Structural barriers to screening for and treatment of cervical cancer in Peru

Abstract 77 Background: Cervical cancer, a disease that is largely preventable through organized screening programs, still impacts over 500,000 women every year. Sub-Saharan Africa has the highest global incidence and mortality, largely due to lack of screening coverage. Low-cost and simple-to-implement screening technologies can potentially impact the rates of cervical cancer, if they are acceptable and scalable. As part of a trial to evaluate implementation strategies for cervical cancer prevention in western Kenya, we sought to identify the barriers and facilitators of screening, as well as opinions on a strategy employing self-collection of specimens for human papillomavirus (HPV) testing. Methods: Providers and female community members were recruited for focus groups using purposive sampling. Two focus group discussions (FGDs) with community members (n=24) and one FGD with providers (n=12) and key stakeholders were held in Migori County, Kenya, using structured guides to assess and current cervical cancer knowledge, screening practices, barriers to screening and potential strategies to facilitate screening access and uptake, including self-collected HPV testing. Results: Participants in both groups assessed the education around HPV, cervical cancer, and screening as very low in the community, and identified this lack of education as the main barrier to screening. Community members reported fear of pain and embarrassment as significant barriers to a screening pelvic exam. They also reported that lack of knowledge and discomfort among providers were significant barriers. Having undergone screening themselves or talking to someone with experience increased willingness to screen. Providers reported workload and lack of supplies and trained staff as significant barriers. Most participants in both FGDs felt that self-collection would help address barriers. Women expressed willingness to self-collect if given adequate instructions and if knowledgeable counselors were present to discuss results. Conclusion: Cervical cancer prevention strategies employing effective educational components and self-collected HPV testing could address many of the identified barriers to screening. Key findings from analysis of the focus group transcripts will be used to inform the implementation of community health campaigns. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

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Knowledge about cervical cancer prevention and psychosocial barriers to screening among Mexican women

Journal of Psychosomatic Obstetrics & Gynecology ◽

10.3109/0167482x.2013.846904 ◽

2013 ◽

Vol 34 (4) ◽

pp. 163-169 ◽

Cited By ~ 12

Author(s):

Maria Luisa Marván ◽

Yamilet Ehrenzweig ◽

Rosa Lilia Catillo-López

Keyword(s):

Cervical Cancer ◽

Cancer Prevention ◽

Cervical Cancer Prevention ◽

Mexican Women ◽

Barriers To Screening ◽

Psychosocial Barriers

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The relationship between a microfinance-based healthcare delivery platform, health insurance coverage, health screenings, and disease management in rural Western Kenya

10.21203/rs.3.rs-17000/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Molly Rosenberg ◽

James Akiruga Amisi ◽

Daria Szkwarko ◽

Dan N. Tran ◽

Becky Genberg ◽

...

Keyword(s):

Cervical Cancer ◽

Health Insurance ◽

Disease Management ◽

Insurance Coverage ◽

Healthcare Delivery ◽

Health Insurance Coverage ◽

Health Screening ◽

Structural Barriers ◽

Western Kenya ◽

Health Screenings

Abstract Introduction Structural barriers often prevent rural Kenyans from receiving healthcare and diagnostic testing. The Bridging Income Generation through grouP Integrated Care (BIGPIC) Family intervention facilitates microfinance groups, provides health screenings and treatment, and delivers education about health insurance coverage to address some of these barriers. This study evaluated the association between participation in BIGPIC microfinance groups and health screening/disease management outcomes.Methods From November 2018 to March 2019, we interviewed a sample of 300 members of two rural communities in Western Kenya, 100 of whom were BIGPIC microfinance members. We queried participants about their experiences with health screening and disease management for HIV, diabetes, hypertension, tuberculosis, and cervical cancer. We used log-binomial regression models to estimate the association between microfinance membership and each health outcome, adjusting for key covariates. We also examined the individual and joint effects of microfinance and health insurance coverage on each health outcome.Results Microfinance members were more likely to be screened for the health conditions we queried, including those provided by BIGPIC [e.g. diabetes: aPR (95% CI): 3.46 (2.60, 4.60)] and those not provided [e.g. cervical cancer: aPR (95% CI): 2.43 (1.21, 4.86)]. Only 11% had active health insurance, yet we found some trends of better disease management among microfinance group members and those with health insurance.Conclusions In rural Kenya, a microfinance program integrated with healthcare delivery may be effective at increasing health screening. Interventions designed to thoughtfully and sustainably address structural barriers to healthcare will be critical to improving the health of those living in low-resource settings.

