Determinants of primary care physicians’ intention to provide breast cancer screening services for rural women: a structural equation model based on the theory of planned behavior

BackgroundIt was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.MethodsA cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.ResultsThere were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p < 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p < 0.001), attitude (β = 0.152, p < 0.001), past behavior (PB) (β = 0.150, p < 0.001), knowledge (β = 0.121, p < 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p < 0.05). The advocacy and education (A&E), medical level and service attitude (ML&SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&E and PBC 2 (p < 0.01) and the effect of PB on BI (p < 0.001).ConclusionThe TPB with the addition of PB, knowledge, ML&SA, and A&E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.

BackgroundPromoting cervical cancer screening (CCS) is undoubtedly effective in combating severe public health problems in developing countries, but there are challenges to its implementation. Understanding the factors influencing primary care physicians' intentions to provide CCSs to rural women is crucial for the future implementation of screening programs. The aim of this study was to assess the intentions of primary care physicians to provide cervical cancer screening services (CCSSs) to rural women and their determinants.MethodsThis cross-sectional study included 1,308 primary care physicians in rural primary health care, and the data collection tool was developed based on the theory of planned behavior (TPB), which included demographic characteristics, the basic constructs of TPB, and the degree of knowledge of CCSSs as an extended variable of the TPB model. Structural equation modeling was used to analyze the relationships between each factor.ResultsPathway analysis found that TPB is an appropriate theoretical basis for predicting primary care physicians' intent to provide CCSSs (χ2/df = 2.234 < 3, RMSEA = 0.035, and SRMR = 0.034). Meanwhile, the structural equation model showed that attitude (β = 0.251, p < 0.001), subjective norm (β = 0.311, p < 0.001), perceived behavioral control (β = 0.162, p < 0.001), and knowledge level (β = 0.152, p < 0.01) positively predicted primary care physicians' intention to provide CCSSs.ConclusionsTPB model, with the addition of knowledge, was useful in predicting primary care physicians' intention to provide CCSSs for rural Chinese women. The findings of this study provide a reference for the government and hospitals to develop strategies to improve the intent of primary care physicians to provide CCSSs.

Knowledge, attitude and practices around breast cancer and screening services among women of reproductive age in Turbo sub-county, Kenya

Chinese rural women aged 35-64 years are encouraged to complete breast cancer screening (BCS) free of charge. However, it is challenging to reach a satisfying BCS uptake rate. In this study, rural women's preferences and preferences heterogeneity were measured for the development of strategies to enhance participation in BCS. A cross-sectional survey with a discrete choice experiment (DCE) was conducted via convenience sampling via face-to-face interviews in Jiangsu, China. Six DCE attributes were identified through a systematic literature review; our previous study of Chinese rural women's BCS intentions; a qualitative work involving in-depth interviews with rural women (n = 13), medical staff (n = 4), and health care managers (n = 2); and knowledge of realistic and actionable policy. The D-efficient design was generated using Ngene 1.3.0. A mixed logit model (MXL) in Stata 18.0 was used to estimate the main effect of attribute levels on rural women's preferences. The relative importance and willingness to utilize BCS services (WTU) were also estimated. The heterogeneous preferences were analyzed by a latent class model (LCM). Sociodemographic status was used to predict the characteristics of class membership. The WTU for different classes was also calculated. A total of 451 rural women, aged 35-64 years, were recruited. The MXL results revealed that the screening interval (SI) was the most important attribute for rural women with regard to utilizing BCS services, followed by the level of screening, the attitude of medical staff, ways to get knowledge and information, people who recommend screening, and time spent on screening (TSS). Rural women preferred a BCS service with a shorter TSS; access to knowledge and information through multiple approaches; a shorter SI; a recommendation from medical staff or workers from the village or community, and others; the enthusiasm of medical staff; and medical staff with longer tenures in the field. Two classes named "process driven" and "efficiency driven" were identified by the preference heterogeneity analysis of the LCM. There is a higher uptake of breast cancer screening when servicesare tailored to women's preferences. The screening interval was the most important attribute for rural women in China with a preference for a yearly screening interval versus longer intervals.

Cancer screening policy in Hungary.

