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To explore the attitudes, views and understanding of women attending a Hindu temple in London, UK towards cervical screening, human papillomavirus (HPV) testing and two HPV self-sample collection devices: the Dacron swab and Evalyn(®) brush.
A mixed methods design comprising a survey and four focus groups was adopted. Focus group discussions were r...
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Citations
... Such limitations include lack of infrastructure for and travel time to health care services [55], cultural values and beliefs surrounding male healthcare providers and maintaining privacy of genitalia [56], as well the cost associated with fees for screening by a healthcare provider [57]. While such benefits exist, commonly cited barriers for self-sampling among women include a lack of self-confidence for collecting a reliable sample, fear of injuring oneself, concerns about accuracy of the test, and interpersonal stigma and burden related to diagnosis of sexually transmitted infections (STIs) [58][59][60]. As demonstrated by our findings, the widespread implementation of educational interventions that are tailored to various populations may address some of these factors. ...
Background:
While cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman-centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India.
Methods:
Our community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30-69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants' uptake of cervical cancer screening was assessed after attendance in SHE.
Findings:
Results revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS.
Conclusions:
The implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs.
... Previous studies highlighted this internal conflict between trust in self to perform the self-collection procedure or whether to have the health care worker perform the procedure. As highlighted in previous research, some women preferred clinician-collected screening because they lack confidence in their abilities to perform the test correctly [49,[57][58][59][60]. Further research could explore key factors that increase and/or reduce women's self-efficacy to perform self-collection, as well as women's preferences of the method of collection. ...
... In addition, albeit self-collection was accepted by women of all ages, a few participants over 45 years of age stated that self-collection could be used to increase uptake of younger women. Research has shown that women of childbearing age will be more accepting of self-collection [58]. ...
Background
A field trial to evaluate a self-collect point-of-care HPV screen-and-treat (HPV S&T) program was implemented in two Well Women Clinics in Papua New Guinea (Papua New Guinea). Assessing the acceptability of a health intervention is a core element of evaluation. In this study, we examined women’s acceptability of both self-collection and HPV S&T intervention in Papua New Guinea.
Methods
Sixty-two semi-structured interviews were conducted with women who had undergone cervical screening in the same-day self-collected HPV screen-and-treat program in Madang and Western Highlands Provinces, Papua New Guinea. Data were thematically analysed using the Theoretical Framework of Acceptability (TFA) and managed using NVivo 12.5.
Results
Most women agreed that self-collection was transformative: it helped circumvent the culturally embarrassing pelvic examination and increased their self-efficacy, especially due to the provision of health education, instructions, and pictorial aids. The availability of same-day results, and treatment if indicated, was particularly valued by the women because it reduced the financial and temporal burden to return to the clinic for results. It also meant they did not need to wait anxiously for long periods of time for their results. Women also appreciated the support from, and expertise of, health care workers throughout the process and spoke of trust in the HPV-DNA testing technology. Most women were willing to pay for the service to ensure its sustainability and timely scale-up throughout Papua New Guinea to support access for women in harder to reach areas.
Conclusion
This study reported very high levels of acceptability from a field trial of self-collection and HPV same-day screen-and-treat. The program was deemed culturally congruent and time efficient. This innovative cervical screening modality could be the ‘solution’ needed to see wider and more immediate impact and improved outcomes for women in Papua New Guinea and other high-burden, low-resource settings.
... In a study involving focus groups of Indian women in London, age and country of birth were noted as barriers. Participants stated that their mothers, raised in India, have limited education and awareness about health and prefer not to utilize "orthodox" medicine, hospitals, and clinics [9]. ...
