Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island.

BACKGROUND: Réunion Island is a French overseas territory located in the southern Indian Ocean, with a challenging socioeconomic and multicultural context. Compared to mainland France, Réunion has an overincidence and overmortality of cervical cancer. In order to investigate these two issues, it is important to evaluate the barriers and potential levers to Pap smear screening among female inhabitants of the island. We aimed to identify the specific socio-demographic factors, cultural factors, and living conditions associated with Pap smear screening in Réunion, with a view to increasing uptake. METHODS: We conducted a Knowledge Attitude Behavior and Practices (KABP) survey on cervical cancer screening practices among women aged between 25 and 65 years old living in Réunion Island, selected using random digit dialing sampling. Data were collected using Computer Assistant Telephone Interviews. Weighted chi-squared tests and Student's t-tests were used to compare women who had up-to-date Pap smear screening with women who did not. Weighted logistic models were used to identify the factors associated with not having up-to-date screening. RESULTS: A total of 1000 women were included in the study. Of these, 88.1% had a Pap smear test during the previous three years. Factors independently associated with not being up to date were as follows: aged over 55 (AOR 2.3 [1.2-4.3]), no children (AOR 2.5 [1.4-4.3]), having free universal health coverage (AOR 1.7 [1.1-2.7]), an income per unit consumption lower than 1500€ per month (AOR 2.0 [1.1-3.7]), low health literacy (AOR 2.7 [1.7-4.1]), not consulting a general practitioner in the prior 12 months (AOR 3.6 [2.0-6.5]), and a BMI > 30 (AOR 2.6 [1.5-4.4]). CONCLUSIONS: This is the first large-scale survey focusing on recommended Pap smear screening uptake in Réunion Island. Although self-reported screening incidence was higher than in mainland France, national screening policies must take into account the island's diverse social and cultural characteristics (e.g., an ageing population, low health literacy), while implementing actions to fight against poverty and increase general access to healthcare.

Women's motivation towards Pap smear screening based on sexual and screening status: A cross-sectional study using protection motivation theory.

INTRODUCTION: Cervical cancer remains a reproductive health burden. Pap smear (PS) screening can detect cervical cancer early but is underused despite being subsidized. Motivational factors play a role in promoting PS screening. This study aimed to determine the women's motivation toward PS screening based on Protection Motivation Theory (PMT), which mainly focused on sexual and screening status. MATERIALS AND METHODS: The study was conducted electronically throughout Malaysia from January to February 2022 by disseminating Google Form (https://forms.gle/cD7fkUKYR4Cq6kZC8) via multiple WhatsApp groups to reach 526 women aged 21-65 years. The questionnaire consists of 24 items based on seven PMT constructs [perceived vulnerability, perceived severity, self-efficacy, response efficacy, fear (threat appraisal), response costs (coping appraisal), and protection motivation]. The descriptive statistics and independent t-test was used to analyze data using IBM SPSS Statistics software, version 25. RESULTS: Most respondents were sexually active [80.6% (n = 424)] and have heard of PS screening [95.8% (n = 504)]. More than half of respondents did not have PS screening in the last three years [59.3% (n = 312)]. Sexually active women have heard and have undergone PS screening feel less threatened with low coping appraisals. Undergoing PS screening made women perceived more response efficacy (P =. 011), more self-efficacy (P <. 001), and higher protection motivation (P <. 001) toward PS screening. CONCLUSIONS: Women's motivation related to PS screening needs to be highlighted. Future development of health education strategy should include motivation focused in emphasizing the threat and coping appraisal into educational plan to ensure women come forward for screening.

Screening for cervical dysplasia and reproductive tract infections in Kerala, India: A multicentric study.

