Cervical Cancer Screening and Associated Barriers among Women in India: A Generalized Structural Equation Modeling Approach
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Data
2.2. Measures
2.3. Analysis
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Cervical Cancer Screening | p | |
---|---|---|---|
Yes | No | ||
Age—15:34 | 78,480 (17.06) | 381,477 (82.94) | <0.001 |
Age—35:49 | 68,900 (28.74) | 170,829 (71.26) | |
BMI—Underweight | 22,438 (14.89) | 128,221 (85.11) | <0.001 |
BMI—Normal | 83,587 (20.37) | 326,849 (79.63) | |
BMI—Overweight | 29,397 (30.27) | 67,719 (69.73) | |
BMI—Obese | 9868 (34.09) | 19,077 (65.91) | |
Visiting health facility—Not a big problem | 97,774 (22.16) | 343,517 (77.84) | <0.001 |
Visiting health facility—only distance a big problem | 10,596 (21.03) | 39,800 (78.97) | |
Visiting health facility—only transport a big problem | 7468 (20.00) | 29,876 (80.00) | |
Visiting health facility—transport & distance a big problem | 31,542 (18.48) | 139,113 (81.52) | |
Contraception use—condoms | 9458 (32.04) | 20,059 (67.96) | <0.001 |
Contraception use—others | 70,756 (30.53) | 160,985 (69.47) | |
Contraception use—none | 67,166 (15.32) | 371,262 (84.68) | |
Children—none | 15,075 (6.76) | 207,992(93.24) | <0.001 |
Children—one or two | 74,678 (29.68). | 176,906 (70.32) | |
Children—three or four | 44,925 (27.08) | 120,985 (72.92) | |
Children—more than four | 12,702 (21.48) | 46,423 (78.52) | |
Autonomy—respondent decides on health care alone | 2865 (30.36) | 6573 (69.64) | <0.001 |
Autonomy—respondent decides on health care along with husband | 16,976 (30.19) | 39,262 (69.81) | |
Autonomy—Husband and family decides on health care | 6009 (28.43) | 15,126 (71.57) | |
Sex partners—one | 25,482 (29.94) | 59,624 (70.06) | <0.001 |
Sex partners—two | 475 (26.60) | 1311 (73.40) | |
Sex partners—more than two | 239(24.24) | 747 (75.76) | |
STI awareness—no | 4809 (17.21) | 23,468 (24.86) | <0.001 |
STI awareness—yes | 23,127 (82.79) | 70,947 (75.14) | |
Years of schooling—median(IQR) | 7 (0,10) | 8(0,10) | <0.001 |
Religion—Hindu | 109,376 (21.06) | 409,905 (78.94) | <0.001 |
Religion—Muslim | 19,247 (20.35) | 75,344 (79.65 | |
Religion—Christian | 9454 (18.14) | 42,659 (81.86) | |
Religion—others | 9303 (27.60) | 24,398 (72.40) | |
Wealth Index—poorest | 18,224 (13.68) | 115,025 (86.32) | <0.001 |
Wealth Index—poorer | 25,994 (17.39) | 123,472 (82.61) | |
Wealth Index—middle | 30,999 (21.06) | 116,169 (78.94) | |
Wealth Index—richer | 33,826 (24.42) | 104,676 (75.58) | |
Wealth Index—richest | 38,337 (29.20) | 92,964 (70.08) |
Endogenous Variables | Exogenous Variables | Direct Effect on Respective Endogenous Variable | Indirect Effect on Screening * | Total Effect on Screening ** | |||
---|---|---|---|---|---|---|---|
