among women, and reducing financial and geographic barriers to treatment may help improve screening rates, decrease late-stage diagnosis and reduce mortality in women who have a pre-cancer diagnosis, respectively. Further studies are needed to generalize study findings to settings other than Lima, Peru.
Project description:In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection and treatment. Existing reviews on CCS have limited insights into the barriers and facilitators for SEA. Hence, this study aims to identify key barriers and facilitators among women living in SEA. A systematic literature review was conducted on Pubmed, Embase, PsycINFO, CINAHL, and SCOPUS. Primary qualitative and quantitative studies published in English that reported barriers and facilitators to CCS were included. The Mix Methods Appraisal Tool was used for the quality assessment of the included studies. Among the 93 included studies, pap smears (73.1%) were the most common screening modality. A majority of the studies were from Malaysia (35.5%). No studies were from Timor-Leste and the Philippines. The most common barriers were embarrassment (number of articles, <i>n</i> = 33), time constraints (<i>n</i> = 27), and poor knowledge of screening (<i>n</i> = 27). The most common facilitators were related to age (<i>n</i> = 21), receiving advice from healthcare workers (<i>n</i> = 17), and education status (<i>n</i> = 11). Findings from this review may inform health policy makers in developing effective cervical cancer screening programs in SEA countries.