Thèses sur le sujet « Perceived barriers to cervical screening »

Background: Breast cancer is considered the most common cancer among females followed by cancers of the cervix, lung, and stomach. Its mortality can be avoided by early detection. Aim: This thesis aimed to explore Saudi women’s barriers facilitators and experiences, when accessing breast and cervical cancer screening services in the United Kingdom (UK) and Saudi Arabia. Methods: A mixed method approach was used to fulfil the thesis objectives. A quantitative questionnaire was administered to 503 Saudi women living in the United Kingdom and in Kingdom of Saudi Arabia. This was followed up by a qualitative study using seven focus groups discussions. Results: Survey and focus groups provided some consistent findings regarding Saudi women’s perceptions, knowledge, beliefs of the barriers and facilitators in accessing both breast and cervical cancer screening services in the UK and Saudi Arabia. Fear of having cancer and lack of knowledge of the importance of early detection, particularly in cervical cancer were major findings with regard to barriers to attend screening services. However, being employed and highly educated was correlated with better knowledge and awareness of the signs, symptoms, and treatment of both breast and cervical cancer. Participants shared their responsibilities with health professionals and the structure of the health system in the arrangement of early screening of breast and cervical cancers. Additionally, they suggested the role of media, education, and use of places such as mosques in disseminating information about the importance of early cancer detection. Conclusion: While the data reported in this thesis are encouraging, rich and diverse, conclusions must be drawn with caution. Important barriers included health and cultural beliefs and attitudes, language and unsupportive attitudes of health professionals. A majority of Saudi participants believed educational programs would increase breast and cervical cancer awareness and knowledge and use of screening services. The health belief model was utilized to structure and explain the thesis findings and analysis.

Diet related factors are associated with the 2 most prevalent oral diseases- caries and periodontal disease. Furthermore, there is growing evidence of a synergistic link between nutrition, systemic health, and oral health. Regardless of this evidence and in spite of recommendations by dental associations, researchers have shown the majority of dental professionals are consistently excluding nutritional screenings and dietary counseling in their dental services. The purpose of this study was to examine the nutritional screening and dietary counseling practices of Utah dental hygienists and to evaluate possible associations between various factors influencing the implementation of nutritional services. Surveys were collected from members of the Utah Dental Hygienists’ Association. Mean scores showed low frequency and low confidence levels in performing nutritional services and high perceptions of barriers to care. Little to no difference in mean scores occurred when differentiating between degree achievements, years in dental hygiene practice, or component affiliation.

Intimate Partner Violence (IPV) is a major problem in the United States. There are many health concerns associated with IPV (e.g. chronic pain, gynecological problems), leading researchers to examine the detection and management of IPV in primary care settings. However, a disproportionate amount of this research has focused on the detection and management of IPV in urban primary care clinics, with the detection and management of IPV in rural primary care being largely understudied. The current study addresses this gap in the literature by describing the screening practices and barriers to screening reported by rural providers as well as differences in rural and urban providers in regards to amount and type of barriers reported. Eighty-seven primary care providers (47=Rural) were surveyed about IPV screening practices and barriers to screening. Providers identified barriers related to both professional issues and personal beliefs. There were no significant differences in rural and urban providers in regards to number and type of reported barriers. Implications for the management of IPV in rural primary care settings are discussed.

