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A systematic review of the effectiveness of health education interventions to increase cervical cancer screening uptake

Agide FD, Garmaroudi G, Sadeghi R, Shakibazadeh E, Yaseri M, Koricha ZB, et al.

Eur J Public Health, 2018 12 01;28(6):1156-1162.
PMID: 30346504 DOI: 10.1093/eurpub/cky197

Background: Cervical cancer screening reduced cancer morbidity and mortality in developed countries. Health education interventions are expected to enhance screening and early detection. Thus, this review is aimed to see the effectiveness of the interventions in cervical cancer screening uptake.
Methods: Online databases (PubMed/MEDLINE/PubMed Central, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar) were searched for all published eligible research articles in the past 12 years (as of January 2005-2017). A total of 17 research articles were included. The interventions were classified as 'individual level', 'community level' and 'cultural sensitive educations' which contains various interventions in their content as compared with usual care. A quality coding system was assessed using Cochrane checklists and rated by each researcher independently and the average score was given accordingly. This study was registered in PROSPERO 2017: CRD42017060405.
Results: The review dovetailed 17 studies. Ten studies (58.82%) were conducted in the United States, three in Iran (17.65%) and one each in Malaysia, China, Cameroon and Nigeria (23.53%). Almost all levels of the interventions boosted the screening uptake and the Pap test. However, the individual level health education interventions were prioritized in many of the studies.
Conclusion: The review indicated that health education interventions have immense contributions in boosting the screening uptake. However, the effectiveness varies with study setting, populations and the way of delivery. Therefore, the limited quality of the studies indicated that further research is required to develop a simple and effective intervention to boost cervical cancer screening uptake.

Matched MeSH terms: Vaginal Smears/statistics & numerical data
Fulltext Perception and opinion of medical students about Pap smear test: a qualitative study

Al-Naggar RA, Isa ZM

Asian Pac J Cancer Prev, 2010;11(2):435-40.
PMID: 20843130

OBJECTIVE: the objective of this study is to explore the perceptions of medical students regarding the Pap smear test.

METHODOLOGY: Focus group discussion was held with twenty three medical students. The students were divided into three focus groups; two groups of female participants consisting of 9 and 8 students; respectively. The third group consisted of 6 male students. Questions regarding Pap smear testing included barriers that prevented women from taking the test, gender preference for the physician to conduct the cervical screening test, willingness to suggest Pap smear test to the family or friends. The data obtained were classified into various categories and analyzed manually.

RESULTS: Most of the study participants mentioned that the main barriers for women to not perform Pap smear test is lack of awareness 16 (70%), followed by shyness 12 (52%) and the cost of the test 12 (52%). Most agreed that the gender of the physician will affect the women decision to do Pap smear test. All mentioned that the advantage of a regular Pap smear test is to detect the abnormality at the early stage of cervical cancer. Some of the participants 9 (39%) mentioned that the disadvantages are expense, possible injury in the vagina due to the test procedures 8 (35%), associated infection 7(30.4%) and pain 7(30.4%) . The majority, 20 (87%) mentioned that the most effective prevention methods for cervical cancer are having sex only after getting married with the spouse only, HPV vaccination 15 (65%) and Pap smear 14 (61%).

CONCLUSION: The main barriers for women to not perform Pap smear test is lack of awareness, shyness and the cost of the test. Gender of the physician will affect the women decision to do Pap smear test.

Matched MeSH terms: Vaginal Smears/statistics & numerical data*
Prevalence and determinants of cervical cancer screening: a community-based study in Singapore

Seow A, Lee HP

Ann Acad Med Singap, 1994 May;23(3):342-7.
PMID: 7944247

A cross-sectional survey of 568 married women aged 21-65 years in the Pasir Panjang Constituency was conducted to determine the prevalence of cervical cancer screening in the community and the factors affecting acceptance of this screening test. Results show that 309 (54.4%) of the respondents had ever had a Pap smear. The women who reported having had a smear were more likely to be below 45 years of age (prevalence ratio 1.47, 95% confidence interval 1.15 to 1.88), Chinese and of a higher socioeconomic status (1.68, 1.33 to 2.12). They were also more likely to have married at a later age (1.68, 1.21 to 2.31) than women who had not had a smear. Age and socioeconomic status remained independent predictors on multivariate analysis. The findings suggest that an important task of public health practitioners is to increase the uptake of screening among older and socially disadvantaged women who are known to be at the highest risk of cervical cancer. In addition, strategies to encourage younger women to continue regular attendance at screening clinics beyond their childbearing years will be important for the future.

Matched MeSH terms: Vaginal Smears/statistics & numerical data*
Cervical cancer screening after 50: near extinction?

