Population Research Institute at the Pennsylvania State University, University Park, PA 16802, USA.
Am J Public Health. 2011 Jul;101(7):1297-305. doi: 10.2105/AJPH.2010.300061. Epub 2011 May 12.
We investigated whether health care system distrust is a barrier to breast and cervical cancer screening and whether different dimensions of distrust-values and competence-have different impacts on cancer screening.
We utilized data on 5268 women aged 18 years and older living in Philadelphia, Pennsylvania, and analyzed their use of screening services via logistic and multinomial logistic regression.
High levels of health care system distrust were associated with lower utilization of breast and cervical cancer screening services. The associations differed by dimensions of distrust. Specifically, a high level of competence distrust was associated with a reduced likelihood of having Papanicolaou tests, and women with high levels of values distrust were less likely to have breast examinations within the recommended time period. Independent of other covariates, individual health care resources and health status were associated with utilization of cancer screening.
Health care system distrust is a barrier to breast and cervical cancer screening even after control for demographic and socioeconomic determinants. Rebuilding confidence in the health care system may improve personal and public health by increasing the utilization of preventive health services.
我们调查了医疗保健系统不信任是否是乳腺癌和宫颈癌筛查的障碍，以及不同维度的不信任——价值观和能力——是否对癌症筛查有不同的影响。
我们利用了宾夕法尼亚州费城 5268 名 18 岁及以上女性的数据，通过逻辑回归和多项逻辑回归分析了她们对筛查服务的使用情况。
高度的医疗保健系统不信任与较低的乳腺癌和宫颈癌筛查服务利用率有关。这种关联因不信任的维度而异。具体来说，高度的能力不信任与巴氏试验检查率降低有关，而价值观不信任程度较高的女性则不太可能在推荐的时间内进行乳房检查。独立于其他协变量，个人医疗保健资源和健康状况与癌症筛查的利用有关。
即使在控制了人口统计学和社会经济决定因素后，医疗保健系统的不信任也是乳腺癌和宫颈癌筛查的障碍。重建对医疗保健系统的信心可能会通过增加预防性卫生服务的利用来改善个人和公共健康。