BACKGROUND: Cancer of the uterine cervix is estimated to the second most frequently occurring malignancy among females in India. Cancer mortality profile in India estimates that 20.7% of cancer deaths in females are cervical cancer. This well elucidates the fatal aspect of the disease and the need for early detection. AIMS: To screen for cervical dysplasias and reproductive tract infections in various parts of Kerala, India, and determine its associated factors. METHODS AND METHODOLOGY: This was a descriptive cross-sectional study conducted in various parts of Kerala, India. This study included an interview schedule to collect data and the procedures included per speculum examination along with a Pap smear test. RESULTS: A total of 199 women were screened with mean age of 45.87 ± 9.84 years. Of these, 13.5% showed inflammatory smears, 1% showed infective pathology and 1.5% showed pre-malignant lesions. CONCLUSION: The increased rates of inflammation and infection show its importance in public health. Similar community-based screening as well as routine screening by physicians/gynaecologists is recommended for early detection of cervical cancer and reproductive tract infections. Community education among the population proves to be an important factor; especially regarding HPV vaccination.

Non-Adherence to recommended Pap smear screening guidelines and its associated factors among women attending health clinic in Malaysia.

INTRODUCTION: Cervical cancer ranks as the second most frequent cancer among women in Malaysia. Although a cervical screening program has been introduced since 1960s and is provided free of charge in all government health facilities, the coverage and adherence rate to recommendation among Malaysian women remains low. OBJECTIVES: To determine the proportion of non-adherence to Pap smear screening guidelines and its associated factors among women attending a health clinic in Malaysia. METHOD: A cross sectional study involving 316 women aged 20 to 65 years who had undergone a Pap smear. Universal sampling method was applied to select participants among women who attended the selected health clinic from January 2013 to May 2013. A self-administered questionnaire was used to obtain the socio-demographic characteristics, socio-health data and perceptions about cervical cancer and Pap smear screening. The data was analysed using descriptive statistics and multiple logistic regression. RESULT: The proportion of non-adherence to Pap smear screening was 90.5%. Age, marital status, duration of marriage, education level, employment, household income and number of children were not significantly associated with non-adherence. Perceived severity, perceived susceptibility, perceived benefit, perceived barrier and cues to action did not show significant association with non-adherence to Pap smear screening. CONCLUSION: Non-adherence to Pap smear screening was high among Malaysian women. Measures should be taken to increase Pap smear screening coverage in our country. Other factors beyond Health Belief Model that influence Pap smear screening practice among Malaysian women should be explored.

Social and Cultural Barriers to Women's Participation in Pap Smear Screening Programs in Low- and Middle-Income Latin American and Caribbean Countries: An Integrative Review.

PURPOSE: Pap smear screening programs have been ineffective in reducing cervical cancer mortality in most Latin American and Caribbean countries, in part due to low screening rates. The purpose of this review was to analyze recent studies to identify demographic, social, and cultural factors influencing women's participation in Pap screening programs in Latin America and the Caribbean. DESIGN/METHOD: For this integrative review, cervical cancer screening in Latin America and the Caribbean was searched using PubMed, CINAHL, EMBASE, and PsycINFO databases. Findings/Results: Demographic barriers to screening were socioeconomic status, education, race/ethnicity, and geography. Social barriers included lack of uniformity in screening guidelines, lack of knowledge regarding cervical cancer, and lack of preventive culture. Cultural barriers were fear/embarrassment and gender roles. CONCLUSIONS: There are multilevel barriers to Pap smear utilization among women in Latin America and the Caribbean. IMPLICATIONS FOR PRACTICE: Findings highlight a need for health system engagement, promotion of preventive care, and community-generated educational programs and solutions.

Non-Adherence to recommended Pap smear screening guidelines and its associated factors among women attending health clinic in Malaysia

Introduction: Cervical cancer ranks as the second most frequent cancer among women inMalaysia. Although a cervical screening program has been introduced since 1960s and isprovided free of charge in all government health facilities, the coverage and adherence rate torecommendation among Malaysian women remains low.Objectives: To determine the proportion of non-adherence to Pap smear screening guidelines andits associated factors among women attending a health clinic in Malaysia.Method: A cross sectional study involving 316 women aged 20 to 65 years who had undergonea Pap smear. Universal sampling method was applied to select participants among womenwho attended the selected health clinic from January 2013 to May 2013. A self-administeredquestionnaire was used to obtain the socio-demographic characteristics, socio-health data andperceptions about cervical cancer and Pap smear screening. The data was analysed using descriptivestatistics and multiple logistic regression.Result: The proportion of non-adherence to Pap smear screening was 90.5%. Age, marital status,duration of marriage, education level, employment, household income and number of children were notsignificantly associated with non-adherence. Perceived severity, perceived susceptibility, perceived benefit,perceived barrier and cues to action did not show significant association with non-adherence to Papsmear screening.Conclusion: Non-adherence to Pap smear screening was high among Malaysian women. Measuresshould be taken to increase Pap smear screening coverage in our country. Other factors beyondHealth Belief Model that influence Pap smear screening practice among Malaysian women shouldbe explored.

