Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Variables
2.3. Data Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalnce Worldwide in 2012. Available online: http://globocan.iarc.fr/Default.aspx (accessed on 12 June 2018).
- International Agency for Resarc on Cancer Working group. Human Papillomaviruses. In IARC Monographs on the Evalutation of Carcinogenic Risks to Humans; International Agency for Research on Cancer: Lyon, France, 1995; Volume 64. [Google Scholar]
- Associazione Italiana di Oncologia Medica-Associazione Italiana dei Registri Tumori. I Numeri del Cancro in Italia. 2016. Available online: http://www.registri-tumori.it/PDF/AIOM2016/I_numeri_del_cancro_2016.pdf (accessed on 11 April 2017).
- Regional Health Authority of Sicily. Atlante Sanitario della Sicilia: Incidenza, Prevalenza, Sopravvivenza, Mortalità e Ospedalizzazione della Patologia Oncologica. 2013. Available online: http://pti.regione.sicilia.it/portal/page/p (accessed on 11 April 2017).
- Peirson, L.; Fitzpatrick-Lewis, D.; Ciliska, D.; Warren, R. Screening for cervical cancer: A systematic review and meta-analysis. Syst. Rev. 2013, 2, 35. [Google Scholar] [CrossRef] [PubMed]
- Whitlock, E.P.; Vesco, K.K.; Eder, M.; Lin, J.S.; Senger, C.A.; Burda, B.U. Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: A systematic review for the U.S. Preventive Services Task Force. Ann. Intern. Med. 2011, 155, 687. [Google Scholar] [CrossRef] [PubMed]
- Dhendup, T.; Tshering, P. Cervical cancer knowledge and screening behaviors among female university graduates of year 2012 attending national graduate orientation program, Bhutan. BMC Women’s Health 2014, 14, 44. [Google Scholar] [CrossRef] [PubMed]
- Akinlotan, M.; Bolin, J.N.; Helduser, J.; Ojinnaka, C.; Lichorad, A.; McClellan, D. Cervical Cancer Screening Barriers and Risk Factor Knowledge Among Uninsured Women. J. Community Health 2017, 42, 770–778. [Google Scholar] [CrossRef] [PubMed]
- Menvielle, G.; Richard, J.B.; Ringa, V.; Dray-Spira, R.; Beck, F. To what extent is women’s economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010. Cancer Causes Control 2014, 25, 977–983. [Google Scholar] [CrossRef] [PubMed]
- Osservatorio Nazionale Screening. Rapporto Ons 2017. Available online: https://wwwosservatorionazionalescreeningit/content/rapporto-ons-2017 (accessed on 12 June 2018).
- Rosenstock, I.M. The Health Belief Model and preventative health behavior. Health Educ. Behav. 1974, 2, 354–386. [Google Scholar]
- Boonpongmanee, C.; Jittanoon, P. Predictors of Papanicolaou testing in working women in Bangkok, Thailand. Cancer Nurs. 2007, 30, 384–389. [Google Scholar] [CrossRef] [PubMed]
- Burak, L.J.; Meyer, M. Using the Health Belief Model to examine and predict college women’s cervical cancer screening beliefs and behavior. Health Care Women Int. 1997, 18, 251–262. [Google Scholar] [CrossRef] [PubMed]
- Lambert, C.C.; Chandler, R.; McMillan, S.; Kromrey, J.; Johnson-Mallard, V.; Kurtyka, D. Pap test adherence, cervical cancer perceptions, and HPV knowledge among HIV-infected women in a community health setting. J. Assoc. Nurses AIDS Care 2015, 26, 271–280. [Google Scholar] [CrossRef] [PubMed]
- Peterson, E.B.; Ostroff, J.S.; DuHamel, K.N.; D’Agostino, T.A.; Hernandez, M.; Canzona, M.R.; Bylund, C.L. Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev. Med. 2016, 93, 96–105. [Google Scholar] [CrossRef] [PubMed]
- Simth, M.; French, L.; Barry, H.C. Periodic Abstinence from Pap (PAP) Smear Study: Women’s Perceptions of Pap Smear Screening. Ann. Fam. Med. 2003, 1, 203–208. [Google Scholar] [CrossRef]
- Italian Ministry of Health. Raccomandazioni per la Pianificazione e l’Esecuzione degli Screening di Popolazione per la Prevenzione del Cancro della Mammella, del Cancro della Cervice Uterina e del Cancro del Colon Retto. 2006. Available online: http://www.salute.gov.it/imgs/C_17_pubblicazioni_774_allegato.pdf (accessed on 11 April 2017).
