Reaching women in the Peruvian Andes through cervical cancer screening campaigns: assessing attitudes of stakeholders and patients (original) (raw)
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Preventive medicine reports, 2020
Cervical cancer mortality is high among Peruvian women of reproductive age. Understanding barriers and facilitators of cervical cancer screening and treatment could facilitate development of contextually-relevant interventions to reduce cervical cancer incidence and mortality. From April to October 2019, we conducted a crosssectional survey with 22 medical personnel and administrative staff from Liga Contra el Cancer, in Lima, Peru. The survey included structured and open-ended questions about participants' roles in cervical cancer prevention and treatment, perceptions of women's barriers and facilitators for getting screened and/or treated for cervical cancer, as well as attitudes towards adopting new cervical cancer interventions. For structured questions, the frequency of responses for each question was calculated. For responses to open-ended questions, content analysis was used to summarize common themes. Our data suggest that the relative importance and nature of barriers that Peruvian women face are different for cervical cancer screening compared to treatment. In particular, participants mentioned financial concerns as the primary barrier to treatment and a lack of knowledge or awareness of human papillomavirus and/or cervical cancer as the primary barrier to screening uptake among women. Participants reported high willingness to adopt new interventions or strategies related to cervical cancer. Building greater awareness about benefits of cervical cancer screening among women, and reducing financial and geographic barriers to treatment may help improve screening rates, decrease late-stage diagnosis and reduce mortality in women who have a pre-cancer diagnosis, respectively. Further studies are needed to generalize study findings to settings other than Lima, Peru.
International Journal of Environmental Research and Public Health
Background: Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish “El Valle”. Method: A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. Results: Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, t...
Women's participation in a cervical cancer screening program in northern Peru
Health Education Research, 2007
Cervical cancer is often the most common cancer among women in developing countries, yet current screening efforts have not been effective in reducing incidence and mortality rates in these settings. In an effort to increase knowledge about screening participation in low-resource settings, this study sought to identify key factors affecting women's participation in a cervical screening program in north central Peru. We studied women who were exposed to various health promotion educational activities and compared a total of 156 women who sought screening between July 2001 and October 2003 with 155 women who did not. Results from logistic regression identified four significant predictors of screening: higher relative wealth, knowing other screened women, seeking care from a health facility when sick and satisfaction with services at the health facility. When we restricted our analysis to women who had experienced screening in the past, two additional predictors emerged: having a husband who was supportive of screening participation and attending an awareness-raising session. These results have important programmatic value for tailoring outreach efforts for women and indicate that different strategies may be required to best reach women who have never been screened.
BMC Women's Health
Background Cervical cancer is a leading cause of cancer deaths among women of reproductive age in Peru. Screening and early identification of pre-cancerous lesions are a cornerstone of the cervical cancer prevention strategy. Yet, there is limited literature on barriers to screening among Peruvian women. In this cross-sectional study, we aimed to examine Peruvian women’s knowledge, attitudes, and practices regarding cervical cancer screening and identify possible reasons for the gap between knowledge and screening. Methods The study was conducted in metropolitan Lima from June–August 2019. We purposefully recruited 12 women who had previously been screened, and 12 who had never been screened for cervical cancer. The women completed a 40-question knowledge and attitude survey and an in-depth interview about barriers to screening. Descriptive analysis was used to calculate a knowledge and attitude score and qualitative analysis was guided by the Health Belief Model constructs. Results...
Assessing participation of women in a cervical cancer screening program in Peru
Revista Panamericana de Salud Pública, 2009
Methods. In November 2000, a new cervical cancer screening program was introduced in the Region of San Martin, Peru. A total of 107 683 women, ages 25-49, were eligible for screening. This report covers the initial period from program inception through 31 October 2003. We used data from the program information system to identify systemic factors and individual characteristics influencing women's participation. We conducted a three-step analysis: we assessed systemic factors at the level of micronetworks or group of health centers, we estimated the odds of being a new user (never screened or not screened in the past 5 years) according to sociodemographic characteristics, and we assessed how women learned about the availability of screening services while controlling for influential factors identified in previous analyses. Results. During the 3-year period, 36 759 eligible women attended screening services, for a participation rate of 32.3%. While attendance varied by area and time period, the program attracted 12 208 new users. Health care micronetworks with available static screening services had higher participation. New users were more likely than regular users to have less education and to report low use of family-planning services. All other factors being equal, they were also more likely than regular users to hear about screening services from a health care provider.