In India, cervical cancer associated with human papillomavirus (HPV) infection is a leading cause of cancer-related mortality among women. However, uptake of the vaccine in India is low. We assessed knowledge and attitudes towards HPV, assess participants’ willingness to accept the vaccination for themselves and their children, and determine factors associated with intention to receive the HPV vaccine among women in Mangalore, India. This cross-sectional study surveyed a convenient sample of 237 women aged 18–45 years using a semi-structured questionnaire. All respondents reported being aware of HPV infection. However, 22.36% (n = 53) of the respondents have never heard about genital warts and 18.57% (n = 44) have never heard about HPV vaccine. Participants displayed good general knowledge of HPV infection (median score, 1.26; Interquartile Range (IQR): 1.04–1.52) and average knowledge of HPV vaccine (e.g., median score, 1.18; IQR: 0.73–1.45). HPV general knowledge and vaccine knowledge were associated with intention to receive the HPV vaccine and recommend it to children. Participant awareness of the HPV vaccine predicted vaccine intent for themselves. Participants’ willingness to recommend the vaccine for their children was associated with older age, married status, having one or more children, and having a college education. Lack of awareness about genital warts was strongly associated with participants’ refusal to get the HPV vaccine or recommend it for their own children (Relative Risk Ratio RRR: 12.21; 95% C.I.: 2.33–63.99). Our study validated the questionnaire as a reliable tool for assessing HPV and HPV vaccine knowledge, attitudes, awareness, and vaccine intentions in women aged 18–45 years. Public health education should focus on increasing awareness of genital warts as a sequela of HPV, as well as promote awareness of role and safety of HPV vaccination in -children.
... These feelings of embarrassment and shame decreased women's motivation to make appointments and were a key barrier to attending or reattending routine cervical screening. (Addawe et al., 2018;Abdullahi et al., 2009;Anaman-Torgbor et al., 2017;Azerkan et al., 2015;Batarfi, 2012;Butler et al., 2020;Cadman et al., 2015;Chiu et al., 1999;Gele et al., 2017;Hamdiui et al., 2021;Kwok et al., 2011;Logan & McIlfatrick, 2011;Marlow et al., 2019;Marlowet al., 2015;Ogunsiji et al., 2013;Omolo, 2019;Szarewski et al., 2009) discussed feeling fear in relation to making, attending or even talking about a cervical screening appointment. This fear appeared to be related to two distinct aspects of the screening process; fear of the actual test, and fear of the potential outcome. ...
... Participants across eight studies (Addawe et al., 2018;Abdullahi et al., 2009;Anaman-Torgbor et al., 2017;Batarfi, 2012;Cadman et al., 2015;Gele et al., 2017;Hamdiui et al., 2021;Salad et al., 2015) also referred to their religious belief's surrounding sickness and disease and suggested that praying to Allah or God would keep them safe from cervical cancer (Batarfi, 2012;Gele et al., 2017). Some believed the development of cervical cancer to be the result of a curse or engagement in negative behaviours or attitudes (Anaman-Torgbor et al., 2017;Batarfi, 2012). ...
... Eleven studies (Addawe et al., 2018;Abdullahi et al., 2009;Anaman-Torgbor et al., 2017;Azerkan et al., 2015;Cadman et al., 2015;Chiu et al., 1999;Idehen et al., 2020;Ogunsiji et al., 2013;Omolo, 2019;Parajuli et al., 2020;Team et al., 2013) referred to a lack of familiarity with cervical screening. As well as being exacerbated by the language barriers and lack of peer/family support described above, migrant participants discussed the differences between healthcare in their home country and the country they were living in now; this being particularly problematic when individuals had migrated from countries with no formal screening programme (Addawe et al., 2018;Abdullahi et al., 2009;Ogunsiji et al., 2013;Anaman-Torgbor et al., 2017;Cadman et al., 2015). ...
Objective:
Routine, population-wide cervical screening programmes reduce cervical cancer incidence and mortality. However, socioeconomically deprived communities and ethnic minority groups typically have lower uptake in comparison to the general population and thus are described as 'underserved.' A systematic qualitative literature review was conducted to identify relevant determinants of participation for these groups.
Methods:
Online databases were searched for relevant literature from countries with well-established, call-recall screening programmes. Overall, 24 articles were eligible for inclusion. Data was synthesized via Framework synthesis. Dahlgren & Whitehead's social model of health was used as a broad a priori coding framework.
