The Comprehensive Cancer Network (NCCN) recommends genetic cancer risk assessment (GCRA) referral to women at high risk of hereditary breast and ovarian cancer. Latinas affected by breast cancer have the second highest prevalence of BRCA1/2 mutations after Ashkenazi Jews. Compared to non-Hispanic Whites, Latinas have lower GCRA uptake. While some studies have identified barriers for GCRA use in this population, few studies have focused on health care providers’ perspectives. The purpose of the study was to examine providers’ perceptions of barriers and facilitators for at-risk Latina women to participate in GCRA and their experiences providing services to this population. We conducted semi-structured interviews with 20 healthcare providers (e.g., genetic counselors, patient navigators) recruited nationally through snowballing. Interviews were transcribed. Two coders independently coded each interview and then met to reconcile the codes using Consensual Qualitative Research guidelines. Providers identified several facilitators for GCRA uptake (e.g., family, treatment/prevention decisions) and barriers (e.g., cost, referrals, awareness, stigma). Genetic counselors described important aspects to consider when working with at-risk Latina including language barriers, obtaining accurate family histories, family communication, and testing relatives who live outside the US. Findings from this study can inform future interventions to enhance uptake and quality of GCRA in at-risk Latina women to reduce disparities.
Objective
To explore reasons for variations in anxiety in women testing positive for human papillomavirus (HPV) with normal cytology at routine HPV primary cervical cancer screening.
Methods
In‐depth interviews were conducted with 30 women who had tested HPV‐positive with normal cytology, including 15 with low‐to‐normal anxiety and 15 with high anxiety. Data were analysed using Framework Analysis to compare themes between low and high anxiety groups.
Results
Several HPV‐related themes were shared across anxiety groups, but only highly anxious women expressed fear and worry, fatalistic cognitions about cancer, fertility‐related cognitions, adverse physiological responses and changes in health behaviour(s). In comparison to those with low anxiety, women with high anxiety more strongly voiced cognitions about the 12‐month wait for follow‐up screening, relationship infidelity, a lower internal locus of control and HPV‐related symptom attributions.
Conclusions
Receiving an HPV‐positive with normal cytology result related to various emotional, cognitive, behavioural and physiological responses; some of which were specific to, or more pronounced in, women with high anxiety. If our observations are confirmed in hypothesis‐driven quantitative studies, the identification of distinct themes relevant to women experiencing high anxiety can inform targeted patient communications and HPV primary screening implementation policy.
Incentivising vaccine consent form return may improve vaccine uptake and be seen as less coercive than incentivising vaccination itself. We assessed the acceptability of financial incentives in this context among adolescent females and explored potential mechanisms by which incentives might change behaviour. Design Focus groups and analysis of free-text questionnaire responses. Methods Study 1: 36 female secondary students in London (age 13-14) participated in six focus groups exploring the use of incentives in the context of vaccination. Data were analysed thematically. Study 2: was conducted to triangulate the findings of Study 1, by analysing freetext questionnaire responses from 181 female secondary students in London (age 12-13) reporting their opinion of incentivising consent form return. Data from Study 1 was also used to explore perceived potential mechanisms of action by which incentives might encourage consent form return.
Men who have sex with men (MSM) in England are eligible for vaccination against human papillomavirus (HPV) via specialist sexual health services and HIV clinics. Uptake among clinic attendees is incomplete, but the reason for this is unclear. We do not know who is accessing and being offered the vaccine. This cross-sectional study conducted in England examined socio-demographic correlates of vaccine uptake for MSM and how frequently the vaccine is being offered in clinics. MSM completed an online questionnaire asking about socio-demographic characteristics, whether they had recently attended a sexual health or HIV clinic, and if so, whether they had been offered the vaccine, and vaccination status. Around 52% of MSM (N = 115; mean age = 30.2) had received at least one dose of the vaccine, and 70% of clinic attendees had been offered the vaccine. MSM were more likely to have initiated the vaccine series if they were homosexual (versus bisexual; OR: 5.22; 95% CI: 1.55–17.51) or had heard about the vaccine from one or two types of sources (versus no sources: OR: 14.70; 95% CI: 4.00–54.00 and OR: 26.00; 5.74–117.77 respectively). Initiation was not associated with age, ethnicity, education level, or number of sexual partners. Hepatitis B vaccination status was associated with vaccination initiation only in unadjusted models. The majority of eligible MSM are being offered the vaccine in clinics. Socio-demographic differences in uptake of the HPV vaccine among MSM may lead to inequalities in HPV-related disease.
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