Objectives This dissertation had two overarching objectives: 1. To determine how stakeholders perceive women’s preferences for cervical screening modalities. 2. To understand methods to measure women’s cervical screening preferences, to inform the development and testing of a person-centered, evidence-informed approach to preference-elicitation. Methods The overarching conceptual framework was the Ottawa Decision Support Framework. The first objective was addressed by interview studies with (1) guideline developers and program managers and (2) health professionals and women considering screening. This was complemented by a systematic review of quantitative, qualitative and mixed-methods studies of women’s cervical screening preferences, using the Grading of Recommendations, Assessment, Development, and Evaluation approach to developing preference-based recommendations. This approach was also used in a systematic review of methods to elicit women’s preferences, addressing the second objective. These findings led to the development and field testing of a preference-elicitation tool using International Patient Decision Aid Standards criteria, and the development of a protocol for a population-based study of women’s preferences. iv Results Objective 1 Experts disagree about whether there is enough evidence to include alternative modalities in cervical screening programs. Women and health care professionals do not recognize that women face a choice to participate in cervical screening. A narrative synthesis of relevant literature presented challenges in aggregating preferences across diverse study objectives, designs, and contexts. Objective 2 Preference-elicitation approaches for cervical screening are heterogenous in design and rigour. I therefore developed and field tested a tool to elicit women’s preferences, which demonstrated that women found the tool helpful to identify their preferences. I then propose a study that uses multiple methods to apply the tool more broadly. Conclusions Synthesized preferences data might not be the optimal approach to incorporate preferences into cervical screening guidelines. A tool grounded in shared decision-making can help women identify their informed, values-based screening preferences.

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Indiana University-Purdue University Indianapolis (IUPUI) / Women who are medically underserved may be less likely to obtain provider-based cervical cancer screening because of structural and intrapersonal barriers. Self-collection for human papillomavirus (HPV) testing, a method for women to collect their own sample through a vaginal swab or urine collection, has accuracy comparable to provider-based cervico-vaginal HPV testing and may be useful in overcoming barriers to provider-based cervical cancer screening. The purpose of this dissertation study is to examine factors associated with self-collection for HPV testing, psychometrically test Diffusion of Innovations (DOI) instruments, and identify preferences for self-collection for HPV testing. Three distinct aims were developed: 1) factors (sociodemographic, health-related, and theoretical variables) associated with mailed return of vaginal self-collection for HPV testing, 2) psychometric examination of DOI ÷instruments (relative advantages and complexity), and 3) dimensions of self-collection and characteristic preferences to self-collection for HPV testing stratified by age cohorts. This dissertation involved two cross-sectional studies. In Chapters 2-3, data were collected from women (n=168) at food pantries and online. Women were eligible if they were: 1) female, 2) between the ages of 30-65, 3) could read and speak English, and 4) at 2019 federal poverty guidelines for income and family size as defined by the Department of Health and Human Services. Women were not eligible if they had a history of hysterectomy or were adherent to cervical cancer screening guidelines. Logistic regression analyses, item analysis, Cronbach’s alpha, exploratory factor analysis, and tests were used to analyze data. Chapter 4 involved collection of data from an online survey with a sample (n=878) provided by Dynata. Participants evaluated 9 scenarios that varied along 4 attributes: HPV self-collection kit type (vaginal swab or urine collection), HPV self-collection kit delivery (mail, pharmacy pick-up, or clinic pick-up), HPV self-collection kit return (mail, pharmacy drop-off, or clinic drop-off), and HPV test result communication (mail, phone call, or text message). Ratings-based conjoint analysis (RBCA) determined how each attribute influenced the ratings of each scenario.

