比利时佛兰德斯地区未接受和未定期接受宫颈癌筛查妇女的筛查障碍和促进因素 - 基于社区和医疗保健提供者观点的定性研究。
Barriers and facilitators to cervical cancer screening among under- and neverscreened women in Flanders, Belgium - a qualitative study on community and healthcare providers' perspectives.
机构信息
International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium.
Department of Obstetrics and Gynaecology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000, Belgium.
出版信息
BMC Public Health. 2024 Oct 18;24(1):2870. doi: 10.1186/s12889-024-20166-9.
BACKGROUND
Cervical cancer is detectable and preventable in premalignant stages. In 2013, a population-based cervical cancer screening (CCS) programme was set up in Flanders (Belgium) promoting screening by means of sending reminder letters. Yet, in 2021, only a CCS coverage of 63.6% has been reached, which is just a bare increase since the implementation of the programme (62.7% in 2013) (Jaarrapport 2022, Centrum voor Kankeropsporing (CvKO), 2022; Jaarrapport 2015, Centrum voor Kankeropsporing (CvKO), 2015).
OBJECTIVES
To explore the characteristics of under- and neverscreened women in Flanders and to gain a better understanding of the barriers that prevent these women from attending CCS as well as factors that may facilitate CCS uptake.
METHODS
Twelve in-depth interviews and six focus group discussions were conducted with gynaecologists, general practitioners, community health workers and stakeholders providing support to women belonging to potentially underscreened population groups. Reported barriers and facilitators were subsequently classified using the Socio-Ecological Model (SEM). Finally, a causal loop diagram was constructed to visualise the dynamic interrelations among the barriers and facilitators.
RESULTS
Stakeholders and healthcare professionals confirm the vulnerability for cervical cancer screening in women with a substance use disorder and women with a migration background. The participation in screening among female sex workers is contingent upon their specific work environment. The group of never- or underscreened women is very heterogeneous and includes many women who are either unaware of CCS or have other priorities. A lack of focus on prevention is the most commonly reported barrier at the healthcare system level. Increasing awareness about cervical cancer (screening) and creating more opportunities for healthcare workers to offer prevention services are the primary facilitators.
CONCLUSION
To improve screening participation in Flanders, different screening strategies tailored to a diversity of women are needed.
背景
宫颈癌在癌前阶段是可检测和可预防的。2013 年，在佛兰德斯（比利时）建立了一项基于人群的宫颈癌筛查（CCS）计划，通过发送提醒信来促进筛查。然而，到 2021 年，CCS 的覆盖率仅达到 63.6%，这只是自该计划实施以来的微小增长（2013 年为 62.7%）（2022 年年度报告，癌症监测中心（CvKO），2022 年；2015 年年度报告，癌症监测中心（CvKO），2015 年）。
目的
探讨佛兰德斯未接受和未接受过筛查的女性的特征，更好地了解阻碍这些女性接受 CCS 的障碍以及可能促进 CCS 参与的因素。
方法
对妇科医生、全科医生、社区卫生工作者和为属于潜在筛查不足人群的女性提供支持的利益相关者进行了 12 次深入访谈和 6 次焦点小组讨论。随后，使用社会生态模型（SEM）对报告的障碍和促进因素进行分类。最后，构建了一个因果循环图，以直观地展示障碍和促进因素之间的动态相互关系。
结果
利益相关者和医疗保健专业人员证实，患有药物滥用和移民背景的女性宫颈癌筛查的脆弱性。性工作者参与筛查取决于其特定的工作环境。从未接受或接受过筛查的女性群体非常多样化，其中包括许多不知道 CCS 或有其他优先事项的女性。医疗保健系统层面最常报告的障碍是对预防的关注不足。提高对宫颈癌（筛查）的认识并为医疗保健工作者提供更多提供预防服务的机会是主要的促进因素。
结论
为了提高佛兰德斯的筛查参与度，需要针对不同的女性制定不同的筛查策略。
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