School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Gauteng Provincial Health Department, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
PLoS One. 2021 Feb 10;16(2):e0246574. doi: 10.1371/journal.pone.0246574. eCollection 2021.
Cervical cancer is a major global public health concern, with 85% of cases occurring in low- and middle-income countries. In South Africa, it is the second most common cancer amongst women. Screening and treatment of cervical cancer precursor lesions is associated with a lower incidence and mortality. This research determines the associations between women's beliefs about cervical cancer and screening and the uptake of Papanicolaou (Pap) smears in Johannesburg, where cervical screening uptake is suboptimal.
This research was approved by the University of Witwatersrand Human Research Ethics Committee (Medical), clearance certificate number: M170243 and the Johannesburg District Heath Research Committee prior to conducting the study. All participants signed a consent form prior to participating in this study. This cross-sectional analytical study used an interviewer-administered validated measurement scale based on the Health Belief Model (HBM) to describe health beliefs regarding cervical cancer and screening among 280 women aged 30 years and older, attending Johannesburg primary care facilities in 2017. Logistic regression models, with robust estimation of variance to account for clustering of women within clinics, were fitted to identify health beliefs (perceived susceptibility, severity, barriers and benefit, cues to action, and self-efficacy) associated with ever having had a Pap smear (screening uptake), while controlling for knowledge of screening and potential confounders.
Of the 280 women, 177 (63.2%) had ever been screened, 180 (64.3%) were never married, 199 (71.1%) attained secondary education and 133 (47.5%) were employed full time. Women of older age (AOR = 1.6 for a 5-year increase in age; CI: 1.3-1.9; P<0.001), with higher knowledge scores (AOR = 2.5 for a 5-point increase in knowledge score; 95% CI:1.0-6.3;P = 0.051), with lower perceived barriers scores (AOR = 0.4 for a 5-point increase in barriers score; 95% CI:0.3-0.5; P<0.001) and higher perceived severity scores (AOR = 1.3 for a 5-point increase in severity score; 95% CI:1.0-1.6; P = 0.017) were more likely to have had a Pap smear.
This study shows that women who take up screening are older, more knowledgeable regarding cervical cancer and screening, less likely to perceive screening barriers, and more likely to perceive cervical cancer as a severe disease. This highlights that for public health interventions to increase screening uptake, the focus should include tailored behaviour change communication strategies that address women's beliefs regarding screening barriers and emphasize the severity of cervical cancer.
宫颈癌是一个重大的全球公共卫生问题，85%的病例发生在低收入和中等收入国家。在南非，它是女性中第二常见的癌症。筛查和治疗宫颈癌前病变与发病率和死亡率的降低有关。这项研究旨在确定女性对宫颈癌的信念与筛查之间的关联，并确定在约翰内斯堡接受巴氏涂片检查（Pap 涂片）的情况，在约翰内斯堡，宫颈癌筛查的接受率不理想。
这项研究得到了威特沃特斯兰德大学人类研究伦理委员会（医学）的批准，注册号为 M170243，并在开展研究之前得到了约翰内斯堡地区卫生研究委员会的批准。所有参与者在参与本研究之前都签署了同意书。这项横断面分析性研究使用了基于健康信念模型（HBM）的经过验证的测量量表，对 280 名年龄在 30 岁及以上的女性进行了描述，这些女性在 2017 年参加了约翰内斯堡初级保健机构。使用逻辑回归模型，采用稳健方差估计方法，以考虑到诊所内女性的聚类，以确定与曾经进行过巴氏涂片检查（筛查接受率）相关的健康信念（感知易感性、严重程度、障碍和益处、线索行动和自我效能），同时控制了对筛查的了解和潜在的混杂因素。
在 280 名女性中，177 名（63.2%）曾接受过筛查，180 名（64.3%）从未结婚，199 名（71.1%）接受过中等教育，133 名（47.5%）全职就业。年龄较大的女性（AOR=1.6，每增加 5 岁；CI：1.3-1.9；P<0.001）、知识得分较高的女性（AOR=2.5，知识得分增加 5 分；95%CI：1.0-6.3；P=0.051）、感知障碍得分较低的女性（AOR=0.4，障碍得分增加 5 分；95%CI：0.3-0.5；P<0.001）和感知严重程度得分较高的女性（AOR=1.3，严重程度得分增加 5 分；95%CI：1.0-1.6；P=0.017）更有可能进行巴氏涂片检查。
这项研究表明，接受筛查的女性年龄较大，对宫颈癌和筛查的了解程度较高，感知筛查障碍的可能性较低，且更有可能将宫颈癌视为严重疾病。这表明，为了提高公共卫生干预措施的筛查参与率，重点应包括针对女性对筛查障碍的信念的有针对性的行为改变沟通策略，并强调宫颈癌的严重程度。