2007
Methods. The program consisted of radio broadcasts targeting rural women and presentations to community nurses. The effectiveness of the radio broadcasts was assessed using a cross-sectional design (control groups n = 124, n = 243; intervention group n = 233). A pre-/ post-test design was used to evaluate the nurses' training program (n = 32). A subset of nurses (n = 16) was retested two years later. Evaluation included t tests, chi-square and Fisher exact analyses. Results. The radio broadcast increased the proportion of women who were familiar with the term "cervical cancer," who could identify means of preventing cervical cancer, and who understood the purpose of the Pap smear. In addition, older and under-screened women were successfully recruited for screening via radio. The nurses' program improved understanding of the correct use of the Pap smear, the age-related risk of dysplasia, and the proper triage of abnormal results. The nurses retained a significant amount of knowledge two years after this training. Conclusions. In developing countries, inexpensive, community-based educational programs using radio broadcasts and lecture presentations can increase cervical cancer knowledge and improve screening behavior.
Women's Health
Objectives: To undertake an descriptive analysis of the health needs, healthcare practices and barriers to accessing healthcare faced by women in Lower Napo River Region, Peru, and to understand health literacy regarding cervical cancer and the need for more effective cervical cancer screening services. Methods: We performed a community-based needs assessment adapting Demographic and Health survey methodology with additional questions determining female health literacy on cervical cancer and assessing the availability and need for cervical cancer screening services. We surveyed women (N = 121) across all households in six communities along the Lower Napo River, Loreto, Peru, in May 2015. Data were collected as part of the larger Amazon Community Based Participation Cervical Cancer Screen-and-Treat Programme. Survey data were compared to national results from ENDES 2014. Results: Comparison between our findings and the ENDES 2014 survey highlighted considerable inequality between ind...
PLOS ONE, 2021
Globally, over 300,000 women die of cervical cancer annually. Given that human papillomavirus vaccines are highly effective in the primary prevention of cervical cancer, it is important to explore the barriers and facilitators to vaccination uptake in areas where the burden of disease remains high. This study, informed by the socio-ecological model, aimed to qualitatively explore vaccination uptake via in-depth interviews with eleven nurses and ten teachers involved in vaccine delivery in Iquitos, Peru. The results highlighted that vaccine uptake was influenced by multiple factors including individuals’ knowledge and attitudes, community beliefs, geography, and policy level variables. Findings suggested that professionals were informed and supportive of the HPV vaccination program but perceived that parents were uninformed about the vaccine. There is a need for community education programs, for a revision of the process of obtaining parental consent, for improved communication betwe...
Perceived barriers and benefits to cervical cancer screening in Latin America
Preventive Medicine, 2004
Background. This article describes the results of studies on the barriers and benefits of cervical cancer screening from the perspective of women, men, and health providers in five Latin American countries and compares them to other findings from the literature. Methods. Five separate qualitative studies (focus groups and interviews) were conducted among low-income women in Venezuela, Ecuador, Mexico, El Salvador, and Peru regarding barriers and benefits of cervical cancer screening. Views from health providers and men were also included. Results. The main barriers identified by all participants are accessibility and availability of quality services, facilities that lack comfort and privacy, costs, and courtesy of providers, which interact with poor service delivery. Barriers that pertain to women's beliefs are anxiety borne by women awaiting test results, associated with negligence and fear of cancer (although not to a particular cancer or a particular procedure). Benefits of screening are peace of mind and being in control of their health, which then enable other life activities to continue unhindered. Conclusions. Except for the accessibility and availability of quality services, these results are consistent with findings from other studies in developed and developing countries. Barriers could be lifted if health service delivery was enhanced, for instance, through quality improvement techniques that are available at low cost. Women's anxiety over test results still needs to be further assessed to devise risk communication strategies that take into account broader cultural frameworks. It is to be noted that such strategies should permeate the way health services are provided for cervical cancer prevention regardless of the specific test used. Vulnerability perceived by low-income women with respect to their capacity to cope with diseases and trust the health services and how this affects their perceptions of risk and their behaviors have not been studied as yet.
The Peru Cervical Cancer Prevention Study (PERCAPS): The technology to make screening accessible
Gynecologic Oncology, 2013
Objective-This study utilized a combination of HPV self-sampling, iFTA elute specimen cards, and long distance transport for centralized processing of specimens to determine the feasibility of large-scale screening in remote and transient populations. Methods-This study was performed in two locations in Peru (Manchay and Iquitos). The "just for me" cervico-vaginal brush and iFTA elute cards were used for collection and transport of specimens. Samples were shipped via FedEx to China and tested for 14 types of high-risk HPV using PCR based MALDI-TOF. HPV positive women were treated with cryotherapy after VIA triage, and followed-up with colposcopy, biopsy, ECC, and repeat HPV testing at 6 months. Results-Six hundred and forty three women registered, and 632 returned a sample over a 10 day period. Within 2 weeks, specimens were shipped, samples tested, and results received by study staff. Sixty-eight women (10.8%) tested positive, and these results were delivered over 4