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.

In 2015, there were 257,524 women with cervical cancer (CC) in the United States (U.S.). CC is preventable; screening detects early-stage cancer when treatment is most successful. This study aimed to identify predictors for CC screening adherence among U.S. women, describe predictors for screening adherence by marital status, and examine physician recommendation for CC screening and adherence to those recommendations. Predictors were grouped as demographic, acculturation, access to care, chronic conditions, and health behaviors. Descriptive analyses were performed on a sample of 10,667 women from the 2015 National Health Interview Survey, and multiple logistic regression models determined predictors of CC screening adherence, physician recommendations, and adherence to physician recommendations. Overall, 81.7% (95%CI=80.7-82.7%) of U.S. women adhered to CC screening guidelines. Adherence declined with increasing age after 39 years old. Never married women (adjusted odds ratio[aOR]=0.67, CI=0.56-0.79) or current smokers (aOR=0.70, CI=0.59-0.84) had lower odds, while college-educated women had greater odds (aOR=1.38, CI=1.14-1.67) of CC screening adherence. Among unmarried women, 78.6% adhered to CC screening. Unmarried women who were unemployed (aOR=0.48, CI=0.38-0.62), had no physician visits (aOR=0.58, CI=0.40-0.85), no usual source of care (aOR=0.67, CI=0.50-0.89), never heard of HPV (aOR=0.59, CI=0.46-0.76), never received HPV vaccine (aOR=0.50, CI=0.34-0.75), no birth control use (aOR=0.33, CI=0.23-0.47), no flu shot (aOR=0.62, CI=0.48-0.80), and perceived low breast cancer risk (aOR=0.66, CI=0.47-0.92) had lower odds of adherence. Among women with a physician, 55.6% received screening recommendations. Race/ethnicity, access to care, HPV knowledge and vaccine receipt, age when first child was born, and flu shot were significant predictors of physician recommendation for CC screening. Significant predictors of adherence to physician recommendation included education, employment, English proficiency, outpatient clinic visits, usual source of care, age when first child was born, birth control, alcohol use, smoking status, flu shot, and health status. Based on our results, two levels of intervention should be explored. First, targeted interventions are needed for women who are unmarried, have low socio-economic status, and limited access to care to reduce cervical cancer risk. Second, interventions for physicians to increase screening recommendations to all eligible women are needed to improve national screening rates.

Community Health Centers (CHCs) are the nation's primary care safety-net for vulnerable populations, including racial/ethnic minorities, migrant workers and the uninsured. Women from these populations contribute disproportionately to cervical cancer morbidity and mortality, largely due to underutilization of Pap smear screening. The purpose of this cross-sectional study was to identify factors that may be related to Pap smear screening compliance among a large cohort of women seen at 10 Community Health Centers in Florida. Building upon an ecologic framework, this research went beyond patient-level risk factors, which are generally well-known, and explored provider and organizational variables that may also be associated with Pap smear screening compliance in this population. Ten CHCs in Florida met study inclusion criteria of having at least four complete years of claims and patient registration data stored in an Electronic Health Record (HER) data system maintained at HCN. EHR data were merged with provider gender obtained from a credentialing database and with data from a short organizational survey administered to the Medical Directors of the CHCs. Descriptive statistics, chi-squared analysis, and multiple logistic regression were used to examine Pap smear screening rates for women (n=71,234) in relation to a variety of patient, provider and organizational variables. Younger, Hispanic and insured women were most likely to have had a screening in the past three years compared to older, white non- Hispanic and uninsured women. Among providers, patients who received care from female providers generally had higher Pap smear compliance rates, but these findings differed by patient insurance and race/ethnicity group. Organizational factors that appeared to be associated with higher Pap compliance rates included diffusion of an EHR system, implementation of "Care Model Principals", and having recently implemented a Pap smear screening process improvement project. Results demonstrated that multi-level factors, operating on the patient, provider and organizational levels, contribute to Pap smear compliance among women seen at CHCs. Results suggested that improving screening compliance within this population of women requires interventions that are ecologic in scope, incorporate targeted education to high-risk women and providers, and include organizational strategies that can optimize care delivery at point-of-care.

Cervical cancer is a disease that annually claims the lives of over a quarter of a million women. A substantial number of these deaths could be prevented if population wide cancer screening, based on the Papanicolaou test, were globally available. The Papanicolaou test involves a visual review of cellular material obtained from the uterine cervix. While being relatively inexpensive from a material standpoint, the test requires highly trained cytology specialists to conduct the analysis. There is a great shortage of such specialists in developing countries, causing these to be grossly overrepresented in the mortality statistics. For the last 60 years, numerous attempts at constructing an automated system, able to perform the screening, have been made. Unfortunately, a cost-effective, automated system has yet to be produced. In this thesis, a set of methods, aimed to be used in the development of an automated screening system, are presented. These have been produced as part of an international cooperative effort to create a low-cost cervical cancer screening system. The contributions are linked to a number of key problems associated with the screening: Deciding which areas of a specimen that warrant analysis, delineating cervical cell nuclei, rejecting artefacts to make sure that only cells of diagnostic value are included when drawing conclusions regarding the final diagnosis of the specimen. Also, to facilitate efficient method development, two methods for creating synthetic images that mimic images acquired from specimen are described.

