Sharma Drishti, Rohilla Latika, Bagga Rashmi, Srinivasan Radhika, Jindal Har Ashish, Sharma Nikita, Kankaria Ankita, Jamir Limalemla, Suri Vanita, Singh Rakesh Kumar, Duggal Mona
School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Public Health Nurs. 2018 Nov;35(6):526-533. doi: 10.1111/phn.12517. Epub 2018 May 28.
The Indian national program stresses implementation of cervical cancer screening by health workers/nurses using VIA (Visual Inspection under Acetic acid). We demonstrate its feasibility and reliability in rural setting, assessing the role of smartphone-imaging for continuous training of nurses.
A cross-sectional design to assess the reliability of the nurse-led VIA test. To assess feasibility, VIA positive patients were observed till confirmative diagnosis was made.
Hospital-based purposive sampling was used to recruit participants.
A structured questionnaire for recording participants' details, VIA findings and follow-up information; and an observational checklist to record implementation parameters during each clinic. An expert assessed the nurse's judgment using smartphone-images of cervix.
During October 2016-June 2017, 2758 patients attended the weekly clinic; 238 (8.6%) met the criteria, of those 180 (75.6%) tested after consent. Nurse reported 25 (13.8%) VIA-positive cases, but only 19 accessed the referral service. Kappa statistic: 0.45 (CI: 0.26-0.63) suggested moderate nurse-expert agreement. Image retrieval and quality affected expert's evaluation. Implementation challenges include low awareness among the population and referral link-up.
Appropriately trained nurses can reliably conduct screening. Real-time expert feedback might improve reporting. Rigorous awareness activities and on-site treatment can reduce drop-outs. The medical institute's involvement and administrative will were instrumental.
印度国家计划强调由卫生工作者/护士使用醋酸肉眼观察法（VIA）开展宫颈癌筛查。我们在农村地区证明了其可行性和可靠性，评估了智能手机成像在护士持续培训中的作用。
采用横断面设计评估护士主导的VIA检测的可靠性。为评估可行性，对VIA检测呈阳性的患者进行观察，直至做出确诊。
采用基于医院的立意抽样法招募参与者。
使用一份结构化问卷记录参与者的详细信息、VIA检测结果和随访信息；以及一份观察清单记录每次门诊期间的实施参数。一名专家利用宫颈的智能手机图像评估护士的判断。
在2016年10月至2017年6月期间，2758名患者参加了每周的门诊；238名（8.6%）符合标准，其中180名（75.6%）在获得同意后接受了检测。护士报告了25例（13.8%）VIA检测呈阳性的病例，但只有19例获得了转诊服务。卡方统计值：0.45（置信区间：0.26 - 0.63）表明护士与专家的一致性为中等。图像检索和质量影响专家的评估。实施方面的挑战包括人群意识淡薄和转诊联系不畅。
经过适当培训的护士能够可靠地进行筛查。实时专家反馈可能会改善报告情况。开展严格的宣传活动和现场治疗可以减少退出率。医学院校的参与和行政支持起到了重要作用。