Purpose: Nearly 50% of Kenyan women with breast cancer present with advanced disease – owing partially to limited patient awareness of the importance of breast cancer screening and financial limitations of screening in low- and middle-income countries. With increasing access to nurse-led cervical cancer screening in government clinics in Kenya, we investigated provider-perceived barriers and facilitators to integrating breast cancer screening into ongoing cervical cancer screening programs in Kisumu County, Kenya. Methods: Providers offering cervical cancer screening within Ministry of Health Clinics in Kisumu County were recruited to participate in a two-phase, sequential, mixed methods study. Providers' knowledge of breast cancer screening guidelines was assessed with a questionnaire based on the 2018 Kenya National Cancer Guidelines. Providers with significant cervical and breast cancer screening experience were invited to complete a 1-on-1 interview to discuss barriers and facilitators to integration. Results: Sixty-nine nurses and clinical officers from 20 randomly selected facilities participated in the survey. Providers all agreed that breast cancer screening was very important. While 93% said they routinely offered clinical breast examinations, only 22% of these providers screened at least 8 of their last 10 patients. Forty-four percent correctly identified 4 or more of 5 signs and symptoms of breast cancer and 45% correctly identified the recommended screening frequency for women aged 40-55 years. While providers showed enthusiasm for integration, several barriers were identified and grouped into four themes: 1) fragmentation of services; 2) staffing shortage and inadequate on-job training; 3) limited space and referral system challenges; 4) limited patient awareness on need for cancer screening. Conclusion: Addressing providers' concerns by providing routine on-job clinical training, strengthening the diagnostic and treatment referral pathway, and increasing patient education are some of the first steps in facilitating integration of breast and cervical cancer screening services in primary care clinics in Kenya. Citation Format: Prisca Diala, Magdalene Randa, Jackline Odhiambo, Gregory Ganda, Craig Cohen, Chemtai Mungo. Barriers and Facilitators to Integrating Breast and Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 104.

Early diagnosis of breast cancer is a key factor affecting patient survival, so screening can reduce the burden of this disease. The present study aimed to investigate the effect of education based on the theory of planned behavior (TPB) on breast cancer screening in rural women. In this quasi-experimental study, 480 women referring to the health care centers in the cities of Fasa and Shiraz were divided into two groups, intervention (n = 240) and control (n = 240), using cluster random sampling method, in 2021-2022. We randomly selected two health care centers in Shiraz and Fasa and invited them to participate in the study. The demographic information questionnaire and a researcher-made questionnaire based on the TPB were used to collect the data. The intervention included 50-minute sessions on topics such as breast cancer basics, screening methods, barriers to mammography, and the role of peer groups. Data were collected before and 4months after the intervention. The results showed no difference between the two groups in awareness, attitude, perceived behavioral control, subjective norms, behavioral intention, and breast cancer screening performance before the intervention. Four months after the intervention, a significant increase was found in the intervention group in awareness (7.46 ± 1.50 to 18.54 ± 1.20), attitude (28.55 ± 4.62 to 58.69 ± 4.35), perceived behavioral control (22.52 ± 3.32 to 40.88 ± 3.84), and subjective norms (20.37 ± 3.34 to 21.99 ± 3.38). Instead, no significant difference in the mentioned constructs (P < 0.05) was observed in the control group. This study demonstrated that TPB-based education enhanced awareness, attitude, perceived behavioral control, subjective norms, and behavioral intention towards breast cancer screening. The TPB empowers women in rural communities to prioritize their health and seek timely breast cancer screening. Continued efforts and improved access to screening services are crucial for improved outcomes.

There is a continuing need to monitor and evaluate the impact of organized screening programmes on cancer incidence and mortality. We report results from a programme assessment conducted within the International Cancer Screening Network (ICSN) to understand the characteristics of cervical screening programmes within countries that have established population-based breast cancer screening programmes. In 2007-2008, we asked 26 ICSN country representatives to complete a web-based survey that included questions on breast and cervical cancer screening programmes. We summarized information from 16 countries with both types of organized programmes. In 63% of these countries, the organization of the cervical cancer screening programme was similar to that of the breast cancer screening programme in the same country. There were differences in programme characteristics, including year established (1962-2003 cervical; 1986-2002 breast) and ages covered (15-70+ cervical; 40-75+ breast). Adoption of new screening technologies was evident (44% liquid-based Pap tests; 13% human papillomavirus (HPV)-triage tests cervical; 56% digital mammography breast). There was wide variation in participation rates for both programme types (<4-80% cervical; 12-88% breast), and participation rates tended to be higher for cervical (70-80%) than for breast (60-70%) cancer screening programmes. Eleven ICSN member countries had approved the HPV vaccine and five more were considering its use in their organized programmes. Overall, there were similarities and differences in the organization of breast and cervical cancer screening programmes among ICSN countries. This assessment can assist established and new screening programmes in understanding the organization and structure of cancer screening programmes.