PC (95% CI) | p | PC (95% CI) | p | PC (95% CI) | p | ||
Screening (n = 82,533) | Age—15:34 | Ref | - | - | - | - | - |
Age—35:49 | 0.148 (0.112, 0.183) | <0.001 | - | - | - | - | |
BMI—Underweight | Ref | - | - | - | - | - | |
BMI—Normal | 0.022 (−0.022, 0.066) | 0.317 | |||||
BMI—Overweight | 0.125 (0.071, 0.180) | <0.001 | |||||
BMI—Obese | 0.187 (0.112, 0.261) | <0.001 | |||||
Visiting health facility—not a big problem | Ref | - | - | - | - | - | |
Visiting health facility—only distance a big problem | 0.012 (−0.048, 0.073) | 0.695 | - | - | - | - | |
Visiting health facility—only transport a big problem | 0.010 (−0.063, 0.082) | 0.795 | - | - | - | - | |
Visiting health facility—transport and distance a big problem | 0.006 (−0.033, 0.046) | 0.749 | - | - | - | - | |
Contraception use—none | Ref | - | - | - | - | - | |
Contraception use—condom | 0.046 (−0.018, 0.110) | 0.156 | - | - | - | - | |
Contraception use—others | 0.169 (0.135, 0.203) | <0.001 | - | - | - | - | |
Children—none | Ref | - | - | - | - | - | |
Children—one or two | 0.221 (0.162, 0.280) | <0.001 | - | - | - | - | |
Children—three or four | 0.126 (0.060, 0.192) | <0.001 | - | - | - | - | |
Children-more than four | 0.009 (−0.071, 0.089) | 0.821 | - | - | - | - | |
Autonomy—respondent decides on health care alone | Ref | - | - | - | - | - | |
Autonomy—respondent decides on health care along with husband | 0.016 (−0.034, 0.066) | 0. 521 | - | - | - | - | |
Autonomy—husband and family decides on health care | 0.016 (−0.040, 0.072) | 0.576 | - | - | - | - | |
Sex partners—one | Ref | - | - | - | - | - | |
Sex partners—two | −0.002 (−0.117, 0.114) | 0.974 | - | - | - | - | |
Sex partners—more than two | −0.209 (−0.367, −0.052) | 0.009 | - | - | - | - | |
STI awareness—no | Ref | - | - | - | - | - | |
STI awareness—yes | 0.327 (0.285, 0.370) | <0.001 | - | - | - | - | |
Years of schooling | −0.014 (−0.017, −0. 010) | <0.001 | - | - | - | - | |
Religion—Hindu | Ref | - | - | - | - | - | |
Religion—Muslim | 0.161 (0.117, 0.206) | <0.001 | - | - | - | - | |
Religion—Christian | 0.015 (−0.053, 0.083) | 0.669 | - | - | - | - | |
Religion—others | 0.224 (0.015, 0.295) | <0.001 | - | - | - | - | |
Wealth Index—poorest | Ref | - | - | - | - | - | |
Wealth Index—poorer | 0.309 (0.254, 0.364) | <0.001 | - | - | - | - | |
Wealth Index—middle | 0.528 (0.472, 0.584) | <0.001 | - | - | - | - | |
Wealth Index—richer | 0.698 (0.639, 0.757) | <0.001 | - | - | - | - | |
Wealth Index—richest | 0.916 (0.851, 0.981) | <0.001 | - | - | - | - | |
Contraception Use—No usage versus condom (n = 699,686) | Religion—Hindu | Ref | - | Ref | - | Ref | - |
Religion—Muslim | 0.197 (0.165, 0.229) | <0.001 | 0.009 (−0.004, 0.022) | 0.158 | Via no.of child level 1 | ||
0.056 (−0.001, 0.112) | 0.051 | ||||||
Via no.of child level 2 | |||||||
0.149 (0.102, 0.198) | <0.001 | ||||||
