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Factors Influencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study


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Background: In an effort to decrease the toll of cervical cancer, by its knowledge, prevention and treatment services in the community, we provided a nuanced consideration of the sociological and anthropological insight into the women's knowledge and its association with that of socioeconomic-demographic profile in the course of understanding cervical symptomatology, screening and cancer.
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Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Community Medicine & Health Education
Singh and Badaya, J Community Med Health Educ 2012, 2:6
Research Article Open Access
Factors Influencing uptake of Cervical Cancer Screening among Women
in India: A Hospital based Pilot Study
Sandeep Singh* and Sorabh Badaya
G. R. Medical College, Gwalior, India
Background: In an effort to decrease the toll of cervical cancer, by its knowledge, prevention and treatment
services in the community, we provided a nuanced consideration of the sociological and anthropological insight
into the women’s knowledge and its association with that of socioeconomic- demographic prole in the course of
understanding cervical symptomatology, screening and cancer.
Methods: Study through an in-depth questionnaire was conducted at JA Groups of Hospital’s Obstetrics and
Gynecology OPD, Gwalior, India on a total of 812 women with a modal average age of 35.51 ± 10.64 years, from
June-August 2010.
Results: We found a large amount of lack in awareness and perception in Indian women. Surprisingly all women
presented were married. Only 9.59% of women had ever heard of cervical cancer, mostly belonging to upper socio-
economic group with only 11.62% underwent at least one cervical screening in their life time. None of them reported
exact purpose of the Pap test. Male partner were the sole decision maker of the family in 47.20% women. 73.65% of
the respondents were using clothes instead of tampons or sanitary pads during menstruation.
Discussion: This study revealed the limited knowledge of Indian women about the susceptibility of cervical
cancer, and the necessity of cervical cancer screening among the women. Inadequate public health education, lack
of patient-friendly health services, socio-cultural health beliefs, and personal difculties were the most salient barriers
to screening.
*Corresponding author: Sandeep Singh, G. R. Medical College, Gwalior,
M.P., 474001, India, Tel: +91-141-2761078; Fax: +91-751-2403403; E-mail:
Received June 06, 2012; Accepted June 23, 2012; Published June 25, 2012
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer
Screening among Women in India: A Hospital based Pilot Study. J Community Med
Health Educ 2:157. doi:10.4172/2161-0711.1000157
Copyright: © 2012 Singh S, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Cervical cancer awareness; Socio-economic status;
Sexually transmitted diseases; Health facilities in India
Cervical cancer is the second most common cancer in the women
worldwide and the leading cause of cancer deaths among women in
developing countries [1]. e burden of cervical cancer in India is
enormous accounting for about 20 percent of all cancer related deaths
in women and is the number one cause of death in the middle age Indian
women [2]. It is paradoxical that so many deaths are occurring whilst
being a preventable disease. Organized population based screening
linked to treatment of the detected neoplasias can lead to more than
70 per cent reduction of disease related mortality [3]. Where screening
quality and coverage have been high, invasive cervical cancer has
been reduced by as much as 90 percent. is indicates the usefulness
of screening in the population, but with major barriers towards lower
screening coverage [4]. ere are no eective, organized population-
based high-level opportunistic screening programs for cervical cancer
in any of the states in India contemporary to developed nations [2,5-
7], due to which routine screening of asymptomatic women have been
almost non-existent [8]. For a screening program to be successful, a
good attending rate of women undertaking the test is must in context
to which complete thorough exploration of their socio-economic-
demographic prole is a preliminary requirement [9]. Several factors
inuencing cervical cancer screening have been reported which
includes lack of awareness, inadequate access to healthcare facility with
poor infrastructure in addition to unawareness among the doctors at
rural areas regarding importance of early diagnosis and treatment,
existence of alternative medicinal systems and quacks [10], decient
economic and moral support from husband and family [11-12] and
an inappropriate demand for providing cervical cancer screening from
the potential beneciaries could be enumerated as the chief causes [8].
ere are no such studies existing indulging with cervical cancer
screening and its dynamic relations with various stated factors from
Gwalior (Madhya Pradesh, Central India) where the crude incidence
rate of cervical cancer is 3.12% [13]. erefore a study with qualitative
and quantitative components was undertaken using face-to-face
in depth interviews to investigate cervical cancer screeners and to
explore various factors inuencing screening uptake of these women
emphasizing and comparing majorly with their socio-demographic
prole and a call for improvement.
Study place
Discussions with subjects were undertaken in Obstetrics and
Gynecology OPD of Jayarogya Hospital (JAH). JAH is a teaching
hospital for G.R. Medical College, Gwalior, one among the six medical
college hospitals in Madhya Pradesh.
Study participants
A total of 812 women participated the questionnaire carried out
for the guided women for Pap test when attending the Obstetrics
and Gynecological OPD at JAH, Gwalior held from June-August,
2010. Age of participants ranges from 18-85 years. Verbal Informed
consents were sought from the participants prior to their interview and
no one declined participation. Ethical clearance was sought from the
Institutional Ethical Committee (IEC) prior to advent of the study.
Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
Page 2 of 6
Study instruments
A questionnaire was carried out by the authors to determine
womens’ socio-demographic and fertility prole and their knowledge
regarding the Pap test. Instrument contained questions regarding
socio-demographic factors, their prior history of Pap smear, knowledge
about cervical cancer, cultural beliefs, male behavior and family
supportiveness towards women health issues.
Before the advent of discussions, participants were made aware
about the purpose of the meeting, condentiality of their personal
information and consent regarding discussion and to note down them.
All discussions were in the local language Hindi and then translated into
English while formulating manuscript. It contained an introduction,
purpose of the meeting, rules during the discussions i.e. condentiality,
encouragement of open all-inclusive discussions and nondisclosure of
their personal information. Discussion usually lasts for 10-15 minutes
and the hand notes were prepared from them. One author conducted
the discussion and another acted as an observer and took hand notes.
Questionnaire was asked to the women by the authors (both
males) in a separate room restricting interference from the others (also
family members) except within the presence of few medical personals
(females). Open ended questions were asked on dierent aspects of
their personal and cultural life with a common set and style to avoid
any interference in the data. Personal particulars which include name,
belonging (husband/father), age, parity, occupation, residential address,
chief complaints for appearing were asked directly. Information on
earning was asked as “Who is the source of earning for the family?
