Utilization Of Screening Services Research Articles

Knowledge, Awareness and Prevention of Cervical Cancer among Women Attending a Tertiary Care Hospital in Puducherry, India.

Cervical cancer is one of the most common cancers among women worldwide, with highest mortality in India. The incidence and mortality of cervical cancer can be reduced by screening women for precancerous lesion and by administration of human papilloma virus vaccine to adolescent girls. Knowledge of the women about cervical cancer and awareness about its prevention are the key factors that determine their utilization of screening services. A cross sectional survey of women attending Gynaecology Out-Patient Department (OPD) in a tertiary care hospital in Puducherry was conducted. Information about their knowledge of cervical cancer, awareness of its prevention and their socio demographic characters were collected. Mean age of the study population was 40.45 ± 12 years. Less than half of the study population (178, 44.5%) knew about cervical cancer. Less than one-fourth of the population knew about screening services for prevention of cervical cancer, and majority (389, 97.2%) were not aware of vaccination as prevention for cervical cancer. Our study population shows poor knowledge about cervical cancer and is unaware of the concept of prevention. Hence extensive health education to the public is needed regarding cervical cancer and its prevention.

Utilization of Cervical Cancer Screening Services and Trends in Screening Positivity Rates in a ‘Screen-And-Treat’ Program Integrated with HIV/AIDS Care in Zambia

BackgroundIn the absence of stand-alone infrastructures for delivering cervical cancer screening services, efforts are underway in sub-Saharan Africa to dovetail screening with ongoing vertical health initiatives like HIV/AIDS care programs. Yet, evidence demonstrating the utilization of cervical cancer prevention services in such integrated programs by women of the general population is lacking.MethodsWe analyzed program operations data from the Cervical Cancer Prevention Program in Zambia (CCPPZ), the largest public sector programs of its kind in sub-Saharan Africa. We evaluated patterns of utilization of screening services by HIV serostatus, examined contemporaneous trends in screening outcomes, and used multivariable modeling to identify factors associated with screening test positivity.ResultsBetween January 2006 and April 2011, CCPPZ services were utilized by 56,247 women who underwent cervical cancer screening with visual inspection with acetic acid (VIA), aided by digital cervicography. The proportion of women accessing these services who were HIV-seropositive declined from 54% to 23% between 2006–2010, which coincided with increasing proportions of HIV-seronegative women (from 22% to 38%) and women whose HIV serostatus was unknown (from 24% to 39%) (all p-for trend<0.001). The rates of VIA screening positivity declined from 47% to 17% during the same period (p-for trend <0.001), and this decline was consistent across all HIV serostatus categories. After adjusting for demographic and sexual/reproductive factors, HIV-seropositive women were more than twice as likely (Odds ratio 2.62, 95% CI 2.49, 2.76) to screen VIA-positive than HIV-seronegative women.ConclusionsThis is the first ‘real world’ demonstration in a public sector implementation program in a sub-Saharan African setting that with successful program scale-up efforts, nurse-led cervical cancer screening programs targeting women with HIV can expand and serve all women, regardless of HIV serostatus. Screening program performance can improve with adequate emphasis on training, quality control, and telemedicine-support for nurse-providers in clinical decision making.

PS1-54: Clinical Perspectives on Under- and Overutilization of Cervical Cancer Screening Services

Background/Aims The underutilization of cancer screening services is an on-going concern to program planners and policy makers; such underutilization is common among under-insured, ethnic- and language-minority populations and is associated with advanced stage of disease detection, limited treatment options, and diminished survival. At the same time, growing research interest has focused on the over-utilization of cancer screening services. We sought to gather the perceptions of clinic personnel at Latino-serving federally qualified health centers about patients’ utilization of screening services for cervical cancer.