Abdullah NN, Daud S, Al-Kubaisy W, Saari IS, Saad SR

Eur J Obstet Gynecol Reprod Biol, 2016 Nov;206:136-140.
PMID: 27693934 DOI: 10.1016/j.ejogrb.2016.09.011

OBJECTIVES: The objectives of this study were to determine the prevalence and predictors of Pap smear screening among women aged 50 years and older.
STUDY DESIGN: This cross-sectional study was conducted at two large urban health centres in Selangor. A total of 515 women aged 50 and older were recruited.
RESULTS: The mean age of the respondents was 58.83±7.05, with a range of 50- 83 years. The prevalence of Pap smear screening was 39.22% (n=202). From the multivariate analysis, Pap smear screening was significantly associated with health care provider advice (adjusted odds ratio (AOR)=18.75; 95% CI=8.30, 42.37); tertiary (AOR=11.26; 95% CI=1.50, 84.68) and secondary education level (AOR=9.47; 95% CI=1.43, 62.84); use of contraception (AOR=2.90; 95% CI=1.48, 5.69); heart disease (AOR=0.22; 95% CI=0.05, 0.97); and worry about Pap smear results (AOR=0.20; 95% CI=0.09, 0.42).
CONCLUSION: The prevalence of Pap smear screening in the older women is unsatisfactory. Health care provider advice, education level, use of contraception, heart disease and worry about Pap smear results were predictors of undergoing Pap smear screening in this study population.
Study site: Two Klinik Kesihatan in Gombak, Selangor, Malaysia

Matched MeSH terms: Vaginal Smears/statistics & numerical data*
Fulltext Cervical screening uptake and its predictors among rural women in Malaysia

Gan DE, Dahlui M

Singapore Med J, 2013 Mar;54(3):163-8.
PMID: 23546031

INTRODUCTION: Cervical cancer is the third most common cancer among Malaysian women. However, the uptake of cervical cancer screening--Pap smear--by women in Malaysia has been low and remains a challenge. This study was conducted to assess the cervical screening practices of rural women in Malaysia and to examine the factors associated with such practices.

METHODS: A cross-sectional survey was conducted in five rural districts in Perak, Malaysia. 1,000 households were selected through multistage random sampling. Women aged 20-64 years were interviewed by trained enumerators using structured questionnaires. Binomial logistic regression was used to identify predictors of cervical screening through univariate and multivariate analyses.

RESULTS: Among the 959 respondents, only 48.9% had undergone Pap smear at least once in the past three years. Women in the age group 40-49 years (odds ratio 3.027, 95% confidence interval 1.546-5.925; p < 0.005) were found to be significantly more likely to attend cervical cancer screening as compared to those in the age group 20-29 years. Other significant predictors were being married with children, having knowledge of cervical cancer symptoms, receiving relevant information regarding cervical cancer from health personnel or campaigns, being engaged in family planning and receiving encouragement from husbands.

CONCLUSION: Efforts to boost the uptake of Pap smear screening among the rural population should be targeted toward the predictors of positive uptake.

Matched MeSH terms: Vaginal Smears/statistics & numerical data
Health-care providers' perceptions, attitudes towards and recommendation practice of cervical cancer screening

Hweissa NA, Lim JN, Su TT

Eur J Cancer Care (Engl), 2016 Sep;25(5):864-70.
PMID: 27350095 DOI: 10.1111/ecc.12537

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.

Matched MeSH terms: Vaginal Smears/statistics & numerical data
Fulltext The Acceptability and Preference of Vaginal Self-sampling for Human Papillomavirus (HPV) Testing among a Multi-ethnic Asian Female Population

Khoo SP, Lim WT, Rajasuriar R, Nasir NH, Gravitt P, Woo YL

Cancer Prev Res (Phila), 2021 01;14(1):105-112.
PMID: 32917643 DOI: 10.1158/1940-6207.CAPR-20-0280

Vaginal self-sampling for human papillomavirus (HPV) testing can potentially increase cervical screening coverage. This study aimed to investigate the acceptability of vaginal self-sampling for HPV testing and factors that might influence a woman's preference for this as a cervical screening method. This was a cross-sectional study that recruited 725 women from the urban and suburban areas of Selangor, Malaysia. All study participants were instructed to self-collect vaginal sample using a dry flocked swab before responding to a detailed questionnaire documenting their experience and preference for self-sampling. Most of the study participants (>80%) perceived vaginal self-sampling as easy, convenient, not embarrassing, comfortable, and were confident in performing the test. This suggests high acceptability toward vaginal self-sampling for HPV testing. Of the 725 women, 83% preferred self-sampling HPV testing over healthcare personnel sampling HPV testing and Pap test. Women with higher household income and full-time employment status were more likely to prefer self-sampling. Those who had not undergone Pap test also expressed preference for self-sampling HPV testing. Convenience and women's confidence in performing a vaginal self-sampling for HPV testing were the independent key factors that influenced the preference for self-sampling method. Vaginal self-sampling for HPV testing is highly acceptable among Malaysian women. It is the preferred choice as a primary cervical screening method and serves as an alternative to healthcare-acquired sample for Pap test. PREVENTION RELEVANCE: Organized cervical cancer screening remains unachievable in many countries. Self-sampling HPV testing is an evidence-based method that can remove barriers to cervical screening. This is particularly important for developing countries in order to achieve the WHO global strategy to accelerate cervical cancer elimination.

Matched MeSH terms: Vaginal Smears/statistics & numerical data