Cervical cancer in Pakistan: A review.

Cervix carcinoma is the second commonest condition in women under 50 years of age and third after breast and oral cavity cancers across all age groups. Though a preventable disease, the mortality rate is very high because it is an ignored ailment in Pakistan in terms of screening, prevention and vaccination. More than 70% of cancer patients report with very advanced stage of malignancy and this is the cause of the high rate of mortality in Pakistan. We covered studies cited during the previous 11 years (2005-2015) that reviewed many aspects of cervical cancer in Pakistan, including epidemiology, risk factors, screening test and their barriers, clinical presentation and prevention. Our analysis indicated that infections associated with human papillomavirus posed the greatest risk of carcinoma and consequent mortality rate, especially because of low socioeconomic status and poor knowledge of screening. Emphasis is laid on a need to organise proper screening programme taking into account what already is known about Pakistani women.

Risk of cervical intra-epithelial neoplasia and invasive cancer of the cervix in DES daughters.

OBJECTIVE: Women exposed to diethylstilbestrol in utero (DES) have an increased risk of clear cell adenocarcinoma (CCA) of the vagina and cervix, while their risk of non-CCA invasive cervical cancer is still unclear. METHODS: We studied the risk of pre-cancerous (CIN) lesions and non-CCA invasive cervical cancer in a prospective cohort of 12,182 women with self-reported DES exposure followed from 2000 till 2008. We took screening behavior carefully into account. Incidence was obtained through linkage with the Netherlands Nationwide Pathology database (PALGA). General population data were also derived from PALGA. RESULTS: The incidence of CIN1 was increased (Standardized Incidence Ratio (SIR)=2.8, 95% Confidence Interval (CI)=2.3 to 3.4), but no increased risk was observed for CIN2+ (CIN2, CIN3 or invasive cancer) compared to the screened general population (SIR=1.1, 95% CI=0.95 to1.4). Women with DES-related malformations had increased risks of both CIN1 and CIN2+ (SIR=4.1, 95%CI=3.0 to 5.3 and SIR=1.5, 95%CI=1.1 to 2.0, respectively). For CIN2+, this risk increase was largely restricted to women with malformations who were more intensively screened. CONCLUSIONS: An increased risk of CIN1 among DES daughters was observed, especially in women with DES-related malformations, probably mainly due to screening. The risk of CIN2+ (including cancer) was not increased. However, among DES daughters with DES-related malformations a true small risk increase for non-CCA cervical cancer cannot be excluded.

Educação popular em saúde como estratégia à adesão na realização do exame colpocitológico / Educación popular en salud como estrategia para la adhesión en la realización de la prueba de papanicolaou / Popular education in health as a strategy for adherence to pap smear screening

RESUMO O câncer de colo do útero, a segunda causa de neoplasia entre as mulheres, tem uma alta prevalência no Brasil. Uma das formas de prevenção ocorre através da realização do exame colpocitológico. Nesseaspecto, este estudo objetiva apresentar a experiência com educação popular em saúde como metodologia ativa de aprendizagem, desenvolvida por uma equipe de Estratégia de Saúde de Família (ESF) da grande Porto Alegre, na adesão das mulheres à realização do exame colpocitológico no período de 2010 a 2013. Através de intervenções de educação popular em saúde sobre o tema nos mais diversos ambientes sociais e comunitários, como escola e templos religiosos, foi possível desenvolver nas mulheres melhorias no autocuidado, tais como a adesão à coleta do exame preventivo. Também se constatou que estratégias de educação popular em saúde junto à comunidade podem permitir melhor adesão à realização do exame citopatológico do colo do útero, uma das estratégias públicas mais efetivas, seguras e de baixo custo para detecção precoce desse tipo de câncer, o que pode contribuir para a redução da incidência de novos casos nessa comunidade.

