Dareng Eileen O, Jedy-Agba Elima, Bamisaye Patience, Isa Modibbo Fatima, Oyeneyin Lawal O, Adewole Ayodele S, Olaniyan Olayinka B, Dakum Patrick S, Pharoah Paul D, Adebamowo Clement A
Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.
Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2015 Nov 3;10(11):e0141679. doi: 10.1371/journal.pone.0141679. eCollection 2015.
Whereas systematic screening programs have reduced the incidence of cervical cancer in developed countries, the incidence remains high in developing countries. Among several barriers to uptake of cervical cancer screening, the roles of religious and cultural factors such as modesty have been poorly studied. Knowledge about these factors is important because of the potential to overcome them using strategies such as self-collection of cervico-vaginal samples. In this study we evaluate the influence of spirituality and modesty on the acceptance of self-sampling for cervical cancer screening.
We enrolled 600 participants in Nigeria between August and October 2014 and collected information on spirituality and modesty using two scales. We used principal component analysis to extract scores for spirituality and modesty and logistic regression models to evaluate the association between spirituality, modesty and preference for self-sampling. All analyses were performed using STATA 12 (Stata Corporation, College Station, Texas, USA).
Some 581 (97%) women had complete data for analysis. Most (69%) were married, 50% were Christian and 44% were from the south western part of Nigeria. Overall, 19% (110/581) of the women preferred self-sampling to being sampled by a health care provider. Adjusting for age and socioeconomic status, spirituality, religious affiliation and geographic location were significantly associated with preference for self-sampling, while modesty was not significantly associated. The multivariable OR (95% CI, p-value) for association with self-sampling were 0.88 (0.78-0.99, 0.03) for spirituality, 1.69 (1.09-2.64, 0.02) for religious affiliation and 0.96 (0.86-1.08, 0.51) for modesty.
Our results show the importance of taking cultural and religious beliefs and practices into consideration in planning health interventions like cervical cancer screening. To succeed, public health interventions and the education to promote it must be related to the target population and its preferences.
尽管系统筛查项目已降低了发达国家宫颈癌的发病率，但在发展中国家发病率仍居高不下。在宫颈癌筛查推广的诸多障碍中，诸如谦逊等宗教和文化因素所起的作用鲜有研究。了解这些因素很重要，因为有可能通过诸如自行采集宫颈阴道样本等策略来克服它们。在本研究中，我们评估了灵性和谦逊对接受宫颈癌筛查自我采样的影响。
2014年8月至10月期间，我们在尼日利亚招募了600名参与者，并使用两个量表收集了有关灵性和谦逊的信息。我们使用主成分分析来提取灵性和谦逊的得分，并使用逻辑回归模型来评估灵性、谦逊与自我采样偏好之间的关联。所有分析均使用STATA 12（美国德克萨斯州大学站市的Stata公司）进行。
约581名（97%）女性拥有完整数据用于分析。大多数（69%）已婚，50%为基督教徒，44%来自尼日利亚西南部。总体而言，19%（110/581）的女性更喜欢自我采样而非由医护人员采样。在调整年龄和社会经济地位后，灵性、宗教信仰和地理位置与自我采样偏好显著相关，而谦逊则无显著关联。与自我采样关联的多变量OR（95%CI，p值），灵性为0.88（0.78 - 0.99，0.03），宗教信仰为1.69（1.09 - 2.64，0.02），谦逊为0.96（0.86 - 1.08，0.51）。
我们的结果表明，在规划诸如宫颈癌筛查等健康干预措施时，考虑文化和宗教信仰及习俗很重要。要取得成功，公共卫生干预措施及其推广教育必须与目标人群及其偏好相关。
