Department of Internal Medicine, University of New Mexico, USA.
Public Health Research Institute of India, Mysore, India.
Glob Health Promot. 2020 Dec;27(4):50-58. doi: 10.1177/1757975920915677. Epub 2020 May 13.
Cervical cancer is the second most common cancer diagnosed among women in India and current estimates indicate low screening rates. To implement successful population-based screening programs, there is an urgent need to explore the social and cultural beliefs among women residing in underserved communities. An innovative, community-based participatory approach called photovoice was used with 14 women aged between 30-51 years, residing in rural and tribal villages around Mysore, Karnataka, India. Each participant was trained in photovoice techniques, provided with a digital camera, and asked to photo document their everyday realities that could influence their intentions to undergo cervical cancer screening. Over 6 months, participants took a total of 136 photos and participated in 42 individual interviews and two group discussions. These data helped identify specific beliefs prevalent in the target population and were organized according to the Integrated Behavior Model. Some women reported a lack of perceived susceptibility to cervical cancer whereas others mentioned the fatal nature of cancer as a disease and believed that no screening exam could prevent death if they were destined to get cancer. Husbands, mothers-in-law, and their peers in the community had an important influence on the social identity of women and influenced their intentions to participate in the screening exams. Seeking healthcare was associated with an economic burden, not only in terms of out-of-pocket expenses for healthcare services but also in missing daily labor wages or taking unpaid leave from work to seek healthcare when they were asymptomatic. Several action steps were proposed including: identifying community liaisons or champions, repeated community activities to raise awareness of cervical cancer, and educating men and other family members about women's health issues. Study findings can conceptually help design and develop educational efforts for mobilizing women to undergo screening and inform future research to help understand disparities.
在印度，宫颈癌是女性中第二大常见癌症，目前的估计表明筛查率较低。为了实施成功的基于人群的筛查计划，迫切需要探索居住在服务不足社区的妇女的社会和文化信仰。一种名为影像照护的创新的社区参与式方法在 14 名年龄在 30-51 岁之间的女性中进行，这些女性居住在印度卡纳塔克邦迈索尔周围的农村和部落村庄。每位参与者都接受了影像照护技术的培训，提供了数码相机，并要求他们拍摄可以影响她们进行宫颈癌筛查意愿的日常生活照片。在 6 个月的时间里，参与者总共拍摄了 136 张照片，并参加了 42 次个人访谈和 2 次小组讨论。这些数据有助于确定目标人群中普遍存在的特定信仰，并根据综合行为模型进行了组织。一些女性表示对宫颈癌的易感性认识不足，而另一些女性则提到癌症的致命性质，并认为如果她们注定要患上癌症，任何筛查检查都无法预防死亡。丈夫、婆婆和社区中的同龄人对女性的社会身份有重要影响，并影响她们参加筛查检查的意愿。寻求医疗保健不仅会带来医疗服务的自付费用负担，还会因日常劳动工资的损失或在无症状时请假去看医生而带来经济负担。提出了几项行动步骤，包括：确定社区联络人或拥护者、重复社区活动以提高对宫颈癌的认识，以及教育男性和其他家庭成员有关妇女健康问题。研究结果可以从概念上帮助设计和开发动员妇女进行筛查的教育工作，并为未来的研究提供信息，以帮助了解差异。