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Reducing the Excess Burden of Cervical Cancer among Latinas

Californian Journal of Health Promotion ◽

10.32398/cjhp.v11i1.1517 ◽

2013 ◽

Vol 11 (1) ◽

pp. 45-57 ◽

Cited By ~ 13

Author(s):

Lourdes Baezconde-Garbanati ◽

Sheila T. Murphy ◽

Meghan Bridgid Moran ◽

Victoria K. Cortessis

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Los Angeles ◽

Cervical Cancer Screening ◽

Invasive Cervical Cancer ◽

Pap Test ◽

Barriers To Screening ◽

Tailored Interventions ◽

Health Promotion Interventions ◽

Culturally Tailored Interventions

Purpose: Although deaths from cervical cancer are declining, Latinas are not benefiting equally in this decline. Incidence of invasive cervical cancer among Los Angeles’, California Latinas is much higher than among non-Latina Whites (14.7 versus 8.02 per 100,000). This paper examines cervical cancer screening among Latinas. Methods: Ninety-seven women of Mexican origin participated in 12 focus groups exploring barriers to screening. Saturation was reached. Results: All participants knew what a Pap test was and most knew its purpose. More acculturated participants understood the link between HPV and cervical cancer. More recent immigrants did not. There was confusion whether women who were not sexually active need to be screened. Most frequently mentioned barriers were lack of time and concern over missing work. Lower income and less acculturated women were less likely to be aware of free/lowcost clinics. Older and less acculturated participants held more fatalistic beliefs, were more embarrassed about getting a Pap test, were more fearful of being perceived as sexually promiscuous, and were more fearful of receiving disapproval from their husbands. Conclusions: Latinas are informed regarding cervical cancer screening; rather they encounter barriers such as a lack of time, money and support. Health promotion interventions can be enhanced via peer-to-peer education, by addressing barriers to cervical cancer screening with in-language, culturally tailored interventions, and working with clinics on systemic changes, such as extended clinic hours.

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The relationship between a microfinance-based healthcare delivery platform, health insurance coverage, health screenings, and disease management in rural Western Kenya

10.21203/rs.3.rs-17000/v2 ◽

2020 ◽

Author(s):

Molly Rosenberg ◽

James Akiruga Amisi ◽

Daria Szkwarko ◽

Dan N. Tran ◽

Becky Genberg ◽

...

Keyword(s):

