Asare Matthew, Elizondo Anjelica, Dwumfour-Poku Mina, Mena Carlos, Gutierrez Mariela, Mamudu Hadii M
Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA.
North American University, Stafford, TX 77477, USA.
Healthcare (Basel). 2023 May 5;11(9):1323. doi: 10.3390/healthcare11091323.
Human Papillomavirus (HPV) self-sampling has the potential to increase Cervical Cancer Screening (CCS) and reduce the cervical cancer burden in Medically Underserved Women (MUW). However, interventions promoting self-sampling are limited. We examined the effectiveness of an intervention study in increasing CCS among MUW. We conducted a quasi-experimental intervention study. A face-to-face verbal approach was used to recruit MUW ( = 83, mean age 48.57 ± 11.02) living in a small city in the US. Behavioral intervention based on reframing, reprioritizing, and reforming (3R model) was used to educate the women about CCS in a group format. The women ( = 83) completed pre-and post-intervention assessments, and 10 of them were invited for follow-up interviews. The primary outcome was CCS uptake. Mixed methods analyses were conducted using a -test for the primary outcome, PROCESS for mediation analysis, and NVivo for interview data. The majority of women (75%) completed self-testing. High-risk HPV among women was 11%, and of those, 57% followed up with physicians for care. We found that the significant increase in the women's post-intervention screening behaviors was mediated by the increase in knowledge (Indirect Effect [IE] = 0.1314; 95% CI, 0.0104, 0.4079) and attitude (IE = 0.2167; 95% CI, 0.0291, 0.6050) scores, ( < 0.001). Interview analyses offered further explanations why MUW found the intervention messages acceptable (encourages proactive behavior), feasible (simple and easy to understand), and appropriate (helpful and informative). Barriers, including lack of trust and fear of results, were identified. The findings suggest that an intervention that combines the 3R model and self-sampling may increase CCS among MUW.
人乳头瘤病毒（HPV）自我采样有潜力增加宫颈癌筛查（CCS）并减轻医疗服务不足女性（MUW）的宫颈癌负担。然而，促进自我采样的干预措施有限。我们研究了一项干预研究在增加MUW的CCS方面的有效性。我们进行了一项准实验性干预研究。采用面对面口头方式招募居住在美国一个小城市的MUW（n = 83，平均年龄48.57±11.02岁）。基于重新构建、重新排序和重新塑造（3R模型）的行为干预以小组形式对这些女性进行宫颈癌筛查教育。这些女性（n = 83）完成了干预前和干预后的评估，其中10人被邀请参加随访访谈。主要结局是CCS的接受情况。采用t检验分析主要结局、PROCESS进行中介分析以及NVivo分析访谈数据。大多数女性（75%）完成了自我检测。女性中的高危HPV感染率为11%，其中57%的人后续找医生进行了诊治。我们发现，干预后女性筛查行为的显著增加是由知识（间接效应[IE]=0.1314；95%可信区间，0.0104，0.4079）和态度（IE = 0.2167；95%可信区间，0.0291，0.6050）得分的增加介导的（P<0.001）。访谈分析进一步解释了为什么MUW认为干预信息是可接受的（鼓励积极行为）、可行的（简单易懂）和恰当的（有帮助且信息丰富）。同时也确定了一些障碍，包括缺乏信任和对结果的恐惧。研究结果表明，结合3R模型和自我采样的干预措施可能会增加MUW的CCS。
