Knowledge and perspectives of the new National Cervical Screening Program: a qualitative interview study of North Queensland women—‘I could be that one percent’

ObjectivesTo investigate women’s understanding and attitudes towards the National Cervical Screening Program (NCSP) and to explore methods to improve screening participation.DesignSemi-structured face-to-face interviews were conducted through convenience and snowball sampling. Thematic analysis occurred using the interpretivist framework.SettingA private general practice in North Queensland.ParticipantsWomen between the ages of 18 and 74 who attended the general practice were eligible to participate. Fourteen women between 20 and 58 years old were interviewed.ResultsParticipants were concerned that the new NCSP would miss cancer due to longer screening intervals and reliance on primary human papilloma virus (HPV) testing. They believed that young women are at increased risk of cervical cancer, due to perceived HPV vaccine ineffectiveness and parent objection to vaccination. Most participants were not agreeable to self-sampling and preferred their doctor to perform screening. Personal and practitioner beliefs influenced a woman’s screening participation. Personal factors include being healthy for themselves and their family, previous abnormal smears and family history of cancer. Emphasis was placed on feeling ‘comfortable’ with their practitioner which included patient rapport and gender preference. Proposed methods to improve cervical screening included education programmes, advertising campaigns, general practitioner interventions and improving accessibility.ConclusionsIt is apparent that women are hesitant about the new NCSP. However, when provided with additional information they were more amenable to the changes. This highlights the need to improve awareness of cervical screening and the new NCSP.

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Women’s experiences of the renewed National Cervical Screening Program in Australia 12 months following implementation: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-039041 ◽

2020 ◽

Vol 10 (7) ◽

pp. e039041 ◽

Cited By ~ 1

Author(s):

Rachael H Dodd ◽

Olivia A Mac ◽

Kirsten J McCaffery

Keyword(s):

Screening Program ◽

Cervical Screening ◽

Test Results ◽

Women’S Experiences ◽

Women's Experiences ◽

Hpv Status ◽

Increased Risk ◽

Qualitative Interview Study ◽

History Of ◽

Abnormal Results

ObjectiveTo explore women’s experiences of the renewed National Cervical Screening Program in Australia from the perspective of women who have received different human papillomavirus (HPV) test results. Women aged 25 to 74 are now screened every 5 years with primary HPV screening.DesignQualitative interview study.SettingAustralia.ParticipantsWomen in Australia aged 25 to 74 who reported participating in cervical screening since December 2017, purposively sampled by test result (HPV positive, HPV negative and HPV status unknown).Methods26 interviews with women aged 25 to 74 were conducted and analysed thematically.ResultsThree main themes emerged: knowledge and attitudes about the programme changes, information dissemination, the meaning and responses to test results and the new cervical screening test (CST). Some women showed little awareness of the changes, but others understood that HPV is detected earlier than abnormal cells. Some expressed positive attitudes towards the CST and were not anxious about less frequent screening. Most women envisaged the changes would have minimal impact on their screening behaviour. Women mainly wanted more information about the changes and the possible results from the new CST. Overall women could recall their HPV results and understand the implications for future cervical screening. Anxiety about being at ‘increased risk’ was more apparent in women who were HPV positive without history of abnormal results.ConclusionsWomen show some understanding of HPV and the new CST, but more written and public communication about the changes and possible results are warranted. Efforts are needed to ensure that women who are HPV positive without history of abnormal results receive the information needed to alleviate anxiety.

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What do women know about breast density? A public screening program perspective

10.1101/2020.04.02.20048371 ◽

2020 ◽

Author(s):

Monique Robertson ◽

Ellie C Darcey ◽

Evenda K Dench ◽

Louise Keogh ◽

Kirsty McLean ◽

...