From where you and your family get money? How many members
are there in your family, and how much money you actually get out of
that?” Age at marriage was deduced by asking indirectly “How many
years have passed while you married”. is is subtracted from the age
of the women. History of contraceptive use is directly asked as “Are
you using any method for garbh-nirodh (contraception)? What is that?
ey were also simultaneously counseled towards benets and harms
of various stated factors.
Statistical analyses
Quantitative data was coded and analyzed using SPSS for frequency
distribution, chi square testing and odds ratio. A frame work analysis
regarding qualitative part of the study was conducted from the advent
of the data collection (Ritchie and Spencer). e noted data were gone
through by the authors to get familiarize with the issues. ematic
frame work was developed from the prior and emergent themes. is
was then applied to sort out data according to the themes (these were
titled as presented in the ndings). en the explanations were deduced
from the ndings in Indian context.
Questionnaires were analyzed for all 812 women with mean age of
35.51 ± 10.64 years. Women from rural setting were found to be 54.80%
as compared to 45.19% urbanites. All women were married with 85.96%
under 45 years (reproductive age group) while 14.03% above. Mean
value of pregnancies for an individual woman was found to be 2.70
with nil pregnancy rates to be 9.85%. e socioeconomic characteristics
of participants are shown in Table 1. Participants using sterilization,
oral contraceptive, and intrauterine device (IUD) as contraceptive
methods were 24.09%, 5.58% and 1.42% respectively. 68.91% women
were either using any other method of contraception or not using any
of them. Chance of ever received Pap smear was higher among women
from lower socioeconomic class, parous women, belonging to Hindu
religion and from urban background (Table 2). Comparative analysis
and independent t test of ever received Pap smears among urban and
rural for the studied variables has been presented in table 3 and table 4
respectively. Participants who never undergone screening was 84.97%
with that of one previous Pap smear screening 11.62%, 2.82% with
two and 0.59% with more than two previous Pap smear screening.
74.21 % women had previous Pap smear screening within last 1 year,
20.31% within last 5 years and 5.46% within last 10 years. Findings are
presented according to the themes identied in the analysis
Knowledge on cervical cancer
Participants were asked, had they ever heard of cervical cancer,
human papilloma virus (HPV), whether cigarette smoking could cause
cervical cancer? How they could catch the disease, from whom they
got the knowledge regarding disease, where to rst contact regarding
treatment. Majority of the women had never heard of cervical cancer
and not even a single respondent of HPV and cigarette smoking could
lead to cervical cancer. Only 9.59% of the women had ever heard cancer
as a cancer of “mouth of uterus”. Majority of them, 51.20%, described
having no idea that unhygienicity can cause the disease. Mother in law
was the main source of knowledge for majority of women who had
ever heard of the disease. “My mother in law told me that if u not
maintains hygiene during menstrual period, you could get the disease”.
Unawareness about the cervical cancer could partly be due to poor
communicating health service providers. Most of the women, 44.80%
seek public health services (PHC/CHC level) or hakim and vaidh
Characteristic(s) Distribution Within Sample, n
Age (years)
Mean ± SD 35.51 ± 10.64
Median (range) 35(15-85)
Age at marriage (years) Mean ± SD 16.89 ± 4.29
0-3 585(45.19%)
≥ 4 228(28.07%)
No schooling 369(45.19%)
Primary school 80(9.85%)
High school 215(26.47%)
> High school 148(18.22%)
Professional and semi-professional 30(3.69%)
Clerical and shop owner 12(1.47%)
Skilled worker 15(1.84%)
Semiskilled worker 150(18.47%)
Unskilled worker 597(73.52%)
Unemployed 8(0.98%)
Socio -economic status
Low and low upper 606(74.63%)
Middle and upper middle 200(24.63%)
Upper 6(0.73%)
H/o tobacco exposure 101(12.43%)
H/o ever-use of oral contraception 51(6.28%)
≤ 979 12(1.47%)
980-2935 270(33.25%)
2936-4893 261(32.14%)
4894-7322 117(14.40%)
≥ 7323 152(18.71%)
Table 1: Socio demographic prole of study participants.
Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
Page 3 of 6
Variables Distribution Within Sample, nReceived Pap Odds Ratio CI 95% P Value
> 45 114 18(15.78)
≤ 45 698 104(14.89) 1.07 0.59-1.90 0.77
Illiterate 377 60(15.91) 1.13 0.76-1.70 0.55
Literate 435 62(14.25)
House wife 315 51(16.19) 1.15 0.76-1.74 0.48
Working 497 71(14.28)
Parous 735 116(15.78) 2.21 0.94-5.22 0.06
Nulliparous 77 6(7.79)
L-LM 612 99(16.17) 1.48 0.89-2.48 0.11
UM- U 200 23(11.50)
Urban 367 62(16.89) 1.30 0.87-1.95 0.20
Rural 445 60(13.48)
Hindu 741 115(15.51) 1.68 0.71-4.11 0.22
Non Hindu 71 7(9.85)
Table 2: Socio-demographic variables Associated with Receipt of Pap Smear.
*All the data in parentheses are in percent
Table 3: Variable distribution among urban and rural population.
Variables Distribution Within Sample, nReceived Pap
Rural Urban Rural Odds Ratio CI 95% P Value Urban Odds Ratio CI 95% P Value
Age (years)
≤ 20 9 16 1(11.11) 11(6.25) 1
21-30 138 164 21(15.21) 0.69 0.03-6.04 126(15.85) 0.35 00.01-2.75 0.47
31-40 180 111 25(13.88) 0.77 0.03-6.60 120(18.01) 0.30 0.01-2.42 0.46
41-50 82 51 6(7.31) 1.58 0.06-16.97 0.53 11(21.56) 0.24 0.01-2.12 0.26
> 50 36 25 9(25) 0.37 0.01-3.82 0.65 2(8) 00.76 0.02-12.47 1
No schooling 267 110 37(13.85) 123(20.90) 1
Primary school 53 31 6(11.32) 1.26 0.47-3.53 0.82 5(16.12) 1.37 0.43-4.59 0.79
High school 79 131 13(16.45) 0.87 0.39-1.72 0.58 22(16.79) 1.31 0.65-2.63 0.50
> High school 46 95 6(13.04) 1.07 0.39-3.03 110(10.52) 2.24 0.95-5.4 0.05
Age at marriage (years)
< 18 307 181 42(13.68) 135(19.33) 1
≥ 18 138 186 20(14.49) 0.93 0.50-1.73 0.88 25(13.44) 1.54 0.85-2.80 0.15
Hindu 415 326 61(14.69) 154(16.56) 1
Non Hindu 30 41 1(3.33) 4.99 0.70-100.44 0.100 6(14.63) 1.15 0.43-3.23 1
Nulliparous 33 44 2(6.06) 13(6.81) 1
Parous 412 323 60(14.56) 0.37 0.06-1.68 0.29 57(17.64) 0.34 0.08-1.20 0.08
Upper 0 7 0 2(28.57) 0.55 0.09-4.28 0.61
Middle- upper middle 86 107 9(10.46) 1.48 0.66-3.37 0.38 12(11.21) 1.75 0.85-3.68 0.11
Low-low upper 359 253 53(14.76) 146(18.18) 1
≤ 979 7 5 1(14.28) 12(40) 1
980-2935 143 127 23(16.08) 0.87 0.03-7.95 125(19.68) 2.7 0.29-21.62 0.27
2936-4893 156 105 17(10.89) 1.36 0.05-12.80 0.56 15(14.28) 4 0.42-33.42 0.17
4894-7322 58 59 10(17.24) 0.80 0.03-8.30 110(16.94) 3.26 0.32-29.45 0.23
≥ 7323 81 71 11(13.58) 1.06 0.04-10.71 18(11.26) 5.25 0.51-49.29 0.12
Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
Page 4 of 6
(Greek and Ayurvedic medicine practioners) and 23.2% reported self
or no treatment prior to the visit to this center. “Usually the health
workers don’t tell us from what we are suering and we cannot read
and understand the prescription due to illegible handwriting and
English language”.
