Improving Cancer Screening Among Women With Mobility Impairments: Randomized Controlled Trial of a Participatory Workshop Intervention

Article (PDF Available)inAmerican journal of health promotion: AJHP 26(4):212-6 · March 2012with42 Reads
DOI: 10.4278/ajhp.100701-ARB-226 · Source: PubMed
Abstract
To assess the efficacy of an intervention to promote mammography and Papanicolaou (Pap) testing among women with mobility impairments overdue for screenings. Randomized controlled trial. Urban and suburban Oregon. Women aged 35 to 64 with mobility impairments who reported not receiving a Pap test in the past 3 years and/or mammogram (if age >40 years) in the last 2 years were eligible. A total of 211 women were randomized, and 156 completed the study (26% attrition). The majority were not employed and reported annual income <$10,000. The Promoting Access to Health Services (PATHS) program is a 90-minute, small-group, participatory workshop with 6 months of structured telephone support, based on the health belief model and social cognitive theory. Perceived susceptibility to breast and cervical cancer, perceived benefits of and self-efficacy for screening, intention to be screened, and self-reported receipt of mammography and Pap testing. ANALYSIS . Chi-square tests to examine the proportion of women obtaining screening; analysis of covariance to examine change in theoretical mediators. The intervention group received more Pap tests than the control group at posttest (intervention 61%, control 27%, n  =  71, p < .01). No significant group effect was observed for mammography (intervention 49%, control 42%, n  =  125, p  =  .45). Findings indicate that the PATHS intervention promotes Pap testing but not mammography among women with mobility impairments.
    • "International research indicates that women with physical disabilities are less likely to participate in cervical screening due to access barriers (Angus et al., 2012; Armour et al., 2009; Becker et al., 1997; Chen et al., 2009; Cheng et al., 2001; Chun et al., 2012; Iezzoni et al., 2001; Liu & Clark, 2008; Ministry of Health, 2011; Peterson et al., 2012; Ramirez et al., 2005; Thierry, 2000). The aim of this study has been to explore what women with physical disabilities experience when attempting to undergo cervical screening within New Zealand. "
    [Show abstract] [Hide abstract] ABSTRACT: Using Interpretive Description as an approach, this qualitative study explores and identifies what women with physical disabilities experience when attempting to access cervical screening services. Recent literature has focused on identified barriers associated with accessing services. Consequently there is limited knowledge within the New Zealand context surrounding aspects of cervical screening. This study aimed to explore what women were experiencing, aspects of their screening habits and if they did encounter barriers. Purposeful sampling strategies were used to drive recruitment. Semi-structured interviews were carried out with eleven women who participated in this study. A central theme and three sub-themes surfaced when exploring the women’s experiences: the theme of barriers joins with the three sub-themes in that women in New Zealand do experience barriers when attempting to undergo cervical screening. The framework of barriers were organised into sub-themes such as structural, physical, systematic and attitudinal. Although, these participants encountered barriers, they were able to overcome the barriers and engage with screening services. In sharing their experiences, the participants identified aspects of clinician’s behaviour that allowed them to engage in services. Also, these participants indicated that they had created support systems in order to continue their health maintenance. This study found that these women were both confronted with barriers but were able to overcome barriers in order to continue cervical screening. Findings indicate that valuable insights have been gleaned from the women’s accounts surrounding practitioner’s method of service delivery. In addition, the aspects that these women put in place for themselves could also be considered by services and health providers.
    Full-text · Thesis · Dec 2015 · American journal of health behavior
  • [Show abstract] [Hide abstract] ABSTRACT: Cancer burden lies heavily on women with physical disabilities (WPD) because WPD are much lesslikely to receive preventive care. This disparity of use of cancer screening is directly linked to the inaccessibility of health care clinics, which often arises from obstacles in the physical environment. The purpose of study was to gain information regarding physical accessibility of a health care clinic for WPD. The study was set up as a two-part case study of a single outpatient health care clinic. The first part of the study utilized two checklists which were used to manually measure the accessibility of the clinic by atrained research assistant. These checklists included the Outpatient Health Care Usability Profile and the Kentucky Cabinet Survey. The clinic was found to be usable for WPD in all areas except parking, signage, controls, telephones, counters, and exam rooms. The second part of the study included interviews of two WPD who were the patients at the measured clinic to gain perspective on personally experienced barriers within the clinic. They identified the use human resources as means to overcome obstacles in the clinic. Implications for this study include the removal of barriers found to impede accessibility in the clinic and training of staff to assist WPD with transfers.
    Full-text · Article · Jan 2013 · American journal of health behavior
  • [Show abstract] [Hide abstract] ABSTRACT: To assess the barriers and facilitators to mammogram use in middle aged women with mobility limitations who had completed an educational workshop, Promoting Access to Health Service (PATHS), on clinical preventive services. Women aged 40 to 64 with mobility impairments who reported not receiving a mammogram in the last 2 years were randomly assigned to a PATHS workshop and received follow-up monthly phone call interviews over 6 months. Individual (eg, comorbidities, family responsibilities), interpersonal (eg, unclear provider communication, negative history), and environmental (eg, healthcare availability, insurance coverage, finances) factors were identified as unsolved barriers and potential facilitators (eg, reminders, physical proximity), to obtaining a mammogram. A multi-level intervention approach is required to promote mammogram use by women with disabilities.
    Full-text · Article · Sep 2013
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