Results:
Participation was influenced by determinants at multiple levels. Overall, patient-provider relationships and peer support facilitated engagement. Cultural disparities, past healthcare experience and practical barriers hindered service access and exacerbated negative thoughts, feelings and attitudes towards participation. Complex interrelationships between determinants suggest barriers have a cumulative effect on screening participation.
Conclusions:
These findings present a framework of psychosocial determinants of cervical screening uptake in underserved women and emphasise the role of policy makers and practitioners in reducing structural barriers to screening services. Additional work, exploring the experience of those living within socioeconomically disadvantaged areas, is needed to strengthen understanding in this area.
... Our findings also add to the existing body of literature on the effectiveness of the Health Belief Model in guiding health promotion interventions in medically underserved populations. [40][41][42] The HBM constructs such as selfefficacy and were significantly predictors to the uptake of healthy behaviors; intervention components need to effectively address these factors with cultural competency to be effective. ...
... Previous studies have found that when women are unsure whether they conducted self-sampling correctly, they were less confident about the results than the results of tests conducted by a physician. 26,[40][41][42] This study is not without limitations. We did not include a control group in this study, hence our inability to demonstrate that the positive changes in outcomes were entirely due to the effects of the intervention components. ...
Background:
Asian American women face disproportionate burden of cervical cancer (CC) than non-Hispanic white women in the U.S. The goal of this study was to assess the feasibility and impact of a culturally tailored intervention to promote Human papillomavirus (HPV) self-sampling test among hard-to-reach Asian American women.
Methods:
We adopted the community-based participatory research (CBPR) approach to conduct this efficacy study. A total of 156 female participants (56 Chinese, 50 Korean, and 50 Vietnamese) were recruited from community-based organizations (CBOs) in the greater Philadelphia metropolitan area. The intervention components included HPV-related education, HPV self-sampling test kit and instructions, group discussions, and patient navigations, all available in Asian languages. We examined several outcomes, including the completion of HPV self-sampling, HPV-related knowledge, perceived social support, self-efficacy, and comfort with the self-sampling test at post-intervention assessment.
Results:
The majority of Asian American women had low annual household income (62.3% earned less than $20,000) and low educational attainment (61.3% without a college degree). We found significant increase in participants' knowledge on HPV (baseline: 2.83, post: 4.89, P <.001), social support (baseline: 3.91, post: 4.09, P < .001), self-efficacy (baseline: 3.05, post: 3.59, P < .001), and comfortable with HPV self-sample test (baseline: 3.62, post: 4.06, P < .001).
Conclusion:
To the best of our knowledge, this is the first intervention study that promoted HPV self-sampling test among Asian American women. Our findings showed that CBPR culturally tailored intervention of self-sampling was highly effective in empowering low-income Asian American women to conduct HPV self-sampling tests.
... Collection of a clinician-collected cervical screening test requires women or other people with a cervix (hereafter referred to as screening participants) to undergo a speculum examination performed by a practitioner to visualize the cervix and take a cervical sample. For people who are not screening at recommended intervals, there is a significant body of work describing the personal, practical and system-level barriers to clinician-collected cervical screening test, including embarrassment about undergoing a pelvic examination, 16 cultural barriers, 17 a history of trauma or sexual abuse 18 or a lack of time to attend primary care for screening. 19 Some of these barriers, particularly personal barriers which relate to the nature of the cliniciancollected cervical screening test, can be addressed through self-collected cervical screening, where a screening participant can use a flocked swab to take their own HPV sample from their vagina. ...
Background
Australia has had significant successes in the prevention of cervical cancer. However, there is considerable scope for improving screening participation. In December 2017, Australia shifted from cytology to a human papillomavirus–based screening program as part of the renewed National Cervical Screening Program. This provided the opportunity to introduce a clinician-supported self-collection cervical screening pathway, which allows screening participants aged 30 years or more and who are under-screened or never-screened to screen via a self-collected human papillomavirus test.