Cervical Cancer ◽

Health Insurance ◽

Disease Management ◽

Insurance Coverage ◽

Healthcare Delivery ◽

Health Insurance Coverage ◽

Health Screening ◽

Structural Barriers ◽

Western Kenya ◽

Health Screenings

Abstract Background: Structural barriers often prevent rural Kenyans from receiving healthcare and diagnostic testing. The Bridging Income Generation through grouP Integrated Care (BIGPIC) Family intervention facilitates microfinance groups, provides health screenings and treatment, and delivers education about health insurance coverage to address some of these barriers. This study evaluated the association between participation in BIGPIC microfinance groups and health screening/disease management outcomes.Methods: From November 2018 to March 2019, we interviewed a sample of 300 members of two rural communities in Western Kenya, 100 of whom were BIGPIC microfinance members. We queried participants about their experiences with health screening and disease management for HIV, diabetes, hypertension, tuberculosis, and cervical cancer. We used log-binomial regression models to estimate the association between microfinance membership and each health outcome, adjusting for key covariates.Results: Microfinance members were more likely to be screened for most of the health conditions we queried, including those provided by BIGPIC [e.g. diabetes: aPR (95% CI): 3.46 (2.60, 4.60)] and those not provided [e.g. cervical cancer: aPR (95% CI): 2.43 (1.21, 4.86)]. Microfinance membership had weaker and non-statistically significant associations with health insurance uptake and disease management outcomes. Conclusions: In rural Kenya, a microfinance program integrated with healthcare delivery may be effective at increasing health screening. Interventions designed to thoughtfully and sustainably address structural barriers to healthcare will be critical to improving the health of those living in low-resource settings.

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Knowledge, attitudes, and practices regarding cervical cancer screening among women in metropolitan Lima, Peru: a cross-sectional study

BMC Women s Health ◽

10.1186/s12905-021-01431-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michelle M. Pieters ◽

Rae Jean Proeschold-Bell ◽

Emily Coffey ◽

Megan J. Huchko ◽

Lavanya Vasudevan

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cross Sectional Study ◽

Cross Sectional ◽

Attitudes And Practices ◽

Barriers To Screening ◽

Screening Services ◽

Knowledge And Attitude ◽

Screening Behaviors

Abstract Background Cervical cancer is a leading cause of cancer deaths among women of reproductive age in Peru. Screening and early identification of pre-cancerous lesions are a cornerstone of the cervical cancer prevention strategy. Yet, there is limited literature on barriers to screening among Peruvian women. In this cross-sectional study, we aimed to examine Peruvian women’s knowledge, attitudes, and practices regarding cervical cancer screening and identify possible reasons for the gap between knowledge and screening. Methods The study was conducted in metropolitan Lima from June–August 2019. We purposefully recruited 12 women who had previously been screened, and 12 who had never been screened for cervical cancer. The women completed a 40-question knowledge and attitude survey and an in-depth interview about barriers to screening. Descriptive analysis was used to calculate a knowledge and attitude score and qualitative analysis was guided by the Health Belief Model constructs. Results Previously screened participants had greater knowledge of cervical cancer symptoms, risk factors, and prevention (mean score = 28.08, S.D. = 4.18) compared to participants who had never been screened (mean score = 21.25, S.D. = 6.35). Both groups described lack of priority and embarrassment as barriers to cervical cancer screening. For participants who had never been screened before, major barriers included the fear of a cancer diagnosis and lack of information about screening services. Pregnancy, unusual gynecological symptoms and encouragement from friends and family were cues to action for participants seeking screening. Most participants in both groups recognized the benefits of getting screened for cervical cancer. Being previously screened increased participants’ self-efficacy for engaging in screening behaviors again. Misconceptions regarding screening procedures and cervical cancer were also noted as barriers for participants accessing screening services. Conclusions Improving knowledge and awareness about cervical cancer and screening programs may improve screening behaviors among women. Targeting women who have never been screened before and addressing their fears and concerns around embarrassment may be other areas for intervention. Misconceptions that deter women from screening services are an important issue that should be addressed in order to increase the number of women who get timely screenings.

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The relationship between a microfinance-based healthcare delivery platform, health insurance coverage, health screenings, and disease management in rural Western Kenya

BMC Health Services Research ◽

10.1186/s12913-020-05712-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Molly Rosenberg ◽

James Akiruga Amisi ◽

Daria Szkwarko ◽

Dan N. Tran ◽

Becky Genberg ◽

...

