Family Decision Research Articles

Family Support in Premarital Screening: Efforts to Prevent Thalassemia

Thalassemia is an inherited disorder syndrome and is included in the hemoglobinopathy group, which is a disorder caused by impaired hemoglobin csynthesis due to mutations in or near globin genes. Thalassemia disease has no cure, so early prevention is more important than treatment. The World Health Organization recommends two ways of prevention, namely pregnancy screening and population screening to look for carriers of thalassemia traits. This study aims to determine the relationship between family support and premarital screening decision-making in thalassemia adolescents at Banyumas Regional General Hospital. The method used is quantitative descriptive. This study is a correlation study with a cross-sectional design. The sample in this study was thalassemia adolescents with an age range of 12 to 21 years in the thalassemia room of Banyumas Regional General Hospital as many as 75 people. This study used a sampling technique, namely purposive sampling. The research instrument used family support questionnaires and decision-making. The data were analyzed using the Chi-Square test. Univariate test results found that most respondents had high family support as many as 52 people (69.3%), and most respondents decided to conduct premarital screening as many as 54 people (72.0%). The results of the bivariate test obtained a relationship between family support and premarital screening decision-making in thalassemia adolescents in the thalassemia room of Banyumas Regional General Hospital (p-value 0.047). Family support can also be an influential factor in determining an individual's beliefs and decisions. The higher the family support, the more supportive the thalassemia adolescent to make premarital screening decisions.

Family decision making for Madurese women with pregnancy complications: a qualitative study

Background/Aims A delay in referring women with pregnancy complications to medical care is a significant contributor to maternal mortality worldwide. In Madura, Indonesia, these delays can be exacerbated by the role of a woman's family in decision making. This study aimed to explore family decision making in seeking healthcare for women with pregnancy complications in Madura. Methods Using a descriptive qualitative approach, in-depth interviews were conducted to explore the decision-making experiences of 12 pregnant women, 12 of their family members and 10 midwives. Results Three themes were identified: women empowerment issues, cultural factors, and important considerations in seeking healthcare for women with pregnancy complications. Conclusions Continuous health education is needed to increase knowledge of appropriate maternal care for pregnant women and their families. The involvement of religious leaders in programmes to enhance referral decision making would be beneficial.

Family Decision-Making Path for the Referral of Terminal Patients in Tertiary Hospitals

Objective To gain an in-depth understanding of the motivations,patterns,and related factors in family decision-making regarding the referral of terminal patients in tertiary hospitals. Methods Using purposive sampling,terminal patients and their family members from three tertiary hospitals in Beijing were selected as subjects.Semi-structured interviews were conducted,and the interview data were subjected to thematic analysis. Results Following the saturation principle,a total of 11 patients and 15 family members were included.The interview data were organized and analyzed,yielding six major themes:decision premises,decision patterns,family support,support from the referring hospital's medical team,referral channel conditions,and involvement of volunteer teams and social support.Based on these findings,a flowchart illustrating the family decision-making process for the referral of terminal patients was constructed. Conclusions The study provides a comprehensive analysis of various factors influencing family decision-making in the referral of terminal patients in tertiary hospitals.The results underscore the significance of internal and external factors,emphasizing the integrated impact of decision patterns,family support,medical team support,referral channel conditions,and the involvement of volunteer teams and social support.The research offers profound insights into improving the referral process for terminal patients and enhancing the quality of family decision-making.It provides valuable recommendations for future improvements in medical services and decision support.

Family Satisfaction with Care Provided in Intensive Care Unit; a Multi-Center, Cross-Sectional Study.