Bacterial Vaginosis (BV) is a disorder of unknown etiology, characterized by a foul smelling vaginal discharge, loss or reduction of the normal vaginal Lactobacilli, and overgrowth of other anaerobic bacteria. Thus, it presents a formidable problem for clinicians as well as microbiologists researching its etiology, clinical course, treatment, and epidemiology. The present work focuses on the unresolved issues of the epidemiology and treatment of BV in order to provide valid methods for treatment studies of this condition and to describe the prevalence of BV in defined populations. The first study validates the use of PAP-stained smears in the diagnosis of BV. The study assesses the methods of Amsel’s clinical criteria and Nugent criteria on Gram-stain smears, against Pap-stained smears and also validates different observers. The result shows that the PAP-staining of vaginal smears is a good method in BV diagnosis; the kappa value is 0.86 (interobserver weighted kappa index) compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. This enables population based studies on archived PAP-stained smears from the screening of cervical cancer. In the second study, we use the knowledge gained from study one to investigate the prevalence of BV in a cohort from the population of Åland. The prevalences of BV on the Åland Islands were: 15.6 %, 11.9 %, 8.7 %, and 8.6% in 1993, 1998, 2003, and 2008, respectively. This means that the prevalence of BV decreased between1993-2008 from 15.6% to 8.6%. The confidence intervals are not overlapping, thus indicating a significant decrease in prevalence from 1993 to 2008. The third study is a prospective, double-blind placebo controlled treatment study of BV. After conventional treatment with clindamycin, the patients were treated with adjuvant treatment of Lactobacilli-loaded tampons or placebo. The study showed no differences between the treatment and the placebo group, indicating that the tampon does not work at all. There are a variety of possible explanations for the result, which are analyzed in this thesis. The fourth study aimed to evaluate whether clindamycin is retained for a long time in the vaginal mucosa, thus disturbing the Lactobacilli in an attempt to reimplant Lactobacilli in the probiotic treatment studies. In conventional treatment, it is also useful to know whether clindamycin is retained, especially when considering the pressure from antibiotics on the antimicrobial sensitivity pattern. In the study, we found that the clindamycin disappears rapidly. Conclusion: BV research requires effort from many different scientific disciplines and the riddle of this condition and its treatment can only be resolved by concerted actions in research and treatment. The vision for the future includes, among other factors, better molecular biology based diagnostic tools, and knowledge of population based bacterial floras.

Minority immigrant women are more likely to be diagnosed with and suffer from cervical cancer compared to other minority women in the United States. The purpose of this qualitative ethnographic study was to explore cultural health perceptions, behaviors, and barriers to cervical cancer prevention among Korean immigrant women (KIW) in Hawaii. The health belief model and the social-ecological model were used to guide the study. Data were collected using individual structured interviews with 20 KIW ages 21 to 65 who are first-generation KIW immigrant to Hawaii. Data were coded and analyzed to identify themes. Findings revealed that participants (a) prefer a female gynecologist and Korean-speaking physicians; (b) are highly motivated to maintain physical health, including prevention; (c) prefer culturally appropriate community-based cancer prevention programs, and (d) expect innovative health maintenance approaches. Findings may be used by healthcare providers to identify culturally specific health needs of KIW related to cervical cancer screening and to implement appropriate preventive measures for KIW to reduce cancer death.

Pap smear screening detects cervical cancer in its earliest stages, yet thousands of women in the United States die annually from this disease. Social networking websites commonly provide information about recommended health screenings. In this quantitative study, the Health Belief Model provided the theoretical framework to determine if the use of social networking websites affected nurses' decisions to receive Pap smear screening. A convenience sample of nurses was used, with the rationale that they were knowledgeable of and receptive to participating in a relevant health study. A total of 2,336 registered nurses practicing in Durham, North Carolina were invited to participate in the study. Over a period of 4 weeks, 107 participants responded to questions from the Health Belief Questionnaire and Pew Internet and American Life survey through an electronic questionnaire. Chi-square analysis determined the association between the receipt of Pap smear screening and the use of a social networking website use. Logistic regression further analyzed this association with age as a covariate. Nearly all participants reported having a Pap smear screening within the last 12 months. However, the lack of significant results showed that social networking website use was not a factor for higher screening rates. Despite the non-significant findings, the participants nevertheless reported a high use of social networking websites. These findings indicate that such platforms can be used to educate women on the importance of Pap smear screening. The study's implications for positive social change are to use such sites to more effectively, to promote and educate on the importance of Pap smear screening.