PS1-55: Strategies and Opportunities to STOP Colon Cancer in Priority Populations: Pragmatic Study Design and Methods

Background/AimsColorectal cancer (CRC) is the second leading cause of cancer death in the United States. One key factor thought to explain the relative high mortality is low utilization of screening services for CRC. Data from the National Health Interview Survey show that, in 2010, 41% of adults aged 50–75—nearly 35 million people—were not up-to-date with CRC screening. Almost 30% of eligible adults have never had any type of CRC screening. Screening rates are alarmingly low among certain population subgroups, including those with minimal education, low income, or having no health insurance. The subgroups least likely to be up-to-date with screening are those who receive preventive care services, including CRC screening, at Federally Qualified Health Centers (FQHCs). Strategies and Opportunities to STOP Colorectal Cancer in Priority Populations (STOP CRC) is a collaborative partnership between health research institutions and FQHCs to raise rates of CRC screening in FQHCs. STOP CRC uses a pragmatic design to evaluate health systems-based approaches to CRC screening among age-eligible patients who receive care at FQHCs.MethodsSTOP CRC has two phases. In Phase I (Year 01), we will pilot-test an evidence-based approach to improve participation in CRC screening in two FQHCs. This phase will include an assessment of the intervention’s feasibility, effectiveness, and cost. In Phase II (Years 02–05), we will conduct a comparative effectiveness pragmatic clinical trial, using a mixed-methods approach to evaluate the adoption, implementation, and maintenance of our CRC screening program. Throughout the project, we will involve a diverse planning advisory group of FQHC clinicians and patients, community representatives, state policy makers, and researchers, using principles of Community-Based Participatory Research.ConclusionsSTOP CRC is a large-scale approach to raising rates of colorectal cancers screening in FQHCs. STOP CRC is expected to expand meaningful use of electronic health information; synergistically meet national goals to improve cancer screening rates, address health disparities, reduce health care costs; and act as a catalyst for future systems-based approaches to improve care delivery in FQHCs and other health systems.

P3.074 Men’s Preferences For STD Screening Programs: Initial Prevalence of STD in the Study Population

Background STD control efforts in the US and western Europe have had less than desirable impact, in part due to an inability to reach populations of men at risk for these diseases. We are currently conducting a study of programme options, including self-collection of specimens and community based access to test kits, that would increase men’s utilisation of screening services. Methods Using peer-incentivized referral, a type of snowball sampling, beginning with men attending an STD clinic in the US, we are interviewing men in the community to determine the optimal combination of programme features that would encourage asymptomatic STD screening. To demonstrate the relevance of these men’s opinions in terms of reaching a high prevalence group, they were tested for STDs at the time of their interview. Urine samples were collected and rectal sampling was offered to all men. STD testing was performed using nucleic acid amplification testing. Results To date, 25 men from the community have been enrolled and interviewed. 40% of participants were black, 40% were white, and 20% were Hispanic. The median age of participants is 24. Urine samples were available for testing from all 25 men and rectal samples were available from 5 men. 4 (16%) men tested positive for a STD: 2 (8%) men tested positive for chlamydia and 2 (8%) men tested positive for trichomonas. No gonococcal infections were detected. None of the rectal samples had a positive result. Conclusion While these results represent pilot data, the study is ongoing and given the nature of snowball sampling, the sample size will expand rapidly. Early prevalence rates are higher than have been reported in nationally representative surveys in the US. This suggests that we are recruiting from a population of interest to gather opinions about preferred screening options.

Perceptions of Under and Overutilization of Cervical Cancer Screening Services at Latino-Serving Community Health Centers

We sought to gather the perceptions of clinic personnel at Latino-serving Federally Qualified Health Centers (FQHCs) about patients' utilization of screening services for cervical cancer. We conducted one-on-one interviews among 17 clinic personnel at four Latino-serving FQHCs in Oregon. The clinic personnel we interviewed observed both under and overutilization of cervical cancer screening services. Clinic personnel estimated that 20-60% of eligible patients were underscreened for cervical cancer, with 30% the most commonly cited percentage. Underscreening was thought to occur among low-income, underinsured, and undocumented patients. Overscreening for cervical cancer was estimated to occur in 10-50% of eligible patients, with 10% the most frequently cited proportion. Overscreening was thought to occur among women younger than age 21 and women with a recent pregnancy. Our findings may inform future efforts to promote guideline-appropriate cancer screening and coordinated follow-up care.