Keyword(s):

Breast Cancer ◽

Breast Density ◽

Screening Program ◽

Mammographic Screening ◽

Descriptive Data ◽

Additional Information ◽

Dense Breasts ◽

Increased Risk ◽

Main Message ◽

First Time

AbstractBackgroundThis study assesses knowledge of breast density, one of breast cancer’s strongest risk factors, in women attending a public mammographic screening program in Western Australia that routinely notifies women if they have dense breasts.MethodsSurvey data was collected from women who were notified they have dense breasts and women who had not (controls). Descriptive data analysis was used to summarize responses.ResultsOf the 6183 women surveyed, over 85% of notified women knew that breast density makes it difficult to see cancer on a mammogram (53.9% in controls). A quarter of notified women knew that having dense breasts puts women at increased risk for breast cancer (13.2% in controls). Overall, 50.1% of notified women indicated that they thought the amount of information provided was “just right” and 24.9% thought it was “too little”, particularly women notified for the first time (32.1%).ConclusionThe main message of reduced sensitivity of mammography in women with dense breasts provided by the screening program appears to be getting though. However, women are largely unaware that increased breast density is associated with increased risk. Women notified of having dense breasts for the first time could potentially benefit from additional information.

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Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17217899 ◽

2020 ◽

Vol 17 (21) ◽

pp. 7899

Author(s):

Esther E. Idehen ◽

Anni Virtanen ◽

Eero Lilja ◽

Tomi-Pekka Tuomainen ◽

Tellervo Korhonen ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Screening Program ◽

Cervical Screening ◽

Well Being ◽

Migrant Health ◽

Finnish Population ◽

Screening Participation ◽

Cancer Screening Participation

Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008–2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010–2012 and Health 2011 Survey; aged 30–64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9–66.6), Somalis 19% (16.4–21.6), Kurds 69% (66.6–71.1), and Finns 67% (63.3–69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74–1.16), Somalis 0.16 (0.11–0.22), and Kurds 1.37 (1.02–1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27–2.35), gynecological 2.47 (1.65–3.68), or other reasons 1.53 (1.12–2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.

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Marnin Business: Anthropological Interpretations of Cervical Screening among Australian Aboriginal Women

Australian Journal of Primary Health ◽

10.1071/py98019 ◽

1998 ◽

Vol 4 (2) ◽

pp. 43 ◽

Cited By ~ 8

Author(s):

Sandy Toussaint ◽

Donna Mak ◽

Judith Straton

Keyword(s):

Pap Smear ◽

Screening Program ◽

Cervical Screening ◽

Medical Practitioner ◽

Indigenous Populations ◽

Effective Prevention ◽

Australian Aboriginal ◽

Aboriginal Women ◽

And Gender ◽

Cross Cultural Education

Cervical cancer remains a significant cause of morbidity and mortality among Australian Aboriginal women despite the existence of effective prevention in the form of the Papanicolaou (Pap) Smear. An anthropological assessment of a successful cervical screening program in remote northern Australia reveals that a large proportion of women participated in the program because of the gender, skills, dedication and history of a female medical practitioner, and work practices which incorporated recognition of indigenous beliefs and practices. Without the direct involvement of the practitioner, and with health services which undermined the influence of local cultural behaviours, the program declined. Aboriginal and non-Aboriginal responses to the program are described, and it is suggested that understandings about culture and gender are crucial to the design and application of future Pap Smear programs. Committed health care practitioners, cross-cultural education, and improved socioeconomic conditions for indigenous populations, are also identified as key elements for better service delivery in regard to cervical screening and other health-related issues in Aboriginal Australia.

