Tacken Margot A J B, Braspenning Jozé C C, Hermens Rosella P M G, Spreeuwenberg Peter M M, van den Hoogen Henk J M, de Bakker Dinny H, Groenewegen Peter P, Grol Richard P T M
WOK, Centre for Quality of Care Research, Radboud University Nijmegen Medical, Centre/University of Maastricht The Netherlands.
Eur J Public Health. 2007 Apr;17(2):178-85. doi: 10.1093/eurpub/ckl082. Epub 2006 Jul 12.
This study aims to examine the impact of women's characteristics (demographics, risk behaviour, and beliefs) on the uptake of cervical cancer screening, taking practice characteristics (demographic and organizational) into account.
Routinely collected data of screening status were sampled from electronic medical records of 32 Dutch general practices. Additionally, a questionnaire was sent to a sample of 2224 listed women-1204 screened, 1020 unscreened. We used a step-by-step, logistic, multilevel approach to examine determinants of the screening uptake.
Analyses of data for 1392 women (968 screened and 424 unscreened) showed that women's beliefs about cervical screening and attendance are the best predictors of screening uptake, even when demographic and organizational aspects are taken into account. Women aged 40-50 years who felt high personal moral obligation, who had only one sexual partner ever, and who were invited and reminded by their own general practice had the greatest likelihood of screening uptake. A non-response study was performed; the non-responders to the questionnaire (mainly unscreened) thought they had less risk of cervical cancer, were less motivated, less often intended to get future screening, and were more convinced that cervical cancer cannot be cured.
To improve the uptake rate, we should focus on the personal moral obligation of eligible women, beliefs about the risks of cervical cancer, and available cures. Invitations and reminders within general practices enhance the uptake rate.
本研究旨在探讨女性特征（人口统计学、风险行为和信念）对宫颈癌筛查接受情况的影响，并考虑诊所特征（人口统计学和组织方面）。
从32家荷兰普通诊所的电子病历中抽取常规收集的筛查状态数据。此外，向2224名在册女性样本发放了问卷，其中1204人已接受筛查，1020人未接受筛查。我们采用逐步逻辑多水平方法来研究筛查接受情况的决定因素。
对1392名女性（968名已筛查和424名未筛查）的数据进行分析表明，即使考虑到人口统计学和组织方面的因素，女性对宫颈癌筛查和就诊的信念仍是筛查接受情况的最佳预测指标。40至50岁的女性，若感到个人道德义务感强烈、仅有过一个性伴侣且受到自己所在普通诊所的邀请和提醒，则接受筛查的可能性最大。进行了一项无应答研究；问卷无应答者（主要是未筛查者）认为自己患宫颈癌的风险较低，积极性较低，较少打算未来进行筛查，且更坚信宫颈癌无法治愈。
为提高接受率，我们应关注符合条件女性的个人道德义务、对宫颈癌风险的信念以及现有治疗方法。普通诊所内部的邀请和提醒可提高接受率。
