在马来西亚多民族女性中，影响自我采集宫颈阴道样本进行人乳头瘤病毒（HPV）基因分型以替代巴氏试验的可接受性的态度和因素。
Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women.
作者信息
Ma'som Mahirah, Bhoo-Pathy Nirmala, Nasir Nazrila Hairizan, Bellinson Jerome, Subramaniam Shridevi, Ma Yuntong, Yap Siew-Hwei, Goh Pik-Pin, Gravitt Patti, Woo Yin Ling
机构信息
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
National Clinical Research Centre, Ministry of Health, Malaysia Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
出版信息
BMJ Open. 2016 Aug 4;6(8):e011022. doi: 10.1136/bmjopen-2015-011022.
OBJECTIVE
The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women.
METHOD
A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, previous Pap smear experience, and attitudes towards self-administered cervicovaginal sampling were collected and analysed. Acceptability was inferred using a five-item Likert scale that included six different subjective descriptives: experience, difficulty, convenience, embarrassment, discomfort or pain, and confidence in collecting one's own sample.
RESULTS
Of the 839 participants, 47.9% were Malays, followed by 30.8% Indians, 18.8% Chinese and 2.5% from other ethnicities. The median age of the participants was 38 years (IQR 30-48). Some 68.2% of participants indicated a preference for self-sampling over the Pap test, with 95% indicating willingness to follow-up a positive result at the hospital. Age, ethnicity and previous Pap test experience were significant independent factors associated with preference for self-sampling. The older the individual, the less likely they were to prefer self-sampling (adjusted OR 0.94, 95% CI 0.90 to 0.98). The Chinese were less likely to prefer self-sampling (72.6%) than the Malays (85.1%) (adjusted OR 0.57, 95% CI 0.33 to 0.98, p=0.004). Participants who had never undergone a Pap smear were also more likely to prefer self-sampling (88.5%) than women who had undergone a previous Pap (80.9%) (adjusted OR 0.06, 95% CI 0.35 to 0.87).
CONCLUSIONS
Overall, urban Malaysian women from multiethnic backgrounds found self-sampling to be an acceptable alternative to Pap smear.
目的
本研究的目的是确定在马来西亚多民族女性中，与传统医生采集的巴氏涂片相比，自行采集宫颈阴道样本的态度和可接受性。
方法
2013年8月至2015年8月期间，在雪兰莪州的五家政府运营的城市健康诊所，通过访员管理的调查进行了一项横断面研究。研究对象是一项正在进行的基于社区的人乳头瘤病毒（HPV）患病率研究的参与者，他们在自行采样前后回答了一份标准问卷。使用一种简单的刷子（“只为我所用”；香港国际预防肿瘤学）进行HPV基因分型的宫颈阴道自行采样。收集并分析了有关社会人口统计学、以往巴氏涂片检查经历以及对自行采集宫颈阴道样本的态度的详细数据。使用包含六个不同主观描述的五项李克特量表推断可接受性，这六个主观描述分别为：体验、难度、便利性、尴尬程度、不适或疼痛以及对自行采集样本的信心。
结果
839名参与者中，47.9%为马来人，其次是30.8%为印度人，18.8%为华人，2.5%来自其他种族。参与者的年龄中位数为38岁（四分位距30 - 48岁）。约68.2%的参与者表示比起巴氏试验更喜欢自行采样，95%的参与者表示愿意在医院跟进阳性结果。年龄、种族和以往巴氏试验经历是与更喜欢自行采样相关的显著独立因素。年龄越大，越不太可能更喜欢自行采样（调整后的比值比为0.94，95%置信区间为0.90至0.98）。华人比起马来人（85.1%）更不太可能更喜欢自行采样（72.6%）（调整后的比值比为0.57，95%置信区间为0.33至0.98，p = 0.004）。从未接受过巴氏涂片检查的参与者比起曾接受过巴氏涂片检查的女性（80.9%）也更有可能更喜欢自行采样（88.5%）（调整后的比值比为0.06，95%置信区间为从0.35至0.87）。
结论
总体而言，来自多民族背景的马来西亚城市女性发现自行采样是巴氏涂片的可接受替代方法。
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