Background: Cervical cancer is the second cause of cancer related mortality for Filipino women. Mortality rates of cervical cancer are high amongst Filipino women; however, uptake of cervical cancer screening (e.g., pap-testing) is low. In 2015, 2.34 million overseas Filipino workers (OFW) were recorded. Migration may present additional barriers to accessing pap-testing. Gaining understanding of barriers and facilitators to pap-testing for OFWs is crucial to improve uptake of pap-testing. Methods: An explanatory sequential mixed-methods research design was adopted comprising two phases, a web-based cross-sectional survey (N=480), followed by web-based qualitative interviews (N=8). A socio-ecological conceptual framework was used to explore barriers and pap-test uptake. Bivariate and multivariate logistic regression analyses were used to assess key determinants of pap-testing. Qualitative results were analysed using thematic content analysis. Results: The sample included 480 OFWs (59.3% domestic workers) living and working in 28 different countries (mean age 36.69, age range 23-58). The largest proportion of women who participated lived in Hong Kong (24.4%). Nearly all (96.4%) of OFWs were aware of pap-testing but less than half (43.5%) had ever engaged in pap-testing. Statistically significant predictors of pap testing were: marital status; fear of outcome of pap-test; having sufficient time; recommendation from health care provider; and collectivism values. Exploration of results through interviews, revealed additional findings and social and structural contexts not conducive to pap-testing, including poverty and the overriding need to provide financially for family. Conclusion: This study demonstrated the complexity and multifactorial characteristics of pap-testing following the socio-ecological framework. For OFWs, individual, social-cultural, and institutional barriers to pap-testing were embedded in structural barriers, resulting in health inequalities. Recommendations targeted at multiple levels offer the potential for further understanding and the development of culturally appropriate interventions, with the ultimate aim of increasing OFWs’ uptake of pap-testing.

Breast cancer is a widespread public health issue in the United States which affects all women. Although mammography is a proven screening tool, screening rates vary widely. Self-reported health status may play a role in how women perceive their risks for developing breast cancer, which may affect mammography use. The purpose of this cross-sectional survey study was to assess the association between self-reported health status and perceived risk for developing breast cancer, as well as perceived barriers towards mammography screening and use. Social action theory, which holds that social and the psychological factors influence health behaviors, served as the theoretical foundation of the study. A convenience sample of 309 African American, non-Hispanic White, and Hispanic women, aged 30+, was recruited to participate in the study. Linear and logistic regression analyses revealed the model including all variables were significance between self-reported health status, demographic characteristics, and the dependent variables perceived risk of breast cancer, receipt of a mammogram in the last 2 years, and barriers (personal, economic, and health). However, self-reported health status was not a significant individual predictor in any of the analyses, and the null hypotheses for the research questions were not rejected. This study may promote positive social change by providing information on the necessity of interdisciplinary and interrelated educational and intervention approaches to address the challenges of women from diverse populations receiving regular mammograms.

Magister Public Health - MPH
The aim of the study was to explore the challenges to uptake of cervical cancer screening among women accessing maternal and child health services at Nsambya Hospital in Kampala, Uganda.

Between one quarter and one third of all primary care patients meet criteria for at least one mental disorder. However, many women are not screened for mental disorders as recommended by the literature. Some studies suggest even lower rates of screening and treatment in rural areas. This researcher sought to identify barriers and facilitators to mental and behavioral health screening and treatment for women in primary care and solicit feedback on how to ameliorate perceived barriers. Given the limited extant data describing rural Appalachian women’s perceptions of barriers and facilitators to receiving mental health services an exploratory qualitative analysis was conducted. Eighteen individual interviews with female primary care patients were conducted. Results identified stigma, lack of support, and lack of patient education around mental health as major barriers; facilitators included integrated care and positive experiences with providers. Directions for future research and implications for behavioral health practice in rural primary care are discussed.

Free cervical cancer screening services are provided in Malawi’s public healthcare institutionssince 1999. Few women aged 42 and older, utilise these services. Cervical cancer continues to be a major cause of morbidity and mortality among this group of women. Structured interviews were conducted with 381 women who attended three healthcare centers in Blantyre and semi-structured interviews with 14 nurse/midwives working at the same centers. The results for both phases arepresented within the Health Belief Model’s constructs. Phase 1 revealed that women had low levels of perceived susceptibility to cervical cancer. Although the interviewed women perceived cervical cancer to be a serious condition, they did not regard themselves to be at risk of suffering from cervical cancer. Knowledge that cervical cancer screening could detect this cancer at an early stage, embarrassment, stigma, social support, financial costs, traditional practices and available sources of information, influenced women’s intentions to be screened for cervical cancer. In phase 2, the nurse/midwives indicated that Malawian women lacked information about cervical cancer, available screening tests and the purpose of such screening.These women perceived cervical canceras being incurable and linked to witchcraft. Women’s utilisation of cervical screening services was hampered by barriers relating to healthcare institutions, women themselves and nurse/midwives. Local radio and television broadcasts, friends and nurse/midwives motivated individual women to use these screening services.Women preferred receiving information about cervical cancer screening during community activities. Health education should be intensified, nurse/midwives should be more empathetic, clinic days and hours should be extended. Misconceptions should be addressed and more service providers should be trained. This would enable more Malawian women to use cervical screening services, enhancing early detection and treatment of cervical cancer and reducing the morbidity and mortality statistics related to this condition in Malawi.
Health Studies
D. Litt. et Phil. (Health Studies)

