Barriers to Access the Pap Smear Test for Cervical Cancer Screening in Rural Riverside Populations Covered by a Fluvial Primary Healthcare Team in the Amazon
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Total Sample n (%) | <25 Years n (%) | 25–59 Years n (%) |
---|---|---|---|
Last screening test | |||
Never | 18 (8.1) | 13 (28.9) | 5 (2.9) |
Less than 1 year ago | 150 (67.9) | 25 (55.5) | 125 (71.4) |
1 -| 2 years ago | 26 (11.8) | 6 (13.3) | 20 (11.4) |
2 -| 3 years ago | 10 (4.5) | 1 (2.2) | 9 (5.1) |
More than 3 years ago | 17 (7.7) | 1 (2.2) | 16 (9.1) |
Reasons for not performing screening test (n = 18) | |||
Never had intercourse | 1 (5.6) | 1 (7.7) | - |
Did not deem necessary | 5 (27.8) | 1 (7.7) | 4 (80.0) |
Felt ashamed | 3 (16.7) | 2 (15.4) | 1 (20.0) |
Had never been instructed on undergoing the test | 1 (5.6) | 1 (7.7) | - |
Had trouble scheduling the test | 2 (11.1) | 2 (15.4) | - |
Because of age | 3 (16.7) | 3 (23.1) | - |
Fear | 2 (11.1) | 2 (15.4) | - |
Could not inform | 1 (5.6) | 1 (7.7) | - |
Result waiting time (n = 203) | |||
Less than a month | 15 (7.4) | 2 (6.2) | 13 (7.6) |
1 -| 3 months | 113 (55.7) | 20 (62.5) | 92 (54.1) |
3 -| 6 months | 38 (18.7) | 4 (12.5) | 34 (20.0) |
Six months or more | 1 (0.5) | - | 1 (0.6) |
Has not received the result yet | 32 (15.8) | - | 26 (15.3) |
Never received the result | 3 (1.5) | 6 (18.8) | 3 (1.8) |
Never went to get the result | 1 (0.5) | - | 1 (0.6) |
Location of screening test (n = 203) | |||
Public service | 194 (95.6) | 31 (96.9) | 162 (95.3) |
Private service | 8 (3.9) | 1 (3.1) | 7 (4.1) |
Does not know/did not answer | 1 (0.5) | - | 1 (0.6) |
Variable | Mean (±SD)/ n (%) | OR | 95% CI | p-Value |
---|---|---|---|---|
Structural determinants | ||||
Age | 35 (±11.04) | 0.94 | 0.89–0.99 | 0.010 * |
Years of education | 1.13 | 0.99–1.30 | 0.061 a | |
Never went to school | 4 (1.8%) | |||
1–9 years of education | 136 (61.5%) | |||
10–12 years of education | 70 (31.7%) | |||
13 years of education of more | 9 (4.1%) | |||
No information | 3 (1.4%) | |||
Family income (R$) | 908.6 (±769.0) | 1.00 | 1.00–1.00 | 0.452 |
Occupation | ||||
Others | 119 (53.8%) | ref | ||
Housewife | 102 (46.2%) | 0.36 | 0.14–0.93 | 0.034 * |
Access to care | ||||
Easy | ref | |||
Difficult | 1.15 | 0.36–3.76 | 0.812 | |
Intermediary determinants | ||||
Self-perception of general health | ||||
Very good/good | 121 (54.8%) | 1.24 | 0.25–6.21 | 0.797 |
Regular | 71 (32.1%) | 1.26 | 0.23–6.85 | 0.788 |
Poor/very poor | 15 (6.8%) | ref | ||
No information | 14 (6.3%) | |||
Level of difficulty to schedule appointments | 1.35 | 0.82–2.25 | 0.234 | |
Very easy/easy | 86 (49.1%) | 1.06 | 0.36–3.12 | 0.915 |
Not easy nor difficult | 29 (16.6%) | 3.91 | 0.45–34.21 | 0.218 |
Difficult/very difficult | 49 (28%) | ref | ||
Does not know/did not answer | 11 (6.3%) | |||
First place you go when you are sick or in need of health care | ||||
Primary care | 162 (73.4%) | 1.01 | 0.32–3.24 | 0.981 |
Another healthcare service | 35 (15.8%) | ref | ||
None/another/no information | 24 (10.9%) | |||
How do you travel to get to the service you usually look for? | ||||
On foot | 76 (34.4%) | ref | ||
Boat/canoe | 127 (57.5%) | 0.57 | 0.21–1.56 | 0.277 |
Other/no information | 18 (8.2%) | |||
Knowledge of the healthcare unit responsible for covering the community | ||||
Community health clinic or boat | 170 (76.9%) | ref | ||
Healthcare unit outside the community | 26 (11.8%) | 0.98 | 0.21–4.69 | 0.984 |
There is not one/does not know | 25 (11.3%) | 0.26 | 0.06–1.10 | 0.067 a |
Time it takes from home to the healthcare unit during floods | 15.44 (±15.44) | 1.00 | 0.97–1.03 | 0.861 |
Time it takes from home to the healthcare unit during drought | 29.19 (±32.40) | 1.00 | 0.98–1.01 | 0.887 |
Opinion about the distance from home to the health unit | ||||
Close | 141 (63.8%) | ref | ||
Far | 54 (24.4%) | 1.78 | 0.49–6.52 | 0.385 |
