Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis

Abstract

BackgroundAlthough cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of cancer-related morbidity and mortality globally.ObjectivesThe objective of this systematic review is to understand the evidence of the effect of cervical cancer education compared to control conditions on cervical cancer screening rates in eligible women population at risk of cervical cancer. We also sought to understand the effect of provider recommendations for screening to eligible women on cervical cancer screening (CCS) rates compared to control conditions in eligible women population at risk of cervical cancer.MethodsWe used the PICO (Problem or Population, Interventions, Comparison and Outcome) framework as described in the Cochrane Collaboration Handbook to develop our search strategy. The details of our search strategy has been described in our systematic review protocol published in the International Prospective Register of systematic reviews (PROSPERO). The protocol registration number is CRD42016045605 available at: http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016045605. The search string was used in Pubmed, Embase, Cochrane Systematic Reviews and Cochrane CENTRAL register of controlled trials to retrieve study reports that were screened for inclusion in this review. Our data synthesis and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We did a qualitative synthesis of evidence and, where appropriate, individual study effects were pooled in meta-analyses using RevMan 5.3 Review Manager. The Higgins I2 was used to assess for heterogeneity in studies pooled together for overall summary effects. We did assessment of risk of bias of individual studies included and assessed risk of publication bias across studies pooled together in meta-analysis by Funnel plot.ResultsOut of 3072 study reports screened, 28 articles were found to be eligible for inclusion in qualitative synthesis (5 of which were included in meta-analysis of educational interventions and 8 combined in meta-analysis of HPV self-sampling interventions), while 45 were excluded for various reasons. The use of theory-based educational interventions significantly increased CCS rates by more than double (OR, 2.46, 95% CI: 1.88, 3.21). Additionally, offering women the option of self-sampling for Human Papillomavirus (HPV) testing increased CCS rates by nearly 2-fold (OR = 1.71, 95% CI: 1.32, 2.22). We also found that invitation letters alone (or with a follow up phone contact), making an appointment, and sending reminders to patients who are due or overdue for screening had a significant effect on improving participation and CCS rates in populations at risk.ConclusionOur findings supports the implementation of theory-based cervical cancer educational interventions to increase women’s participation in cervical cancer screening programs, particularly when targeting communities with low literacy levels. A...

Effect of an Intervention in General Practice to Increase the Participation of Immigrants in Cervical Cancer Screening

“…To our knowledge, the present study is the first randomized clinical trial in general practice aiming to increase participation of immigrant women in CCS, and it proved to be effective. Our approach concurs with a recent systematic review and meta-analysis on CCS 24 The intervention showed an effect of 2% in the fully adjusted model. This effect size was significant, but smaller than what we expected to achieve.…”

Cervical cancer screening among women living with HIV: a cross-sectional study using the baseline questionnaire data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS)

“…More than a quarter of participants reported that a nurse or doctor had never discussed with them the need for regular cervical cancer screening (73% for women who had never had a Pap smear). As previously reported in the general population, providers have a crucial role to play in the adherence to cervical cancer screening recommendations 31,32 and our results underline the importance of better communicating the need for cervical cancer screening to women with HIV. The specialty of the HIV provider as reported by participants did not change the odds of adherence to cervical cancer screening.…”

“…Indeed, HPV self-sampling for cervical cancer screening has been shown to be very acceptable and feasible for hard-to-reach women, including ethnic minorities and Indigenous women, 45,46 particularly when the kits are mailed or delivered home in person. 32,[47][48][49] Being in a relationship and sexually inactive increased the likelihood of cervical cancer screening delays, as previously reported by others. 50,51 Explanations about HPV-related cancers need to specify that the risk remains even if a woman is no longer sexually active, because decades can pass between an initial HPV infection and the development of cervical cancer.…”

A Novel, Versatile Speculum-free Callascope for Clinical Examination and Self-Visualization of the Cervix

“…A third barrier is that in many settings, women are often not aware of their reproductive anatomy and health, which can deter positive health-seeking behavior, particularly as it relates to cervical cancer screening. 18 In 2014, the American Congress of Obstetricians and Gynecologists (ACOG) and Women's Health magazine conducted a survey of 7,500 women and found that 64% of them could not identify a picture of the cervix. The same survey found that 54% of women admitted keeping secrets related to their reproductive anatomy from their gynecologists, perhaps out of embarrassment related to issues pertaining to their reproductive system.…”

“…[20][21][22] Further, several studies have found that educating women on their cervix and cervical cancer significantly increased cervical cancer screening rates more than two-fold. 18,19,[23][24][25][26][27][28][29] Simply put, giving women access to accurate information and a comprehensive education on their sexual anatomy can significantly improve their understanding of sexual and reproductive health. One strategy to empower women to care and advocate for their reproductive autonomy is the provision of self-exploration technology that facilitates women's visualization, understanding and appreciation of their own vagina and cervix.…”