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“A Pap smear saved my life”: Personal experiences of cervical abnormalities shape attitudes to cervical screening renewal

Journal of Medical Screening ◽

10.1177/0969141319889648 ◽

2019 ◽

Vol 27 (4) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

Helena M Obermair ◽

Kirsten J McCaffery ◽

Rachael H Dodd

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Screening Program ◽

Cervical Screening ◽

Personal History ◽

Pap Smears ◽

Increased Risk ◽

Women's Lives ◽

History Of ◽

Screening Intervals

Objective In 2017, the Australian National Cervical Screening Program changed from two-yearly Pap smears between ages 18 and 69, to five-yearly human papillomavirus screening between ages 25 and 74 (the “Renewal”). This study investigated attitudes towards the changes, among individuals previously affected by cervical abnormalities/cervical cancer, personally or through a friend/relative. Methods We conducted a thematic analysis of comments expressing personal history or a family/friend history of cervical abnormalities/cervical cancer as a reason for opposing changes to the cervical screening program. The comments were taken from a 20% random sample of 19,633 comments posted on the “Change.org” petition “Stop May 1st Changes to Pap Smears – Save Women's Lives” in February–March 2017. Results There were 831 (20.8%) commenters who reported that they were concerned about a change in screening due to: feelings of increased personal vulnerability to cervical cancer due to their own personal history of cervical abnormalities; comparison of extended screening intervals and later age of first screening to their own experiences; and a perception of increased personal risk due to family history. Conclusion Women previously affected by cervical abnormalities or cervical cancer, personally or through a friend/relative, expressed concern about changes to cervical screening due to perceived increased risk and feeling vulnerable due to personal history.

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Health professionals’ identified barriers to trans healthcare: a qualitative interview study

British Journal of General Practice ◽

10.3399/bjgp.2021.0179 ◽

2021 ◽

pp. BJGP.2021.0179

Author(s):

Magdalena Mikulak ◽

Sara Ryan ◽

Richard Ma ◽

Sam Martin ◽

Jay Stewart ◽

...

Keyword(s):

Professional Education ◽

Health Professionals ◽

Qualitative Interview ◽

Interview Study ◽

Structural Level ◽

Snowball Sampling ◽

Gender Diverse ◽

Trans People ◽

Qualitative Interview Study ◽

And Gender

Background: Trans people face multiple barriers within healthcare. Primary care practitioners are key to trans healthcare but they often lack training in, and understanding of trans identities, and healthcare options. Few studies have examined health professionals’ understanding of the barriers that exist in healthcare for trans people. Aim: To map out barriers to providing good quality healthcare to trans and gender diverse people and ways to address them. Design and setting: A qualitative interview study involving 20 health professionals working with trans and gender diverse people. Method: Participants were recruited through purposive and snowball sampling. Data were generated using semi-structured qualitative interviews. A thematic analysis involved coding and categorising data using Nvivo software and further conceptual analysis in which developing themes were identified. Results: The study identified four barrier domains to good quality care for trans and gender diverse people: structural (related to lack of guidelines, long waiting times, shortage of specialist centres), educational (based on lack of training on trans health), cultural and social (reflecting negative attitudes towards trans people) and technical (related to information systems and technology). Conclusion: There is an urgent need to address the barriers trans and gender diverse people face in healthcare. Structural level solutions include health policy, professional education and standards; at the practice level, GPs can act as potential drivers of change in addressing the cultural and technical barriers to better meet the needs of their trans and gender diverse patients.

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Using Clinical Prompts in General Practice to Increase Participation in the National Bowel Cancer Screening Program: A Case Study Protocol

Journal of Global Oncology ◽

10.1200/jgo.18.25400 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 52s-52s

Author(s):

S. Lee ◽

B. Bowring ◽

A. Cooper ◽

M. Gardiner

Keyword(s):