Objective
This study aimed to explore screening participant experiences of a clinician-supported self-collection cervical screening pathway.
Methods
Interviews (n = 45) were conducted with participants who had used the clinician-supported self-collection cervical screening pathway in the Australian National Cervical Screening Program between December 2017 and April 2019. Interviews were analyzed using template analysis.
Results
Under-screened and never-screened participants reported a variety of interrelated barriers to cervical screening due to the nature of the test. For these participants, self-collection was a preferable way to perform screening as it overcame various barriers, was easy to use and promoted a sense of empowerment. Participants reported that the role of their practitioner was influential in their decision to undertake cervical screening, and that the support and information provided was a key factor in their experiences of the self-collection pathway.
Conclusion
Findings support the use of a clinician-supported model of care, as an alternative screening modality in Australia’s National Cervical Screening Program. As more countries consider the move from a cytology to human papillomavirus–based cervical screening program, this model may assist in greater engagement of under-screened participants.
... Three studies conducted in the UK and one in the US assessed how the different types of self-collection devices available on the market were perceived by women and determined that the characteristics of the swab had a significant influence on women's perceptions of self- collection [40,49,52]. Studies explain that the size of the swab made a difference in women's perceptions, with smaller brushes described as 'easy' and 'friendlier' while larger ones were seen as painful [40,49]. ...
... Three studies conducted in the UK and one in the US assessed how the different types of self-collection devices available on the market were perceived by women and determined that the characteristics of the swab had a significant influence on women's perceptions of self- collection [40,49,52]. Studies explain that the size of the swab made a difference in women's perceptions, with smaller brushes described as 'easy' and 'friendlier' while larger ones were seen as painful [40,49]. These perceptions were reinforced in a study led by Richman et al. (2011) which described the different types of swabbing devices and concluded that the brush, smaller in comparison to the other two devices being examinedthe lavage and the wand-was perceived as 'simple, easy and less invasive' [52]. ...
... Self-efficacy Self-efficacy is a theme that was recurrent in most of the studies [18,40,41,43,45,48,49,51,55,58,60,61,[63][64][65]67]. This theme highlighted women's perceived ability, intention, and motivation to perform self-collection. ...
Background
Cervical cancer is the fourth most common cancer affecting women worldwide, with 85% of the burden estimated to occur among women in low and middle-income countries (LMICs). Recent developments in cervical cancer screening include a novel self-collection method for the detection of oncogenic HPV strains in the collected samples. The purpose of this review is to synthesise qualitative research on self-collection for HPV-based testing for cervical screening and identify strategies to increase acceptability and feasibility in different settings, to alleviate the burden of disease.
Methods
This review includes qualitative studies published between 1986 and 2020. A total of 10 databases were searched between August 2018 and May 2020 to identify qualitative studies focusing on the perspectives and experiences of self-collection for HPV-based cervical screening from the point of view of women, health care workers and other key stakeholders (i.e., policymakers). Two authors independently assessed studies for inclusion, quality, and framework thematic synthesis findings. The Socio-Ecological Model (SEM) was used to synthesize the primary studies.
Results
A total of 1889 publications were identified, of which 31 qualitative studies were included. Using an adapted version of SEM, 10 sub-themes were identified and classified under each of the adapted model’s constructs: (a) intrapersonal, (b) interpersonal, and (c) health systems/public policy. Some of the themes included under the intrapersonal (or individual) construct include the importance of self-efficacy, and values attributed to self-collection. Under the intrapersonal construct, the findings centre around the use of self-collection and its impact on social relationships. The last construct of health systems focuses on needs to ensure access to self-collection, the need for culturally sensitive programs to improve health literacy, and continuum of care.
Conclusion
This review presents the global qualitative evidence on self-collection for HPV-based testing and details potential strategies to address socio-cultural and structural barriers and facilitators to the use of self-collection. If addressed during the design of an HPV-based cervical cancer screening testing intervention program, these strategies could significantly increase the acceptability and feasibility of the intervention and lead to more effective and sustainable access to cervical screening services for women worldwide.