Perceptions of primary health care physicians about the prescription of antibiotics in Saudi Arabia: Based on the model of Theory of planned behaviour

Background Non-AIDS-defining cancers (NADCs) are a leading cause of morbidity and mortality among PWH. With healthcare digitization and evolving HIV care models, equitable access to preventative care is crucial. We investigated individual and system-level factors associated with completion of BC and CRC screenings. Methods This was a single-center, retrospective cohort study from 7/1/2022 to 7/1/2023. Established PWH (≥ 3 appointments between 7/1/2020-7/1/2023 with ≥ 1 within the study period) aged 40-75 were included. The primary outcome was ordering and completion of BC and CRC screenings. Demographics were summarized using frequency and percentage for groups with differing screening statuses. Chi-Square or Fisher’s exact test were used to evaluate associations between factors and outcomes. Descriptive statistics and p values were considered for evaluating associations between characteristics and screening status. Results 178 PWH eligible for BC screening were included. 113 (63.5%) were of Black/African American race, 151 (84.8%) had a primary care physician (PCP), and 138 (77.5%) were enrolled in an electronic medical record application (MyChart®). 52.7% were up to date on BC screening. Demographics and BC screening statuses are listed in Table 1. We observed a statistically significant association between having a PCP (90.2% vs 75.8%; p=0.018) and ordering of BC screening. Moreover, patients who completed BC screening are less likely to have obesity (39.4% vs 56.0%; p=0.039) (Table 2). 739 PWH eligible for CRC screening were included. 591 (80%) were assigned male sex at birth, 634 (85.8%) had a PCP, and 601 (81.3%) were enrolled in MyChart®. 349 (47.2%) were up to date on CRC screening. Demographics and CRC screening statuses are listed in Table 3. Significant associations were noted between having a PCP (90.8% vs 81.3%; p &amp;lt; 0.001), higher median income (79.6% vs 69.9%; p=0.003), and MyChart® enrollment (88.0% vs 75.4%; p &amp;lt; 0.001) and CRC screening completion. Other notable variables are listed in Table 4. Conclusion BC and CRC screening is essential in reducing morbidity, mortality, and disparities of BC and CRC among PWH. Our findings provide insight on target populations for interventions and highlight opportunities to utilize digital technologies to improve cancer screening rates. Disclosures Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healhcare: Advisor/Consultant

BackgroundIn the Community of Latin American and Caribbean States (CELAC), breast cancer and cervical cancer are the first and third causes of cancer death among females. The objectives are to assess the characteristics of the cervical and breast cancer screening programmes in CELAC, their level of organization, and the association of screening organization and coverage of essential health services.MethodsRepresentatives of the Ministries of Health of 33 countries were invited to the CanScreen5 project. Twenty‐seven countries participated in a “Train The Trainers” programme on cancer screening, and 26 submitted data using standardized questionnaires. Data were discussed and validated.The level of organization of the screening programmes was examined adapting the list of essential elements of organized screening programmes identified in a recently published IARC study.ResultsTwenty‐one countries reported a screening programme for cervical cancer and 15 for breast cancer. For cervical cancer, 14 countries dedicated budget for screening (66.7%), and women had to pay in 3 countries for screening (14.3%), 9 for diagnosis (42.9%) and 8 for treatment (38.1%). Only 4 countries had a system to invite women individually (19.0%). For breast cancer, 8 countries dedicated budget for screening (53.3%), and women had to pay for screening in 3 countries (20.0%), diagnosis in 7 (46.7%) and treatment in 6 (40.0%). One country (6.7%) invited women individually.There was variability in the level of organization of both cancer screening programmes. The level of organization of cervical cancer screening and coverage of essential health services were correlated.ConclusionLarge gaps were identified in the organization of cervical and breast cancer screening services. CELAC governments need pragmatic public health policies and strengthened health systems. They should guarantee sustainable funding, and universal access to cancer diagnosis and treatment. Moreover, countries should enhance their health information system and ensure adequate monitoring and evaluation.