Keyword(s):

Cervical Cancer ◽

Health Insurance ◽

Disease Management ◽

Insurance Coverage ◽

Healthcare Delivery ◽

Health Insurance Coverage ◽

Health Screening ◽

Structural Barriers ◽

Western Kenya ◽

Health Screenings

Abstract Background Structural barriers often prevent rural Kenyans from receiving healthcare and diagnostic testing. The Bridging Income Generation through grouP Integrated Care (BIGPIC) Family intervention facilitates microfinance groups, provides health screenings and treatment, and delivers education about health insurance coverage to address some of these barriers. This study evaluated the association between participation in BIGPIC microfinance groups and health screening/disease management outcomes. Methods From November 2018 to March 2019, we interviewed a sample of 300 members of two rural communities in Western Kenya, 100 of whom were BIGPIC microfinance members. We queried participants about their experiences with health screening and disease management for HIV, diabetes, hypertension, tuberculosis, and cervical cancer. We used log-binomial regression models to estimate the association between microfinance membership and each health outcome, adjusting for key covariates. Results Microfinance members were more likely to be screened for most of the health conditions we queried, including those provided by BIGPIC [e.g. diabetes: aPR (95% CI): 3.46 (2.60, 4.60)] and those not provided [e.g. cervical cancer: aPR (95% CI): 2.43 (1.21, 4.86)]. Microfinance membership was not significantly associated with health insurance uptake and disease management outcomes. Conclusions In rural Kenya, a microfinance program integrated with healthcare delivery may be effective at increasing health screening. Interventions designed to thoughtfully and sustainably address structural barriers to healthcare will be critical to improving the health of those living in low-resource settings.

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A Qualitative Study of Provider Perspectives of Structural Barriers to Cervical Cancer Screening Among First Nations Women

Women s Health Issues ◽

10.1016/j.whi.2013.06.005 ◽

2013 ◽

Vol 23 (5) ◽

pp. e319-e325 ◽

Cited By ~ 28

Author(s):

Marion Maar ◽

Ann Burchell ◽

Julian Little ◽

Gina Ogilvie ◽

Alberto Severini ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Qualitative Study ◽

First Nations ◽

Cervical Cancer Screening ◽

Structural Barriers ◽

Provider Perspectives ◽

First Nations Women

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The relationship between a microfinance-based healthcare delivery platform, health insurance coverage, health screenings, and disease management in rural Western Kenya

10.21203/rs.3.rs-17000/v4 ◽

2020 ◽

Author(s):

Molly Rosenberg ◽

James Akiruga Amisi ◽

Daria Szkwarko ◽

Dan N. Tran ◽

Becky Genberg ◽

...

Keyword(s):

Cervical Cancer ◽

Health Insurance ◽

Disease Management ◽

Insurance Coverage ◽

Healthcare Delivery ◽

Health Insurance Coverage ◽

Health Screening ◽

Structural Barriers ◽

Western Kenya ◽

Health Screenings

Abstract Background: Structural barriers often prevent rural Kenyans from receiving healthcare and diagnostic testing. The Bridging Income Generation through grouP Integrated Care (BIGPIC) Family intervention facilitates microfinance groups, provides health screenings and treatment, and delivers education about health insurance coverage to address some of these barriers. This study evaluated the association between participation in BIGPIC microfinance groups and health screening/disease management outcomes.Methods: From November 2018 to March 2019, we interviewed a sample of 300 members of two rural communities in Western Kenya, 100 of whom were BIGPIC microfinance members. We queried participants about their experiences with health screening and disease management for HIV, diabetes, hypertension, tuberculosis, and cervical cancer. We used log-binomial regression models to estimate the association between microfinance membership and each health outcome, adjusting for key covariates.Results: Microfinance members were more likely to be screened for most of the health conditions we queried, including those provided by BIGPIC [e.g. diabetes: aPR (95% CI): 3.46 (2.60, 4.60)] and those not provided [e.g. cervical cancer: aPR (95% CI): 2.43 (1.21, 4.86)]. Microfinance membership was not significantly associated with health insurance uptake and disease management outcomes. Conclusions: In rural Kenya, a microfinance program integrated with healthcare delivery may be effective at increasing health screening. Interventions designed to thoughtfully and sustainably address structural barriers to healthcare will be critical to improving the health of those living in low-resource settings.

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