COMPARATIVE ANALYSIS OF THE IMPACT OF THE WORK OF MEDICAL PERSONNEL IN URBAN AND RURAL AREAS ON THE ADHERENCE OF THE FEMALE POPULATION TO CERVICAL CANCER SCREENING
Background. Globally, cervical cancer (CC) ranks among the most prevalent malignancies impacting women's reproductive health. Active screening significantly mitigates the incidence of invasive cervical cancer. However, the efficacy of screening programs relies on achieving a participation rate of 70% or more within the relevant age groups. This necessitates optimal population adherence to screening, a metric currently standing at 48-50% for cervical cancer screening in Kazakhstan. Literature reviews underscore various effective approaches to enhance population coverage and adherence, such as the training and involvement of healthcare personnel in screening organization. The World Health Organization attests that the success of CC screening programs hinges on the availability of an adequate number of medical personnel proficient in conducting screening tests, as well as executing subsequent diagnosis, treatment, and follow-up. Consequently, the influence of medical personnel on women's adherence to CC screening directly impacts the effectiveness of screening programs. While several studies have delved into the challenges of implementing cervical cancer screening programs in the Republic of Kazakhstan, the specific impact of medical personnel's work on the adherence of urban and rural women to cervical cancer screening remains insufficiently explored.
The aim of the study. This research aims to investigate the influence of medical personnel's work on adherence to cervical cancer screening in urban and rural women.
Materials and Methods. Employing a cross-sectional method, the study enrolled 384 medical workers from rural and urban primary care institutions in the Republic of Kazakhstan. Participants were categorized into two main groups based on the geographic location of the healthcare facility (city or rural). Descriptive analysis was used. Comparisons between the groups were carried out using Pearson's Chi-squared criterion, the strength of the bond was determined by Kramer's criterion V. To determine the statistical significance, the critical level of α-error was assumed to be 5%.
Results: The work experience of the participants: among rural medical staff - 17.17 years, among urban ones - 14.3 years. Respondents from rural medical institutions were less likely to recommend that patients undergo CC screening; a relationship of medium strength was identified (V=0.2). In rural institutions, the main reason was limited time to see patients (23.6%). City medical workers most often answered: “This does not apply to my functions; another department is involved in screening” (33.8%). There were statistically significant differences (χ2=12.41, p<0.05).
Conclusion: The study results highlight that not all hospital staff advocate for CC screening during appointments. Notably, employees of rural medical organizations demonstrate a lower likelihood of recommending screening, potentially contributing to the limited awareness and commitment of rural women to CC screening.
Indira A.Zhetpisbaeva1, https://orcid.org/0000-0002-9528-1196
Fatima D.Kasymbekova1, https://orcid.org/0000-0001-6440-5590
Alla E.Mireeva2, https://orcid.org/0009-0000-9272-197X
Lyazzat A.Nurseitova2, https://orcid.org/0009-0009-4645-9945
Galiya K.Kadirbayeva3, https://orcid.org/0009-0007-0343-1059
Sholpan K.Sarmuldaeva4, https://orcid.org/ 0000-0003-2494-8333
Natalya E.Glushkova4, https://orcid.org/0000-0003-1400-8436
1 Kazakhstan Medical University «High School of Public Health», Almaty, Republic of Kazakhstan;
2 «Kazakh National Medical University named after S. D. Asfendiyarov»,
Department of «General Practice-2», Almaty, Republic of Kazakhstan;
3 «City polyclinic № 29», Women's consultation, Almaty, Republic of Kazakhstan;
4 University of International Business, Department of «International Medical Faculty»,
Almaty, Republic of Kazakhstan;
5 Al-Farabi Kazakh National University, Department «Department of Epidemiology,
Biostatistics & Evidence Based Medicine», Almaty, Republic of Kazakhstan.
1. Бекмухамбетов Е.Ж., Балмагамбетова С.К. Современные тенденции в области скрининга рака шейки матки // Онкология и радиология Казахстана. 2017. № 2(44). С. 30-33.
