Queen Elizabeth Health NHS Foundation Trust, Gateshead, Newcastle, United Kingdom.
University of Aberdeen, Aberdeen, United Kingdom.
PLoS One. 2023 Aug 31;18(8):e0290678. doi: 10.1371/journal.pone.0290678. eCollection 2023.
Major health inequalities exist surrounding the utilisation of cervical cancer screening services globally. Jordan, a low- and middle-income country, has poor screening rates (15.8%), with barriers to accessing services, including lack of education. Emerging studies demonstrate that intimate partner violence (IPV) impacts reproductive health decisions. As a large proportion of Jordanian women have reported experiencing IPV, this study examines the association between IPV and cervical cancer screening in Jordan, the first of its kind using national-level data.
Using Jordan's Demographic Health Survey 2017-18, cervical cancer screening awareness and self-reported screening were estimated in participants who answered questions on IPV (n = 6679). After applying sample weights, Heckman's two-stage probit model determined the association of awareness and utilisation of cervical cancer screening with experience of IPV, adjusting for the socio-economic factors.
Of the women with privacy to answer the IPV module, 180 (3.4%) were found to be victims of sexual violence, 691 of physical violence (12.6%) and 935 (16.2%) of emotional violence. Women subjected to sexual violence were less likely to admit to having awareness of a Pap smear test; however, this did not impact screening rates. Victims of emotional violence were more likely to be screened than non-victims. No association between physical violence and cervical cancer screening was found.
A significant association between cervical screening awareness and IPV demonstrates that cancer screening policies must consider IPV among women to improve screening awareness. The paper further sheds light on the paradoxical association between emotional violence and screening. It is acknowledged this situation may be far worse than reported, as women without autonomy were unlikely to answer IPV questions that may endanger them-targeted surveys on cervical cancer screening warrant further investigation.
在全球范围内，宫颈癌筛查服务的利用存在着严重的健康不平等现象。约旦是一个中低收入国家，其筛查率很低（15.8%），存在着获得服务的障碍，包括缺乏教育。新的研究表明，亲密伴侣暴力（IPV）会影响生殖健康决策。由于很大一部分约旦妇女报告曾经历过 IPV，因此本研究首次使用国家级数据，考察了 IPV 与约旦宫颈癌筛查之间的关联。
利用 2017-18 年约旦人口健康调查的数据，对回答过 IPV 问题的 6679 名参与者进行了宫颈癌筛查意识和自我报告筛查的估计。在应用样本权重后，Heckman 的两阶段概率模型确定了 IPV 经历与宫颈癌筛查意识和利用之间的关联，同时调整了社会经济因素。
在有隐私回答 IPV 模块的女性中，有 180 人（3.4%）被发现遭受过性暴力，691 人（12.6%）遭受过身体暴力，935 人（16.2%）遭受过情感暴力。遭受过性暴力的女性不太可能承认对巴氏涂片检查有认识；然而，这并没有影响筛查率。情感暴力的受害者比非受害者更有可能接受筛查。身体暴力与宫颈癌筛查之间没有关联。
宫颈癌筛查意识与 IPV 之间存在显著关联，这表明癌症筛查政策必须考虑妇女中的 IPV 问题，以提高筛查意识。本文进一步揭示了情感暴力与筛查之间的矛盾关联。应该认识到，这种情况可能比报告的还要严重，因为没有自主权的妇女不太可能回答可能危及她们的 IPV 问题——有必要对宫颈癌筛查进行针对性调查。