Healthcare provided in medical facilities should prioritize the needs of families, as it enhances the quality of care for the patients. Family satisfaction gauges how effectively healthcare professionals address the perceived needs and expectations of family members. Numerous factors, including information dissemination, communication, family dynamics, patient characteristics, hospital facilities, and the caregiving process, serve as predictors of family satisfaction. Thus, this study seeks to evaluate the satisfaction of families with the care received by patients admitted to the intensive care unit. A hospital-based cross-sectional study involving 400 participants was conducted across multiple centers from March to June 2023. Multicollinearity was assessed by examining variance inflation factors (VIF), while the goodness-of-fit was evaluated using the Hosmer and Lemeshow test. Both bivariable and multivariable logistic regression analyses were utilized to identify factors correlated with family satisfaction. Variables with a p-value below 0.2 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals were computed to indicate the strength of association. In the multivariable analysis, variables with a p-value less than 0.05 were deemed statistically significant. The overall family satisfaction with the care provided in the intensive care unit was 58.6%, with a 95% confidence interval ranging from 55.882% to 61.241%. Families expressed higher satisfaction levels with patient care (64.8%) and professional care (67.4%). However, they reported lower satisfaction levels regarding care provided for families (52.2%), the ICU environment (56.8%), and involvement of families in decision-making (55.8%). Lack of formal education (AOR: 1.949, 95% CI: 1.005, 4.169), completion of primary education (AOR: 2.581, 95% CI: 1.327, 5.021), and completion of grades 9-12 (AOR: 2.644, 95% CI: 1.411, 4.952) were found to be significantly associated with overall family satisfaction. The overall level of satisfaction is satisfactory. To enhance service quality and family satisfaction, healthcare providers should prioritize effective and regular communication with family members. Keeping them well informed about the patient's condition and treatment plan is essential.

How do law and religion influence child marriage? A qualitative study using content analysis

AbstractObjectiveThis study was conducted to investigate the effects of religion and law on child marriage in Sanandaj, Iran.BackgroundThe prevalence of child marriage is 16.65% in Iran and 11% in the Kurdish city of Sanandaj. This study considers the legality and legitimacy of this practice in Iran.MethodEligible participants were selected through purposive sampling. Participants included three groups: parents of a married child (n = 7), women who were child brides (n = 19), and experts (sociologists, marriage concluders, and marriage counselors; n = 7). The research question was “What impact do religious and legal factors have on the decision of families in child marriage?” The data were gathered using semistructured in‐depth interviews and analyzed by conventional content analysis method.ResultsThe findings were generally categorized into four main themes including law–religion issues (subthemes: marriageable age in civil law, Sharia principles), predisposed religious interpretations (subthemes: religious interpretations confirming child marriage, interpretations rejecting child marriage), institutional factors (subthemes: official agencies, religious factors), and religious viewpoint of families toward child marriage (subthemes: avoidance of sin, reference of parents/children to religious rules).ConclusionsThe intersection of law, religion, and family institutions, with their interconnected rules, encourage child marriage (particularly for girls) in Sanandaj, Iran. Any change in these factors (mostly civil law and Sharia) may influence the demands of families for child marriage.

National and foreign experience in determining the legal status of guardianship bodies

In the scientific article, the author conducted a scientific study of the peculiarities of the legal status of guardianship and guardianship bodies in Ukraine and other countries. On the basis of the conducted research, the author came to the conclusion that guardianship and guardianship bodies are distinguished by various authorities - local bodies of state executive power and local self-government bodies, separate departments of these bodies, services for children, which function under local state administrations and local councils, and as well as advisory and advisory support bodies. At the same time, the scientific literature notes the inexpediency of such a wide list of guardianship and guardianship bodies and the need to empower these bodies only with services for children. In the family law doctrine, there is no unanimity regarding the definition of the powers of the guardianship and guardianship authorities, which relate to the protection of the rights and legitimate interests of the child; they are contained in special legislation, which, however, does not fully correspond to each other and provides for the presence of a number of bodies that do not actually function or carry out activities formally, without having the appropriate competence (commissions for the protection of children's rights, departments of local state administrations), or at the same time function two bodies that are subordinate to each other (local state administrations and services for children). In the family law doctrine, there is no certainty in the issue of recognition of guardianship bodies and care by subjects of family relations; some scientists attribute them to the subjects of administrative-procedural relations or to the participants of legal relations of a complex nature, which are partly family, while others distinguish them as subjects of family relations. Analogues of guardianship and guardianship bodies in the states of the European Union and candidate states for EU membership are various types of bodies, including quasi-judicial ones, which perform both the functions of appointing, approving or dismissing a guardian, as well as supervising the observance of the rights of the child by its guardian (in France these functions are divided between the "family council” and the "guardianship judge”). Also, these bodies make decisions in family disputes regarding determining a child's surname, establishing his origin, his upbringing and maintenance.

