Sharma Manoj, Batra Kavita, Johansen Christopher, Raich Siddharth
Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA.
Office of Research, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA.
Pharmacy (Basel). 2022 Feb 15;10(1):30. doi: 10.3390/pharmacy10010030.
Globally, cervical cancer is the fourth leading cause of death among women. While overall cervical cancer rates have decreased over the last few decades, minority women continue to be disproportionately affected compared to White women. Given the paucity of theory-based interventions to promote Pap smear tests among minority women, this cross-sectional study attempts to examine the correlates of cervical cancer screening by Pap test using the Multi-theory Model (MTM) as a theoretical paradigm among minority women in the United States (U.S.). Structural Equation Modelling (SEM) was done for testing the construct validity of the survey instrument. Data were analyzed through bivariate and multivariate tests. In a sample of 364 minority women, nearly 31% ( 112) of women reported not having received a Pap test within the past three years compared to the national rate (20.8%) for all women. The MTM constructs of participatory dialogue, behavioral confidence, and changes in the physical environment explained a substantial proportion of variance (49.5%) in starting the behavior of getting Pap tests, while the constructs of emotional transformation, practice for change, and changes in the social environment, along with lack of health insurance and annual household income of less than $25,000, significantly explained the variance (73.6%) of the likelihood to sustain the Pap test behavior of getting it every three years. Among those who have had a Pap smear ( = 252), healthcare insurance, emotional transformation, practice for change, and changes in the social environment predicted nearly 83.3% of the variance in sustaining Pap smear test uptake behavior (adjusted R = 0.833, F = 45.254, < 0.001). This study validates the need for health promotion interventions based on MTM to be implemented to address the disparities of lower cervical cancer screenings among minority women.
在全球范围内，宫颈癌是女性死亡的第四大主要原因。尽管在过去几十年中宫颈癌的总体发病率有所下降，但与白人女性相比，少数族裔女性受其影响的比例仍然过高。鉴于缺乏基于理论的干预措施来促进少数族裔女性进行巴氏涂片检查，这项横断面研究试图以多理论模型（MTM）为理论范式，在美国少数族裔女性中研究通过巴氏试验进行宫颈癌筛查的相关因素。采用结构方程模型（SEM）来检验调查问卷的结构效度。通过双变量和多变量检验对数据进行分析。在364名少数族裔女性样本中，近31%（112名）的女性报告在过去三年内未接受过巴氏试验，而所有女性的全国比率为20.8%。参与性对话、行为信心和物理环境变化等MTM结构解释了开始进行巴氏试验行为中很大一部分的方差（49.5%），而情感转变、变革实践、社会环境变化，以及缺乏医疗保险和家庭年收入低于25000美元，显著解释了每三年持续进行巴氏试验行为可能性的方差（73.6%）。在进行过巴氏涂片检查的人群中（n = 252），医疗保险、情感转变、变革实践和社会环境变化预测了持续进行巴氏涂片检查行为中近83.3%的方差（调整后R = 0.833，F = 45.254，p < 0.001）。本研究证实了有必要实施基于MTM的健康促进干预措施，以解决少数族裔女性宫颈癌筛查率较低的差异问题。