Women knowledge on Pap test
Participants were asked, had they ever heard of pap test, from
whom they got the knowledge regarding the test, purpose of pap test,
their previous pap test result, had they under gone test prior to their
marriage. 15.02% of the participants who received Pap test prior to this
visit reported it as “kaanch ki patti wali test (glass slide test)”. 15.02%
of the participants who once undergone the test knows about the test
from health care providers. 28% and 24% of the participants responded
the purpose of test for knowing cause of excessive vaginal discharge
and infertility, infection respectively and rest of them don’t know the
purpose of the test. None of them reported exact purpose of the Pap
test. Out of 15.02% participants who previously received Pap test,
9.97% reported ‘gaath’ (tumor) in their report and rest of them had
no idea of it. Not a single respondent had under gone Pap test prior to
Cultural construct about cervical cancer
Some respondents perceived the illness as a “traditional” disease.
On describing symptoms like excessive vaginal bleeding many
explained it as a normal phenomenon of menstruation with some
bleeding excessive and some less. On inquiring for late reporting to
the hospital some participants argued “illness in females is “traditional”
which every women have to face and elderly women in community says
that it could be get rid by self medications prepared at home so what’s
the need to go to doctor to waste money and time”. Many reported
“due to custom and cultural boundaries we are not allowed to go
outside alone without any male members of the family and it is very
embarrassing if to get examined of the private part by the male doctor”.
Economic factors and male partner inuences
Male partner were sole decision maker of the family in 47.20%
women as compared to 27.20% of cases where both partners were
involved. Male is the sole nancial controller in the family. “Our
partners are the ones who have control over the family pocket. Asking
money from them is very troublesome. Having illness of private part
let him thinks that I cheated him” Money is an imperative factor
inuencing the health seeking behavior, “Hospital is very far from my
home so it takes a very long time and cost a lot for it and undergoing
dierent tests. Meeting daily needs are more crucial; preventive
care and detecting cervical cancer is not the priority”. 73.65% of the
respondents were using clothes instead of tampons or sanitary pads
during menstruation.
Health services factors
ere was a great concern regarding the wastage of time, “Waiting
time is too long in the hospital which spoils whole day for getting
one’s turn”. “It is very problematic to reach the consultancy room to
seek physician and fee counter to pay for the consultancy and testing.
We don’t know where to go in such a big OPD and a lot of time goes
in searching the exact place”. Negative perception is there towards
healthcare providers and health facilities. “Health care provider behaves
rudely. If I am having money they give better response and time to you
otherwise not. We always have doubt especially in cleanliness of the
materials used in the process”.
Our study revealed a greater rise towards a particular class of women
among each specic components of socio-economic-demographic
prole viz married, parous, low socioeconomic group, less educated,
early marriage, and residing in urban setting involving the screening
facility users. Social factors of cost incurred, educational background,
and cultural issues of modesty and embarrassment contributed deeply
to the screening attendance [14].
Knowledge was low among the participants regarding cervical
cancer and Pap smear screening. ere are no awareness campaigns and
programs regarding disease prevention similar to eective enthusiastic
campaigns against the HIV/AIDS, malaria and tuberculosis. Older
ladies and family are still being the major reservoir of the health
knowledge in Indian society.
Women from higher socioeconomic class, higher educated and
with high family income were very low during the questionnaire. As
the study depicts, women were not satised with the health services
regarding to time consumed up to consultancy, material used and their
cleanliness in government hospitals, as also raised in other studies [15].
One of the main predictor of satisfaction with the service were the
behavior of the sta and the facilities at the centre [11,16-19] which
being unsupportive may even deter these women from attending
public health facilities demanding approach to private health facilities
where 80% of the India’s annual cervical smear is done [5].
Utilization of screening services was found directly proportional
to parity of the women [20,21] indicating that previous contacts with
reproductive health services in their earlier parity (in the form of
gynecological checkups) may increase awareness among women to
be more responsive towards health workers and facilities and getting
Table 4: Independent t test for ever received Pap test among Rural and Urban groups.
Std. Error
95% condence interval of differences
Lower Upper
Age (Years) Rural 36.97 10.74 1.47 34.01 40.29 1.54 0.12
Urban 33.82 10.38 1.40 31.60 36.37
Age at marriage (Years) Rural 16.08 4.08 0.56 15.27 17.38 1.93 0.05
Urban 17.66 4.34 0.58 15.84 17.83
Parity Rural 3.28 1.60 0.21 2.82 3.74 1.78 0.07
Urban 2.68 1.87 0.25 2.26 3.05
No of times Pap received previously Rural 1.71 1.13 0.15 1.4 2.02 2.28 0.024
Urban 1.31 0.62 0.08 1.15 1.48
Time of last Pap received Rural 12.79 15.72 2.15 8.54 17.04 1.67 0.096
Urban 19.10 22.63 3.05 12.84 24.88
Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
Page 5 of 6
screened opportunistically [12]. Strikingly all the participants were
married which is consistent with the ndings from others in India and
other low resource settings [12,17,21-23]. It is explainable with the fact
that unmarried women may not be feeling themselves to be at the right
stage for reproductive health facilities [18] or relatively raised need for
frequent obstetrics and gynecology care and increased recommended
tests for reproductive symptoms only for married had overshadowed
the data [12,24]. Also, associated stigma due to the prevailing cultural
disbelief especially in rural India as these tests are meant for sexually
active women forces them to retreat screening [12,23,25].
