Development of an HPV stigma assessment scale and a stigma-reducing intervention to improve cervical cancer prevention in El Salvador

项目摘要 本申请是为了响应被标识为“NOT-CA-”的特别利益通知（NOSI）而提交的。 23-036”。宫颈癌是低收入和中等收入国家妇女癌症死亡的主要原因 （中低收入国家）。女性经常会经历与宫颈癌筛查相关的痛苦，恐惧和羞耻，但 缺乏有效的心理测量评估来衡量宫颈癌或与HPV相关的耻辱。 来自合作伙伴、社区成员或医疗保健提供者的内在和预期的耻辱感已经被 显示减少在其他健康状况下寻求健康的行为，很可能是宫颈癌， HPV相关的耻辱影响筛查率在中低收入国家，即使提供筛查。在萨尔瓦多，高达30% 被邀请参加筛查的妇女中有30%没有参加。因此，迫切需要更好地了解和衡量 如何理解和表现HPV污名，并设计干预措施， 消除对妇女的歧视和增加对宫颈癌预防服务的接受。本行政管理的目的 补充是调整现有的心理测量工具，以评估HPV的耻辱，并设计一个试点准备耻辱- 减少“短暂干预”。该提案与父母补助金保持一致，这将在临床上验证一种新的 HPV检测用于LMIC。本补充文件将侧重于以下具体目标：1）调整伯杰 耻辱量表（BSS）的HPV和删节，用于在萨尔瓦多萨尔瓦多和其他LMIC设置，2）进行混合- 方法在萨尔瓦多萨尔瓦多的背景下，对宫颈癌和HPV相关的耻辱进行形成性评估。 宫颈癌预防计划，以及3）设计一个试点准备的简短干预（BI），以减少HPV相关的 在萨尔瓦多萨尔瓦多宫颈癌预防计划中，本项目的里程碑 将是一个有效的，简短的规模，以评估HPV相关的耻辱在中低收入国家和一个完整的“简报 “干预”协议已准备好进行测试。我们计划寻求后续资金，以测试干预措施的有效性。 我们拥有在有生之年消除宫颈癌的工具，但迫切需要改进策略 开展疫苗接种、筛查和治疗工作。识别和测量HPV相关的污名是一个 采取必要步骤，减少障碍，增加宫颈癌预防的采用，并关闭 全球宫颈癌发病率和死亡率之间的差距令人无法接受。

Project Abstract This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA- 23-036”. Cervical cancer is a leading cause of cancer death for women in low and middle income countries (LMICs). Women often experience distress, fear, and shame associated with cervical cancer screening, but there is a lack of validated psychometric assessments that measure cervical cancer or HPV-related stigma. Internalized and anticipated stigma from partners, community members, or healthcare providers have been shown to reduce health-seeking behaviors in other health conditions, and it is likely that cervical cancer and HPV-related stigma impact screening rates in LMICs even when screening is offered. In El Salvador, up to 30% of women invited to screening do not attend. Thus, there is an urgent need to better understand and measure how HPV stigma is understood and manifested, and to design interventions that can reduce HPV-related stigma and increase uptake of cervical cancer preventive services. The purpose of this Administrative Supplement is to adapt an existing psychometric tool to assess HPV stigma and to design a pilot-ready stigma- reducing “brief intervention”. This proposal is aligned with the parent grant, which will clinically validate a new HPV test for use in LMICs. This Supplement will focus on the following Specific Aims: 1) Adapt the Berger Stigma Scale (BSS) to HPV and abridge it for use in El Salvador and other LMIC settings, 2) Conduct a mixed- methods formative assessment of cervical cancer and HPV-related stigma in the context of El Salvador's cervical cancer prevention program, and 3) Design a pilot-ready brief intervention (BI) to reduce HPV-related stigma and increase adherence in El Salvador cervical cancer prevention program. Milestones for this project will be a validated, short-form scale to assess HPV-related stigma in LMICs and a completed “brief intervention” protocol that is ready for testing. We plan to seek subsequent funding to test intervention efficacy. We have the tools to eliminate cervical cancer in our lifetime, but there is a critical need for improved strategies to implement vaccination, screening, and treatment efforts. Identifying and measuring HPV-related stigma is a necessary step to reduce barriers and increase adoption of cervical cancer prevention and to close the unacceptable gap in global cervical cancer incidence and mortality.