Health Disparities Among Family Decision-Makers in China: An Ordered Probit Analysis of the China Family Panel Studies.

The family decision-makers serve as the backbone of the family, and their health status warrants consideration. This study aims to explore how the health status of this group of people, namely the family decision-making group, is affected, and to delve into the mechanisms of influence based on this. The goal is to provide reliable evidence and strategies for the health management of the family decision-makers group, contributing to the achievement of the "Healthy China 2030" Planning Outline. Drawing on data from the China Family Panel Studies (CFPS), this study utilizes an Ordered Probit Model to analyze and compare the health status of family decision-makers and non-decision-makers. The findings indicate that decision-makers tend to experience poorer health outcomes than other family members, with increased pressure related to decision-making identified as a significant contributor to their declining health. Heterogeneity analysis reveals that the negative effect is less pronounced in households with higher net worth but more pronounced in those with more significant housing, education, and medical spending pressures. Moreover, this study analysis highlights that enhancing individual or family socioeconomic status can alleviate the adverse health effects experienced by family decision-makers. The study reveals the presence of certain health adverse effects among family decision-makers. The implications drawn from this research hold significance for the health management of this demographic, underscoring the necessity for tailored interventions aimed at addressing the distinctive challenges confronted by this group.

Review of Determinants of Nonmedical Caesarean Section in Indonesia: A Systematic Review

Caesarean section (C-section) delivery has increased worldwide. The number of deliveries using the C-section procedure at the age of 10–54 years in Indonesia reached up to 17.6% of the total number of deliveries, due to the presence of medical and nonmedical indications. This study aims to analyze about nonmedical indications of C-section. This study uses a systematic review method. The inclusion criteria for the investigated studies were articles published in 2011–2021, written in English or Bahasa Indonesia, observational studies with case control or cohort as the design, and available to be downloaded in full text. In total, 12 articles were included in this systematic review. The nonmedical factors that influence the C-section procedure are antenatal care, the mother's level of education, residency, health insurance, socio-economics, occupation, previous birth histories, the mother's demand, the family's support and decision-making, and doctor's referral. The government, through the help of health practitioners, needs to increase the education to pregnant women and their families regarding the advantages and disadvantages of their preferred delivery methods.

Shifting paradigms: The examination of adolescent influence in Pakistani family consumer choices

Within the Pakistani family structure, decision-making authority pertaining to domestic and financial affairs is vested in the patriarch. Nevertheless, as time passes, a substantial change in the interplay of forces has been noted, in which adults, in addition to their parents, exert considerable influence in the decision-making process. Furthermore, the marketer recognized this delegation of decision-making power. The initiated investigation of this phenomenon was motivated by research findings that corroborate its existence. The study's objective is to investigate the emergence of adolescent influence in Pakistani decision-making processes. By utilizing a quantitative methodology, this study investigates the increasing influence of adolescents throughout different phases of decision-making and focuses on particular aspects pertaining to product selections within the family environment. The study posits that adolescents do, in fact, exert influence over the intricate web of family decision-making, which is consistent with previous research patterns. Nonetheless, a salient observation arises: parents maintain their authority in directing comprehensive family decisions. Given the absence of previous investigations in this particular domain, this study represents an innovative endeavor that sheds light on various facets of consumer behavior within the Pakistani context.

Empowering Women Through Contraceptive Education Makes Responsible Family Decisions A Reality

Empowering Women Through Contraceptive Education Makes Responsible Family Decisions A Reality

Impact of language ideologies on educational choices in intermarriages

This paper explores how parents in intermarriages choose between the majority language (Serbian) and the minority language (Hungarian) as their children’s instruction medium in Vojvodina, the northern province of Serbia. Adopting language ideologies as a theoretical framework, the study sheds light on (systems of) cultural ideas concerning social and linguistic relations, encompassing family and societal contexts. Qualitative research involving interviews was conducted with spouses/partners of individuals from the Hungarian national minority who are in a marriage/partnership with members of the majority community in Vojvodina. The analysis reveals that the choice of education in the majority language is influenced by both objective factors (such as the absence of minority language schooling in the parents’ locality) and subjective considerations, which are connected to adopting various language ideologies supported by gender differences. The study highlights the crucial societal function of intermarriage, as family decisions significantly shape the identity and ethnic affiliation of children born into these unions. The choice of the language of instruction for their education plays a significant role in this process, with opting for the majority language accelerating acculturation and assimilation compared to choosing the minority language and maintaining the minority community.