African American women tend to have lower attendance rates at cervical cancer screenings compared to the attendance rates of women from other ethnic groups. The purpose of this research project was to understand how perceptions of African American women affects attendance of future cervical cancer screenings. The goal was to understand what contributes to low attendance. Previous research did not focus on factors contributing or interfering with appointment attendance among African American women, aged 30-65. The conceptual framework was based on individual health behavior. The research questions examined lived experiences affecting attendance of cervical cancer screenings, attendance of future screenings, and perceptions of experiences. Data collection was based on a phenomenological approach. Open-ended questions were used to gather descriptions of 5 participants' experiences via telephone interviews. These interviews were recorded, transcribed, and coded for recurring themes and patterns. Findings revealed 3 emergent themes related to the attendance of screenings: being knowledgeable of the purpose of cervical cancer screening, a female examiner performing the screening, and the encouragement of family and friends. The implications for social change would be increased knowledge among African American women aged 30-65 and the medical community.

Thesis (MPH.) -- University of Limpopo, 2017 / Refer to document

Purpose: The objective of this study was to investigate both depression and psychological distress as determinants of breast and cervical cancer screening. Methods: Ontario female respondents to the Canadian Community Health Survey version 1.2 (2002) were assessed for both Major Depressive Disorder (World Mental Health-Composite International Diagnostic Interview for depression) and psychological distress (Kessler 6-item Distress Scale (K6)>/= 8). Respondents eligible for screening (N=4042 for cervical cancer; N=1403 for breast cancer) were linked to Ontario administrative health service data to prospectively ascertain screening outcomes. Results: Women with K6 >/= 8 had reduced breast cancer screening compliance in adjusted analyses (AOR 0.63, 95% CI 0.40-0.97). The association between K6 >/= 8 and cervical cancer screening approached significance in women over age 40 (AOR=0.65, 95%CI 0.41-1.04). Conclusion: Decreased likelihood of screening in women with clinically significant psychological distress suggests that attention to adequacy of preventive services is a potential target for intervention.

Purpose: The objective of this study was to investigate both depression and psychological distress as determinants of breast and cervical cancer screening. Methods: Ontario female respondents to the Canadian Community Health Survey version 1.2 (2002) were assessed for both Major Depressive Disorder (World Mental Health-Composite International Diagnostic Interview for depression) and psychological distress (Kessler 6-item Distress Scale (K6)>/= 8). Respondents eligible for screening (N=4042 for cervical cancer; N=1403 for breast cancer) were linked to Ontario administrative health service data to prospectively ascertain screening outcomes. Results: Women with K6 >/= 8 had reduced breast cancer screening compliance in adjusted analyses (AOR 0.63, 95% CI 0.40-0.97). The association between K6 >/= 8 and cervical cancer screening approached significance in women over age 40 (AOR=0.65, 95%CI 0.41-1.04). Conclusion: Decreased likelihood of screening in women with clinically significant psychological distress suggests that attention to adequacy of preventive services is a potential target for intervention.

Cancer is the leading cause of death for Hispanics, and cervical cancer incidence is higher (64%) for Hispanics than for non-Hispanic whites. In Texas Hispanic women 50 and older are the lowest screened and present with higher incidence of invasive cervical cancer as compared to non-Hispanic white women. They are diagnosed at a peak age of 65-74, which suggests that Hispanic women need to be screened past the recommended screening age. An estimated 90 million people in the U.S. lack basic literacy skills and low literacy may contribute to low screening. Few studies have addressed the relationship between low health literacy and cervical cancer screening among older women of Mexican-American ancestry. This study sought to uncover the cervical cancer screening beliefs, practices, health literacy, knowledge, and experiences of English and/or Spanish-speaking older women of Mexican-American ancestry. Thirty women participated in focus group or individual interviews in English and/or Spanish. Women 50 years of age or older living in the community were recruited from senior centers in South Texas from a purposeful convenience sample. Data collection was conducted through audio-taped semi-structured interviews following a moderator guide developed using Zarcadoolas, Pleasant, and Greer’s (2005) health literacy model. Data were transcribed, analyzed in original language, translated for meaning, aggregated for analysis using qualitative content analysis; matrices were developed and analyzed individually, and then data were aggregated. The Newest Vital Sign, a health literacy tool, was used to partially assess fundamental literacy. Major themes elucidated were (a) Reasons “I don’t go” [fundamental literacy], (b), Prevention of cancer and “everything else” [science literacy], (c) We are different,[cultural literacy], (d) There is always “consejos” (advice, messages) [civic literacy], and media literacy, (e) Telenovelas (soap-operas) teach a lot, and (f) Learning from Internet brochures. The study supports a multidimensional model of health literacy and focus group research, accounting for the group’s cultural norms, language, and educational preferences. It adds information for nurse clinicians about providing holistic care, for nurse educators regarding communication strategies for diverse older populations, and for researchers to continue developing strategies that improve health literacy and health outcomes for minority older women. / text