2. Жетписбаева И.А., Касымбекова Ф.Д., Миреева А.Э., Нурсеитова Л.А., Сармулдаева Ш.К., Глушкова Н.Е. Влияние работы медицинского персонала на приверженность к скринингу РШМ // Тезисы выступлений. XV Международный юбилейный конгресс КАРМ. Приложение к журналу «Репродуктивная медицина», 2023. N4, C.1-36. DOI: 10.37800/RM.4(S1).2023.1-36
3. Шалабекова М.Т., Кудайбергенова Т.А. Влияние программ популяционного скрининга на показатели рака репродуктивной системы // Вестник Алматинского государственного института усовершенствования врачей. 2018. №3. С. 67–75.
4. Abdul Rashid R.M., Mohamed M., Hamid Z.A., Dahlui M. Is the phone call the most effective method for recall in cervical cancer screening? Results from a randomised control trial // Asian Pac J Cancer Prev. 2013.14(10):5901-4. doi: 10.7314/apjcp.2013.14.10.5901. PMID: 24289597.
5. Arroyave A.M., Penaranda E.K., Lewis C.L. Organizational change: a way to increase colon, breast and cervical cancer screening in primary care practices // J Community Health. 2011 Apr. 36(2):281-8. doi: 10.1007/s10900-010-9309-7. PMID: 20835777.
6. Brouwers M.C., De Vito C., Bahirathan L., Carol A., Carroll J.C., Cotterchio M., Dobbins M., Lent B., Levitt C., Lewis N., McGregor S.E., Paszat L., Rand C., Wathen N. What implementation interventions increase cancer screening rates? A systematic review // Implement Sci. 2011 Sep 29. 6:111. doi: 10.1186/1748-5908-6-111. PMID: 21958556; PMCID: PMC3197548.
7. Clark C.R., Baril N., Kunicki M., Johnson N., Soukup J., Ferguson K., Lipsitz S., Bigby J. REACH 2010 Breast and Cervical Cancer Coalition. Addressing social determinants of health to improve access to early breast cancer detection: results of the Boston REACH 2010 Breast and Cervical Cancer Coalition Women's Health Demonstration Project // J Womens Health (Larchmt). 2009 May. 18(5):677-90. doi: 10.1089/jwh.2008.0972. PMID: 19445616.
8. Everett T., Bryant A., Griffin M.F., Martin-Hirsch P.P., Forbes C.A., Jepson R.G. Interventions targeted at women to encourage the uptake of cervical screening // Cochrane Database Syst Rev. 2011 May 11;2011(5):CD002834. doi: 10.1002/14651858.CD002834.pub2. Update in: Cochrane Database Syst Rev. 2021 Sep 6;9:CD002834. PMID: 21563135, PMCID: PMC4163962.
9. Gannon M., Dowling M. Increasing the uptake of cervical screening programs // Br J Nurs. 2008 Nov 13-26. 17(20):1280-4. doi: 10.12968/bjon.2008.17.20.31642. PMID: 19043332.
10. Han H.R., Song Y., Kim M., Hedlin H.K., Kim K., Ben Lee H., Roter D. Breast and Cervical Cancer Screening Literacy Among Korean American Women: A Community Health Worker-Led Intervention // Am J Public Health. 2017 Jan. 107(1):159-165. doi: 10.2105/AJPH.2016.303522. Epub 2016 Nov 17. PMID: 27854539. PMCID: PMC5308166.
11. Hendren S., Winters P., Humiston S., Idris A., Li S.X., Ford P., Specht R., Marcus S., Mendoza M., Fiscella K. Randomized, controlled trial of a multimodal intervention to improve cancer screening rates in a safety-net primary care practice // J Gen Intern Med. 2014 Jan. 29(1):41-9. doi: 10.1007/s11606-013-2506-1. Epub 2013 Jul 2. PMID: 23818159. PMCID: PMC3889982.