A theoretical explanation of naloxone provision among primary care physicians and community pharmacists in Tennessee

Satisfaction of women with breast cancer screening programs is important to ensure the program effectiveness. To assess the experience and satisfaction of women with breast cancer screening services. This was a descriptive study targeting 312 women undergoing mammography screening in Riyadh Region in Saudi Arabia. The data were collected through telephone interviews using a structured questionnaire covering eight domains. Weighted means were calculated by dividing the average scores for each item and domain by their maximum scores. Multiple regression was performed to identify the factors related to general satisfaction. Overall satisfaction weighted mean was 0.879. Experiences were best for physical surroundings and perceived competency of staff domains with weighted means of 0.929 and 0.914 respectively. Accessibility and waiting time, and staff interpersonal skills domains came next with weighted means of 0.901 and 0.876 respectively. Information transfer, physical discomfort and psychological discomfort domains came last with weighted means of 0.783, 0.736 and 0.673 respectively. General satisfaction was related to waiting time and access domain (Exp(B) =.709 (95% CI: .595-.843, p value: .000), staff interpersonal skills domain (Exp(B) = .815 (95% CI: .686- .968, p value: .020) and perceived competency of the staff domain (Exp(B) = .660 (95% CI: .458- .951, p value: .026). Overall satisfaction with breast cancer screening was high and the experience of women was highly positive for most of the domains. More efforts are needed to improve the information transfer by addressing the language barriers and to enhance the physical and psychological experiences.

Satisfaction of women with breast cancer screening programs is important to ensure the program effectiveness. To assess the experience and satisfaction of women with breast cancer screening services. This was a descriptive study targeting 312 women undergoing mammography screening in Riyadh Region in Saudi Arabia. The data were collected through telephone interviews using a structured questionnaire covering eight domains. Weighted means were calculated by dividing the average scores for each item and domain by their maximum scores. Multiple regression was performed to identify the factors related to general satisfaction. Overall satisfaction weighted mean was 0.879. Experiences were best for physical surroundings and perceived competency of staff domains with weighted means of 0.929 and 0.914 respectively. Accessibility and waiting time, and staff interpersonal skills domains came next with weighted means of 0.901 and 0.876 respectively. Information transfer, physical discomfort and psychological discomfort domains came last with weighted means of 0.783, 0.736 and 0.673 respectively. General satisfaction was related to waiting time and access domain (Exp(B) =.709 (95% CI: .595-.843, p value: .000), staff interpersonal skills domain (Exp(B) = .815 (95% CI: .686- .968, p value: .020) and perceived competency of the staff domain (Exp(B) = .660 (95% CI: .458- .951, p value: .026). Overall satisfaction with breast cancer screening was high and the experience of women was highly positive for most of the domains. More efforts are needed to improve the information transfer by addressing the language barriers and to enhance the physical and psychological experiences.

The total coverage of both the Flemish breast cancer and cervical screening program remain suboptimal, with approximately 63% for both. Of all the women invited to the breast cancer screening program, 14.1% never underwent any type of breast cancer screening (any type of mammogram, ultrasound, or clinical breast examination). For the cervical cancer screening, this proportion of 'never-screeners' is 12.1%. We conducted two randomized controlled trials to assess whether various communication and presentation styles in the invitation package, were effective at motivating women who had never participated to attend. The study population was limited to never-screeners (women who had never participated in the screening program). The RCT embedded in the breast cancer screening consisted of seven intervention arms and one control arm (all of them included a fixed appointment by letter). The RCT embedded in the cervical cancer screening consisted of three intervention arms and two control arms. In both RCTs, several content and style adaptations were made to the invitation letter, information leaflet, and envelope. None of the intervention arms in either the breast cancer screening or the cervical cancer screening had a statistically significant impact on the participation rate compared to 'usual care' (the regular invitation package used in the screening program). Sending adapted invitation packages to never-screeners, from the Flemish breast and cervical cancer screening program, does not seem to be effective in increasing the proportion of women screened. Innovative methods are needed to motivate never-screeners to be screened.