RESUMEN El cáncer del cuello uterino, la segunda causa de neoplasia entre las mujeres, tiene una alta prevalencia en Brasil. Una de las formas de prevenciónocurre a través de la realización de la prueba de Papanicolaou. A este respecto, este estudio tiene como objetivo presentar la experiencia con educación popular en salud como metodologia activa de aprendizaje, desarrollada por un equipo dela Estrategia Salud de la Familia (ESF) de la gran ciudad de Porto Alegre-RS-Brasil, en la adhesión de las mujeres a la realización de la prueba de Papanicolaou en el período de 2010 a 2013. Através de las intervenciones de educación popular en salud sobre el tema en diversos entornos sociales y comunitarios, tales como la escuela y templos religiosos, fue posible desarrollar en las mujeres mejoras en el autocuidado, así como la adhesión a la recolección del examen preventivo. Aún secon stató que estrategias de educación popular en salud junto a la comunidad pueden permitir una mejor adhesión a la realización de la prueba de Papanicolaou, una de las estrategias públicas más eficaces, seguras yde bajo costo para la detección precoz de este tipo de cáncer, lo que puede contribuir para la reducción de la incidencia de nuevos casos en esta comunidad.

ABSTRACT Cervical cancer, the second leading cause of cancer among women, has a high prevalence in Brazil. One way to prevent it is through Pap smear screening. This study aims to present the experience with health education for the population, as developed by a Family Health Strategy (FHS) team at the metropolitan region of Porto Alegre, in order to promote adherence of women to Pap smear screening in the period from 2010 to 2013. Through health educational interventions for the population in various social and community settings, such as schools and churches, professionals could develop improvements in self-care of women, as adherence to the Pap smear screening. Therefore, it was found that education strategies for the community can increase adherence to Pap smear screening, one of the most effective, safe and cost-effective public strategies for early detection of cervical cancer, which may contribute to the lower incidence of new cases in this community.

The utilization and barriers of Pap smear among women with visual impairment.

BACKGROUND: Many evidences illustrate that the Pap smear screening successfully reduces if the cervical cancer could be detected and treated sufficiently early. People with disability were higher comorbidity prevalence, and less likely to use preventive health care and health promotion activities. There were also to demonstrate that people with visual impairment has less access to appropriate healthcare services and is less likely to receive screening examinations. In Taiwan, there was no study to explore utilization of Pap smear, associated factors and use barriers about Pap smear screening test among women with visual impairment. The purpose is to explore the utilization and barriers of using Pap smear for women with visual impairment in Taiwan. To identify the barriers of women with visual from process of receiving Pap smear screening test. METHODS: The cross-sectional study was conducted and the totally 316 participators were selected by stratified proportional and random sampling from 15 to 64 year old women with visual impairment who lived in Taipei County during December 2009 to January 2010. The data was been collected by phone interview and the interviewers were well trained before interview. RESULTS: The mean age was 47.1 years old and the highest percentage of disabled severity was mile (40.2 %). Totally, 66.5 % of participators were ever using Pap smear and 38.9 % used it during pass 1 year. Their first time to accept Pap smear was 38.8 year old. There was near 50 % of them not to be explained by professionals before accepting the Pap smear. For non-using cases, the top two percentage of barriers were "feel still younger" (22.3 %), the second was "there's no sexual experience" (21.4 %). We found the gynecology experiences was key factor for women with visual impairment to use Pap smear, especially the experiences was during 1 year (OR = 4). CONCLUSIONS: Associated factors and barriers to receive Pap smear screening test for women with visual impairment can be addressed through interventions aimed at improving on cognitions and attitudes for cervical cancer risk factors. Our study would be as a reference resource for erasing the barriers and inequality among the visually disabled women.

Prenatal diethylstilbestrol exposure and high-grade squamous cell neoplasia of the lower genital tract.

