Salud Global, Urriolagoitia #354 Primer Piso Urriolagoitia 354, Sucre, Bolivia.
Touro University California Public Health Program, CEHS, 1310 Club Drive Vallejo, Vallejo, CA, 94592, USA.
BMC Womens Health. 2023 Jul 5;23(1):359. doi: 10.1186/s12905-023-02500-2.
Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas.
Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software.
Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members' lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening.
Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers' ability to perform screening.
尽管玻利维亚努力增加农村地区的宫颈癌筛查机会，但参与率仍然很低。玻利维亚是美洲宫颈癌死亡率最高的国家之一。随着其加倍努力提供全民健康覆盖，玻利维亚政府需要了解限制宫颈癌筛查机会和利用的因素，特别是在农村地区。
我们的定性研究探讨了宫颈癌筛查的障碍，并描述了社区和提供者对护理的看法和经验。玻利维亚和美国的研究人员分析了从玻利维亚埃尔南多·西莱斯的四个有目的选择的农村社区的 8 个焦点小组（男性和女性社区成员，n=80）和 6 个医疗保健提供者访谈中收集的数据。使用 MaxQDA 软件，使用演绎和归纳代码对数据进行主题分析。
数据中出现了四个主题：知识/误解缺乏、卫生系统不足、对提供者缺乏信心和改进机会。男性和女性对宫颈癌的病因、后果、推荐的筛查频率以及获取护理的方式都存在误解。提供者指出，社区成员缺乏知识和低风险意识是利用障碍，但也强调了医疗服务质量差和健康教育不一致是因素。医疗保健质量差是一个重大障碍；这包括患者与提供者之间沟通不畅、缺乏前往筛查设施的交通工具以及在等待检测结果时严重延误。提供者还指出了提供者培训和筛查物理空间方面的问题。社区成员报告说对护士进行筛查缺乏信心，更喜欢医生和专家。他们还表示，男性医疗保健提供者进行筛查时感到不适。改进的建议包括加强对农村地区的宫颈癌宣传，并让专家培训低级别提供者进行筛查。
我们的研究结果表明，除了获得医疗服务的物理障碍外，医疗服务质量差也影响了筛查的参与率。这表明需要采取措施减少巴氏涂片检查结果的报告时间，将基于社区的 HPV 自我采样纳入筛查方案，并实施旨在提高社区对提供者进行筛查能力的信心的计划。