Idag erbjuds alla kvinnor mellan åldern 23 – 70 gratis gynekologisk cellprovtagning i Sverige. Trots detta är det bara 63,7% i åldersgruppen 23 – 29 som deltar i screeningen. Kallelse till besök kommer via posten. I denna studie har det undersökts om man med hjälp av visualiseringar kan få fler kvinnor att delta i gynekologisk cellprovtagning samt att minska obehaget inför ett besök. Under studiens gång har gestaltningsförslag tagits fram med målet att öka deltagandet. Tidigare studier kring varför kvinnor i Sverige avböjer att delta i gynekologisk cellprovtagning och hälsokommunikation tillsammans med bilder samt teorier inom kognition, perception, bild och text i samspel har legat till grund för hela arbetet. Metoder som intervju, dokumentanalys och skiss har använts för att motivera gestaltningsförslagets utformning. Allt detta resulterade i ett gestaltningsförslag i form av ett informationsblad som skickas med det brev den nuvarande kallelse kommer i, till de kvinnor som inte tidigare har valt att delta i provtagningen i Sverige. Informationsbladet innehåller illustrationer som komplement till information om vad HPV är, hur det sprids, varför det är viktigt att delta och hur själva provtagnings processen går till. Resultatet pekar mot att större andel av målgruppen hade övervägt att delta i screeningen samt att de upplever att obehaget skulle minskas vid användande av illustrationer. / Nowadays all women between the ages of 23 - 70 get offered free pap smear in Sweden. Despite this, only 63,7% attend the screening between the ages of 23 – 29. The women receive a mail that include a call notice for the visit. This study is going to explore how visualization could help increase the amount that attend the pap smear and reduce the discomfort before a visitation.  During the study, an artefact was created. Previous studies about why women in Sweden do not participate in pap smear testing, images in health communication and theories about cognition, perception and image and text in interaction laid the foundation for the work. Methods like interviews, documentation analysis and sketches were used to motivate the artefact design. All of this concluded in an artefact representing an information sheet, which is supposed to be sent out alongside the mail of the current call notice to all women in Sweden who have decided to not attend the pap smear. The information sheet includes information about what HPV is, how it spreads, why it is important to attend, and how the actual process of the testing is done, with illustrations as a supplement. The results point toward an indication that more women in Sweden would consider attending the pap smear, and that the discomfort about the process is reduced.

In the three chapters of my dissertation, I analyze the individual behaviors including health (vaccination and preventive care) and consumer (financial literacy) behaviors and the corresponding interventions by nonlinear econometric modeling. In the first chapter, I suggest an appropriate econometric model that investigates the effect of paid sick leave on workers' decision to receive the seasonal flu vaccination. For this investigation, I apply a Bayesian non-linear structural regression model with one-outcome and two-endogenous equations. The results of my estimation indicate that having paid sick leave affects workers' vaccination decisions differently based on their income levels. Low-income workers are willing to be vaccinated because they perceive the high cost of claiming paid sick leave. However, high-income workers are willing to be vaccinated because paid sick leave reduces the cost of vaccination for seasonal flu. In the second chapter, I suggest new econometric regression models that investigate the effect of "Don't Know" or "Refuse" (DK/RF) responses on parameter identification. I estimate the effect of group characteristics and financial education on the level of young respondents' objective financial knowledge and find the actual effects and biases by my suggested models. This study examines six questions about personal finance and selects covariates in the 2015 National Financial Capability Study (NFCS). Because these questions include DK/RF responses, a simple regression model that does not consider DK/RF responses could lead to misleading conclusions, such as gender/income difference and educational effectiveness in schools. In the last chapter, I investigate the effect of three health-related interventions including a doctor's recommendation, information about human papillomavirus (HPV), and HPV vaccination, on the misuse of cervical cancer screening including too-early screening, unnecessary HPV test, annual Pap test, and no Pap smear that are not recommended for women younger than 30 years. I examine the National Health Interview Survey conducted in 2015 and applies binary and multinomial logistic regression models. From the estimation result, I observe that doctor's recommendation plays a significant role in increasing the probability of receiving cervical cancer screening while it induces the too-early screening, unnecessary HPV testing, and overuse of Pap smears. / Ph. D.

Perception of cervical cancer screening among Immigrant African women residing in Houston, Texas Esther I. Orji M.Ed., University of Lagos, 2002 B. Ed, Abia State University, 1998 A.C. E. University of Benin, 1990 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Disparities in cervical cancer screening participation still exist especially among immigrant and minority women compared to non immigrant populations. Research investigators through multiple studies have explored reasons for non participation in cervical cancer screening among immigrant and minority women. However, there was limited research specifically on how immigrant women of African descent could be empowered to overcome barriers associated with cervical cancer screening in Houston Texas. The purpose of this study was to explore and understand the perceptions of factors which are barriers to perform cervical cancer screening tests among immigrant women of African descent, as well as their beliefs on preventive medicine, and how immigrant women could be empowered in order to overcome barriers associated with cervical cancer screening. The theoretical framework was based on the health belief model. The participants for the study were 20 immigrant women of African descent aged 21-65. A semi-structured interview schedule which comprised of open ended questions was used to collect data on the perspectives of immigrant women towards cervical cancer screening. Data was transcribed verbatim and analyzed thematically. The social change implications of the study can be that immigrant women could be more encouraged to seek access to the appropriate state of the art in cervical cancer screening which could contribute in reducing mortality, morbidity rate, and costs associated with cervical cancer.