Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study.
Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study.
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DOI：
10.1186/s12905-022-01777-z
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发表时间：
2022-05-28
影响因子：
2.5
通讯作者：
Grover, Surbhi
中科院分区：
文献类型：
--
作者：
Rendle, Katharine A.;Ramogola-Masire, Doreen;Monare, Barati;Ogden, Shannon N.;Toneff, Hannah K.;Saia, Chelsea A.;Wainwright, Jocelyn, V;Friebel-Klingner, Tara M.;Bazzett-Matabele, Lisa;Bhatia, Rohini;Bonner, Natalie;Ralefala, Tlotlo B.;Vuylsteke, Peter;Luckett, Rebecca;Grover, Surbhi
筛查和及时诊断方面的延误在很大程度上造成了博茨瓦纳和其他低收入和中等收入国家，特别是艾滋病毒感染率高的国家宫颈癌死亡率的全球差距。从妇女本身的角度来看，造成这些延迟的可改变因素以及这些观点在艾滋病毒感染者和非艾滋病毒感染者之间可能有何不同，我们所知甚少。从2019年3月至5月，我们对博茨瓦纳一家多学科肿瘤学诊所接受宫颈癌治疗的女性进行了一项同步、混合方法研究。入选的参与者完成了一次性的、同时进行的半结构化访谈和结构化问卷，评估患者的特征、筛查和艾滋病毒相关的信念和知识，以及筛查和随访护理的障碍和促进因素。定性数据采用治疗途径模型指导下的定向内容分析进行分析，并与定量问卷数据进行三角测量，以确定趋同和分歧的领域。使用Fisher精确检验来探索问卷数据（例如，筛查知识）与艾滋病毒状况之间的关联。42名妇女参加了这项研究，其中64%的人感染了艾滋病毒，26%的人被诊断为第三期宫颈癌。艾滋病毒感染者的中位年龄为45岁（IQR 54-67），未感染者的中位年龄为64岁（IQR 42-53）。有症状疾病前的总体筛查率较低（24%）。从最近端筛查到诊断的中位时间为52天（IQR 15-176）， HIV感染状况无显著差异。艾滋病毒感染者的一般筛查知识高于非艾滋病毒感染者（100% vs 73%, p < 0.05），但两组对HPV和其他危险因素的知识都较低。与问卷调查结果类似，定性结果表明，人们对在出现症状之前进行筛查的必要性认识有限，这是及时筛查的主要障碍。一些与会者还指出，收到筛查结果的延误和恐惧也造成了治疗延误。然而，许多与会者也描述了帮助他们克服其中一些挑战的无数社会和有形支持来源。需要采取干预措施，加强常规筛查，支持及时认识和获得护理，以缩小宫颈癌的全球差距。
Delays in screening and timely diagnosis contribute significantly to global disparities in cervical cancer mortality in Botswana and other low- and middle-income countries, particularly those with high rates of HIV. Little is known about the modifiable factors shaping these delays from the perspectives of women themselves and how these perspectives may differ between those living with and without HIV. From March–May 2019, we conducted a concurrent, mixed methods study of women receiving treatment for cervical cancer at a multidisciplinary oncology clinic in Botswana. Enrolled participants completed a one-time, concurrent semi-structured interview and structured questionnaire assessing patient characteristics, screening and HIV-related beliefs and knowledge, and barriers and facilitators to screening and follow-up care. Qualitative data were analyzed using directed content analysis guided by the Model of Pathways to Treatment and triangulated with quantitative questionnaire data to identify areas of convergence and divergence. Fisher’s exact tests were used to explore associations between questionnaire data (e.g., screening knowledge) and HIV status. Forty-two women enrolled in the study, 64% of whom were living with HIV and 26% were diagnosed with stage III cervical cancer. Median age was 45 years (IQR 54–67) in those living with HIV and 64 years (IQR 42–53) in those living without. Overall screening rates before symptomatic disease were low (24%). Median time from most proximal screen to diagnosis was 52 median days (IQR 15–176), with no significant differences by HIV status. General screening knowledge was higher among those living with HIV versus those without (100% vs 73%; p < 0.05), but knowledge about HPV and other risk factors was low in both groups. Similar to questionnaire results, qualitative results indicate limited awareness of the need to be screened prior to symptoms as a central barrier to timely screening. Some participants also noted that delays in the receipt of screening results and fear also contributed to treatment delays. However, many participants also described myriad sources of social and tangible support that helped them to overcome some of these challenges. Interventions focused on increasing routine screening and supporting timely awareness and access to care are needed to reduce global disparities in cervical cancer.
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影响因子：
3.7
作者：
Matenge, Tjedza G.;Mash, Bob
通讯作者：
Mash, Bob
影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
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作者：
Bhatia RK;Rayne S;Rate W;Bakwenabatsile L;Monare B;Anakwenze C;Dhillon P;Narasimhamurthy M;Dryden-Peterson S;Grover S
通讯作者：
Grover S
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Maiga M
DOI：
10.1097/igc.0b013e318249470a
发表时间：
2012-05-01
影响因子：
4.8
作者：
Mingo, Alicea M.;Panozzo, Catherine A.;Brewer, Noel T.
通讯作者：
Brewer, Noel T.