India is still a patriarchal society where males are the sole decision
maker in the external, economic and social aairs of the family
signicantly in rural areas. Here females are not freely allowed to go
outside alone without male members, thus being as gate keepers for
women to access health services [11,19]. Study from India suggest,
despite the social stigma attached to the screening for unmarried
women they approached to the screening centers, by encouraging
males to promote female participation through community leaders,
irrespective of their marital status [12]. us an eective program needs
to target both genders. Women with less education were found more
likely to be screened, a nding that is inconsistent with the previous
studies [12,20]. Previous studies on relation between socioeconomic
factors and use of health services had shown educational inuences on
screening behavior through its eect on income [26-27].
Education and socioeconomic status decides the living standard of
a person and chances of getting the disease through use of cloths rather
than sanitary napkins which may prone them for genital infections
[28,29]. Women who ever had an STI requires a gynecological
examination so a smear may have been taken as part of the consultation
regarding STI [21,30]. Although rural women were less educated,
underserved but nancially stronger, frequency of getting ever
screened was higher among urban women as compared to rural [31-
33]. is strengthens the hypothesis which advocates being farer away
from hospital may decline access to the health facilities, proved in
other studies too [31-36], since some level of opportunistic cytology
screening are mainly available in tertiary care centers of urban areas
[5] leading to accessibility being easier for urban women despite of low
family income [8]. is nearness may be a major predictor diluting the
disparity of income between urban and rural being [21] as travelling to
hospital kills a lot of time and wages in our and previous studies [24].
Study reveals that early marriage was associated with higher
frequency of being screened with majority (58.99%) of the women
married earlier than 18 years the legal age of marriage in India. Early
marriage prone to have early rst coitus [37] and have young age of
rst pregnancy leading to have more years to become pregnant and
for multiple times [27] which may lead to frequent visit of this women
to reproductive health facilities and greater chance to get screened for
cervical cancer in an opportunistic setting [23].
Cultural beliefs and custom barriers faced by women let her shy to
discuss their problems and getting examined by the male doctors which
could have lead to decreased ever received of pap in women especially
muslims [17,18]. Training of village health nurses could be done, as
being trained nurses are able to identify a cervical abnormality and to
take an adequate pap smear [38] to overcome the cultural barrier of
being get screened by males [19] as patient feels better to get screened
by female [17,18,39].
Economic constraints prioritizes women towards nancial and
social responsibilities and self neglect [15,10] towards their health issues
by curtailing their expenses in the form of time and money in visiting
far to the screening health facilities [40] mainly available in tertiary
care centers [8]. As the most untouched population is being rural and
availability of facility in their society would increase the compliance to
get screened [18,39,41]. Self remedies and self medication, inuence
of local Gods [42], disbelief in healing power of modern medicine
and inuence of medical quacks on the socio-cultural aspects of the
society [18] and their life poses a drastic ill eect in the course of cancer
diagnosis and treatment. Sacricing attitude of the Indian women
are their hall mark worth of the image in the world but render them
susceptible to malnutrition, infection and thus can lead to cervical
us our study contributed towards the much needed lag in the
knowledge of cervical cancer, its screening with the socio-demographic
prole of the women participated and their belief towards the disease
and the health care system which had been decient in our literature
specially from developing countries. us, this pilot study can be
instrumental for a larger future studies to be undertaken to target much
implementative and cost eective measures to make a change in their
beliefs and knowledge.
As this is a single hospital based study, with its some part memory
based, so a recall biased could be anticipated.
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Volume 2 • Issue 6 • 1000157
J Community Med Health Educ
ISSN: 2161-0711 JCMHE, an open access journal
Citation: Singh S, Badaya S (2012) Factors Inuencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study.
J Community Med Health Educ 2:157. doi:10.4172/2161-0711.1000157
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... The illness is also believed to be treatable with selfmedication at home, thus not warranting a visit to the doctor that might "waste money and time." 22 Other major barriers include the fear of revealing private parts, especially to a male healthcare practitioner, the lack of family support, 14,22,23 the fear of the examination procedure, the fear to undergo a test, particularly the one detecting cancer, in the absence of symptoms. 24,25 Next, economic limitations direct women toward self-neglect of their health issues, often by curtailing their expenses in the form of time and money in visiting the screening health facilities. ...
... The illness is also believed to be treatable with selfmedication at home, thus not warranting a visit to the doctor that might "waste money and time." 22 Other major barriers include the fear of revealing private parts, especially to a male healthcare practitioner, the lack of family support, 14,22,23 the fear of the examination procedure, the fear to undergo a test, particularly the one detecting cancer, in the absence of symptoms. 24,25 Next, economic limitations direct women toward self-neglect of their health issues, often by curtailing their expenses in the form of time and money in visiting the screening health facilities. ...
... 24,25 Next, economic limitations direct women toward self-neglect of their health issues, often by curtailing their expenses in the form of time and money in visiting the screening health facilities. 14,22,23 Logistical and technical barriers, such as lack of trained staff and infrastructure at the grassroots level, quality assurance, repeat screening/testing, and economic barriers, affect the feasibility of traditional, cytology-based examinations for screening programs in India. 26,27 Perhaps the main underlying factor for most of these barriers pertains to the low awareness about the disease among the general public; provision of extensive, accessible, and sensitive public health education surrounding the disease, its screening, and prevention is thus essential to ensure an increased screening uptake in India. ...