Cervical cancer remains the main source of mortality among women around the world. It is a burden in developing countries and generally recognized through the complications of the advanced stages. The aim of this study was to investigate the utilisation of cervical cancer screening services among women living with HIV in Hawassa in order to develop a strategy to enhance cervical cancer screening service utilisation among this population in Ethiopia. A quantitative approach with a cross-sectional study design was used in this study. The data were collected using a standard structured questionnaire from 309 women living with HIV attending health care facilities in Hawassa city Administration. Statistical Package for Social Sciences version 25 software was used to analyse data. The results are presented based on the Health belief Model’s construct. The result revealed a low utilisation of cervical cancer screening services. Knowledge and perception of cervical cancer and cervical cancer screening service were also low. The main reason for being not screened was feeling healthy, lack of awareness, and embarrassment. Knowledge of cervical cancer was affected by factors such as knowing someone with cervical cancer, educational status, and monthly income. The finding indicated that utilisation of screenings could be determined by composite knowledge, perceived susceptibility to cervical cancer, duration on Highly Active Anti-Retroviral Treatment and willingness to be screened. The findings of this study, findings from the literature review and relevant legislation guided the researcher to develop a strategy to enhance cervical cancer screening service utilisation among women living with HIV Ethiopia. Relevant recommendations were put forward to promote utilisation of strategy and also for future research. The utilisation of the developed strategy may improve the uptake of screening for cervical cancer, improve early diagnosis and treatment of cervical malignant growth, and decrease mortality among women living with HIV in Hawassa city organization.
Health Studies
Ph. D. (Public Health)

Despite the availability, accessibility and affordability of cervical cancer screening (CCS) in Malawi, many women do not utilize the CCS services. This research was conducted in Blantyre district, Malawi. The main objective of the study was to identify factors that act as barriers to the uptake of cervical cancer screening programs among urban and rural women in the Blantyre district of Malawi. A quantitative design was used and convenience sampling was applied in selecting a sample of 196 women from the population of women aged 18 and over in two Reproductive Health clinics, one urban clinic at Queen Elizabeth Central Hospital and one rural clinic at Mlambe hospital in Blantyre district, Malawi. A structured questionnaire was used to collect data. The questionnaire was translated from English into the local Chichewa language so that respondents were interviewed and responded in a language that they were able to comprehend. Analysis and discussion of findings are presented in five sections. Data were processed into numeric values using SPSS version 15.0 and Microsoft Excel to give meaning to the findings of the study. In order to test for statistically significant associations between variables, the Pearson correlation was applied. The study revealed that the main barrier to CCS was that women lack knowledge and information about cervical cancer and there is a lack of publicity about CCS services. Lack of knowledge was found in relation to - risk factors, prevention of, detection of and benefits of cervical cancer screening with a greater knowledge deficit being found in the rural women. Higher levels of education in both the urban and rural groups did not have a positive influence on the screening behaviours of the women. Commencing sexual intercourse at ages 15 to 19 years and having multiple sexual partners were the main risk factors to cervical cancer among the women in the study. It was also found that although rural women perceived themselves being very likely to be at risk of cervical cancer, this perception did not translate into CCS behaviour. v
Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

Thesis (Ph. D.)--Florida State University, 2006.
Advisor: Laurie Grubbs, Florida State University, College of Nursing. Title and description from dissertation home page (viewed Jan. 22, 2007). Document formatted into pages; contains vi, 60 pages. Includes bibliographical references.