Via no.of child level 3 | |||||||
0.175 (0.117, 0.233) | <0.001 | ||||||
Religion—Christian | −1.719 (−1.807, −1.631) | <0.001 | −0.080 (−0.190, 0.030) | 0.156 | Via no.of child level 1 | ||
−0.153 (−0.279, −0.028) | 0.017 | ||||||
Via no.of child level 2 | |||||||
−0.089 (−0.214, 0.036) | 0.162 | ||||||
Via no.of child level 3 | |||||||
−0.062 (−0.191, 0.066) | 0.339 | ||||||
Religion—others | 0.506 (0.461, 0.551) | <0.001 | 0.023 (−0.009, 0.060) | 0.156 | Via no.of child level 1 | ||
0.240 (0.162, 0.318) | <0.001 | ||||||
Via no.of child level 2 | |||||||
0.237 (0.159, 0.316) | <0.001 | ||||||
Via no.of child level 3 | |||||||
0.245 (0.162, 0.327) | <0.001 | ||||||
Years of schooling | 0.065 (0.062, 0.067) | <0.001 | 0.003 (−0.001, 0.007) | 0.156 | Via STI 0.053 (0.045, 0.063) | <0.001 | |
Contraception Use—No usage versus Others (n = 699,686) | Religion—Hindu | Ref | - | Ref | - | Ref | - |
Religion—Muslim | −0.636 (−0.653, −0.620) | <0.001 | −0.108 (−0.130, −0.086) | <0.001 | Via no.of child level 1 | ||
−0.061 (−0.115, −0.007) | 0.027 | ||||||
Via no.of child level 2 | |||||||
0.033 (−0.015, −0.081) | 0.179 | ||||||
Via no.of child level 3 0.058 | |||||||
(−0.005, 0.122) | 0.070 | ||||||
Religion—Christian | −0.773 (−0.796, −0.751) | <0.001 | −0.131 (−0.158, −0.104) | <0.001 | Via no.of child level 1 | ||
−0.204 (−0.277, −0.132) | <0.001 | ||||||
Via no.of child level 2 | |||||||
−0.140 (−0.211, −0.069) | <0.001 | ||||||
Via no.of child level 3 | |||||||
−0.113 (−0.187, −0.040) | 0.003 | ||||||
Religion—others | 0.029 (0.005, 0.054) | 0.017 | 0.005 (0.001, 0.009) | 0.021 | Via no.of child level 1 | ||
0.222 (0.150, 0.293) | <0.001 | ||||||
Via no.of child level 2 | |||||||
0.219 (0.147, 0.291) | <0.001 | ||||||
Via no.of child level 3 | |||||||
0.226 (0.151, 0.301) | <0.001 | ||||||
Years of schooling | −0.065 (−0.067, −0.062) | <0.001 | −0.015 (−0.019, −0.012) | <0.001 | Via STI 0.035 (0.026, 0.045) | <0.001 | |
Children (One–two) (n = 699,686) | Wealth Index—poorest | Ref | - | Ref | - | Ref | - |
Wealth Index—poorer | 0.104 (0.084, 0.123) | <0.001 | 0.023 (0.015, 0.030) | <0.001 | 0.332 (0.276, 0.387) | <0.001 | |
Wealth Index—middle | 0.190 (0.171, 0.209) | <0.001 | 0.042 (0.030, 0.054) | <0.001 | 0.570 (0.513, 0.627) | <0.001 | |
Wealth Index—richer | 0.302 (0.283, 0.321) | <0.001 | 0.068 (0.048, 0.085) | <0.001 | 0.765 (0.703, 0.827) | <0.001 | |
Wealth Index—richest | 0.383 (0.365, 0.403) | <0.001 | 0.085 (0.062, 0.108) | <0.001 | 1.001 (0.932, 1.069) | <0.001 | |
Religion—Hindu | Ref | - | Ref | - | Ref | - | |
Religion—Muslim | −0.518 (−0.535, −0.500) | <0.001 | −0.115 (−0.145, −0.084) | <0.001 | - | - | |
Religion—Christian | −0.399 (−0.421, −0.377) | <0.001 | −0.088 (−0.112, −0.064) | <0.001 | - | - | |