Health and Prevention among East African Women in the U.S.

African-born individuals in the U.S. face significant health challenges, including low utilization of preventive screening services. Using a community-based participatory research framework, we describe preliminary efforts at establishing a collaborative relationship with the East African communities of San Diego, identifying salient community health needs, and developing a framework for disseminating information and addressing identified health gaps. To this end, 40 East African-born women participated in focus groups with the purpose of eliciting community perspectives on U.S. health care services, beliefs about preventive screening, and to garner recommendations for future outreach. Qualitative analyses identified participants' desire to engage in primary prevention techniques that incorporated best practices from their home countries and the U.S., and the need for health education programs to provide information on increasingly prevalent chronic diseases. The findings are discussed in connection with continued community-engaged efforts and the implications for health and resettlement policies to reduce inequities disfavoring resettled refugees.

Utilization of screening services for cancer of the cervix in Makurdi, Nigeria

Background: Cancer of the cervix is a leading cause of death due to female genital malignancies in developing countries. Early detection through cervical screening is crucial for prevention and treatment. Objective: To determine the awareness and utilization of screening services for cancer of the cervix amongst women in Makurdi. Methods: A cross-sectional study using interviewer administered questionnaires to women attending the outpatient gynecological clinic at the Benue State University Teaching Hospital, Makurdi, North-Central, Nigeria between March and August 2012. Results: The average age and parity of respondents was 35±11.2 years and 2.4±2.3 respectively. Most 48.3% were civil servants, Married 89.0% and had post-secondary education (64.5%). About 65% were aware of cancer of the cervix. Fifty one percent were aware of cervical cancer screening. Main source of information was through the mass media (35.5%). Among the ‘aware’ group for screening services, only 13.6% had utilized the services (X 2 =12.2, p=0.0004, OR=3.7). Overall, only 7% of the study population have ever screened for the disease. Education significantly affected awareness for both cancer of the cervix (p=0.0001) and screening services (P=0.0002). Reasons for non utilization of services were; Ignorance, absence of screening centres, perceived non necessity, faith in God, prohibitive cost, physician’s non recommendation among others. Conclusion: Most women were aware of cancer of the cervix and screening for the disease but utilization of screening services was very poor. Services should be made available, accessible and affordable to the women while sustaining awareness campaigns.

Factors Influencing Prenatal Screening for Down’s Syndrome

This article attempts to identify the factors that influence prenatal screening uptake. About 1400 postdelivery, still-hospitalized women in 15 hospitals in Zhejiang Province were surveyed from November to December 2007. Univariate analysis was used to describe screening uptake and compare respondents with different characteristics. Stepwise logistic regression (forward) was then used to assess the relative strength of those influencing factors. It was found that 49.7% of the respondents received maternal serum prenatal screening. The factors that influenced prenatal screening service utilization included place of residence (urban vs countryside), migrant versus nonmigrant status, attitudes toward screening, frequency of routine prenatal checkups, and doctor's advice. Migrants had a lower probability of getting screened than permanent residents (odds ratio = 0.456; 95% confidence interval [CI] = 0.31, 0.68). The screening uptake probability of women with doctor's advice was 12 times as great as that of women without doctor's advice (95% CI = 7.91, 18.69).