Full-text available
Priya Ganeshkumar Objectives We evaluated the impact of a standardized, simple audio-visual (AV) training video developed in regional languages on cervical cancer awareness among apparently healthy women and their willingness to undergo regular cervical cancer screening. Materials and Methods This cross-sectional noninterventional multicentric survey was conducted in 69 centers across 14 states in India and one center in UAE among women aged between 18 and 88 years attending clinics for a variety of indications. Using a short questionnaire, cervical cancer awareness and willingness to undergo cervical cancer screening were assessed before and after the AV training. Statistical Analysis In addition to descriptive analysis, improvement in awareness after the AV training was assessed using McNemar's test, and comparison of responses between subgroups was performed using Pearson chi-squared test. Results The survey was completed by 3,188 apparently healthy women (mean age: 36.8 ± 11.3 years). Before AV training, correct answers were given to only 4/6 questions by majority of the participants; most participants were unaware about the main cause of cervical cancer (1,637/3,188, 51.4%), availability of cervical cancer screening tests (1,601/3,188, 50.2%), and cervical cancer vaccines (1,742/3,188, 54.6%). Only 576 women (18.1%) had undergone cervical cancer screening in the past. After the AV training, the proportion of women correctly responding to all six questions improved significantly (p
... The other explanation might also be that increasing risk with women's age leads the women to have more contact with healthcare facilities. However, the study conducted in Ethiopia's Tigray region public hospitals and India indicated that women in the younger age groups were more likely to utilize cervical cancer screening than women in the older age groups [28,40]. The possible reasons for the discrepancy in the results might be due to the variation in the study participants, time deference', availability of information, and freedom of access to information regarding cervical cancer screening and its predisposing factors through social media and other routes. ...
... The findings of this study revealed that being parity five or above among women was 4.5 times more likely to utilize cervical cancer screening when compared to being less than parity five. The result of this study was comparable with the study findings reported from Arba Minch town, southern Ethiopia, Tanzania, Dare Salaam, and India, which showed that women with a history of more parity were more likely to utilize cervical cancer screening [40][41][42][43]. This may be due to repeated visits to healthcare facilities for family planning, deliveries, and antenatal care follow-up so that they may get advice to use the service and also receive screening during their early deliveries. ...
... The result of this study showed that women who use modern contraception were 5.4 times more likely to utilize cervical cancer screening as compared with their counterparts. The findings of this study are consistent with the study conducted in Jimma Town, Southwest Ethiopia, Burkina Faso, Malawi, and India, which indicated that those women who used modern contraceptives were more likely to utilize cervical cancer screening as compared to their counterparts [40,[44][45][46]. This could be as a result of customers receiving counseling on cervical cancer screening and predisposing factors while receiving family planning services. ...
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Background Globally, cervical cancer is the second most common and the leading cause of death in women in low-income countries. It is one of the potentially preventable cancers, and an effective screening program can result in a significant reduction in the morbidity and mortality associated with this cancer; however, evidence showed that only a small percentage of the women were screened. As a result, predictors of cervical cancer screening usage among women in Ambo town, central Ethiopia, were identified in this study. Method Unmatched, a community-based case-control study was conducted among 195 randomly sampled women in the age group of 30–49 years in Ambo town from February 1 to March 30, 2020. Data was collected using an interviewer-administered questionnaire. Descriptive, bivariate, and multivariable binary logistic regression analysis was done using SPSS. Results A total of 195 study participants, sixty-five cases and one hundred thirty controls, participated in this study, making a response rate of 100%. Being in the age group of 30–34 years old (AOR = 0.2; 95% CI: 0.06–0.7), being Para five and above (AOR = 4.5; 95% CI: 1.4–14.1), modern contraceptive utilization (AOR = 5.4; 95% CI: 1.8–16.3) and having high-level knowledge regarding cervical cancer screening and its predisposing factors (AOR = 5.9; 95% CI: 2–17) were significantly associated with the utilization of cervical cancer screening. Conclusion The age of women, parity, use of modern contraception, and level of knowledge regarding cervical cancer screening and its predisposing factors were the determinants of the utilization of cervical cancer screening among women. As a result, the media, the health bureau, and health professionals should advocate raising awareness about cervical cancer and its preventative methods, which are primarily focused on screening.
... In all, 52 studies had been performed by the quantitative method 3,10-61 , 20 by the qualitative method 8,[62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80] , and one by the mixed method 81 . All quantitative studies were cross-sectional, with data collected through a questionnaire or interview. ...
... Knowledge of cancer, its prevention, and its early detection are the main pillars of screening tests 63,83 . Reports from many developing countries indicate that women lack sufficient knowledge about cervical cancer 18,[25][26][27][28][29][30][31][33][34][35][36][37][38][39][40][41][42][63][64][65][66][67][68][69][70]81,82 . Lack of knowledge about the importance of screening 33,43,63,67,71 , the causes [63][64][65]68,69,72 , risk factors 44,65,68 , symptoms [63][64][65] , and prevention of cervical cancer, screening methods 64,65,70,73 , and the time and duration of screening [44][45][46]65,74 reduce the attendance of cervical cancer screening programs. ...
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Objective: Cervical cancer is largely preventable. Although routine Pap smear screening has reduced cervical cancer-related mortality by 70-80% in all countries and by approximately 90% in developing countries, the gynecologist is still confronted with women in advanced stages of the disease. The eradication of cervical cancer depends on identifying the disease early and removing barriers to its timely detection. Given the significant burden of cervical cancer in Asian countries, we investigated factors related to its screening in Asia. Materials and methods: A comprehensive search was carried out in databases such as Medline, Web of Science and Scopus for articles published until September 2020. The following keywords were used: vaginal smear, Pap smear, cervical cancer screening, barriers, obstacles, challenge, early detection, the name of each Asian country, and a combination of these words. Results: Seventy-five articles were included in the study. The investigation revealed various factors related to cervical cancer screening in Asian women, including sociodemographic factors, awareness, attitudes and beliefs, perceived risk, psychological factors, self-efficacy, previous experiences, time, household, culture, fatalism, social support, access, cost, safety, insurance and health system-related factors. Conclusions: Several barriers hinder the efficacy of a screening program. Its success requires the use of educational interventions, professional and inter-professional cooperation, allocation of sufficient resources, and policymakers focusing on the elimination of barriers.
... At postnatal visits, they were more likely to be recommended Pap test screening. This seems to be supported by our finding that women with one or two or more children had higher odds of previous Pap test than women with no children, similar to results from other research conducted in Jamaica and other LMICs [13,22,23]. Increased interaction with reproductive healthcare by pregnant women is a plausible explanation for their higher likelihood of being screened. ...