Religion—others | −0.032 (−0.058, −0.005) | 0.017 | −0.007 (−0.013, −0.001) | 0.024 | - | - | |
Children (three–four)(n = 699,686) | Wealth Index—poorest | Ref | - | Ref | - | Ref | - |
Wealth Index—poorer | −0.134 (−0.154, −0.114) | <0.001 | −0.017 (−0.026, −0.008) | <0.001 | 0.292 (0.236, 0.348) | <0.001 | |
Wealth Index—middle | −0.287 (−0.307, −0.267) | <0.001 | −0.036 (−0.055, −0.017) | <0.001 | 0.492 (0.433, 0.551) | <0.001 | |
Wealth Index—richer | −0.440 (−0.460, −0.419) | <0.001 | −0.055 (−0.084, −0.026) | <0.001 | 0.643 (0.577, 0.708) | <0.001 | |
Wealth Index—richest | −0.692 (−0.714, −0.671) | <0.001 | −0.087 (−0.133, −0.042) | <0.001 | 0.829 (0.750, 0.907) | <0.001 | |
Religion—Hindu | Ref | - | Ref | - | Ref | - | |
Religion—Muslim | −0.165 (−0.183, −0.146) | <0.001 | −0.021 (−0.032, −0.0097) | <0.001 | - | - | |
Religion—Christian | −0.192 (−0.216, −0.168) | <0.001 | −0.024 (−0.037, −0.011) | <0.001 | - | - | |
Religion—others | −0.079 (−0.110, −0.048) | <0.001 | −0.010 (−0.016, −0.003) | 0.003 | - | - | |
Children (more than four) (n = 699,686) | Wealth Index—poorest | Ref | - | Ref | - | Ref | - |
Wealth Index—poorer | −0.518 (−0.543, −0.494) | <0.001 | −0.005 (−0.046, 0.037) | 0.821 | 0.304 (0.236, 0.372) | <0.001 | |
Wealth Index—middle | −0.994 (−1.020, −0.967) | <0.001 | −0.009 (−0.089, 0.070) | 0.821 | 0.519 (0.425, 0.613) | <0.001 | |
Wealth Index—richer | −1.470 (−1.501, −1.439) | <0.001 | −0.014 (−0.131, 0.104) | 0.821 | 0.684 (0.556, 0.812) | <0.001 | |
Wealth Index—richest | −2.098 (−2.137, −2.058) | <0.001 | −0.019 (−0.187, 0.149) | 0.821 | 0.896 (0.721, 1.072) | <0.001 | |
Religion—Hindu | Ref | - | Ref | - | Ref | - | |
Religion—Muslim | 0.507 (0.484, 0.531) | <0.001 | 0.005 (−0.036, 0.045) | 0.821 | - | - | |
Religion—Christian | 0.262 (0.229, 0.294) | <0.001 | 0.002 (−0.019, 0.023) | 0.821 | - | - | |
Religion—others | −0.306 (−0.361, −0.250) | <0.001 | −0.003 (−0.027, 0.022) | 0.821 | - | - | |
STI | Schooling | 0.197 (0.194, 0.200) | <0.001 | 0.064 (0.056, 0.073) | <0.001 | - | - |
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Nilima, N.; Mani, K.; Kaushik, S.; Rai, S.N. Cervical Cancer Screening and Associated Barriers among Women in India: A Generalized Structural Equation Modeling Approach. Cancers 2022, 14, 3076. https://doi.org/10.3390/cancers14133076
Nilima N, Mani K, Kaushik S, Rai SN. Cervical Cancer Screening and Associated Barriers among Women in India: A Generalized Structural Equation Modeling Approach. Cancers. 2022; 14(13):3076. https://doi.org/10.3390/cancers14133076
Chicago/Turabian StyleNilima, Nilima, Kalaivani Mani, Siddharth Kaushik, and Shesh Nath Rai. 2022. "Cervical Cancer Screening and Associated Barriers among Women in India: A Generalized Structural Equation Modeling Approach" Cancers 14, no. 13: 3076. https://doi.org/10.3390/cancers14133076