General Practice ◽

Cancer Screening ◽

Screening Program ◽

Point Of Care ◽

Bowel Cancer ◽

Screening Programs ◽

Screening Participation ◽

Cancer Screening Program ◽

Number Of Patients ◽

Bowel Cancer Screening

Background: One in 12 Australians is expected to develop bowel cancer by age 85. Over 90% of bowel cancers can be successfully treated if detected early yet participation rates in the National Bowel Cancer Screening Program (NBCSP) are currently only 39%. Research shows that general practitioner (GP) recommendation is a key predictor for bowel cancer screening uptake. However the current NBCSP invitation system does not involve GPs, making it difficult for them to know when a patient has received a test kit in the mail, and in turn play a role in screening behavior. Research suggests that GP point-of-care clinical prompts, encouraging GPs to discuss screening with their patients, can increase fecal occult blood testing. Such a ´reminder´ system is integral to other screening programs in Australia, however no such system exists for the NBCSP. The George Town Medical Centre located in rural Tasmania, has recently implemented a reminder prompt for bowel cancer screening as part of its standard clinical practice. This paper describes the protocol used to implement and evaluate this service. Aim: Our research aims to determine whether a clinical prompt delivered to GPs at point-of-care, can increase bowel cancer screening participation in patients attending a rural Tasmanian general practice. Secondary aims include assessing GP and patient attitudes toward the prompt and determining socio-demographic differences in the effect of the prompt on screening participation. Methods: The clinical prompt was implemented in January 2018. Active patients turning 50 (n=106), 60 (n=141) or 70 (n=103) in 2018 were eligible to receive the prompt. The prompt was created within the practice management software and associated with each eligible patient's file. GPs were provided with information on the NBCSP as well as resources to support their conversation with patients including a sample kit. The number of patients with whom the GP discussed screening and the number of patients who completed a kit will be collected after 12 months. Screening rates of patients eligible for the prompt will be compared with patients turning 54, 64 and 74 in 2018, controlling for potential covariates including age, gender and socioeconomic status. Interviews with all GPs (n=10) and a minimum of 10 patients will be conducted to gain an understanding of attitudes toward the prompt. Results: To date the prompt has been successfully integrated into the practice and GPs have begun encouraging patients to use their NBCSP kits. Attitudes of GPs and patients toward the prompt and preliminary data on kit usage will also be presented. Conclusion: A clinical prompt in general practice may be a simple and cost effective way to increase participation in the National Bowel Cancer Screening Program. The findings from this study will have implications for the program in terms of engaging GPs in the screening invitation process. The results will further be used to inform a pilot study in Tasmania.

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Evaluation of Indicators of Cobalamin Deficiency Defined as Cobalamin-induced Reduction in Increased Serum Methylmalonic Acid

Clinical Chemistry ◽

10.1093/clinchem/46.11.1744 ◽

2000 ◽

Vol 46 (11) ◽

pp. 1744-1750 ◽

Cited By ~ 37

Author(s):

Bjørn J Bolann ◽

Jan Dag Solli ◽

Jörn Schneede ◽

Kjell A Grøttum ◽

Arne Loraas ◽

...

Keyword(s):

General Practice ◽

Methylmalonic Acid ◽

Intrinsic Factor ◽

Cobalamin Deficiency ◽

Additional Information ◽

Erythrocyte Folate ◽

Total Homocysteine ◽

And Gender ◽

Age Range

Abstract Background: Early detection of cobalamin deficiency is clinically important, and there is evidence that such deficiency occurs more frequently than previously anticipated. However, serum cobalamin and other commonly used tests have limited ability to diagnose a deficiency state. Methods: We investigated the ability of hematological variables, serum cobalamin, plasma total homocysteine (tHcy), serum and erythrocyte folate, gastroscopy, age, and gender to predict cobalamin deficiency. Patients (n = 196; age range, 17–87 years) who had been referred from general practice for determination of serum cobalamin were studied. Cobalamin deficiency was defined as serum methylmalonic acid (MMA) >0.26 μmol/L with at least 50% reduction after cobalamin supplementation. ROC and logistic regression analyses were used. Results: Serum cobalamin and tHcy were the best predictors, with areas under the ROC curve (SE) of 0.810 (0.034) and 0.768 (0.037), respectively, but age, intrinsic factor antibodies, and gastroscopy gave additional information. Conclusions: When cobalamin deficiency is suspected in general practice, serum cobalamin should be the first diagnostic test, and the result should be interpreted in relation to the age of the patient. When a definite diagnosis cannot be reached, MMA and tHcy determination will provide additional discriminative information, but MMA, being more specific, is preferable for assessment of cobalamin status.

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