12. Holden D.J., Jonas D.E. et al. Systematic review: enhancing the use and quality of colorectal cancer screening. 2010. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK79086/ (accessed: 20.02.24)
13. Johnson C. E., Mues K. E., Mayne S. L., Kiblawi A.N. Cervical cancer screening among immigrants and ethnic minorities: a systematic review using the Health Belief Model // Journal of Lower Genital Tract Disease, 2010. 14(3), 232-241. doi: 10.1097/LGT.0b013e3181c4f8db
14. Lee S., Chen L., Ma G.X. Challenges and opportunities in building a sustainable community-engaged health research agenda: Lessons learned from the Health of the Asian Indian Population (HAIP) Study // Journal of Health Care for the Poor and Underserved, 2009. 20(2 Suppl), 41-61.
15. Mac Laughlin K.L., Jacobson R.M., Radecki Breitkopf C., Wilson P.M., Jacobson D.J., Fan C., St Sauver J.L., Rutten L.J.F. Trends Over Time in Pap and Pap-HPV Cotesting for Cervical Cancer Screening // J Womens Health (Larchmt). 2019 Feb. 28(2):244-249. doi:10.1089/jwh.2018.7380.
16. Mader E.M., Fox C.H., Epling J.W., Noronha G.J., Swanger C.M., Wisniewski A.M., Vitale K., Norton A.L., Morley C.P. A Practice Facilitation and Academic Detailing Intervention Can Improve Cancer Screening Rates in Primary Care Safety Net Clinics // J Am Board Fam Med. 2016 Sep-Oct. 29(5):533-42. doi: 10.3122/jabfm.2016.05.160109.
17. Martinez-Gutierrez J., Jhingan E., Angulo A., Jimenez R., Thompson B., Coronado G.D. Cancer screening at a federally qualified health center: a qualitative study on organizational challenges in the era of the patient-centered medical home // J Immigr Minor Health. 2013 Oct. 15(5):993-1000. doi: 10.1007/s10903-012-9701-8. PMID: 22878911. PMCID: PMC3530661.
18. Peitzmeier S.M., Khullar K., Potter J. Effectiveness of four outreach modalities to patients overdue for cervical cancer screening in the primary care setting: a randomized trial // Cancer Causes Control. 2016 Sep. 27(9):1081-91. doi: 10.1007/s10552-016-0786-6. Epub 2016 Jul 22. PMID: 27447961.
19. Phillips C.E., Rothstein J.D., Beaver K., Sherman B.J., Freund K.M., Battaglia T.A. Patient navigation to increase mammography screening among inner city women // J Gen Intern Med. 2011 Feb. 26(2):123-9. doi: 10.1007/s11606-010-1527-2. Epub 2010 Oct 8. PMID: 20931294; PMCID: PMC3019333.
20. Rees I., Jones D., Chen H., Macleod U. Interventions to improve the uptake of cervical cancer screening among lower socioeconomic groups: A systematic review // Prev Med. 2018 Jun. 111:323-335. doi: 10.1016/j.ypmed.2017.11.019. Epub 2017 Dec 2. PMID: 29203349.
21. Sabatino S.A., Habarta N., Baron R.C., Coates R.J., Rimer B.K., Kerner J., Coughlin S.S., Kalra G.P., Chattopadhyay S. Task Force on Community Preventive Services. Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers systematic reviews of provider assessment and feedback and provider incentives // Am J Prev Med. 2008 Jul. 35(1 Suppl):S67-74. doi: 10.1016/j.amepre.2008.04.008. PMID: 18541190.
22. Shah S.K., Nakagawa M., Lieblong B.J. Examining aspects of successful community-based programs promoting cancer screening uptake to reduce cancer health disparity: A systematic review // Prev Med. 2020 Dec. 141:106242. doi: 10.1016/j.ypmed.2020.106242. Epub 2020 Aug 31. PMID: 32882299. PMCID: PMC7704699.