... This finding was similar to the findings in our study and several focus group studies. [50][51][52][53] Consistent with these studies, our study found mistrust in the ability to conduct proper self-sampling to be a barrier. Furthermore, mistrust in the Danish health-care system has shown to be a barrier for participation in the national screening programmes. ...
Background
Ethnic minority women from non‐Western countries are less likely than the native women to participate in screening programmes for cervical cancer, breast cancer and colorectal cancer. This social inequality can result in loss of possibility for prevention, delayed diagnosis and treatment and, ultimately, lower chance of survival. Developing a tailored intervention might be the solution to reduce social inequalities in cancer screening, and a key feature in intervention research is to consult the target group.
Objective
To explore ethnic minority women's own ideas and preferences for a cancer screening intervention and identify their attitudes to different strategies.
Methods
An interview study with five focus group interviews, two group interviews with an interpreter and three individual interviews. Thirty‐seven women from 10 non‐Western countries contributed to the study. The interviews were audio‐recorded and transcribed verbatim followed by a thematic analysis.
Results
According to the women, a tailored intervention should focus on knowledge in the form of face‐to‐face teaching. The women further suggested information material in their own language with a simple, positive and concrete communication strategy. They would like to be involved in an awareness strategy and share the knowledge with their network.
Conclusion
Ethnic minority women were interested in a tailored intervention, and they were keen to contribute with ideas and preferences. The findings emphasized the potential of a tailored intervention with specific suggestions to the content when attempting to reduce inequality in cancer screening participation.
Patient or Public Contribution
Minority women were involved in the interview study.
... "I remember leaving it once because I didn't take it seriously … I just thought oh I'll leave it for a while" . Azerkan, F., et al (2015) (Immigrant women aged 23 to 70 years from Denmark and Norway living in the Stockholm area) Cadman et al (2015) (185 Hindu women living in England) . 15 1 "You think well, this isn't relevant to me, but you do it to be on the safe side". ...
... (Idestrom, M., et al., 2002) (Facilitator) "If they find something wrong, I am afraid it might be cancer (46%)". (Barrier) Cadman et al., (2015) (185 Hindu women living in England) . (38 ethnic minority women aged 50-64 years) . ...
... So there's no worries." (Barrier) Abdullahi, A., et al. (2009) Azerkan, F., et al (2015) (Immigrant women aged 23 to 70 years from Denmark and Norway living in the Stockholm area) (198 black and minority women) Cadman et al., (2015) (185 Hindu women living in England) . (Women from ethnic minority backgrounds and White British women). . ...
Aims
To identify and synthesise peer-reviewed, published literature reporting perceived barriers and facilitators associated with cervical cancer screening attendance in EU member states with organised population-based screening programmes.
Methods
Quantitative and qualitative studies reporting perceived barriers/facilitators to attendance for cervical cancer screening were searched for in databases Embase, HMIC, Medline and PsycInfo. Data were extracted and deductively coded to the Theoretical Domains Framework domains and inductive thematic analysis within domains was employed to identify specific barriers or facilitators to attendance for cervical cancer screening.
Results
38 studies were included for data extraction. Five theoretical domains [‘Emotion’ (89% of the included studies), ‘Social influences’ (79%), ‘Knowledge’ (76%), ‘Environmental Context and Resources’ (74%) and ‘Beliefs about Consequences’ (68%)] were identified as key domains influencing cervical cancer screening attendance.
Conclusion
Five theoretical domains were identified as prominent influences on cervical cancer screening attendance in EU member states with organised population-based screening programmes. Further research is needed to identify the relative importance of different influences for different sub-populations and to identify the influences that are most appropriate and feasible to address in future interventions.
... Esta confusión con otras técnicas también es recogida en otros estudios (Darj et al., 2019;Kim et al., 2017). En una investigación llevada a cabo en mujeres hindúes que vivían en Londres, una de las participantes de los grupos focales señaló que con la citología se revisaban el útero y los ovarios (Cadman et al., 2015). ...
