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- Broberg, Gudrun, et al.
(författare)
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Attending cervical cancer screening, opportunities and obstacles : a qualitative study on midwives' experiences telephoning non-attendees in Sweden
- 2014
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 42:7, s. 691-697
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Aspart of a research project aimed at increasing participation in the cervical cancer screening program (CCS), we explored midwives’ unique experiences of telephoning non-attendees and offering Pap smear appointments.Methods: Twenty midwives, in four focus groups, discussed their experiences of a study investigating ways to increase participation in the CCS. The group discussions were tape-recorded and transcribed verbatim and underwent qualitative content analysis.Results: Speaking with more than 1000 non-attendees provided the midwives with new perspective on the CCS and they realisedthat improving it might address a number of reasons for not participating. These reasons were often related to logistics, such as scheduling flexibility and appointment booking. The telephone conversations revealed that some women required more individual attention, while it was discovered that others did not require screening. The midwives considered the CCS to be life-saving; participating in this screening activity gave them a sense of satisfaction and pride.Conclusions: This study shows that midwives can improve access and prevent non-attendance at the cervical cancer screening program when they are aware of women’s varying requirements for attending screening.
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| 2. |
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| 3. |
- Broberg, Gudrun, et al.
(författare)
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Increasing participation in cervical cancer screening: Offering a HPV self-test to long-term non-attendees as part of RACOMIP, a Swedish randomized controlled trial.
- 2014
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 134:9, s. 2223-2230
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Tidskriftsartikel (refereegranskat)abstract
- RACOMIP is a population-based, randomized trial of the effectiveness and cost-effectiveness of different interventions aimed at increasing participation in a well-run cervical cancer screening program in western Sweden. In this article, we report results from one intervention, offering non-attendees a high-risk human papillomavirus (HPV) self-test. Comparison was made with standard screening invitation routine or standard routine plus a telephone call. Women (8,800), aged 30-62, were randomly selected among women without a registered Pap smear in the two latest screening rounds. These women were randomized 1:5:5 to one of three arms: 800 were offered a high-risk HPV self-test, 4,000 were randomized to a telephone call (reported previously) and 4,000 constituted a control group (standard screening invitation routine). Results were based on intention to treat analysis and cost-effectiveness was calculated as marginal cost per cancer case prevented. The endpoint was the frequency of testing. The total response rate in the self-testing arm was 24.5%, significantly higher than in the telephone arm (18%, RR 1.36, 95% CI 1.19-1.57) and the control group (10.6%, RR 2.33, 95% CI 2.00-2.71). All nine women who tested positive for high-risk HPV attended for a cervical smear and colposcopy. From the health-care sector perspective, the intervention will most likely lead to no additional cost. Offering a self-test for HPV as an alternative to Pap smears increases participation among long-term non-attendees. Offering various screening options can be a successful method for increasing participation in this group.
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| 4. |
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| 5. |
- Broberg, Gudrun
(författare)
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Non-attendees need attention - Determinants and interventions affecting participation in cervical cancer screening
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: Non-attendance is the foremost screening-related risk factor for cervical cancer. The overall aim of this thesis is to contribute to preventing cervical cancer by focusing attention on non-attendees, assessing interventions to increase participation in screening and identifying determinants for non-attendance. Methods: The effectiveness and cost-effectiveness of two interventions to increase participation were studied in a population-based, randomised trial in the context of a well-run screening program in western Sweden. Non-attendees were telephoned and offered an appointment to take a Pap smear or mailed an offer to take a high-risk human papillomavirus (HPV) self-test, and the results were compared with a control group. Midwives’ experiences of contacting non-attendees were discussed in focus groups, and analysed by qualitative content analysis. A cross-sectional study with data from population-based registers was carried out to study socioeconomic and demographic factors’ affect on screening participation. The results were analysed using univariate and multivariate logistic regression models. Results: Participation during the follow-up period after the interventions was significantly higher in both the telephone arm (18.0%) and the HPV self-test arm (24.5%) than in the control group (10.6%). There were significantly more detected abnormal smears and followed up abnormalities in the telephone arm (39 and 34, respectively) than in the control group (19 and 18, respectively). The midwives realised that there were a number of reasons for non-attendance that could be addressed by improving the screening program. These reasons were often related to logistics, such as scheduling flexibility and appointment booking. Women with high household income or high education or who were living with a partner, born in Sweden, working or not receiving welfare benefits were found to be more likely to attend cervical screening. The relative risk for attendance related to county of residence varied more than twofold. Conclusions: Long-term non-attendees had a fourfold increase in high-grade cytological atypia, compared with regularly screened women. Both telephone contact and offering a HPV self-test, increased participation among women who had abstained from cervical cancer screening for a long time. The telephone intervention yielded a significant increase in detected and followed up atypical smears. These interventions are also practically feasible and do not seem to increase costs. Offering various screening options can be successful in increasing overall participation rates. Midwives’ awareness of women’s varying requirements for attending screening provides possibilities to improve access and prevent non-attendance in cervical cancer screening. Low socio-economic status, being born abroad and residing in some Swedish counties are independent factors associated with lower attendance in cervical cancer screening. This indicates there is major potential for improvement of cervical cancer screening routines in Sweden in order to increase participation.
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| 6. |
- Broberg, Gudrun, et al.
(författare)
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Socio-economic and demographic determinants affecting participation in the Swedish cervical screening program: A population-based case-control study
- 2018
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Ingår i: Plos One. - San Francisco, CA, USA : Public Library of Science (PLoS). - 1932-6203. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Cervical screening programs are highly protective for cervical cancer, but only for women attending screening procedure. Identify socio-economic and demographic determinants for non-attendance in cervical screening. Population: Source population was all women eligible for screening. Based on complete screening records, two groups of women aged 30-60 were compared. The case group, non-attending women, (N = 314,302) had no smear registered for 6-8 years. The control group (N = 266,706) attended within 90 days of invitation. Main outcome measures: Risk of non-attendance by 9 groups of socioeconomic and demographic variables. Analysis: Unadjusted odds ratios (OR) and OR after adjustment for all variables in logistic regression models were calculated. Women with low disposable family income (adjOR 2.06; 95% confidence interval (CI) 2.01-2.11), with low education (adjOR 1.77; CI 1.73-1.81) and not cohabiting (adjOR 1.47; CI 1.45-1.50) were more likely to not attend cervical screening. Other important factors for non-attendance were being outside the labour force and receiving welfare benefits. Swedish counties are responsible for running screening programs; adjusted OR for non-participation in counties ranged from OR 4.21 (CI 4.06-4.35) to OR 0.54 (CI 0.52-0.57), compared to the reference county. Being born outside Sweden was a risk factor for non-attendance in the unadjusted analysis but this disappeared in certain large groups after adjustment for socioeconomic factors. County of residence and socio-economic factors were strongly associated with lower attendance in cervical screening, while being born in another country was of less importance. This indicates considerable potential for improvement of cervical screening attendance in several areas if best practice of routines is adopted.
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