BACKGROUND: Prenatal diethylstilbestrol (DES) exposure is associated with an excess risk of clear-cell adenocarcinoma of the vagina and cervix, and of high-grade squamous neoplasia. OBJECTIVE: We explored whether neoplasia risk remains elevated among DES-exposed women as they age. STUDY DESIGN: In all, 4062 DES-exposed and 1837 unexposed daughters were followed for approximately 30 years (1982 through 2013) for pathology-confirmed diagnoses of cervical intraepithelial neoplasia grade ≥2 (CIN2+) of the lower genital tract (n = 178). Hazard ratios (HR) and 95% confidence intervals (CI) were estimated adjusting for birth year and individual study cohort. RESULTS: The cumulative incidence of CIN2+ in the DES-exposed group was 5.3% (95% CI, 4.1-6.5%) and in the unexposed group was 2.6% (95% CI, 1.5-3.7%). The HR for DES and CIN2+ was 1.98 (95% CI, 1.33-2.94), and was similar with further adjustment for frequency of cervical cancer screening (HR, 1.97; 95% CI, 1.33-2.93). The HR was 2.10 (95% CI, 1.41-3.13) with additional adjustment for other potential confounders. The HR for DES exposure was elevated through age 44 years (age <45 years HR, 2.47; 95% CI, 1.55-3.94), but not in women age ≥45 years (HR, 0.91; 95% CI, 0.39-2.10). In exposed women, HRs for DES were 1.74 (95% CI, 1.09-2.79) among those who had earlier evidence of vaginal epithelial changes (VEC), presumably reflecting glandular epithelium undergoing transformation to normal, adult-type squamous epithelium, and 1.24 (95% CI, 0.75-2.06) among those without VEC, compared with unexposed women. The HRs for DES and CIN2+ were higher among women with earlier intrauterine exposure (HR, 2.64; 95% CI, 1.64-4.25 for <8 weeks' gestation and HR, 1.41; 0.88-2.25 for ≥8 weeks' gestation), and lowest when exposure began >15th week (HR, 1.14; 95% CI, 0.59-2.20). CONCLUSION: CIN2+ incidence was higher among the DES exposed, particularly those with early gestational exposure and VEC. The HR for DES and CIN2+ remained positive and significant until the mid-40s, confirming that the recommendation of annual cytological screening among these women is appropriate. Whether those ≥45 years of age continue to require increased screening is unclear, and would require a careful weighing of possible risks and benefits.

Perceptions of barriers and facilitators to cervical cancer screening among low-income, HIV-infected women from an integrated HIV clinic.

Significantly elevated rates of cervical cancer and low rates of Papanicolaou (Pap) smear screening have been documented among HIV-infected women. However, little is known about women's perceptions of cervical cancer screening utilization. Hence, this study describes barriers and facilitators related to cervical cancer screening in a sample of HIV-infected women seeking care at an integrated HIV clinic in Houston, Texas. Using an inductive qualitative methodological approach, data were obtained from five focus group discussions with a total of 33, HIV-infected women. The majority of the study sample consisted of women who self-identified as Black (69.7%), and reported heterosexual contact as the mode of HIV acquisition (75.8%). Barriers to cervical cancer screening were described as pain and discomfort associated with receiving Pap smears and subsequent procedures; lack of awareness of cervical cancer as a preventable disease; limited transportation access; and systemic issues as it relates to scheduling gynecological appointments. Facilitators were described as awareness of HIV-infected women's increased risk of cervical cancer and strong provider-patient relationships. To address disparities in cervical cancer screening among low-income HIV-infected women, programs should capitalize on the identified facilitators and alleviate modifiable barriers using multilevel strategies.

Factors associated with Pap smear screening among French women visiting a general practitioner in the Rhône-Alpes region.