Pre-screening counseling in cervical cancer prevention: Implications for nursing

Cervical cancer is the second most common cancer among women worldwide, with an estimated 529,409 new cases and 274,883 deaths in 2008, about 86% of the cases occur in developing countries, representing 13% of female cancers (IARC, GLOBOCAN, 2008). All sexually active women are at risk for the development of this disease and it is one of the leading causes of death for middle-aged women in the developing world. It is almost completely preventable, if precancerous lesions are identified and treated early (Carr and Sellors, 2004; Ayinde and Omigbodun, 2003). Uptake of screening services has remained low. Pre-screening counseling (PSC) could help increase compliance with screening schedule. Various studies identified ignorance/lack of knowledge, inappropriate/cultural beliefs about the illness; apprehension, etc., as barriers to utilization of screening services (Gharoro andIkeanyi, 2006; Mutyaba et al., 2007). Also, a positive correlation between Pap test awareness and utilization was reported by Gharoro and Ikeanyi (2006). Pre-screeningcounseling is very important in order to achieve the purpose of screening. counseling is a two way dialogue that enables a woman gain knowledge and improve her ability to make informed choice about type of screening procedure she will undertake, being fully aware of the risks and benefits of such. This was explained using the theory of planned behaviour. The nurse/midwife should be well versed in cervical cancer natural history, prevention and management in order to counsel effectively. She should also avail herself of every opprtunity to counsel and inform women about cervical cancer. Key words: Counseling, screening, cervical canccer, prevention, women

Utilization of preventive care services and their effect on cardiovascular outcomes in the United States

ObjectiveTo describe and analyze utilization of preventive care services and their effect on cardiovascular outcomes in the United States.MethodsData from the 2007 Medical Expenditure Panel Survey (MEPS) were used to analyze utilization of preventive care services and their effect on cardiovascular outcomes. Recommendations by the Seventh Report of the Joint Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and the National Cholesterol Education Program were used to determine appropriate levels of preventive care utilization. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable, while age, gender, race, ethnicity, insurance status, and perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, while a multivariate logistic regression model was built to predict odds of utilizing appropriate levels of preventive services.ResultsTotal number of adult respondents for which data were available for blood pressure checkup and cholesterol checkup was 20,523 and 15,784, respectively. Overall, MEPS respondents were found to adhere to guideline recommendations for preventive care utilization. Multivariate logistic regression showed that odds of utilization of preventive care services were higher for elderly patients (age >65 years) for blood pressure (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.92–2.97) and cholesterol (OR = 3.05, 95% CI: 2.18–4.27) preventive services compared with younger population (age 18–54 years). Males had much lower odds of getting blood pressure (OR = 0.33, 95% CI: 0.30–0.37) and cholesterol (OR = 0.59, 95% CI: 0.50–0.70) checks done compared with females. Odds of utilization were nearly similar for all races. Uninsured had lower odds for blood pressure (OR = 0.26, 95% CI: 0.23–0.30) and cholesterol (OR = 0.30, 95% CI: 0.24–0.39) checks compared with privately insured people. Asians had lower odds of getting blood pressure checkups compared to Whites (OR = 0.49, 95% CI: 0.39–0.63). Similar trends were recorded for other covariates such as race and perceived health status.ConclusionThe study was successful in identifying existing age, race, income, and insurance-status related disparities in preventive care utilization within a US population.

How Sexual History and Knowledge of Cervical Cancer and Screening Influence Chinese Women's Screening Behavior in Mainland China

Accurate information and knowledge about cervical cancer and screening importantly influence women's cervical screening participation. Sexual behavior plays a crucial role in human papillomavirus transmission and the subsequent development of cervical cancer. Indeed, the uptake of cervical screening among Chinese women is relatively low compared with other populations. To understand women's attendance pattern of cervical screening, knowledge about cervical cancer and screening, and factors influencing their utilization of cervical screening in mainland China. A cross-sectional survey was conducted to collect women's participation pattern for cervical screening, knowledge about cervical cancer and screening, sociodemographic information and sexual history, and barriers to participating in cervical screening. Married women and women who had had their first intercourse after the age of 21 years were significantly more likely to participate in screening. Screened women demonstrated a higher level of knowledge about the cervical screening procedure compared with nonscreened women (P = .002). Also, the scores of individual items such as women's knowledge of cervical screening and risk factors were significantly different between the 2 groups. The current system of free physical examinations for women in mainland China is a major motivator for women's utilization of cervical screening services. Chinese women's marital status and sexual history influence their screening behavior. Unmarried women who have ever had sex should be encouraged to have cervical screening, and consistent and appropriate information about the preventive nature of cervical screening and risk factors associated with cervical cancer should be provided to the general public.