Socio-Economic Determinants of Choosing the Month of Child Birth in the Russian Federation: Statistical Analysis

The results of a statistical analysis of the factors determining the decisions of families regarding the choice of the month of child birth are presented in the article. A review of the literature shows that a wide range of factors – cultural, biological, climatic and socio-economic – can influence these decisions. In the article, the authors focus on socio-economic determinants. In the Russian Federation, as well as throughout the world, there is a steady seasonality of births: between 2000 and 2022 most children were born in July and August. The article formulates a number of hypotheses regarding possible seasonality determinants, which were tested on the basis of Rosstat data from a sample survey of households «Comprehensive observation of living conditions of the population in 2020» and Rosstat data on registered births by month in Russian regions for 2019–2022. Using unordered multiple choice logit model estimates, cluster analysis and correlation analysis the authors obtained results demonstrating that the choice of summer months for the child birth is determined primarily by household, with the increase of which the birth of a child is more often planned for July. In regions characterized by high rates of quality-of-life indicators, predominantly urban population and a high level of contraceptive use, family preferences in choosing the summer months for child birth are also increasing. The influence of mother's age and education was not identified in the work.The results of the study can be used by the authorities to develop an effective strategy in the field of demographic policy.

The Myth of Mutuality: Decision-Making, Marital Power, and the Persistence of Gender Inequality

Invisible power—the ability to resist changing one’s behavior because of an unspoken consensus that the status quo is natural or inevitable—upholds gender inequality in different-gender marriages. Yet the “consensus” that Aafke Komter documented more than 30 years ago—one in which both men and women endorsed male primacy and believed it natural for women to enjoy housework and men to pursue professional ambition—has weakened among the college-educated, upper middle class. We ask: What is the new consensus upholding gendered power imbalances among contemporary highly educated couples? We draw on 112 interviews with members of 44 such couples making career and family decisions to update theorizing on invisible power. Examination of decision-making processes and outcomes across work and family domains over time, including in cases of apparent agreement, reveals the consensus now upholding men’s interests to be couples’ conviction they are practicing mutuality. Partners’ belief that they are mutually pursuing both individuals’ and the family’s best interests by emphasizing “us” and balancing a decision portfolio helps them overlook unsuccessful attempts to minimize power imbalances. Progress toward gender equality among different-gender couples will likely remain stalled as long as efforts to practice mutuality overshadow critical evaluation of their success.

Implementation of an Advance Care Planning Intervention in Nursing Homes: An International Multiple Case Study.

The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study were to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making, and identify costs and supportive conditions for the implementation of the intervention. A multiple-case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and United Kingdom. Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery. There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied by committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time.

Abstract TP104: Functional Prognostication of Patients Receiving Thrombolytics in Acute Ischemic Stroke With Machine Learning

