Cancer Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran.
Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
BMC Public Health. 2020 Nov 11;20(1):1688. doi: 10.1186/s12889-020-09701-6.
Iran has a low incidence but higher rate of death from cervical cancer (CC). The country is in the process of implementing an organized screening program including HPV testing and cytology. Studies show high dropout in continued testing among eligible women. This qualitative study aimed to explore women's awareness regarding CC and CC testing and the role of knowledge, perceived risk, and cues to action in this process.
Through a qualitative study based on the Framework Method, we recruited 81 women aged 25-65 who participated in 15 focus group discussions (FGDs) and two in-depth interviews in Tehran. The interviewees were selected purposefully during January to May 2015 from households belonging to different socioeconomic classes until data saturation. The data were acquired through 11 open-ended questions and 32 related probe questions. All interviews were transcribed and independently analyzed by two researchers (Kappa and agreement testing respectively: 0.77, 97.11%).
The coded texts were categorized under three themes and 13 subthemes. The three thematic areas referred to knowledge, cues to action, and perceived risks regarding CC and screening. The results showed that women had limited and unspecified knowledge about CC and screening, compounded by misconceptions regarding infection and cancer prevention measures. Social and cultural barriers hindered proper communication between health system/providers and clients and within communities on subjects related to CC and screening. The perceived risk of getting CC was low because of overestimating the role of hereditary factors for CC, difficulty in differentiating between cancer and sexually transmitted infections (STI), and the absence of visible symptoms.
The results indicate a strong need to invest more efforts to improve health education and communication in the current national health program to promote awareness of the need to screen for CC through, for example, establishing correct knowledge and risk perceptions among women. In addition, this intervention should address women's social environment in order to prevent misconceptions being communicated to women.
伊朗宫颈癌（CC）的发病率较低，但死亡率较高。该国正在实施一项包括 HPV 检测和细胞学检查的有组织筛查计划。研究表明，符合条件的女性在继续接受检测方面的失访率很高。这项定性研究旨在探讨女性对 CC 和 CC 检测的认知，以及知识、感知风险和行动线索在这一过程中的作用。
通过基于框架方法的定性研究，我们招募了 81 名年龄在 25-65 岁之间的女性，她们参加了 15 个焦点小组讨论（FGD）和 2015 年 1 月至 5 月在德黑兰进行的两次深度访谈。访谈对象是根据不同社会经济阶层的家庭有目的地选择的，直到数据饱和。通过 11 个开放式问题和 32 个相关探针问题获取数据。所有访谈均进行了转录，并由两名研究人员进行独立分析（Kappa 和一致性测试分别为：0.77、97.11%）。
编码文本分为三个主题和 13 个子主题。三个主题领域涉及 CC 和筛查的知识、行动线索和感知风险。结果表明，女性对 CC 和筛查的了解有限且不明确，对感染和癌症预防措施存在误解。社会和文化障碍阻碍了卫生系统/提供者与客户以及社区内部就 CC 和筛查相关主题进行适当沟通。CC 发病风险较低，原因是高估了遗传因素对 CC 的作用，难以区分癌症和性传播感染（STI），以及没有明显症状。
结果表明，需要大力加强努力，改善当前国家卫生计划中的健康教育和沟通，通过例如在女性中建立正确的知识和风险认知，提高对 CC 筛查的认识。此外，这种干预措施应该针对女性的社会环境，以防止错误观念传达给女性。
