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Intention of women to receive cervical cancer screening in the era of human papillomavirus testing.

机译：在人类乳头瘤病毒检测时代，女性有意接受子宫颈癌筛查。

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摘要

Cervical cancer screening and prevention has been one of the great success stories in public health, but is at a critical juncture. Awareness of the essential role of HPV infection in the genesis of cervical cancer, coupled with knowledge of the limitations of cytology has led to a re-visioning of the screening paradigm, towards the use of primary hr-HPV testing for cervical cancer screening instead of cytology. Use of HPV testing could result in significant changes for screening programs including a later start to screening, extended screening intervals, and use of a test for a sexually acquired infection. These changes may have unintended consequences on a woman's willingness to participate in cervical cancer screening. In this dissertation, we explore the potential impact of use of HPV testing for primary screening on women's intentions to be screened for cervical cancer, and outline a plan to guide the change from cytology to HPV testing, using findings from the analyses.;Methods: At study exit, a sample of participants from a randomized trial of primary hr-HPV testing in Canada were invited via email to complete an electronic questionnaire based in Theory of Planned Behaviour, which determined women's intentions to be screened for cervical cancer if: a) hr-HPV was used instead of Pap smears b) HPV based cervical cancer screening was offered only every 4 years and c) HPV based cervical cancer screening started after 25 years of age. Demographic data, sexual history and smoking rates were assessed, and scales for attitudes about hr-HPV testing, perceived behavioural control and direct and indirect subjective norms were created.;Item correlation for scales was calculated to determine item agreement. Univariate analyses compared demographics and scale responses of women who intended to be screened for cervical cancer with HPV to those who did not. All demographic data and scales that were significantly different (p<0.1) were included in a stepwise logistic regression model to determine predictors of intention to be screened for cervical cancer with HPV.;Results: 2016 email invites were sent to women and 981 completed the entire survey for a response rate of 48.7%. There were no demographic and risk behavior differences between survey respondents and non-respondents. Eighty-four percent of women (826/981) responded that they intended to attend for HPV-CCS which decreased to 54.2% with an extended screening interval, and decreased further to 51.4% with a delayed start of age 25. There were not significant differences in demographics, sexual or smoking histories between women who intended to be screened for cervical cancer with HPV and those who did not intend. Women who intended to be screened with HPV were significantly more likely to report positive attitudes toward HPV testing, report positive perceived behavioural control, describe positive influence of direct and indirect subjective norms, and express confidence in their decisions and abilities to communicate their HPV status with partners. In logistic regression modeling, predictors of intentions to undergo screening were attitudes (OR 1.22; 95%CI 1.15, 1.30), indirect subjective norms (OR 1.02; 95%CI 1.01, 1.03) and perceived behavioural controls (OR 1.16; 95% CI 1.10; 1.22).;Discussion: Although women expressed intentions to be screened for cervical cancer with HPV, intentions decreased substantially when coupled with the extended screening interval and delayed screening start. Use of primary HPV testing may optimize the screening paradigm, but programs must anticipate women's potential responses and concerns with program changes, such as extended intervals and delayed program starts, and should ensure robust planning and education to mitigate any negative impact on screening attendance rates. Using Kotter's eight step model and integrating key findings from this study, essential elements to successfully implement this change are outlined.
机译：宫颈癌的筛查和预防一直是公共卫生领域的巨大成功案例之一，但目前正处于紧要关头。意识到HPV感染在宫颈癌的发生中的重要作用，加上对细胞学局限性的了解，导致对筛查范式的重新认识，转向使用主要的hr-HPV检测代替宫颈癌筛查细胞学。使用HPV检测可能会导致筛查程序发生重大变化，包括以后开始筛查，延长筛查间隔以及对性传播感染进行检测。这些变化可能会对妇女参加宫颈癌筛查的意愿产生意想不到的后果。在本文中，我们探讨了使用HPV检测进行初筛对女性宫颈癌筛查意图的潜在影响，并利用分析结果概述了指导从细胞学转向HPV检测的计划。在研究出口处，通过电子邮件邀请了加拿大hr-HPV原发性随机试验随机试验的参与者样本，以完成一项基于计划行为理论的电子问卷，该问卷确定了在以下情况下女性接受宫颈癌筛查的意图： hr-HPV代替了子宫颈抹片检查b）仅每4年进行一次基于HPV的子宫颈癌筛查，并且c）25岁以后才开始进行基于HPV的子宫颈癌筛查。评估了人口统计学数据，性史和吸烟率，并建立了对hr-HPV测试态度，感知的行为控制以及直接和间接主观规范的量表;计算了量表的项目相关性，以确定项目一致性。单因素分析比较了打算通过HPV筛查子宫颈癌的女性和没有进行宫颈癌筛查的女性的人口统计学和规模反应。逐步logistic回归模型包括所有明显不同（p <0.1）的人口统计学数据和量表，以确定HPV子宫颈癌筛查意图的预测因子。结果：2016年向女性发送了电子邮件邀请，其中981人完成了整个调查的答复率为48.7％。受访者和未受访者之间在人口统计学和风险行为方面没有差异。 84％的女性（826/981）回答说，他们打算参加HPV-CCS，但随着筛查间隔的延长，该比例降低至54.2％，而随着25岁的开始延迟，比例进一步降低至51.4％。打算接受HPV子宫颈癌筛查的女性与不打算接受宫颈癌筛查的女性在人口统计学，性或吸烟史方面的差异。打算接受HPV筛查的女性更有可能报告对HPV检测的积极态度，报告积极的行为控制，描述直接和间接主观规范的积极影响，并对与HPV状况沟通的决策和能力表达信心伙伴。在逻辑回归建模中，进行筛查的意图的预测因素是态度（OR 1.22； 95％CI 1.15，1.30），间接主观规范（OR 1.02； 95％CI 1.01、1.03）和感知的行为控制（OR 1.16； 95％CI）讨论：1.10; 1.22）。讨论：尽管女性表达了接受HPV宫颈癌筛查的意愿，但随着筛查间隔时间的延长和筛查开始时间的延迟，意愿明显降低。使用主要的HPV检测可以优化筛查范式，但是计划必须预见女性对计划变更的潜在反应和担忧，例如间隔时间延长和计划启动延迟，并应确保进行有力的计划和教育，以减轻对筛查出勤率的任何负面影响。使用Kotter的八步模型并整合了这项研究的主要发现，概述了成功实施此更改的必要要素。

著录项

  • 作者

    Ogilvie, Gina Suzanne.;

  • 作者单位

    The University of North Carolina at Chapel Hill.;

  • 授予单位 The University of North Carolina at Chapel Hill.;
  • 学科 Public health.
  • 学位 Dr.P.H.
  • 年度 2012
  • 页码 113 p.
  • 总页数 113
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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