BACKGROUND: To help prevent cervical cancer, three yearly opportunistic Pap smear screening is recommended in France for women aged 25-65 years. Pap smear screening coverage varies with age and socioeconomic level. The aim of this cross-sectional study was to identify factors associated with a low uptake of Pap smear screening among women with no limited access to healthcare. METHODS: We analyzed data from women aged 25-65 living in the Rhône-Alpes region who completed a self-administered questionnaire given to them by general practitioners between June and August 2008. The questionnaire covered knowledge about cervical cancer and its prevention as well as the women's history of Pap smear screening and other health-related behaviors. The relationship between low uptake of Pap smear screening--defined as not having had the test within the past 3 years--and a range of possible contributing factors was investigated using logistic regression. RESULTS: Of 1186 women with an intact uterus who completed the questionnaire, 89.1% said they had had a Pap smear within the past 3 years. On multivariate analysis, the 10.9% who had not were significantly more likely to live alone (1.76 [1.13-2.74]), to have no children (2.17 [1.31-3.62]), to have never used contraception (5.35 [2.98-9.62]), to have less knowledge about Pap smear screening (3.40 [1.55-7.49]), and to be unvaccinated against hepatitis B (0.55 [0.35-0.87]). CONCLUSION: Despite high overall compliance with Pap smear screening recommendations among women who consulted general practitioners, several factors were significantly associated with a low uptake of the service. Considering these factors may help to refine messages aimed at cervical cancer prevention.

Conventional Pap Smear Screening in HIV Seropositive Women in South India.

OBJECTIVES: To assess the prevalence of Pap smear abnormalities and to characterize the associated risk factors in HIV seropositive women. MATERIAL AND METHODS: We conducted a cross-sectional study on 252 HIV seropositive women in and around Krishna district, Andhra Pradesh, India by screening them for cervical cytological abnormalities by means of conventional Pap smear screening and the abnormalities reported as per modified Bethesda system. RESULTS: The prevalence of Pap smear abnormalities in HIV seropositive women was found to be 7.17 % which was a twofold increased risk as compared to the general population. On analysis of the risk factors like younger age for abnormal pap smears, mean CD4 count, duration of disease, and ART/HAART therapy the difference between the two groups of HIV seropositive women with normal pap smears and seropositive women with abnormal pap smears was found to be not statistically significant. CONCLUSION: HIV/AIDS is associated with a twofold increased risk for cervical cytological abnormalities, and hence the need for periodic pap smear screening in this high risk group to reduce the global burden of cervical cancer.

Exame Papanicolaou: sentimentos relatados por profissionais de enfermagem ao se submeterem a esse exame / Pap smear screening: sensations reported by nursing professionals when submitted to this test

Objetivou-se conhecer os sentimentos de auxiliares e técnicas de enfermagem ao se submeterem ao exame Papanicolaou. Trata-se de um estudo descritivo com abordagem qualitativa realizado nos meses de setembro a outubro de 2006, com 35 servidoras de uma instituição governamental referência em ginecologia na cidade de Fortaleza (CE). Os dados foram coletados através de entrevista semiestruturada, contendo uma questão norteadora gravada e analisada de acordo com referencial teórico metodológico da fenomenologia social. Os relatos foram agrupados em três temáticas: um exame que causa incômodo, medo e vergonha; um exame que gera ansiedade quanto aos resultados; e um exame que "me deixa calma e tranquila". Apesar de as entrevistadas pertencerem a uma instituição que cuida de mulheres na prevenção do câncer cérvico-uterino, elas não deixaram de emitir sentimentos negativos relacionados ao exame. Concluiu-se a importância de realizar projetos educativos, enfatizando a importância do empoderamento das usuárias a fim de minimizar essas questões.

This work sought to record the impressions of nursing assistants and technicians after submitting to Pap smear screening. This is a descriptive study using a qualitative approach conducted in September and October of 2006 with 35 employees of a public institution, which is a benchmark in gynecology in Fortaleza in the State of Ceará (Brazil). The data was collected through semi-structured interviews containing a recorded leading question and analyzed according to the methodological-theoretical reference of social phenomenology. The testimonials were separated in three groups: an exam that causes discomfort, fear and shame; an exam that causes anxiety about the results; and an exam that "makes me calm and relaxed". Despite the interviewees being part of an institution that cares for the prevention of cervical-uterine cancer in women, negative feelings about the Pap smear test were nonetheless reported. The conclusion reached is that it is important to stage educational campaigns emphasizing the importance of empowerment of patients in order to minimize these aspects.