Ampofo Ama Gyamfua, Boyes Allison W, Khumalo Phinda G, Mackenzie Lisa
Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Gynecol Oncol. 2022 Mar;164(3):675-690. doi: 10.1016/j.ygyno.2021.12.021. Epub 2022 Jan 5.
Schools are an ideal environment for promoting cervical cancer prevention among young women. This systematic review and meta-analysis aimed to examine: 1) the effectiveness of school-based education for improving i) knowledge and perceptions of cervical cancer, HPV infection and vaccination, and cervical cancer screening; ii) attitudes and intentions toward, and uptake of HPV vaccination and cervical cancer screening among female students; and 2) the methodological quality of studies testing school-based cervical cancer education.
Medline, EMBASE, CENTRAL, PsycINFO, CINAHL, Web of Science, and ERIC literature databases were searched from inception to November 2020. English language publications describing RCTs of any form of cervical cancer education delivered to female students in a school setting were eligible for inclusion. Included studies were assessed for methodological quality using the revised Cochrane risk of bias tool for randomized trials and the GRADE approach. Standardized Mean Differences and Odds Ratios were calculated and meta-analytically pooled using random-effects models. Subgroup analysis explored heterogeneity.
Of the 13 included studies, only one study was judged overall as having a low risk of bias. School-based education improved knowledge about cervical cancer and HPV infection. It also improved knowledge of and intentions toward HPV vaccination. Although education was ineffective in improving cervical cancer and HPV infection risk perceptions, and attitudes about HPV vaccination, a subgroup analysis found printed education materials focused on HPV-related content may have significant positive effects on risk perceptions. School-based education did not significantly increase HPV vaccination uptake; however, a face-to-face active approach seemed beneficial in a subgroup analysis. Heterogeneity (I) ranged between 0% to 93%, and the quality of evidence was rated from low to moderate.
High-quality evidence from methodologically rigorous studies is needed to provide stronger guidance regarding the benefits of school-based education in improving knowledge and behaviours toward cervical cancer prevention.
学校是促进年轻女性预防宫颈癌的理想环境。本系统评价和荟萃分析旨在探讨：1）以学校为基础的教育在改善以下方面的有效性：i）对宫颈癌、人乳头瘤病毒（HPV）感染与疫苗接种以及宫颈癌筛查的知识和认知；ii）女学生对HPV疫苗接种和宫颈癌筛查的态度、意愿及接受情况；2）检验以学校为基础的宫颈癌教育的研究的方法学质量。
检索了Medline、EMBASE、CENTRAL、PsycINFO、CINAHL、Web of Science和ERIC文献数据库，检索时间从建库至2020年11月。纳入在学校环境中向女学生提供任何形式宫颈癌教育的随机对照试验的英文出版物。使用修订后的Cochrane随机试验偏倚风险工具和GRADE方法对纳入研究的方法学质量进行评估。计算标准化均数差和比值比，并使用随机效应模型进行荟萃分析合并。亚组分析探讨异质性。
在纳入的13项研究中，只有1项研究总体被判定为低偏倚风险。以学校为基础的教育提高了对宫颈癌和HPV感染的知识。它还提高了对HPV疫苗接种的知识和意愿。尽管教育在改善宫颈癌和HPV感染风险认知以及对HPV疫苗接种的态度方面无效，但亚组分析发现，侧重于HPV相关内容的印刷教育材料可能对风险认知有显著的积极影响。以学校为基础的教育并未显著提高HPV疫苗接种率；然而，在亚组分析中，面对面的积极方法似乎有益。异质性（I²）在0%至93%之间，证据质量被评为低到中等。
需要来自方法学严谨研究的高质量证据，以更有力地指导以学校为基础的教育在改善预防宫颈癌的知识和行为方面的益处。