Patient-related barriers may reduce the effectiveness of screening for depression. This study aimed to explore perceived barriers to participation in a Screening Program for Depression by hemodialysis patients. In a cross-sectional study of hemodialysis patients, the Perceived Barriers to Psychological Treatment questionnaire was used to measure barriers to the Screening Program. Of 160 participants, 73.1% perceived at least one barrier (95% CI, 66.2% to 80.0%). The most common barriers were concerns about the side effects of antidepressant medications (40%), concerns about having more medications (32%), feeling that the problem is not severe enough (23%), and perceiving no risk of depression (23%). A high depression score was an independent predictor of barriers related to perceiving no benefit of the Screening Program and psychological, social, and practical barriers. We believe that patient-related barriers need to be addressed before implementing any case identification and treatment program for depression.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008.
Source: Masters Abstracts International, Volume: 46-05, page: 2671. Advisers: Stephanie L. Mc Fall; Maria E. Fernandez. Includes bibliographical references.

Wits School of Public Health May 2015
Background and objectives: Cervical cancer is a major cause of cancer-related deaths in many developing countries yet it is a preventable and treatable in early disease. Recent research has seen increasing morbidity and mortality due to cancer of the cervix attributed to the advent of the human immunodeficiency virus (HIV) epidemic worldwide. Papanicolaou smears (Pap smears) to detect cervical abnormalities are currently the best known form of early detection and prevention of invasive cervical cancer (ICC). Knowledge and awareness about cervical cancer and associated risk factors, and cervical screening is very important in determining appropriate health seeking behaviours with the aim to reduce morbidity and mortality. This study examines awareness, perceived risk and practices related to cervical cancer screening among HIV-positive women in an urban HIV clinic in Johannesburg, South Africa. This will be useful in making recommendations with regards to designing and planning of screening programmes, and addressing cervical cancer education and awareness. Materials and methods: This study analysed secondary data collected from an ongoing cervical cancer study undertaken by Right to Care in partnership with the Clinical HIV Research Unit (CHRU) among HIV-positive adult (18 years and older), female patients enrolled in the Themba Lethu Clinic HIV care and treatment programme in Johannesburg, South Africa from November 2009 to December 2012. Clinical data for all respondents was extracted from TherapyEdge-HIVTM, the electronic medical database system used for patient management at the facility. Descriptive statistics were used to summarise baseline characteristics. Models using logistic regression were developed to estimate odds ratios (OR) to further identify baseline sociodemographic factors and clinical characteristics associated with behaviours studied (awareness, perceived risk and practice related to cervical cancer and Pap smear testing) and to identify the association between these factors and the prevalence and severity of cervical disease. Awareness of the Pap smear test and the human papillomavirus (HPV) was assessed based on whether the women report knowing what a Pap smear test is, and whether they have ever heard about HPV. Perceived risk about getting cervical cancer was assessed based on how worried the study participants were about getting cervical cancer. Previous Pap screening practice was assessed using reported screening history of the study participants. In addition to this, a subanalysis was conducted to see how these responses compare to 1) the recommended practice according to the South African national cervical cancer screening guidelines based on the age of participants, and 2) the latest HIV treatment guidelines based on year of HIV diagnosis. Analysis of attrition of study participants at 12 months of study participation was conducted using different time to event analysis techniques including Kaplan Meier, Log-rank test and Cox proportional hazards model. Cox proportional hazards models were fitted to investigate associations between baseline covariate and attrition. A sub-analysis was also carried out using descriptive statistics and chi-square tests to compare the cohort of patients that were included in the study (the VICAR1 cohort) and the rest of the larger Themba Lethu Clinic (TLC) population that was not included in the study to see if there were any significant differences noted between the two groups. In addition, a sensitivity analysis of the of 12 month follow up study visit was conducted using descriptive statistics and chi-square tests to determine if there were any significant differences between study participants that came for their 12 month study visit and those that did not come for their 12 month study visit. Results: Eight hundred and fifty seven (71.30%) participants reported to be aware of Pap smear screening, with only 18.15% reporting to be aware of HPV. Of