- Janerich, D.T.; Hadjimichael, O.; Schwartz, P.E.; Lowell, D.M.; Meigs, J.W.; Merino, M.J.; Flannery, J.T.; Polednak, A.P. The screening histories of women with invasive cervical cancer, Connecticut. Am. J. Public Health 1995, 85, 791–794. [Google Scholar] [CrossRef] [PubMed]
- Coleman, D.V.; Poznansky, J.J. Review of cervical smears from 76 women with invasive cervical cancer: Cytological findings and medicolegal implications. Cytopathology 2006, 17, 127–136. [Google Scholar] [CrossRef] [PubMed]
- Abed, Z.; O’Leary, M.; Hand, K.; Flannelly, G.; Lenehan, P.; Murphy, J.; Foley, M. Cervical screening history in patients with early stage carcinoma of the cervix. Irish Med. J. 2006, 99, 140–142. [Google Scholar]
- Ponka, D.; Dickinson, J. Screening with the Pap test. CMAJ 2014, 186, 1394. [Google Scholar] [CrossRef] [PubMed]
- Firenze, A.; Marsala, M.G.; Bonanno, V.; Maranto, M.; Ferrara, C.; Giovannelli, L.; Restivo, V. Facilitators and barriers HPV unvaccinated girls after 5 years of program implementation. Hum. Vaccines Immunother. 2015, 11, 240–244. [Google Scholar] [CrossRef] [PubMed]
- Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute dell’Istituto superiore di Sanità Rapporto Nazionale Passi 2008–2015: Screening Cervicale 2016. Available online: http://wwwepicentroissit/passi/dati/ScreeningCervicaleasp (accessed on 17 April 2017).
- Taylor, V.M.; Yasui, Y.; Burke, N.; Nguyen, T.; Acorda, E.; Thai, H.; Qu, P.; Jackson, J.C. Pap testing adherence among Vietnamese American women. Cancer Epidemiol. Biomark. Prev. 2004, 13, 613–619. [Google Scholar]
- Studts, C.R.; Tarasenko, Y.N.; Schoenberg, N.E. Barriers to cervical cancer screening among middle-aged and older rural Appalachian women. J. Community Health 2013, 38, 500–512. [Google Scholar] [CrossRef] [PubMed]
- Boone, E.; Lewis, L.; Karp, M. Discontent and Confusion: Primary Care Providers’ Opinions and Understanding of Current Cervical Cancer Screening Recommendations. J. Women’s Health (Larchmt) 2016, 25, 255–262. [Google Scholar] [CrossRef] [PubMed]
- Montgomery, K.; Bloch, J.R.; Bhattacharya, A.; Montgomery, O. Human papillomavirus and cervical cancer knowledge, health beliefs, and preventative practices in older women. J. Obstet. Gynecol. Neonatal Nurs. 2010, 39, 238–249. [Google Scholar] [CrossRef] [PubMed]
- Coker, A.L.; Eggleston, K.S.; Meyer, T.E.; Luchok, K.; Das, I.P. What predicts adherence to follow-up recommendations for abnormal Pap tests among older women? Gynecol. Oncol. 2007, 105, 74–80. [Google Scholar] [CrossRef] [PubMed]
- Virtanen, A.; Anttila, A.; Nieminen, P. The costs of offering HPV-testing on self-taken samples to non-attendees of cervical screening in Finland. BMC Women’s Health 2015, 15, 99. [Google Scholar] [CrossRef] [PubMed]
Questionnaire Items | All Women N = 365 | Pap Test within the Last 3 Years N = 243 (%) | No Pap test within the Last 3 Years N = 122 (%) | p |
---|---|---|---|---|
Age class | ||||
≥45 | 240 | 158 (65.0) | 82 (67.2) | 0.69 |
<45 | 125 | 85 (35.0) | 40 (32.8) | |
School level | ||||
≤8 years | 169 | 107 (44.0) | 62 (50.8) | 0.14 |
>8 years | 196 | 136 (56.0) | 60 (49.2) | |
Marital status | ||||
Not married | 78 | 47 (19.3) | 31 (25.4) | 0.19 |
Married | 287 | 196 (80.7) | 91 (74.6) | |
Cohabitation | ||||
Not alone | 345 | 227 (93.4) | 118 (96.7) | 0.25 |
Alone | 20 | 16 (6.6) | 4 (3.3) | |
Working activity 1 | ||||
Not employed | 171 | 110 (45.3) | 61 (50.8) | 0.31 |
Employed | 192 | 133 (54.7) | 59 (49.2) | |
Parity | ||||
No | 70 | 44 (18.1) | 26 (21.3) | 0.51 |
Yes | 295 | 199 (81.9) | 96 (78.7) | |
Awareness to get a Pap test by invitation letter | ||||
No | 150 | 92 (37.9) | 58 (47.5) | 0.12 |
Yes | 215 | 151 (62.1) | 64 (52.5) | |
