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

Abstract

Primary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability.

Recent changes in cervical cancer screening guidelines: U.S. women's willingness for HPV testing instead of Pap testing

“…The items for this analysis were selected based on the salience from previous literature on HPV testing. 18 Response options were yes and no. Adherence to cervical screening guidelines was assessed based on the 2012 USPSTF recommendations.…”

“…10 Other countries, such as Australia, have already transitioned to primary HPV testing for their national cervical cancer screening program. However, Australia, a country that has led the way in cervical cancer prevention, [15][16][17] faced difficulties in transitioning to HPV testing from Pap testing because of variations in HPV testing intentions, uptake, and willingness (i.e., acceptability 18 ). Thus, there is a need to examine the acceptability of primary HPV testing in the U.S. with new guideline changes.…”

Are Health Care Professionals Prepared to Implement Human Papillomavirus Testing? A Review of Psychosocial Determinants of Human Papillomavirus Test Acceptability in Primary Cervical Cancer Screening

“…We found the Patient Pathway Framework useful to synthesize factors that influence HCPs acceptability of the HPV test into following categories: a) HCP specific, b) patient-specific, c) HCP practice specific and d) healthcare system specific. Importantly, we found an overlap between patient-specific psychosocial factors related to HPV test acceptability and the results of our previous systematic review of factors that influence women's acceptability of HPV testing in primary screening for cervical cancer (57) . These overlapping patient-specific factors merit special consideration as they can act as barriers in the uptake of HPV testing and include: women's negative attitudes toward increasing the screening interval, negative emotions and perceptions related to HPV testing (e.g., shame and anxiety linked to testing for a sexually transmitted infection), women's low health literacy (i.e., decreased HPV test knowledge and insufficient use of health information channels), risky health behaviors (e.g., smoking), low socioeconomic status and non-white ethnicity (57) .…”

“…Importantly, we found an overlap between patient-specific psychosocial factors related to HPV test acceptability and the results of our previous systematic review of factors that influence women's acceptability of HPV testing in primary screening for cervical cancer (57) . These overlapping patient-specific factors merit special consideration as they can act as barriers in the uptake of HPV testing and include: women's negative attitudes toward increasing the screening interval, negative emotions and perceptions related to HPV testing (e.g., shame and anxiety linked to testing for a sexually transmitted infection), women's low health literacy (i.e., decreased HPV test knowledge and insufficient use of health information channels), risky health behaviors (e.g., smoking), low socioeconomic status and non-white ethnicity (57) . Given these additional barriers, it becomes exceedingly important to recognize that while guidelines, policy changes and training for HCPs to assure improved HPV screening implementation, we must also make equally strong interventions in gauging, guiding and educating all women successfully in kind and in synchrony.…”

How Much I Am Aware of Human Papilloma Virus (HPV)?

“…Kadınlarda rahim ağzı kanseri taramasının cinsel aktiviteye başlamasından üç yıl sonra yapılması önerilmektedir. ABD' de 22 Literatür incelendiğinde Aweke ve ark. Etyopya'da yaptığı çalışmada kadınların % 9,9'u rahim ağzı kanseri için tarama yaptırdığını belirtmektedir.…”