Full-text available
Background About 90% of new cervical cancer cases and deaths worldwide in 2020 occurred in low- and middle-income countries. This can be attributed to the low rates of cervical cancer screening in these countries. This study was conducted to identify factors associated with lack of cervical cancer screening among women in western Jamaica with the aim to increase screening and decrease cervical cancer risk. Methods This cross-sectional study assessed associations between previous Pap testing or lack of testing in five years or more, sociodemographic characteristics, attitudes, and knowledge of cervical cancer among women recruited from clinics and community events in the four parishes of western Jamaica. Analyses included chi-square tests, Fisher’s exact tests, and logistic regression. Results Of the 223 women included in the study, 109 (48.9%) reported Pap testing five years or more previous to the study. In the multivariate analysis, women from St. James (Odds Ratio [OR]: 3.35, 95% Confidence Interval [CI]: 1.12–9.99), Trelawny (OR: 5.34, 95% CI: 1.23–23.25), and Westmoreland (OR: 3.70, 95% CI: 1.10–12.50) had increased odds of having had Pap test screening compared to women from Hanover. Women ≥ 50 years of age compared to women 18–29 years of age (OR: 6.17, 95% CI: 1.76–21.54), and employed compared to unemployed women (OR: 2.44, 95% CI: 1.15–5.20) had increased odds of Pap test screening. Similarly, women with one (OR: 4.15, 95% CI: 1.06–16.22) or two or more children (OR: 8.43, 95% CI: 2.24–31.63) compared to women with no children had higher odds of screening. Women who were aware, compared to women who were unaware, of the purpose of Pap tests had increased odds of screening (OR: 3.90, 95% CI: 1.55–9.82). Lastly, women who believed Pap tests were painful compared to women who did not, had decreased odds of having had a Pap test (OR: 0.33, 95% CI: 0.16–0.71). Conclusions Uptake of Pap tests among the women was suboptimal and varied among parishes. Young women and women without children were less likely to have ever been screened. Increased education of the purpose of Pap tests to treat pre-cancer to prevent cancer and minimization of the notion that Pap tests are painful could promote screening among women in this population.
... For example, the uptake of CCS services among women was 2.2% in Adama [14], 19.9% in Mekele [25], 84.5% in Jimma [26], and 1% in the Arsi zone [27]. Previous studies found that different socio-economic factors(age, marital status, educational level, monthly income, and religion) [26,[28][29][30][31][32], behavioral(awareness and attitude toward CCS and multiple sexual partners) [28,30,[33][34][35][36], reproductive(age of first sex, multiple previous pregnancies, and abortion) [27,31,[37][38][39], and health system-related factors(shortage of CCS reagents, inaccessibility of service in nearby facilities, shortage of trained staff ) [16,36,[40][41][42][43][44] were among the factors affecting the utilization of CCS. In Ethiopia, the FMOH prepared and distributed national CC prevention and control guidelines along with the preparation of Visual Inspection with Acetic Acid (VIA) and cryotherapy training manuals to health facilities to reduce the disease burden and defined eligible women for CCS across the country. ...
Full-text available
Background: Cervical cancer is a major public health problem affecting women worldwide. It is the second cause of mortality among women in Ethiopia. Early Cervical cancer screening has a tremendous impact on reducing morbidity and mortality related to cervical cancer infection. Therefore, this study aimed to assess cervical cancer screening utilization and associated factors among women attending Antenatal Care at Asella referral and teaching hospital, Arsi Zone, south-central Ethiopia. Method: This study employed a facility-based cross-sectional study among 457 Antenatal Care mothers from December 2020 to February 2021. Data collection was performed using interviewer-administered structured questionnaires. Data were entered into EpiInfo Version 7 and transferred to SPSS V.21 for analysis. A logistic regression model was used to determine the factors associated with cervical cancer screening utilization and an adjusted odds ratio with a 95% confidence interval at p-value < 0.05 was computed to determine the level of statistical significance. Result: The magnitude of cervical cancer screening utilization was found to be 7.2%(95% CI: 5.2, 10.6). Educational status of secondary and above (AOR = 2.92; 95%CI = 1.078-7.94), getting screened for any reproductive healthcare services(AOR = 4.95; 95%CI = 2.24-10.94), having multiple sexual partners(AOR = 4.55; 95%CI = 1.83-11.35), and satisfactory knowledge of cervical cancer screening(AOR = 3.89; 95%CI = 1.74-8.56) were significantly associated factors with cervical cancer screening utilization. Conclusion: Utilization of cervical cancer screening was low among women attending Antenatal care at Asella Referral and Teaching hospital, Southcentral Ethiopia. Educational status, history of multiple sexual partners, getting screened for any reproductive healthcare services, and knowledge of cervical cancer screening were significant factors associated with the utilization of cervical cancer screening. Hence, to improve the utilization of Cervical cancer screening, there should be the implementation of programmed health education and awareness creation on the benefits of screening as well as the promotion of reproductive healthcare services at health facilities.
... This is also consequent to a lack of awareness among population. [10,11] Although challenging in community settings, VIA-based cervical cancer screening can be a viable and feasible alternative in countries like India. For a screening program to be successful, good compliance to screening is very important. ...
Full-text available
Background: Low participation in screening and poor follow-up are major challenges in implementing population based screening in developing countries. Determinants of participation in a community-based organized cervical cancer screening program are discussed here. Objectives: The objectives were to study factors determining compliance of women for cervical cancer screening in an urban low socioeconomic setting. Methodology: Community-based service program was conducted for screening uterine cervix cancers with a visual inspection of the cervix on the application of 5% acetic acid by trained primary health workers. The process involved the selection of clusters, household surveys, health education, and screening of eligible women for uterine cervix cancer. Logistic regression analysis was conducted to identify determinants of participation in cervical cancer screening. Results: A total of 138,383 population were surveyed, of which 21,422 eligible women were contacted and 16,424 (82.50%) complied for screening. According to the results of univariate and multivariate analysis, women belonging to the age group of 30-39 (80.69%), literate women with school level or education up to Senior College (78.97% and 80.86%) (odds ratio [OR], 1.323; P ≤ 0.001) and (OR, 1.402; P ≤ 0.001), belonging to Hindu religion (77.20%), speaking Marathi (77.07%), and with a family history of cancer (81.93%) had higher participation for screening, while women belonging to the Muslim community (73.95%) (OR, 0.743; P ≤ 0.001), speaking other than Marathi and Hindi language (73%) (OR, 0.872; P = 0.017), illiterate women (70.71%), and graduate women (70.78%) had lower participation. Conclusion: High compliance can be achieved by providing good-quality health education and setting up of screening clinics in vicinity of participating women.
... The study also revealed that there were no dynamic awareness programs against cervical cancer like the efficient campaigns conducted against human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS), malaria, and tuberculosis. [6] It is important to develop culturally sensitive interventions to motivate women to participate in cervical cancer screening and to reduce cervical cancerrelated health disparities. [7] These sociocultural barriers can be dealt with by planning and implementing screening programs effectively. ...
