Daphne Cockwell School of Nursing, Ryerson University, 4 Josephine Pui-Hing Wong, 350 Victoria Street, M5B 2K3, Toronto, ON, Canada.
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
BMC Public Health. 2023 Apr 11;23(1):671. doi: 10.1186/s12889-023-15602-1.
While cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman-centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India.
Our community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30-69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants' uptake of cervical cancer screening was assessed after attendance in SHE.
Results revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS.
The implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs.
由于巴氏涂片检查（Pap 检查）的广泛应用，宫颈癌死亡人数在高收入国家急剧下降，但在低收入和中等收入国家（LMICs）却没有出现这种趋势。由于医疗基础设施有限、性健康知识缺乏以及对性传播感染（STIs）的污名化等障碍，印度等 LMICs 的筛查服务难以普及。HPV 自我采样（HPV-SS）是一种以女性为中心、在家中进行的筛查方法，可以作为一种独特的筛查工具，克服其中一些障碍。我们的研究考察了 HPV-SS 在印度农村和偏远地区难以接触到的妇女中进行宫颈癌筛查的有效性，该研究得到了以家庭为中心的基于艺术的性健康扫盲的支持。
我们的社区为基础的混合方法试点研究通过印度帕尔加尔区 Shirgoan、Khodala 和 Jamsar 三个村庄的女性认证社会健康活动家（ASHA）招募了 240 名参与者（120 名女性和 120 名男性伴侣或家庭成员）。纳入标准包括年龄在 30-69 岁的未接受或从未接受过筛查（UNS）的女性，以及年龄在 18 岁或以上的男性伴侣/家庭成员。在参加为时 2 小时的基于艺术的性健康教育（SHE）课程之前和之后，使用经过验证的量表评估他们对宫颈癌和筛查的知识和态度，以及他们对性传播感染的感知耻辱感。此外，在参加 SHE 课程后，还评估了参与者接受宫颈癌筛查的情况。
结果显示，在参加 SHE 课程后，参与者对宫颈癌和筛查的知识和态度有了显著改善，对性传播感染的耻辱感也有所降低（知识方面的总体平均差异：z=6.1±2.4，P<0.001；巴氏涂片检查和 VIA 的态度：z=2.2±8.4，P<0.001 和 z=2.9±8.2，P<0.001；性传播感染的耻辱感：z=2.8±12.4，P<0.001）。120 名女性参与者中有 118 名选择接受筛查，115 名选择 HPV-SS。
HPV-SS 与以家庭为中心、基于艺术的、文化上适宜的 SHE 相结合，在促进难以接触到的妇女进行宫颈癌筛查方面具有很大的前景。我们研究中的证据可以用于推进公共卫生政策，并为在印度农村和其他 LMICs 的其他村庄和州扩大类似举措提供信息。
