生殖道自我采样用于 HPV 宫颈癌筛查：在埃塞俄比亚农村地区对偏好和障碍的定性研究。
Genital self-sampling for HPV-based cervical cancer screening: a qualitative study of preferences and barriers in rural Ethiopia.
机构信息
Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
Department of Gynaecology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
BMC Public Health. 2019 Jul 31;19(1):1026. doi: 10.1186/s12889-019-7354-4.
BACKGROUND
In the context of WHO's "task shifting" project and growing global consensus on primary HPV-based cervical cancer screening, self-sampling is a promising new tool to expand screening access, uptake and coverage for women worldwide. We aimed to explore perceptions and acceptability of HPV self-sampling-based cervical cancer screening among community members and health professionals in rural northwest Ethiopia and to identify preferences and socio-cultural barriers regarding self-sampling in order to design a suitable high-coverage screening intervention for a rural African setting.
METHODS
Four community-based focus group discussions (FGD) were conducted in the rural district of Dabat, Northwest Ethiopia, each comprising 8 to 14 female participants, counting a total of 41 participants. The groups were homogenously composed in terms of their socio-economic status in the community. They included health centre attendees, community members, nurses and health development army leaders (HDAL). Two qualitative data collection experts conducted the interviews in the local language, using a FGD guide with several thematic areas. All participants granted written informed consent prior to the conduct of the interviews. As a concrete example of an existing self-sampling approach for cervical cancer screening we used the Evalyn® Brush.
RESULTS
Emerging themes included (i) misconceptions and low awareness about cervical cancer among community residents and primary health care providers in rural northwest Ethiopia, (ii) stigmatization and social exclusion of affected women, (iii) delay in seeking of health care due to poor access and availability of services, and lacking of a concept of early cancer prevention, (iv) need of spousal permission, (v) fear of financial burden and (vi) fear of social marginalization. The self-sampling device was regarded to be acceptable and was judged to be easy to use for most women. The existing Ethiopian health care structure could facilitate a community approach.
CONCLUSION
Home-based self-sampling for cervical cancer screening is a socially acceptable and feasible "task shifting" method that will increase cervical cancer screening access and coverage in the Ethiopian study community. Education, awareness creation, community mobilization and family inclusion are identified as key activities to promote, implement and facilitate "task shifting" approaches like self-sampling.
背景
在世界卫生组织的“任务转移”项目和全球对基于 HPV 的宫颈癌初级筛查的共识不断增强的背景下，自我采样是一种有前途的新工具，可以扩大全球范围内妇女的筛查机会、参与度和覆盖面。我们旨在探索社区成员和埃塞俄比亚农村地区的卫生专业人员对基于 HPV 自我采样的宫颈癌筛查的看法和可接受性，并确定自我采样的偏好和社会文化障碍，以便为非洲农村地区设计一个合适的高覆盖率筛查干预措施。
方法
在埃塞俄比亚西北部的达巴特农村地区进行了 4 次基于社区的焦点小组讨论（FGD），每次讨论由 8 至 14 名女性参与者组成，共有 41 名参与者。这些小组在社区中的社会经济地位方面是同质的。他们包括卫生中心的就诊者、社区成员、护士和卫生发展军队领导人（HDAL）。两位定性数据收集专家用当地语言进行了访谈，使用了一个具有几个主题领域的 FGD 指南。所有参与者在访谈进行之前都签署了书面知情同意书。作为宫颈癌筛查的一种现有自我采样方法的具体示例，我们使用了 Evalyn®Brush。
结果
出现的主题包括：（i）埃塞俄比亚农村地区社区居民和初级卫生保健提供者对宫颈癌的误解和低认识；（ii）受影响妇女的污名化和社会排斥；（iii）由于服务的获取和提供有限以及缺乏早期癌症预防概念，导致寻求医疗保健的延迟；（iv）需要配偶的许可；（v）对经济负担的恐惧；（vi）对社会边缘化的恐惧。自我采样装置被认为是可以接受的，并且大多数女性认为使用起来很容易。现有的埃塞俄比亚医疗保健结构可以促进社区方法。
结论
基于家庭的宫颈癌自我采样是一种社会可接受且可行的“任务转移”方法，将增加埃塞俄比亚研究社区的宫颈癌筛查机会和覆盖面。教育、提高认识、社区动员和家庭包容被确定为促进、实施和促进自我采样等“任务转移”方法的关键活动。
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