Power Rosalie, David Michael, Strnadová Iva, Touyz Lauren, Basckin Caroline, Loblinzk Julie, Jolly Heather, Kennedy Elizabeth, Ussher Jane, Sweeney Sally, Chang Ee-Lin, Carter Allison, Bateson Deborah
Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
Front Psychiatry. 2024 Jul 26;15:1379497. doi: 10.3389/fpsyt.2024.1379497. eCollection 2024.
The World Health Organisation's vision of eliminating cervical cancer as a public health problem is achievable, but elimination must be achieved equitably, including for people with intellectual disability. A better understanding of cervical screening within the context of the lives of people with intellectual disability is needed. This study systematically reviewed research on the rates of cervical screening participation among people with intellectual disability, and facilitators and barriers that affect participation.
Six electronic databases were systematically searched: MEDLINE, CINAHL, Scopus, PsycINFO, Embase and Pro-Quest Central Social Sciences Collection. Empirical studies published between 1986 and 2023, in English language peer-reviewed journals were eligible for inclusion. Further articles were identified through forward and backward citation tracking, and hand-searching the index lists of two key journals. Two authors screened the studies, extracted the data and collated study outcomes using a standardised software program. A meta-analysis was performed using the DerSimonian and Laird method to estimate pooled effect sizes in prevalence rates and odds ratios (ORs). The socio-ecological model (SEM) was used as a framework to thematically analyse facilitators and barriers impacting participation in cervical screening.
Sixty-three articles met the inclusion criteria. Of these, 42 reported on rates of cervical screening participation and 24 reported on facilitators or barriers to cervical screening for people with intellectual disability. Overall, the studies reported a screening prevalence of 35% (95% CI: 26% to 45%), indicating that just over a third of people with intellectual disability have had cervical screening. The pooled odds ratio of 0.30 (95% CI: 0.23 to 0.41) indicated that people with intellectual disability are significantly less likely to have a cervical screening test compared with people without intellectual disability. Most studies examined individual and interpersonal factors impacting cervical screening. These included: (i) fear and anxiety among people with intellectual disability, (ii) misassumptions preventing screening participation, (iii) the role of support people, (iv) the need for education, (v) accessible information, and time to prepare for screening, (vi) patient-provider communication including challenges obtaining informed consent, and (vii) healthcare provider lack of confidence.
Future research, policy and practice efforts must address barriers to cervical screening participation among people with intellectual disability and ensure these efforts are co-produced and community-led. This is critical to ensuring equity in global and local efforts to eliminate cervical cancer.
世界卫生组织将消除宫颈癌作为一个公共卫生问题的愿景是可以实现的，但必须公平地实现消除目标，包括为智障人士消除宫颈癌。需要在智障人士的生活背景下更好地理解宫颈癌筛查。本研究系统回顾了关于智障人士宫颈癌筛查参与率以及影响参与的促进因素和障碍的研究。
系统检索了六个电子数据库：MEDLINE、CINAHL、Scopus、PsycINFO、Embase和Pro-Quest Central Social Sciences Collection。1986年至2023年间发表在英文同行评审期刊上的实证研究有资格纳入。通过向前和向后的引文跟踪以及手工检索两份关键期刊的索引列表来识别更多文章。两名作者筛选研究、提取数据并使用标准化软件程序整理研究结果。采用DerSimonian和Laird方法进行荟萃分析，以估计患病率和比值比（OR）的合并效应大小。社会生态模型（SEM）被用作一个框架，对影响宫颈癌筛查参与的促进因素和障碍进行主题分析。
63篇文章符合纳入标准。其中，42篇报告了宫颈癌筛查参与率，24篇报告了智障人士宫颈癌筛查的促进因素或障碍。总体而言，研究报告的筛查患病率为35%（95%CI：26%至45%），这表明略超过三分之一的智障人士进行了宫颈癌筛查。合并比值比为0.30（95%CI：0.23至0.41），表明与非智障人士相比，智障人士进行宫颈癌筛查的可能性显著更低。大多数研究考察了影响宫颈癌筛查的个人和人际因素。这些因素包括：（i）智障人士中的恐惧和焦虑，（ii）阻碍筛查参与的错误假设，（iii）支持人员的作用，（iv）教育需求，（v）可获取的信息以及准备筛查的时间，（vi）患者与提供者之间的沟通，包括获得知情同意的挑战，以及（vii）医疗保健提供者缺乏信心。
未来的研究、政策和实践努力必须解决智障人士宫颈癌筛查参与的障碍，并确保这些努力是共同产生且由社区主导的。这对于确保全球和地方消除宫颈癌努力中的公平性至关重要。