the 1192 participant who had data to ascertain perceived risk regarding cervical cancer disease, 662 (55.54%) of the women were very worried, 250 (20.97%) were somewhat worried, 280 (23.49%) were not worried about getting cervical cancer. A total of 381 (36.46%) women had adequate practice according to the national cervical cancer screening guidelines. While 304 (28.57%) had adequate practice according to the national HIV treatment guidelines. Factors associated with Pap smear screening awareness were being in the 50+ age group (aOR=4.70, 95% CI 1.63-13.55) as compared to the 18-29 age group, being of non-South African nationality (aOR=0.41, 95% CI 0.20-0.83), having a grade 10 to matric level education (aOR=2.12, 95%CI 1.28-3.52), and a tertiary level education (aOR=2.62, 95%CI 1.07-6.41) as compared to having a less than a grade 10 level education. None of the factors assessed were found to be significantly associated with awareness regarding HPV. Factors associated with perceived risk regarding cervical cancer disease were having a tertiary education (aOR=3.74, 95%CI 1.13-12.38) as compared to having less than a grade 10 level, taking snuff (aOR=0.55, 95%CI 0.33-0.92) and drinking alcohol (aOR=2.53, 95% CI 1.24- 5.17). Being in the 30-39 age group (aOR=12.23, 95%CI 4.00-37.35) as compared to being in 18-29 age group, cohabiting with a partner (aOR=0.36, 95%CI 0.17-0.75) as compared to being single, being self-employed (aOR=2.95, 95%CI 0.82-10.66) as compared to those in full time employment, and being initiated on highly active antiretroviral therapy (aOR=0.17, 95%CI 0.06-0.55) were associated with Pap smear screening practices according to the national cervical cancer guidelines. None of the factors proved to be significantly associated with the practice according to the national HIV treatment guidelines, this is mainly because the HIV treatment guidelines have stricter screening requirements for HIV positive women. Those that had a moderate to severe baseline study Pap smear at enrolment into the study were 92% less likely to have disease progression at their 12 month Pap smear screening (aOR=0.08, 95%CI 0.05-0.13) compared to those that had a negative baseline Pap smear at study enrolment. This is mostly because they would have had a treatment intervention based on their baseline study Pap screening result therefore they would mostly likely not have disease progression at a follow up screening. Only seven women enrolled in the study died of non-cervical cancer related causes during the study period. In the analysis on all-cause attrition (deceased or lost to follow up) those that are initiated on highly active antiretroviral therapy were 92% less likely to be deceased or lost to follow up than those that were not initiated on highly active antiretroviral therapy (aOR=0.08, 95% CI 0.05-0.13). The global test for the overall model showed that the proportional hazard assumption had not been violated, p=0.684. Conclusions: Results for our study showed high levels of Pap smear screening awareness amongst the study participants. However, low levels of Pap screening uptake was observed for study participants. These results and results shown in previous studies show that awareness is only the first hurdle in the challenges related to cervical cancer prevention and treatment. Adequate practice is the factor that will have the most positive influence on the disease morbidity and mortality. Rates of screening practices have been found to be worse in populations with less than 70% Pap smear screening awareness. Findings from this study and similar findings from other studies highlight that more research needs to be done into effective health education programmes to address the gaps in adequate screening practice. These efforts should not only target the clients but also the health providers as they also have an important role to play in improving awareness, knowledge and practices related to cervical cancer and Pap smear screening amongst their clients.

Background: Cervical cancer is the second most common cause of death from cancer among women in Kenya. Various international studies indicate that the knowledge level of cervical cancer and its predisposing and preventive measures is low among the nurses as well as general population. This study aimed to assess knowledge, practices and attitudes of nurses with regards to cervical cancer screening and preventive measures at two Nairobi hospitals in Kenya. Across-sectional quantitative descriptive study design was used. Convenience sampling method was applied and data were collected from respondents using self-administered questionnaire. About 114 nurses aged 18 years and above participated in the study. The study revealed that nurses have the information about cervical cancer, available screening tests and the purpose of screening. Nurses have the knowledge that cancer screening could detect this cancer at an early stage; however, uptake is low. Cervical screening services were hampered by barriers relating to health care institutions, nurses perception and fear of screening technique, embarrassment, stigma, social influence, financial costs and available sources of information
Health Studies
M.A. (Nursing Science)