Department of Microbiology and Parasitology, Universidade Federal Fluminenese, Rua Prof. Ernani Melo, 101, Niterói, RJ 24210-130, Brazil.
Arch Gynecol Obstet. 2013 Jan;287(1):53-8. doi: 10.1007/s00404-012-2511-3. Epub 2012 Aug 12.
The Family Medical Program is a health care system in the Rio de Janeiro state. Women's health services offered by the Family Medical Program include preventive exams and screening, family planning, and prenatal follow-up. Although cervical cancer screening is offered, barriers to care still hinder the full success of the program, and we are attempting to identify these barriers.
We undertook a cross-sectional and prospective study involving 351 women who were referred to the Family Medical Program between March 2009 and November 2010. Demographic data were obtained through a structured household questionnaire. The dependent variable was defined as the non-realization of the Pap smear test following the protocol of the Health Ministry. Cervical samples for screening were collected after clinical examination.
Women who had undergone Pap smear testing at least once every 3 years comprised 282 of the participants (80.3 %). Most of the women had normal or inflammatory cytology (96.3 %). Illiteracy and the absence of symptomatic episodes of sexually transmitted disease were independent barriers to having cancer screening at regular intervals. Illiterate women were more likely to be older, not to be using any contraceptive method, and on average had more than two children, more than four pregnancies, and more than two abortions. Embarrassment was the greatest barrier to seeking professional care reported by all women, regardless of level of educational attainment. Other important barriers to seeking care and/or screening included time constraints, due to work or childcare.
This study indicates that the Family Medical Program effectively provides cervical cancer screening coverage for its eligible population, at the level mandated by the WHO and the Brazilian Health Ministry. Fully 96.3 % of the women in our study had normal or benign inflammation on cytology. Understanding of barriers to care-seeking behavior that limit program adherence is one way to facilitate communication between providers and patients regarding the benefits of cancer screening.
家庭医疗计划是里约热内卢州的一项医疗保健系统。家庭医疗计划提供的妇女健康服务包括预防检查和筛查、计划生育和产前随访。虽然提供了宫颈癌筛查，但仍存在一些障碍，阻碍了该计划的全面成功，我们正在努力识别这些障碍。
我们进行了一项横断面和前瞻性研究，涉及 2009 年 3 月至 2010 年 11 月期间被转介到家庭医疗计划的 351 名妇女。通过结构化家庭问卷获得人口统计学数据。因变量定义为未按卫生部方案进行巴氏涂片检查。筛查时采集宫颈样本进行临床检查。
至少每 3 年进行一次巴氏涂片检查的妇女占 282 人（80.3%）。大多数妇女的细胞学检查结果正常或为炎症（96.3%）。文盲和无性病症状发作是定期进行癌症筛查的独立障碍。文盲妇女更可能年龄较大，不使用任何避孕方法，平均生育两个以上孩子，怀孕四次以上，堕胎两次以上。所有妇女都报告说，感到尴尬是寻求专业护理的最大障碍，无论受教育程度如何。寻求护理和/或筛查的其他重要障碍包括工作或照顾孩子导致的时间限制。
本研究表明，家庭医疗计划有效地为其符合条件的人群提供了宫颈癌筛查服务，达到了世界卫生组织和巴西卫生部规定的水平。在我们的研究中，96.3%的妇女的细胞学检查结果正常或良性炎症。了解寻求护理行为的障碍，可以促进提供者和患者之间就癌症筛查的益处进行沟通。
