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一项范围综述:撒哈拉以南非洲卫生环境中宫颈癌筛查及乳腺癌早期诊断的促进因素和障碍

A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings.

作者信息

Pierz Amanda J, Randall Thomas C, Castle Philip E, Adedimeji Adebola, Ingabire Charles, Kubwimana Gallican, Uwinkindi Francois, Hagenimana Marc, Businge Lydia, Musabyimana Francoise, Munyaneza Athanase, Murenzi Gad

机构信息

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.

出版信息

Gynecol Oncol Rep. 2020 Jun 22;33:100605. doi: 10.1016/j.gore.2020.100605. eCollection 2020 Aug.

Abstract

To address gaps in access to cervical cancer screening and early diagnosis of breast cancer services in Sub-Saharan African (SSA), this scoping review was conducted to explore facilitators and barriers that exist on the patient-, provider-, and system-level. An extensive literature search was conducted in accordance with scoping review methodology and the Cochrane guidelines. Our search criteria were limited to original research studies conducted in community or clinical settings in SSA within the last 10 years (2010-2020). Themes found from this review included patient knowledge and provider education, access to screening services, trust, health-related behaviors, attitudes, values, and practices, community and social values, health infrastructure, resource allocation, and political will. Identified barriers included lack of knowledge about cervical and breast cancer among patients, gaps in education and training among providers, and lack of resources and health infrastructure at the facility level and within the overall health system. Facilitators included perceived risk of cancer, support and encouragement of the provider, and utilization of novel approaches in low-resource settings by health systems. To better address individual-, provider-, and health system and facility-based facilitators and barriers to care, there is a need for political and financial investment and further research on the health service delivery in specific national health systems, especially in the context of the global campaign to eliminate cervical cancer as a public health problem.

摘要

为了解决撒哈拉以南非洲地区宫颈癌筛查和乳腺癌早期诊断服务可及性方面的差距,开展了这项范围综述,以探究患者、提供者和系统层面存在的促进因素和障碍。按照范围综述方法和Cochrane指南进行了广泛的文献检索。我们的检索标准仅限于过去10年(2010 - 2020年)在撒哈拉以南非洲地区社区或临床环境中开展的原始研究。该综述发现的主题包括患者知识和提供者教育、筛查服务可及性、信任、健康相关行为、态度、价值观和实践、社区和社会价值观、卫生基础设施、资源分配以及政治意愿。已识别的障碍包括患者对宫颈癌和乳腺癌缺乏了解、提供者教育和培训方面的差距,以及机构层面和整个卫生系统缺乏资源和卫生基础设施。促进因素包括感知到的癌症风险、提供者的支持和鼓励,以及卫生系统在资源匮乏地区采用新方法。为了更好地应对个体、提供者以及卫生系统和机构层面的护理促进因素和障碍,需要进行政治和财政投资,并进一步研究特定国家卫生系统中的卫生服务提供情况,特别是在将消除宫颈癌作为公共卫生问题的全球运动背景下。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c24/7327246/81371d12fdda/gr1.jpg

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