Screening Mammography: A Cross-Sectional Study to Compare Characteristics of Women Aged 40 and Older From the Deep South Who Are Current, Overdue, and Never Screeners

We sought to identify unique barriers and facilitators to breast cancer screening participation among women aged 40 and older from Mississippi who were categorized as current, overdue, and never screeners. Cross-sectional data from a 2003 population-based survey with 987 women aged 40 and older were analyzed. Chi-square analysis and multinomial logistic regression examined how factors organized under the guidance of the Model of Health Services Utilization were associated with mammography screening status. Nearly one in four women was overdue or had never had a mammogram. Enabling factors, including poor access to care (no annual checkups, no health insurance) and to health information, lack of social support for screening, and competing needs, were significantly associated with being both overdue and never screeners. Pertaining to factors unique to each screening group, women were more likely to be overdue when they had no usual source of health care and believed that treatment was worse than the disease. In turn, women were more likely to be never screeners when they were African American, lacked a provider recommendation for screening, and held the fatalistic view that not much could be done to prevent breast cancer. Similar and unique factors impact utilization of mammography screening services among women. Those factors could inform efforts to increase screening rates.

Knowledge and Utilization of Cervical Cancer Screening Services among Nigerian Students

This study assessed the knowledge of cervical cancer, one of the leading causes of cancer deaths in women, and current screening practices among female students at the University of Ibadan, Nigeria. The study was descriptive and cross-sectional. A multi-stage sampling technique was used to select 350 respondents. Semi-structured questionnaires were used. Nearly two-thirds (63%) of respondents have heard about cervical cancer. Knowledge of predisposing factors for the disease was high for early exposure to sex (82%) and sex with multiple partners (70.6%). Only 15.7% knew that abnormal menstrual bleeding is symptomatic of cervical cancer; 14.9% perceived themselves to be susceptible while 2.6% had ever screened for the disease. Though awareness of cervical cancer and its predisposing factors was high, the perception of self-vulnerability and utilization of screening services were extremely low. Intense and integrated educational programs are urgently needed for this group.

Knowledge of cervical cancer and utilization of pap smear among patients in a tertiary Centre in South West Nigeria

Objective: The objective of the study was to determine the knowledge of cervical cancer, patients' life style in relation to risk factors for cervical cancer and utilization of Pap smear as a screening method for cervical cancer.Materials and Method: A structured questionnaire incorporating demographic, life style and knowledge of cervical cancer and its prevention was distributed to 500 consecutive women attending the gynaecological out- patient clinic of the Obafemi Awolowo University Teaching Hospital.Results: 437 (87.4%) respondents completed the questionnaire. The mean age of respondents was 37.1 years (17-70). Knowledge of cervical cancer was low, as 62.7% of the respondents had never heard of cervical cancer. Also very few had actually done Pap smear.Conclusion: Knowledge of cervical cancer is poor among Nigerian women and there is poor utilization of screening services&#x0D;

Targeting services to reduce social inequalities in utilisation: an analysis of breast cancer screening in New South Wales

BackgroundMany jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia.MethodsUsing the 1997 and 1998 NSW Health Surveys we estimated probit models on the probability of having had a screening mammogram in the last two years for all women aged 40–79. The models examined the relative importance of socio-economic and geographic factors in predicting screening behaviour in three different needs groups – where needs were defined on the basis of a woman's age.ResultsWe find that women in higher socio-economic groups are more likely to have been screened than those in lower groups for all age groups. However, the socio-economic effect is significantly less among women who were in the actively targeted age group.ConclusionThis indicates that recruitment and follow-up was associated with a modest reduction in social inequalities in utilisation although significant income differences remain.

An ethnographic study of cervical cancer among women in rural Kenya: is there a folk causal model?