23. Smith A., Jones L. The impact of healthcare practitioners’ empathetic and communicative behaviors on female patients’ decisions regarding cervical cancer screening // Patient Education and Counseling, 2015. 98(9), 1065-1071. doi: 10.1016/j.pec.2015.05.020
24. Spadea T., Bellini S., Kunst A., Stirbu I., Costa G. The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review // Prev Med. 2010 Apr. 50(4):159-64. doi: 10.1016/j.ypmed.2010.01.007. Epub 2010 Jan 20. PMID: 20093138.
25. Tseng D.S, Cox E., Plane M.B., Hla K.M. Efficacy of patient letter reminders on cervical cancer screening: a meta-analysis // J Gen Intern Med. 2001 Aug. 16(8):563-8. doi: 10.1046/j.1525-1497.2001.016008567.x. PMID: 11556935. PMCID: PMC1495254.
26. Wells K.J., Luque J.S., Miladinovic B., Vargas N., Asvat Y., Roetzheim R.G., Kumar A. Do community health worker interventions improve rates of screening mammography in the United States? A systematic review // Cancer Epidemiol Biomarkers Prev. 2011 Aug. 20(8):1580-98. doi: 10.1158/1055-9965.EPI-11-0276. Epub 2011 Jun 8. PMID: 21653645. PMCID: PMC3153589.
27. World Health Organization Screening for cervical cancer. Published 2020. Available from https://www.who.int/health-topics/cervical-cancer#tab=tab_1 (accessed: 20.02.24)
28. Zapka J., Taplin S.H., Ganz P., Grunfeld E., Sterba K. Multilevel factors affecting quality: examples from the cancer care continuum // J Natl Cancer Inst Monogr. 2012 May. 2012(44):11-9. doi: 10.1093/jncimonographs/lgs005. PMID: 22623591. PMCID: PMC3482973.
References: [1-3]
1. Bekmuhambetov E.Zh., Balmagambetova S.K. Sovremennye tendentsii v oblasti skrininga raka sheiki matki [Current trends in cervical cancer screening]. Onkologiya i radiologiya Kazakhstana [Oncology and radiology of Kazakhstan]. 2017. № 2(44). pp. 30-33. [in Russian]
2. Zhetpisbaeva I.A., Kasymbekova F.D., Mireeva A.Je., Nurseitova L.A., Sarmuldaeva Sh.K., Glushkova N.E. Vliyanie raboty meditsinskogo personala na priverzhennost' k skriningu RShM [The impact of the work of medical staff on adherence to СС screening]. Tezisy vystuplenii. XV Mezhdunarodnyi yubileinyi kongress KARM. Prilozhenie k zhurnalu «Reproduktivnaya meditsina» [Abstracts of speeches. XV International Jubilee Congress of the Kazakhstan Association of Reproductive Medicine. Appendix to the journal "Reproductive Medicine"]. 2023. N4. pp.1-36. DOI: 10.37800/RM.4(S1).2023.1-36 [in Russian]
3. Shalabekova M.T., Kudajbergenova T.A. Vliyanie programm populyatsionnogo skrininga na pokazateli raka reproduktivnoi sistemy [The impact of population-based screening programs on reproductive system cancer rates]. Vestnik Almatinskogo gosudarstvennogo instituta usovershenstvovaniya vrachei [Bulletin of the Almaty State Institute of Advanced Medical Training]. 2018. №3. pp. 67–75. [in Russian]
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Zhetpisbayeva I.A., Kasymbekova F.D., Mireeva A.E., Nurseitova L.A., Kadyrbaeva G.K., Sarmuldaeva Sh.K., Glushkova N.E. Comparative analysis of the impact of the work of medical personnel in urban and rural areas on the adherence of the female population to cervical cancer screening // Nauka i Zdravookhranenie [Science & Healthcare]. 2024, (Vol.26) 1, pp. 61-70. doi 10.34689/SH.2024.26.1.008Related publications:
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