National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
J Med Internet Res. 2022 Oct 26;24(10):e35962. doi: 10.2196/35962.
In the Netherlands, since 1996, a national cervical cancer (CC) screening program has been implemented for women aged 30 to 60 years. Regional screening organizations send an invitation letter and information brochure in Dutch to the home addresses of targeted women every 5 years. Although this screening is free of charge, Turkish- and Moroccan-Dutch women, especially, show low screening participation and limited informed decision-making (IDM). As Turkish- and Moroccan-Dutch women indicated their need for information on the practical, emotional, cultural, and religious aspects of CC screening, we developed a culturally sensitive educational video (CSEV) as an addition to the current information brochure.
In this study, we aimed to evaluate the added effect of the CSEV on IDM regarding CC screening participation among Turkish and Moroccan women aged 30 to 60 years in the Netherlands through a randomized intervention study.
Initial respondents were recruited via several social media platforms and invited to complete a web-based questionnaire. Following respondent-driven sampling, respondents were asked to recruit a number of peers from their social networks to complete the same questionnaire. Respondents were randomly assigned to the control (current information brochure) or intervention condition (brochure and CSEV). We measured respondents' knowledge and attitude regarding CC screening and their intention to participate in the next CC screening round before and after the control or intervention condition. We evaluated the added effect of the CSEV (above the brochure) on their knowledge, attitude, intention, and IDM using intention-to-treat analyses.
The final sample (n=1564) included 686 (43.86%) Turkish and 878 (56.14%) Moroccan-Dutch women. Of this sample, 50.7% (793/1564) were randomized to the control group (350/793, 44.1% Turkish and 443/793, 55.9% Moroccan) and 49.3% (771/1564) to the intervention group (336/771, 43.6% Turkish and 435/771, 56.4% Moroccan). Among the Turkish-Dutch women, 33.1% (116/350) of the control respondents and 40.5% (136/336) of the intervention respondents consulted the brochure (not statistically significant). Among Moroccan-Dutch women, these percentages were 28.2% (125/443) and 37.9% (165/435), respectively (P=.003). Of all intervention respondents, 96.1% (323/336; Turkish) and 84.4% (367/435; Moroccan) consulted the CSEV. The CSEV resulted in more positive screening attitudes among Moroccan-Dutch women than the brochure (323/435, 74.3% vs 303/443, 68.4%; P=.07). Women, who had never participated in CC screening before, showed significantly more often a positive attitude toward CC screening compared with the control group (P=.01).
Our short and easily implementable CSEV resulted in more positive screening attitudes, especially in Moroccan-Dutch women. As the CSEV was also watched far more often than the current brochure was read, this intervention can contribute to better reach and more informed CC screening decisions among Turkish- and Moroccan-Dutch women.
International Clinical Trial Registry Platform NL8453; https://tinyurl.com/2dvbjxvc.
自 1996 年以来，荷兰一直在为 30 至 60 岁的女性实施国家宫颈癌（CC）筛查计划。地区筛查组织每 5 年向目标女性的家庭住址发送一封邀请信和信息手册。尽管这种筛查是免费的，但土耳其裔和摩洛哥裔荷兰女性，尤其是，参与率低，知情决策（IDM）有限。由于土耳其裔和摩洛哥裔荷兰女性表示她们需要了解 CC 筛查的实际、情感、文化和宗教方面的信息，我们开发了一个文化敏感的教育视频（CSEV）作为当前信息手册的补充。
在这项研究中，我们旨在通过一项随机干预研究，评估 CSEV 对 30 至 60 岁的土耳其裔和摩洛哥裔荷兰女性 CC 筛查参与的 IDM 的附加效果。
初始受访者通过多个社交媒体平台招募，并邀请他们完成在线问卷。在受访者驱动抽样之后，要求受访者从他们的社交网络中招募一定数量的同行来完成相同的问卷。受访者被随机分配到对照组（当前信息手册）或干预组（手册和 CSEV）。我们在对照组或干预组前后测量受访者对 CC 筛查的知识和态度以及他们参加下一轮 CC 筛查的意愿。我们使用意向治疗分析评估 CSEV（高于手册）对他们的知识、态度、意愿和 IDM 的附加效果。
最终样本（n=1564）包括 686 名（43.86%）土耳其裔和 878 名（56.14%）摩洛哥裔荷兰女性。在这一样本中，50.7%（793/1564）被随机分配到对照组（350/793，44.1%土耳其裔和 443/793，55.9%摩洛哥裔），49.3%（771/1564）被分配到干预组（336/771，43.6%土耳其裔和 435/771，56.4%摩洛哥裔）。在土耳其裔荷兰女性中，对照组（350）中有 33.1%（116/350）的受访者和干预组（336）中有 40.5%（136/336）的受访者查阅了手册（无统计学意义）。在摩洛哥裔荷兰女性中，这两个百分比分别为 28.2%（125/443）和 37.9%（165/435）（P=.003）。在所有干预组的受访者中，96.1%（323/336；土耳其）和 84.4%（367/435；摩洛哥）查阅了 CSEV。CSEV 使摩洛哥裔荷兰女性对 CC 筛查的态度比手册更积极（323/435，74.3%比 303/443，68.4%；P=.07）。从未参加过 CC 筛查的女性与对照组相比，对 CC 筛查的态度明显更为积极（P=.01）。
我们的简短且易于实施的 CSEV 导致了更积极的筛查态度，尤其是在摩洛哥裔荷兰女性中。由于 CSEV 的观看频率远远高于手册的阅读频率，因此这种干预措施可以帮助土耳其裔和摩洛哥裔荷兰女性更好地了解 CC 筛查并做出更明智的决策。
国际临床试验注册平台 NL8453；https://tinyurl.com/2dvbjxvc。