Awareness to get a Pap test by GP’s advice | ||||
No | 188 | 104 (42.8) | 84 (68.9) | <0.01 |
Yes | 177 | 139 (57.2) | 38 (31.1) | |
Awareness to get a Pap test by mass information campaign | ||||
No | 171 | 119 (49.0) | 52 (42.6) | 0.21 |
Yes | 194 | 124 (51.0) | 70 (57.4) | |
Cervical cancer source of information 1 | ||||
Friends, web | 24 | 13 (5.3) | 11 (9.1) | 0.25 |
General pratictioner, gynaecologist, clinic | 340 | 230 (94.7) | 110 (90.9) | |
Perceived benefits | ||||
No | 93 | 51 (21.0) | 42 (34.4) | <0.05 |
Yes | 272 | 192 (79.0) | 80 (65.6) | |
Perceived severity 1 | ||||
No | 123 | 76 (31.3) | 47 (38.8) | 0.13 |
Yes | 241 | 167 (68.7) | 74 (61.2) | |
Perceived susceptibility 1 | ||||
No | 108 | 49 (20.2) | 59 (48.8) | <0.01 |
Yes | 256 | 194 (79.8) | 62 (51.2) |
Questionnaire Items | Crude-OR | 95% CI | P | Adjusted OR 1 | 95% CI | p |
---|---|---|---|---|---|---|
Age class | ||||||
≥45 | 1 | |||||
<45 | 1.10 | 0.69–1.77 | 0.69 | 1.31 | 0.78–2.21 | 0.31 |
School level | ||||||
≤8 years | 1 | |||||
>8 years | 1.40 | 0.89–2.18 | 0.14 | 0.97 | 0.59–1.58 | 0.89 |
Marital status | ||||||
Not married | 1 | |||||
Married | 1.42 | 0.84–2.41 | 0.19 | 1.25 | 0.70–2.24 | 0.44 |
Cohabitation | ||||||
Not alone | 1 | |||||
Alone | 1.96 | 0.63–6.09 | 0.25 | |||
Working activity | ||||||
Not employed | 1 | |||||
Employed | 1.27 | 0.81–1.99 | 0.31 | |||
Parity | ||||||
No | 1 | |||||
Yes | 1.20 | 0.69–2.09 | 0.51 | |||
Awareness to get a Pap test by invitation letter | ||||||
No | 1 | |||||
Yes | 1.44 | 0.91–2.26 | 0.12 | 1.26 | 0.77–2.05 | 0.35 |
Awareness to get a Pap test by GP’s advice | ||||||
No | 1 | |||||
Yes | 2.92 | 1.83–4.66 | <0.01 | 2.55 | 1.57–4.14 | <0.01 |
Awareness to get a Pap test by mass information campaign | ||||||
No | 1 | |||||
Yes | 0.75 | 0.48–1.18 | 0.21 | |||
Cervical cancer source of information | ||||||
Friends, web | 1 | |||||
General pratictioner, gynaecologist, clinic | 1.64 | 0.71–3.81 | 0.25 | 1.40 | 0.5–3.93 | 0.53 |
Perceived benefits | ||||||
No | 1 | |||||
Yes | 1.94 | 1.18–3.18 | <0.05 | 1.58 | 0.89–2.81 | 0.12 |
Perceived severity | ||||||
No | 1 | |||||
Yes | 1.43 | 0.9–2.28 | 0.13 | 0.94 | 0.54–1.62 | 0.82 |
Perceived susceptibility | ||||||
No | 1 | |||||
Yes | 3.80 | 2.34–6.18 | <0.01 | 3.24 | 1.92–5.48 | <0.01 |
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Restivo, V.; Costantino, C.; Marras, A.; Napoli, G.; Scelfo, S.; Scuderi, T.; Casuccio, A.; Cernigliaro, A.; Giusti, A.; Spila Alegiani, S. Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women. Int. J. Environ. Res. Public Health 2018, 15, 1804. https://doi.org/10.3390/ijerph15091804
Restivo V, Costantino C, Marras A, Napoli G, Scelfo S, Scuderi T, Casuccio A, Cernigliaro A, Giusti A, Spila Alegiani S. Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women. International Journal of Environmental Research and Public Health. 2018; 15(9):1804. https://doi.org/10.3390/ijerph15091804
Chicago/Turabian StyleRestivo, Vincenzo, Claudio Costantino, Antonello Marras, Giuseppe Napoli, Sabrina Scelfo, Tiziana Scuderi, Alessandra Casuccio, Achille Cernigliaro, Angela Giusti, and Stefania Spila Alegiani. 2018. "Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women" International Journal of Environmental Research and Public Health 15, no. 9: 1804. https://doi.org/10.3390/ijerph15091804
APA StyleRestivo, V., Costantino, C., Marras, A., Napoli, G., Scelfo, S., Scuderi, T., Casuccio, A., Cernigliaro, A., Giusti, A., & Spila Alegiani, S. (2018). Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women. International Journal of Environmental Research and Public Health, 15(9), 1804. https://doi.org/10.3390/ijerph15091804