The determinants of cervical cancer screening uptake in women with obesity: application of the Andersen’s behavioral model to the CONSTANCES survey

Abstract

Word count: 199. Purpose Despite their higher risk for and mortality from cervical cancer, evidence indicates low rates of cervical cancer screening (CCS) among women with obesity. The literature on the specific factors related to CCS nonadherence in this population is limited. Methods We examined the data on 2,934 women with obesity included in the CONSTANCES survey from 2012 to 2015. Using the Andersen's behavioral model, we studied the relationships between the socioeconomic, sociodemographic, health, health personal behaviors and healthcare use related factors with CCS nonadherence. The analysis was performed using structural equation models. Results Regular follow-up by a gynecologist, good quality of primary care follow-up and comorbidities were negatively associated with CCS nonadherence. Limited literacy, older age, being single, living without children and financial strain were positively associated with CCS nonadherence. Our results do not point to competitive care, since women with comorbidities had better CCS behaviors, which were explained by a good quality of primary care follow-up. Conclusion Our study identified the factors that explain CCS nonadherence among women with obesity and clarified the effects of health status and healthcare use on screening. Further efforts should be undertaken to reduce the obstacles to CCS by improving care among women with obesity.

Aile Hekimliğine Olan Talebi Etkileyen Faktörler: Davranışsal Model İçin Türkiye Verilerinden Kanıtlar

“…Within the scope of this research, the factors affecting the status of receiving services from the family medicine were examined within the framework of the behavioral model developed by Andersen. In the study, the frequency of using a family medicine was found to be high with 89.1%. In similar studies on the subject, the rate of application to the family medicine was between 35.3% and 84.6% (Hirshfield et al, 2018;Franck et al, 2020). In this study, it was revealed that women (63.5%) mostly used the family medicine in terms of gender.…”

“…Considering similar researches on the subject, depression (Holtzman et al, 2015;Chong et al, 2018), schizophrenia , diabetes, hypertension, an endocrine disorder, gynecology, cancer and obesity diseases (Jin et al, 2019;Franck et al, 2020;Liu et al, 2019), AIDS and heart diseases (Hirshfield et al, 2018) In addition, there are no data on doctor's diagnosis, full-time studentship, the time between referral and mental health assessment, people's preparation for access barriers, special medical needs, preparation for ethnic or cultural distinctions, availability of health-related information, crime rate, foreign language skills of medicine and preparing people for unemployment.…”

“…In this study, it was revealed that the most married people (72.7%) used a family medicine. If we look at similar studies on the subject, it was determined that 52.9% to 84% of the married people use health service (Heider et al, 2014;Hong et al, 2019;Jin et al, 2019;Ogunsanya et al, 2016;Kaya et al, 2019;Franck et al, 2020;Liu et al, 2019). Some studies determine that those who receive health services (66% and 84.6%) are not married (single, divorced and widows) Hirshfield et al, 2018;Lee et al, 2020).…”

“…However, studies are showing that this situation varies from country to country. In some countries, university graduates are more likely to use family medicine services, while in others, high school graduates are reported to receive more services (Dhingra et al, 2010;Heider et al, 2014;Hirshfield et al, 2018;Hong et al, 2019;Conner, 2012;Jin et al, 2019;Ogunsanya et al, 2016;Franck et al, 2020;Roh et al, 2017;Liu et al, 2019;Lee et al, 2020).…”

A systematic review of obesity as a barrier to accessing cancer screening services

“…In a parallel investigation, the specific determinants of cervical cancer screening uptake by women living with obesity were further explored. Factors precluding screening were identified, which included embarrassment, negative body image, and imaging with medical equipment, which posed a barrier to screening in practice 19 . There was a reciprocal correlation between patients and their healthcare providers, both of whom acknowledged difficulties associated with obesity and cancer screening.…”