No information | 26 (11.8%) | |||
How did you schedule the last appointment at the healthcare unit? | ||||
Scheduled or through the team | 140 (63.4%) | ref | ||
On their own | 55 (24.9%) | 1.76 | 0.48–6.46 | 0.393 |
No information | 26 (11.8%) | |||
Waiting time on the last appointment | 85.25 (±81.3) | 1.00 | 1.00–1.00 | 0.765 |
Distance from the house to the boat stop | 2.4 (±3.4) | 0.99 | 0.88–1.12 | 0.885 |
Distance from home to the health unit | 6.8 (±6.4) | 0.98 | 0.92–1.05 | 0.607 |
Multiparity | 3.85 (±2.68) | 0.80 | 0.69–0.94 | 0.005 ** |
Variable | Model 1 | Model 2 | Model 3 | |||
---|---|---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Structural determinants | ||||||
Age | 0.93 (0.89–0.98) | 0.006 ** | 0.96 (0.90–1.02) | 0.159 | ||
Years of education | 0.97 (0.92–1.02) | 0.187 | ||||
Occupation (ref. others) | ||||||
Housewife | 0.36 (0.14–0.94) | 0.037 * | 0.30 (0.10–0.88) | 0.028 * | 0.31 (0.11–0.89) | 0.029 * |
Intermediary determinants | ||||||
Knowledge about the healthcare unit responsible for covering the community (ref. in the community) | ||||||
Healthcare unit outside the community | 0.84 (0.16–4.30) | 0.835 | 0.86 (0.17–4.37) | 0.857 | ||
There is not/does not know | 0.20 (0.04–1.01) | 0.051 | 0.18 (0.04–0.97) | 0.045 * | ||
Multiparity | 0.81 (0.67–0.96) | 0.018 * | 0.76 (0.64–0.90) | 0.002 ** |
Variable | Total Sample 14–83 Years n (%) | <25 Years n (%) | 25–59 Years n (%) |
---|---|---|---|
Total of screening tests (n = 1097) | 1097 (100) | 229 (100) | 803 (100) |
Inappropriately repeated | 35 (3.2) | 7 (3.1) | 26 (3.2) |
Unnecessary performed | 105 (9.6) | 11 (4.8) | 87 (10.8) |
Potentially delayed | 210 (19.1) | 45 (19.7) | 146 (18.2) |
Types of epithelium cells (n = 1097) | |||
No information | 102 (9.3) | 17 (7.4) | 85 (10.2) |
Squamous epithelium | 257 (23.4) | 54 (23.6) | 193 (23.1) |
Glandular epithelium | 1 (0.1) | 1 (0.4) | - |
Squamous/glandular epithelium | 601 (54.8) | 137 (59.8) | 451 (53.9) |
Squamous/metaplastic epithelium | 34 (3.1) | 4 (1.7) | 26 (3.1) |
Squamous/glandular/metaplastic epithelium | 102 (9.3) | 16 (7.0) | 82 (9.8) |
Tests with abnormal or unusual cells (n = 31) | |||
Atypical squamous cells of undetermined significance not ruling out high-grade lesion–ASC-H | 7 (0.6) | 2 (0.9) | 5 (0.6) |
Atypical, possibly non-neoplastic, squamous cells of undetermined significance–ASC-US | 14 (1.3) | 6 (2.6) | 8 (1.0) |
High-grade intraepithelial lesion (cervical intraepithelial neoplasia grade II and III)–HSIL | 3 (3.3) | - | 3 (3.4) |
Low-grade intraepithelial lesion (cytopathic effect linked to HPV and cervical intraepithelial neoplasia grade II and III)–LSIL-H | 2 (0.2) | 1 (0.4) | 1 (0.1) |
Low-grade intraepithelial lesion (cytopathic effect linked to HPV and cervical intraepithelial neoplasia grade I)–LSIL | 5 (5.5) | 4 (1.7) | 1 (0.1) |
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da Silva, D.C.B.; Garnelo, L.; Herkrath, F.J. Barriers to Access the Pap Smear Test for Cervical Cancer Screening in Rural Riverside Populations Covered by a Fluvial Primary Healthcare Team in the Amazon. Int. J. Environ. Res. Public Health 2022, 19, 4193. https://doi.org/10.3390/ijerph19074193
da Silva DCB, Garnelo L, Herkrath FJ. Barriers to Access the Pap Smear Test for Cervical Cancer Screening in Rural Riverside Populations Covered by a Fluvial Primary Healthcare Team in the Amazon. International Journal of Environmental Research and Public Health. 2022; 19(7):4193. https://doi.org/10.3390/ijerph19074193
Chicago/Turabian Styleda Silva, Débora C. B., Luiza Garnelo, and Fernando J. Herkrath. 2022. "Barriers to Access the Pap Smear Test for Cervical Cancer Screening in Rural Riverside Populations Covered by a Fluvial Primary Healthcare Team in the Amazon" International Journal of Environmental Research and Public Health 19, no. 7: 4193. https://doi.org/10.3390/ijerph19074193