Full-text available
BACKGROUND: Cervical cancer is the leading cause of death worldwide, especially in developing countries. More than one-fifth of newly diagnosed cervical cancer cases are occurring in India. Cervical cancer is a highly preventable and curable cancer compared with other types of cancer, if detected at an early stage. The present study has been carried out to assess whether a community-based, multicomponent, nurse-led intervention program improves cervical cancer screening behavior of women. MATERIALS AND METHODS: An experimental randomized controlled trial was carried out by recruiting 419 women in the age group of 30–60 years (246 in the experimental group and 173 in the control group) residing in a selected rural community (selected tribal settlements) of Idukki district of Kerala, India, using multistage cluster sampling. The intervention comprising small group education followed by reinforcement session, telephonic reminders, navigation and guidance for Pap smear, and follow-up visit by the investigator was administered to the experimental group, and the control group did not receive any intervention. Knowledge, attitude, and screening behavior of women related to prevention of cervical cancer were assessed before and twice after the intervention. RESULTS: The experimental and control groups were homogenous in all baseline sociodemographic variables. The community-based intervention program was effective in improving knowledge (P < 0.001), attitude (P < 0.001), and screening behavior (P < 0.001) of women regarding the prevention of cervical cancer. A significant moderate positive correlation was found between knowledge and screening behavior (r = 0.408). Significant association was found between knowledge, attitude, and practice regarding prevention of cervical cancer with education, age at the time of marriage, and number of pregnancies. CONCLUSION: The community-based, multicomponent, nurse-led intervention program was effective in improving cervical cancer screening behavior among women. Repeated motivation and reinforcement are needed to bring behavioral change and to increase uptake of screening services among rural women.
... Financial constraint was also reported as a barrier to screening utilization (Table 3). The available screening services are not free 19 , and women usually prioritize their financial and social responsibilities due to economic constraints 34,35 . It was reported that screening services are unaffordable and expensive in 12 studies [19][20][21][23][24][25][26][27][28][29]32,33 . ...
Full-text available
Background: Cervical cancer is the second most frequent cancer and cause of cancer-related deaths among women in Nigeria. The Visual inspection with acetic acid and cryotherapy "see and treat" screening approach is a feasible and effective method that can be implemented in low resource settings like Nigeria; however, screening utilization is still low. Objective: This systematic review aims at offering a comprehensive synthesis of studies that assessed the barriers preventing women from utilizing cervical cancer screening services in Nigeria. Methods: Electronic data search was performed on PubMed, Cochrane Library, EMbase, Directory of Open Access Journals, Google Scholar, and ScienceDirect, and quality assessment was conducted for the included studies. Data were extracted independently by two authors and thematically analysed for barriers to cervical cancer screening utilization. Results: Fifteen studies, consisting of 9,995 women aged 15 and above published between 2007 and 2020, were included. Frequently reported barriers to cervical screening include lack of knowledge of cervical cancer and screening, health service factors, screening is unnecessary, fear of outcome and procedure, and financial constraints. Conclusion: Lack of adequate information about cervical cancer is a significant hindrance to screening; this factor is strongly associated with the numerous misconceptions and negative perceptions. The study highlights the need for further assessment of the sociodemographic determinants of cervical cancer screening uptake in Nigeria. Preventive strategies should be targeted at improving the dissemination of valid information, reducing the knowledge gap among women, and addressing the financial and health service factors.
... Meanwhile, attendance by South Asian women, which includes Indian, Pakistani and Nepalese women, may be influenced by practical considerations such as access to screening, the gender of the healthcare provider, and knowledge about the screening services. These women were less likely to have attended tests in the past due to a low perceived need for screening, concerns over the unavailability of female healthcare providers, lack of knowledge and transportation issues Crawford et al., 2016;Gele et al., 2017;Kafle & Panth, 2017;Singh & Badaya, 2012). In addition, for South Asians, personal modesty, gender and sex-role expectations in the family, and traditional views and health management practices are major determinants of the decision to attend screening services (Anderson de Cuevas et al., 2018;Crawford et al., 2016). ...
Objective: To report the uptake rate of cervical cancer screening (the Papanicolaou [Pap] test) and identify the perceived barriers associated with screening uptake among South Asian women in Hong Kong. Methods: This cross-sectional study involved a structured survey of 776 South Asian women aged 21 and above, recruited from the community. The participants' demographic characteristics, Pap test uptake and responses to a validated 14-item scale of perceived barriers to screening was collected. The data were analysed using descriptive statistics and logistic regression. Results: The Pap test uptake rate was 40.3%. Multivariate analysis identified two perceived barriers significantly associated with the participants' Pap test uptake: (1) not knowing where to have the test and (2) the belief that they did not need a test if they felt well. Conclusion: Although language problems and embarrassment are commonly reported barriers to screening by South Asians, the participants were more concerned about where to have the test and whether they needed it. Future interventions should thus focus on enhancing their access to the service and clarifying their understanding of the need.
Cervical cancer causes an estimated 266,000 deaths globally, 85% of which occurs in developing countries. It is a preventable disease, if detected and treated early via screen and treat, yet its burden is still huge in Nigeria. In 2012, 21.8% cases and 20.3% deaths due to cervical cancer were recorded in Nigeria. This review, therefore, aims at understanding the determinants of low cervical cancer screening in Nigeria in order to contribute in reducing the burden of the disease. Literature were obtained from Global Health, Popline and PubMed databases; WHO and other relevant websites using Eldis search engine; and from libraries in the University of Leeds and WHO in Geneva. Conceptual framework for analyzing the determinants of cervical cancer screening uptake among Nigerian women was formed by inserting service delivery component of the WHO health system framework into a modified Health Belief Model. Wrong perception of cervical cancer and cervical cancer screening due to low level of knowledge about the disease and inadequate cervical cancer preventive were identified as the major determinants of low cervical cancer screening uptake in Nigeria. Among women, belief in being at risk and/or severity of cervical cancer was low just as belief on benefits of cervical cancer screening, unlike high belief in barriers to screening. Support from the community and screening skills among health-workers were inadequate. Improving uptake of cervical cancer screening will reduce the burden of the disease. Therefore, researchers and other stakeholders interested in prevention of cervical cancer should carry-out studies to identify interventions that could address the key determinants of low cervical cancer screening among Nigerian women.