This article assesses knowledge, attitudes, and practices regarding cervical cancer among rural women of Kenya. One hundred and sixty women (mean age 37.9 years) who sought various health care services at Tigoni subdistrict hospital, Limuru, Kenya, were interviewed using a semistructured questionnaire. In addition, three focus group discussions (25 participants) were held, five case narratives recorded, and a free list of cervical cancer risk factors obtained from a group of 41 women respondents. All women were aged between 20 and 50 years. About 40% knew cervical cancer, although many still lack factual information. A history of sexually transmitted diseases (61.5%), multiple sexual partners (51.2%), and contraceptive use (33%) were identified as risk factors. Other factors mentioned include smoking, abortion, and poor hygiene standards. High parity, early sexual debut, and pregnancy were not readily mentioned as risk factors. We propose a folk causal model to explain the link between these factors and cervical cancer. Lack of knowledge constrains utilization of screening services offered at the clinics. Consequently, respondents support educating women as a way to tackling issues on cervical cancer. It is recommended that an integrated reproductive health program that addresses comprehensively women's health concerns be put in place.

Cancer preventive screening: A cross-border comparison of United States and Canadian Chinese women

Objective To compare screening mammography and Pap testing among Chinese women in Seattle, Washington to Vancouver, and British Columbia. Methods Using community-based sampling methods, trilingual female interviewers surveyed Chinese women in Seattle and Vancouver. Multiple preventive health behaviors and health care access variables were assessed. Mammography analysis included 409 women aged 50–74 years. Pap testing analysis included 973 women aged 20–69 years. Main outcome measures were ever use and use in the last 2 years of screening mammography and Pap testing. Results Chinese women in Vancouver were younger, more educated and fluent in English. Unadjusted rates of mammography and Pap testing were similar between the two cities. Provider type was consistently associated with screening in both cities; female providers had the highest rates and Chinese male providers the lowest. Adjusted logistic regression analysis demonstrated similar mammography use in the two cities. However, for Pap testing, women in Seattle had higher odds of screening compared to Vancouver. Conclusion Despite universal health care coverage and baseline characteristics typically associated with greater utilization of preventive screening services, Chinese women in Vancouver did not have higher rates of screening mammography and Pap testing compared to Chinese women in Seattle.

Stage of breast cancer diagnosis among medically underserved women in California receiving mammography through a state screening program.

This study describes breast cancer stage at diagnosis among California women receiving mammograms through a state-administered screening program in comparison to other California women. Linked data from California-administered screening programs and the California Cancer Registry were used to identify participants diagnosed with breast cancer between 1994 and 2000. Logistic regression was used to compare the adjusted likelihood of late stage disease among program participants (categorized into four subgroups based on the timing and frequency of mammograms) to non-participants in California diagnosed during the same time period. Program participants were significantly more likely than non-participants to be diagnosed at late stage (adjusted OR 1.2; 95% CI 1.1, 1.3), with the highest risk occurring among those diagnosed 0-1 months after initial mammogram (adjusted OR 1.8; 95% CI 1.6, 2.1). The stage distribution among regularly screened participants was similar to non-participants (adjusted OR of late stage disease 0.9; 95% CI 0.7, 1.1). Although program participants were more likely to be diagnosed at late stage than non-participants, their stage distribution was distinctly different according to their pattern of mammography utilization. This likely reflects differential utilization of program diagnostic and screening services, which should be taken into account in program evaluation.

Cultural feasibility assessment of tuberculosis prevention among persons of Haitian origin in South Florida.

A cultural feasibility study was conducted among persons of Haitian origin in South Florida to identify factors which might influence utilization of screening and treatment services for latent tuberculosis infection in this population. Five focus group interviews conducted among men and women explored cultural beliefs and practices related to TB, barriers and incentives to screening, and approaches to increasing treatment adherence. Key findings include the influence of social stigma and fears related to confidentiality of medical status as disincentives to screening. Cultural sensitivity to being labeled as a high risk group for these infections also emerged as a critical variable. Community-based approaches to health education for this population are described. Study recommendations include the planning of programs based on a service delivery model that stresses respect and personal attention to clients, improved interpersonal skills of health center staff, and coordination of services between private doctors and public health agencies.