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Background: Cervical cancer is the second most common cancer among women worldwide and its incidence is higher for certain ethnic groups in Canada, compared to White Canadians. As more women immigrate to Canada, the potential for prevention increases. Failure to prevent cervical cancer is partly due to non-participation in regular screening. The objectives of the research were to (1) explore whether there are cervical cancer screening differences between non-immigrant and immigrant women; (2) explore cervical cancer screening decision-making among immigrant women; and (3) explore the influence of acculturation on cervical cancer screening. Methods: This research consisted of two studies. The first study consisted of quantitative analysis of the 2007-2008 Canadian Community Health Survey (CCHS). Univariate analyses, cross-tabulations, and logistic regression modeling were conducted. Analyses were restricted to women aged 18-69 years old living in Ontario with no history of hysterectomy. Sample weights were applied and bootstrapping was performed. Analyses were conducted on the full Ontario sample (unweighted n=13,549) and the immigrant sample (unweighted n=2,904), the latter of which was stratified into two groups based on self-reported cultural/racial background: immigrant women more likely to report a time-appropriate Pap test (low risk) and those less likely to report a time-appropriate Pap test (high risk). The second study consisted of interviews conducted with 22 older (aged 50-69 years) South Asian immigrant women from Waterloo and Toronto, Ontario. The descriptive qualitative study was informed by grounded theory methodology. Interviews were audio-recorded and transcribed. Results: The first study identified that almost 17% of women reported not having a time-appropriate Pap test. Immigrant women were more likely to report not having a time-appropriate Pap test (21.73%) compared to non-immigrants (14.22%). Among immigrant women, almost 17% of White, Black, and other women (low-risk group) did not report a recent Pap test, compared to 28.67% of Chinese, South Asian, and other Asian women (high-risk group). Among the full Ontario sample, not having a time-appropriate Pap test was associated with being 50-69 years old, single, having low education and income, not having a regular doctor, being of Asian (Chinese, South Asian, other Asian) cultural/racial background, perceiving having less than excellent health, and being a recent immigrant. Among women in the low-risk group, not having a recent Pap test was associated with older age, lower household income, not having a regular doctor, and a lower proportion of life spent in Canada. Among women in the high-risk group, not having a time-appropriate Pap test was associated with lower education and not having a regular doctor. Within the second study, various themes emerged exploring cervical cancer screening decision-making among the sample. Six major categories emerged: (1) the influence of others, (2) health beliefs and knowledge, (3) responsibility over health, (4) experiences in healthcare, (5) components of culture, and (6) the process of acculturation. The influence of doctors on cervical cancer screening decision-making emerged as a strong theme within interviews. Conclusion: Results provide insight into the inequities that still exist in terms of who is participating in cervical cancer screening, as well as the factors involved in screening decision-making and the relationships between them. This research provides an updated overview of Pap test participation in Ontario, as well as advancing our understanding of the influence of factors on screening decision-making among immigrant women. Through this research, it becomes clear that targeted efforts must be directed towards those less likely to get a Pap test.