Factors affecting attendance to cervical cancer screening among women in the Paracentral Region of El Salvador: a nested study within the CAPE HPV screening program

Abstract

BackgroundCervical cancer is the third most commonly occurring cancer among women and the fourth leading cause of cancer-related deaths in women worldwide, with more than 85 % of these cases occurring in developing countries. These global disparities reflect the differences in cervical cancer screening rates between high-income and medium- and low-income countries. At 19 %, El Salvador has the lowest reported screening coverage of all Latin American countries. The purpose of this study is to identify factors affecting public sector HPV DNA-based cervical cancer screening participation in El Salvador.MethodsThis study was nested within a public sector screening program where health promoters used door-to-door outreach to recruit women aged 30–49 years to attend educational sessions about HPV screening. A subgroup of these participants was chosen randomly and questioned about demographic factors, healthcare utilization, previous cervical cancer screening, and HPV knowledge. Women then scheduled screening appointments at their public health clinics. Screening participants were adherent if they attended their scheduled appointment or rescheduled and were screened within 6 months. The association between non-adherence and demographic variables, medical history, history of cancer, sexual history, birth control methods, and screening barriers was assessed using Chi-square tests of significance and logistic regression.ResultsAll women (n = 409) enrolled in the study scheduled HPV screening appointments, and 88 % attended. Non-adherence was associated with a higher number of lifetime partners and being under-screened—defined as not having participated in cervical cancer screening within the previous 3 years (p = 0.03 and p = 0.04, respectively); 22.8 % of participants in this study were under-screened.ConclusionsAdherence to cervical cancer screening after educational sessions was higher than expected, in part due to interactions with the community-based health promoters as well as the educational session itself. More effective recruitment methods targeted toward under-screened women are required.

Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis

“…The study selection flow diagram is presented in Figure 2. We retained 22 primary studies: 5 of qualitative methodology [29][30][31][32][33], 15 of quantitative methodology [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] and 2 in which both methodologies were used [49,50]. Seventeen studies originate in high income countries (8-USA, 2-Canada, 5-Europe and 2 in Australia) and five in low and middle income countries (1-Mexico, 1-El Salvador, 1-China, 1-India and 1 in Nigeria).…”

“…Subjective norms comprise healthcare provider (HCP) recommendation [29,36,38,39,44,46,49,50], screening guidelines [29,40,44,50], and the opinions of spouse and friends [29,40,42,44,50].…”

“…HPV vaccination status [40], history of health check-up [48], including screening for breast cancer [48], usage of birth control methods (e.g., contraceptives) [36,43] and smoking history were synthesized as health behaviors. Adherence to cervical cancer screening depends on the age of the first Pap [40], history of time-appropriate Pap testing [36,37,40,42,48] and intentions to screen with the Pap test [48].…”

A pilot study of community‐based self‐sampling for HPV testing among non‐attenders of cervical cancer screening programs in El Salvador

“…In 2014, El Salvador introduced HPV DNA testing into the public sector through the Cervical Cancer Prevention (CAPE) initiative . However, one study showed that 25%–30% of targeted women in rural areas did not attend scheduled provider‐based screenings. Self‐sampling could increase screening coverage: Rosenbaum et al .…”

Organized Cervical Cancer Screening Program in Barretos, Brazil: Experience in 18 Municipalities of São Paulo State

“…can reduce the number of women remaining outside the programs [19,20] . The option of using liquid-based cytology also helps these initiatives to reduce disparities and facilitate the integration of many women into screening programs since certain HPV tests can be made inside the mobile units, either collected by a physician or nurse, or self-collected, which is a tremendous advance for zones without medical assistance [21] .…”