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Here we report epidemiology of cancer in parts of Madhya Pradesh and Uttar Pradesh. Cancer prevalence (%) in MP was almost double than in UP. However, relative % prevalence of cancers in females was reasonably higher than males. In MP, cancer prevalence (%) was reported maximum in Gwalior and Mahoba in UP. Moreover, prevalence assessed as crude incidence rate (CIR) (%) was comparatively higher in females than males in MP and UP. CIR (%) of cancers in females was highest in Morena of MP and Mahoba of UP. Study of site specific carcinoma showed that prevalence (%) of major female cancers such as cervical, breast, ovary and uterus altogether was 55% whereas for all other cancers 45%. Age wise variation in prevalence (%) of cancers was also studied. The results showed that most commonly affected people were in age group 25-50 and 50-75 years. Around ~ 41 and 51% patients were in age group 25-50 and 50-75 years, respectively. Of 41% patients in age group 25-50 years, 37% were female alone whereas in age group 50-75 years 30 of 51% were males. In MP, CIR (%) rate of cervical cancer was almost double than other female cancers while in UP it was almost similar for all types of cancers. Tobacco and diet particularly non-vegetarian were identified as major risk factors. 87% patients were non-vegetarians and 41% were tobacco chewers. Thus, the study suggests that females in age group 25-50 years are at high risks of cervix and other female cancers. Unlikely, males in age group 50-75 years are most susceptible. Also study has proven tobacco and diet as crucial risk factors for cancers in MP and UP.
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In this article we examine the influence of cultural beliefs on behavior or, more specifically, beliefs about cervical cancer risk factors and the use of Pap exams. Individual Latinas' (Hispanic women) holding of beliefs similar to Latinas' generally (cultural consonance) did not significantly influence their use of Pap exams. Rather, structural factors such as medical insurance, age, marital status, education, and language acculturation explained Latinas' use of this medical service. However, when Latinas held beliefs similar to those of Anglo women, then they were significantly more likely to have had a Pap exam within the past two years. Latinas whose beliefs were closer to those of physicians were significantly less likely to have had the exam recently. Arriving at these findings involved both ethnographic interviews and survey research. That these beliefs proved to be significant influences on behavior suggests not only the important ways that beliefs matter but that ethnographic methods for examining those beliefs also matter. [Latinas and cervical cancer, Pap exams, culture and behavior, ethnography and survey research]
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Cervical cancer incidence and mortality may be reduced by organized screening. Participant compliance with the attendance recommendations of the screening program is necessary to achieve this. Knowledge about the predictors of compliance is needed in order to enhance screening attendance. The Norwegian Co-ordinated Cervical Cancer Screening Program (NCCSP) registers all cervix cytology diagnoses in Norway and individually reminds women who have no registered smear for the past three years to make an appointment for screening. In the present study, a questionnaire on lifestyle and health was administered to a random sample of Norwegian women. The response rate was 68%. To address the predictors of screening attendance for the 12,058 women aged 25-45 who were eligible for this study, individual questionnaire data was linked to the cytology registry of the NCCSP. We distinguished between non-attendees, opportunistic attendees and reminded attendees to screening for a period of four years. Predictors of non-attendance versus attendance and reminded versus opportunistic attendance were established by multivariate logistic regression. Women who attended screening were more likely than non-attendees to report that they were aware of the recommended screening interval, a history of sexually transmitted infections and a history of hormonal contraceptive and condom use. Attendance was also positively associated with being married/cohabiting, being a non-smoker and giving birth. Women who attended after being reminded were more likely than opportunistic attendees to be aware of cervical cancer and the recommended screening interval, but less likely to report a history of sexually transmitted infections and hormonal contraceptive use. Moreover, the likelihood of reminded attendance increased with age. Educational level did not significantly affect the women's attendance status in the fully adjusted models. The likelihood of attendance in an organized screening program was higher among women who were aware of cervical screening, which suggests a potential for a higher attendance rate through improving the public knowledge of screening. Further, the lower awareness among opportunistic than reminded attendees suggests that physicians may inform their patients better when smears are taken at the physician's initiative.
OBJECTIVE: To investigate the relation between women's reported use of breast and cervical screening and sociodemographic characteristics. DESIGN: Cross sectional multipurpose survey. SETTING: Private households, Great Britain. Population 3185 women aged 40-74 interviewed in the National Statistics Omnibus Survey 2005-7. MAIN OUTCOME MEASURES: Ever had a mammogram, ever had a cervical smear, and, for each, timing of most recent screen. RESULTS: 91% (95% confidence interval 90% to 92%) of women aged 40-74 years reported ever having had a cervical smear, and 93% (92% to 94%) of those aged 53-74 years reported ever having had a mammogram; 3% (2% to 4%) of women aged 53-74 years had never had either breast or cervical screening. Women were significantly more likely to have had a mammogram if they lived in households with cars (compared with no car: one car, odds ratio 1.67, 95% confidence interval 1.06 to 2.62; two or more cars, odds ratio 2.65, 1.34 to 5.26), and in owner occupied housing (compared with rented housing: own with mortgage, odds ratio 2.12, 1.12 to 4.00; own outright, odds ratio 2.19, 1.39 to 3.43), but no significant differences by ethnicity, education, occupation, or region were found. For cervical screening, ethnicity was the most important predictor; white British women were significantly more likely to have had a cervical smear than were women of other ethnicity (odds ratio 2.20, 1.41 to 3.42). Uptake of cervical screening was greater among more educated women but was not significantly associated with cars, housing tenure, or region. CONCLUSIONS: Most (84%) eligible women report having had both breast and cervical screening, but 3% report never having had either. Some inequalities exist in the reported use of screening, which differ by screening type; indicators of wealth were important for breast screening and ethnicity for cervical screening. The routine collection within general practice of additional sociodemographic information would aid monitoring of inequalities in screening coverage and inform policies to correct them.
We sought to compare the take-up of cervical screening with Pap smears in a new outreach and pre-existing hospital-based setting (1) to assess the extent to which the two means of provision would overlap; (2) to establish how the utilization rate is influenced by demographic features and geographical distance from the point of provision; and (3) to access whether an outreach service would lead to increased utilization. We used a pre-test–post-test design and used multiple linear regression to assess the effect an outreach service has on utilization after adjusting for participants age, education and martial status. We found that the outreach service independently provided screening to 89% of eligible women and that coverage was inversely associated with distance from the pre-existing hospital provision. After controlling for age, education and martial status, there was a statistically significant increase (53%; 95% CI: 25, 80%) in utilization. There was little overlap between the outreach and hospital-based cervical screening services so that overall accessibility was enhanced, particularly for the elderly, widowed and less well educated. The outreach service also reduced inequalities due to geography.