Introduction: Accurate outcome prognostication in acute ischemic stroke (AIS) informs essential medical decision-making for clinicians, patients, and families. Neuronal Networks (NN) is a machine learning ML algorithm modeled on the workings of human neurons that has been shown to be useful for prediction tasks in the healthcare setting. We tested whether an NN algorithm could accurately predict long-term neurological outcomes for AIS patients receiving intravenous thrombolysis using common clinical variables. Methods: Patients with AIS treated with intravenous thrombolysis in our health system between July 1, 2020-June 28, 2022 were included in model creation and internal validation. Cases with a modified Rankin scale (mRS) of 0-2 at 90 days (i.e. independence) were classified as “good” outcomes and mRS 3-6 (non-independent) as “poor” outcomes. An NN prediction tool was trained using clinical and interventional variables collected in the first 24 hours of the hospitalization, such as age, gender, and thrombectomy status. Imputation was used for missing values. The final network had a size of 10 layers and a 0.5 decay. The evaluation was made with 10-fold cross-validation. Report followed the TRIPOD statement. Results: We identified 547 AIS patients who received intravenous thrombolysis. Median Age was 70 (IQR: 58-81), and 254 (46.4%) were classified as Female. A total of 115 (20.1%) underwent thrombectomy. Good outcomes were achieved in 354 (64.7%) patients at 90 days. Following the optimization of prediction thresholds through the best informedness values, our final model had a sensitivity of 0.81 and a specificity of 0.78 for detecting good outcomes. The corresponding Area Under the Receiver Operator Curve (AUC-ROC) is 0.85. Conclusion: In conclusion, we developed a prognostic algorithm to predict good outcomes in AIS patients receiving thrombolysis with excellent AUC-ROC performance. External validation of our findings is necessary. NN can potentially improve prognostication of post-stroke functional outcomes, aiding individualized medical decision-making.

Developing online communication training to request donation for vascularized composite allotransplantation (VCA): improving performance to match new US organ donation targets.

Approaching families of dying or newly deceased patients to donate organs requires specialized knowledge and a mastery of relational communication. As the transplantation field has progressed, Donation Professionals (DPs) are also leading conversations with family decision makers (FDMs) about the donation of uncommon anatomical gifts, such as face, hands, genitalia, referred to as Vascularized Composite Allotransplants (VCA) without much training or experience. To address the need for training, we adapted and beta tested an evidenced-based communication training program for donation discussions to VCA requests. The overarching goal of Communicating Effectively about Donation for Vascularized Composite Allotransplantation (CEaD-VCA) is to increase the number of VCA authorizations and to improve the socioemotional outcomes of FDMs. We developed CEaD-VCA, an online, on-demand training program based on the previously tested, evidenced-based communication skills training program designed to train DPs to have conversations about solid organ donation. The training was modified utilizing data from a national telephone survey with DPs and results of 6 focus groups conducted with members of the general public. The survey and focus groups assessed knowledge, attitudes, and barriers to VCA donation. The training was shaped by a partnership with a leading industry partner, the Gift of Life Institute.™ RESULTS: Using the results as a guide, the existing CEaD training program, consisting of interactive eLearning modules, was adapted to include technical information about VCA, foundational communication skills, and two interactive example VCA donation request scenarios to facilitate active learning. Forty-two DPs from two partner Organ Procurement Organizations (OPOs) participated in the beta test of CEaD-VCA. Pre- and post-test surveys assessed the impact of the training. The training was scored highly by DPs in effectiveness and ease of use. This project created a standardized, accessible, and comprehensive training for DPs to communicate about VCA donation. CEaD-VCA is an example of how to develop a communication skills training for difficult conversations utilizing input from stakeholders, guided by communication theory. It also demonstrates how gaps in communication skills during medical education can be filled utilizing advanced online Learning Management Systems. The training specifically addresses new CMS rules concerning OPO performance metrics.

Meat reduction meets family reality: Negotiating sustainable diets in households with adolescents

Limited research exists on how the transition towards more sustainable eating takes place at the meso-level of family decision-making, or how children and adolescents engage in and possibly influence the process towards more sustainable diets in families. In this paper, we study how public recommendations that encourage reducing the consumption of meat for the benefit of both health and climate are interpreted, negotiated, and acted upon in Danish families with adolescents (aged 15–20) residing at home. We use novel methodological stimuli, including vignettes and a visual sorting task, embedded in qualitative, in-depth interviews to elicit data on parents' and adolescents’ everyday meat consumption/reduction behaviours. Findings reveal that a desire to uphold harmony and family cohesion serves as simultaneous drivers and barriers to reducing meat consumption. Further, we identify barriers to change in the gendered work hidden in the tasks of planning the integration of more sustainable, green dishes into the meal repertoires. Implications are drawn for social marketers, marketers, and public policymakers, encouraging these to use insights into family food decision-making processes as a lever to facilitate the needed green transition of diets in family households.

