Background: A global cervical cancer health disparity persists despite the demonstrated success of
primary and secondary preventive strategies, such as cervical visual inspection (VI). Cervical
cancer is the leading cause of cancer incidence and death for women in many low resource
areas. The greatest risk is for those who are unable or unwilling to access screening. Barriers
include healthcare personnel shortages, cost, transportation, and mistrust of healthcare providers
and systems. Using community health workers (CHWs) may overcome these barriers, increase
facilitators, and improve participation in screening for women in remote areas with limited access
to clinical resources.
Aim: To determine whether the accuracy of VI performed by CHWs was comparable to VI by
physicians or nurses and to consider the affect components of provider training had on VI
accuracy.
Methods: A systematic review and quantitative meta-analysis of published literature reporting on VI
accuracy, provider type, and training was conducted. Strict inclusion/exclusion criteria, study
quality, and publication bias assessments improved rigor and bivariate linear mixed modeling (BLMM) was used to determine the affect of predictors on accuracy. Unconditional and
conditional BLMMs, controlling for VI technique, provider type, community, clinical setting, HIV
status, and gynecological symptoms were considered.
Results: Provider type was a significant predictor of sensitivity (p=.048) in the unconditional VI
model. VI performed by CHWs was 15% more sensitive than physicians (p=.014). Provider type
was not a significant predictor of accuracy in any other models. Didactic and mentored hours
predicted sensitivity in both BLMMs. Quality assurance and use of a training manual predicted
specificity in unconditional BLMMs, but was not significant in conditional models. Number of
training days, with ≤5 being optimal, predicted sensitivity in both BLMMs and specificity in the
unconditional model.
Conclusion: Study results suggest that community based cervical cancer screening with VI conducted
by CHWs can be as, if not more, accurate than VI performed by licensed providers. Locally based
screening programs could increase access to screening for women in remote areas.
Collaborative partnerships in “pragmatic solidarity” between healthcare systems, CHWs, and the
community could promote participation in screening resulting in decreased cervical cancer
incidence and mortality. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection
| Identifer | oai:union.ndltd.org:fau.edu/oai:fau.digital.flvc.org:fau_33911 |
| Contributors | Driscoll, Susan D. (author), Tappen, Ruth M. (Thesis advisor), Florida Atlantic University (Degree grantor), Christine E. Lynn College of Nursing |
| Publisher | Florida Atlantic University |
| Source Sets | Florida Atlantic University |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation, Text |
| Format | 213 p., application/pdf |
| Rights | Copyright © is held by the author with permission granted to Florida Atlantic University to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder., http://rightsstatements.org/vocab/InC/1.0/ |
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