Factors affecting utilization of cervical cancer prevention services in low-resource settings

Abstract

ResumenLas estrategias para introducir o fortalecer programas de prevención de cáncer cervical deben enfocarse hacia garantizar servicios costo-efectivos, que se encuentren disponibles para que las mujeres que los necesiten puedan utilizarlos. Este artículo resume la experiencia de proyectos de investigación realizados en Bolivia, Perú, Kenya, Sudáfrica y México. Los factores que afectan la tasa de participación en programas de prevención son categorizados en tres secciones. La primera describe los factores que surgen predominantemente por normas socioculturales que influyen en la visión que las mujeres tienen sobre la salud reproductiva. La segunda discute los factores relacionados con los requerimientos clínicos y el tipo de servicio ofrecido, así como el sistema mediante el cual las mujeres están siendo invitadas a participar. La tercera sección discute factores relacionados con la calidad de la atención. Finalmente, se proveen ejemplos de las estrategias sobre los programas que son utilizados para alentar la participación de las mujeres en los servicios de prevención del cáncer cervical. Este artículo también está disponible en: http://www.insp.mx/ salud/index.html Palabras clave: neoplasmas del cuello uterino/prevención y control; participación de la paciente; calidad de la atención de salud This paper is available too at: http://www.insp.mx/salud/index.html Abstract Strategies for introducing or strengthening cervical cancer prevention programs must focus on ensuring that appropriate, cost-effective services are available and that women who most need the services will, in fact, use them. This article summarizes the experiences of research projects in Bolivia, Peru, Kenya, South Africa, and Mexico. Factors that affect participation rates in cervical cancer prevention programs are categorized in three sections. The first section describes factors that arise from prevailing sociocultural norms that influence women's views on reproductive health, well being, and notions of illness. The second section discusses factors related to the clinical requirements and the type of service delivery system in which a woman is being asked to participate. The third section discusses factors related to quality of care. Examples of strategies that programs are using to encourage women's participation in cervical cancer prevention services are provided. This paper is available too at:

Social inequality in Pap smear coverage: identifying under-users of cervical cancer screening in Argentina

“…Rates were much higher where clinics were more accessible or where mobile clinics brought services to women. 16,17 In our study, women with no health insurance coverage, and those who were not using contraceptive methods, were also less likely to have been screened. This profile was basically the same whether the women had not been screened in the previous two years or had never been screened.…”

“…Studies that have analysed other barriers to Pap smear screening showed that waiting times, availability of counselling and arrangements to assure maximum privacy during the examination are important determinants of women's uptake of Pap tests. 16,17 Thus, assuring the availability of women-centred, high quality services is essential to high coverage.…”

Influencing Women's Actions on Cervical Cancer Screening and Treatment in Karawang District, Indonesia

“…They also do not realize that cervical cancer can be treated in its early stages and they may surrender to a sense of fatalism. Similar attitudes and beliefs are common obstacles to screening and treatments in other countries (Bingham et al, 2003). Kaders, community advocacy teams, and television advertising were able to raise awareness, increase knowledge, and prompt many women to go for VIA screening.…”

Making the case for cervical cancer prevention: what about equity?

“…In many cultures, the notion of preventing an illness years in the future may not be valued within the household. 37 Potential socio-cultural barriers to seeking care include embarrassment about the pelvic examination, fear of the procedure or of being associated with sexually transmitted infections, or fear of learning they have cancer. Women may also mistrust health care providers, either because they have been treated badly by them in the past or because they have heard of poor treatment from others.…”

“…It is also possible to overcome the effects of negative local images of cervical cancer as a death sentence, or of a positive screening test as a sign of marital infidelity, by careful messaging in educational materials and interactions. 37 As with other clinical services, ensuring that women are treated with respect and that services are perceived to be of good quality is an important determinant of women's willingness to take up screening and encourage others to do so. 51 Offering HPV vaccine to young adolescent girls…”