Study of Homecare Acceptance by The Elderly in The COVID-19 Era

During the COVID-19 pandemic, the care of elderly patients underwent significant changes. Society tends to avoid interaction outside the family, encouraging increased care of elderly patients at home. In this situation, the role of medical personnel becomes essential. This study examines how knowledge, culture, and interest influence homecare services during a pandemic. Respondents regarding homecare were collected from 71 families through a questionnaire. Data analysis includes univariate, bivariate and multivariate aspects to provide an overview of the relationship between variables. All data were analyzed using SPSS software. The result of this study shows p-value of each construct is less than 0.10, which indicates a strong relationship between variables. The findings show that knowledge influences family decisions about home care (p-value=0.024<0.10), while culture (pvalue=0.999>0.10) and interests (p-value=0.999>0.10) do not support acceptance of this service for the elderly. Therefore, it is hoped that respondents will increase their knowledge of improving elderly care and utilization of health services, which will positively impact the quality of life in old age. An in-depth discussion of these findings is carried out in a research paper.

Development and Validation of a Decision Tree Analysis Model for Predicting Home Discharge in a Convalescent Ward: A Single Institution Study.

Accurately predicting the likelihood of inpatients' home discharge in a convalescent ward is crucial for assisting patients and families in decision-making. While logistic regression analysis has been commonly used, its complexity limits practicality in clinical settings. We focused on decision tree analysis, which is visually straightforward. This study aimed to develop and validate the accuracy of a prediction model for home discharge for inpatients in a convalescent ward using a decision tree analysis. The cohort consisted of 651 patients admitted to our convalescent ward from 2018 to 2020. We collected data from medical records, including disease classification, sex, age, duration of acute hospitalization, discharge destination (home or nonhome), and Functional Independence Measure (FIM) subitems at admission. We divided the cohort data into training and validation sets and developed a prediction model using decision tree analysis with discharge destination as the target and other variables as predictors. The model's accuracy was validated using the validation data set. The decision tree model identified FIM grooming as the first single discriminator of home discharge, diverging at four points and identifying subsequent branching for the duration of acute hospitalization. The model's accuracy was 86.7%, with a sensitivity of 0.96, specificity of 0.52, positive predictive accuracy of 0.88, and negative predictive accuracy of 0.80. The area under the receiver operating characteristic curve was 0.75. The predictive model demonstrated more than moderate predictive accuracy, suggesting its utility in clinical practice. Grooming emerged as a variable with the highest explanatory power for determining home discharge.

Understanding cervical cancer awareness in hard-to-reach areas of Bangladesh: A cross-sectional study involving women and household decisionmakers.

In Bangladesh, the uptake of cervical cancer screening is low. Lack of knowledge and understanding of symptoms and risk factors contributes to low screening uptake. The purpose of this study was to explore the knowledge of cervical cancer risk factors and symptoms and to measure the association with socio-demographic characteristics among women and household decisionmakers living in hard-to-reach areas of Bangladesh. A cross-sectional survey was conducted in five districts in Bangladesh among women aged between 30 and 60 years, their husbands, and their mothers-in-law from April to September 2022. Data were collected using a modified version of the validated AWACAN questionnaire tool. The significance level was considered at p-value <0.05 and odds ratios with 95% confidence. Nearly 50% of participating women in hard-to-reach areas of Bangladesh and their family decisionmakers had low levels of knowledge of the risk factors and symptoms of cervical cancer. Only 20% of respondents in our survey knew about HPV, the most important risk factor for developing cervical cancer. Most respondents were familiar with the terminology of cervical cancer as a disease; however, approximately 40% of respondents did not know that not adhering to cervical cancer screening could be seen as a risk factor. Women do not make decisions about participation in cervical cancer screening on their own. Knowledge of cervical cancer risk factors and symptoms among decisionmakers was significantly associated with higher education and higher household monthly expenditure. Women, their husbands, and mothers-in-law in hard-to-reach areas of Bangladesh had limited knowledge about cervical cancer risk factors and symptoms. Engaging these key decision-makers in targeted health education is vital to improve screening uptake. Conduction of future research to identify and address screening barriers is also essential for effective prevention efforts.