Deborah Bateson

‘Give People More Time and Take the Time to Explain Things Properly’: Cervical Screening Experiences of People With Intellectual Disability

ABSTRACT Background People with intellectual disability have 70% lower cervical screening participation rates. Limited research has captured their experiences, particularly in Australia. Methods This qualitative study used inclusive co‐production and trauma‐informed approaches. Eleven people with intellectual disability (aged 26–65) from New South Wales participated in semi‐structured interviews and arts‐based body mapping, analysed using reflective thematic analysis. Findings Four themes emerged: (1) healthcare interactions ranged from empowering to traumatic, with communication failures and rushed procedures; (2) tensions around informed consent and support roles; (3) gaps in accessible information and systematic reminders and (4) how past trauma and competing health priorities influenced screening. Participants recommended Easy Read materials, adequate appointment time, trauma‐informed care and genuine choice in healthcare decisions. Conclusions Women with intellectual disability encounter systematic barriers to cervical screening encompassing communication failures, inadequate consent and lack of trauma‐informed care. Their recommendations provide actionable solutions for healthcare reform.

The impact of HPV vaccination beyond cancer prevention: effect on pregnancy outcomes

While the benefits of human papillomavirus (HPV) vaccination relating to cervical cancer prevention have been widely documented, recent published evidence is suggestive of an impact on adverse pregnancy outcomes (APOs) in vaccinated mothers and their infants, including a reduction in rates of preterm births and small for gestational age infants. In this review, we examine this evidence and the possible mechanisms by which HPV vaccination may prevent these APOs. Large-scale studies linking HPV vaccination status with birth registries are needed to confirm these results. Potential confounding factors to consider in future analyses include other risk factors for APOs, and historical changes in both the management of cervical precancerous lesions and prevention of APOs. If confirmed, these additional benefits of HPV vaccination in reducing APO rates will be of global significance, due to the substantial health, social and economic costs associated with APOs, strengthening the case for worldwide HPV immunization.

Self‐collection for HPV screening: a game changer in the elimination of cervical cancer

Understanding women’s choices for management of cervical intraepithelial neoplasia 2 (CIN2): Qualitative analysis of a randomised experimental study

BackgroundActive surveillance for cervical intraepithelial neoplasia 2 (CIN2) would allow time for most cases to regress naturally and in turn avoid potentially unnecessary and harmful treatment.AimTo determine reasons for choosing active surveillance over surgery among women given a hypothetical diagnosis of CIN2.Materials and MethodsWomen residing in Australia aged 25–40 years with no prior diagnosis of cervical cancer, cervical abnormality CIN2 or above, and/or previous hysterectomy, were randomised to one of four identical hypothetical scenarios of testing human papillomavirus (HPV)‐positive: high‐grade cytology and a diagnosis of CIN2 that used alternate terminology to describe resolution of abnormal cells and/or inclusion of an overtreatment statement. Participants selected active surveillance or surgery after viewing the scenario and free‐text reason/s for their choice were thematically analysed.ResultsOf the 1638 women randomised, 79% (n = 1293) opted for active surveillance. The most common reasons for choosing active surveillance included concerns about surgery and associated risks, preferring to ‘wait and see’, trusting the doctor’s recommendations and having an emotional response toward surgery. For women who chose surgery, being risk‐averse, addressing the issue straight away and perceiving surgery to be the better option for them were the most common themes identified.ConclusionWhen presented with balanced information on the benefits and harms of different management options for CIN2 and given a choice, most women in this hypothetical situation chose active surveillance over surgery. Addressing women’s concerns about active surveillance may open up the possibility that if deemed safe, it could be an acceptable alternative for women.

Participation in the National Cervical Screening Program Among Women Who Gave Birth in New South Wales, Australia by Place of Maternal Birth: A Data Linkage Analysis

ABSTRACT Objective High participation rates in the National Cervical Screening Program (NCSP) by all groups of women are required to ensure the equitable elimination of cervical cancer in Australia. In this study, we examine screening participation of overseas‐born women compared to Australian‐born women who gave birth. Design Population‐based retrospective cohort study using linked health datasets. Setting and Participants Women who gave birth in New South Wales between January 1, 2000 and June 30, 2017. Main Outcome Measures Participation in the NCSP (≥ 1 cytology test) in the 3‐ and 5‐year periods prior to delivery by place of maternal birth, adjusted for multiple socio‐demographic and health characteristics. Results Among the 1 332 669 mothers who gave birth over the study period, overall cervical screening participation in the 3‐ and 5‐year periods prior to delivery was 67.0% and 75.7%, respectively. Participation was lower for overseas‐born mothers compared to Australian‐born mothers for both the 3‐year (57.8% vs. 71.7%; adjusted odds ratio [aOR]: 0.51, 95% confidence interval [CI]: 0.50–0.51) and 5‐year (64.9% vs. 81.2%; aOR: 0.40, 95% CI: 0.40–0.40) participation periods. All groups of overseas‐born women had substantially lower screening participation compared to Australian‐born women, with the lowest relative 3‐year participation in mothers born in Southern/Central Asia (aOR: 0.30, 95% CI: 0.30–0.31), Oceania (aOR: 0.31, 95% CI: 0.30–0.32), North‐East Asia (aOR: 0.49, 95% CI: 0.48–0.50), and New Zealand (aOR: 0.49, 95% CI: 0.48–0.51). Conclusions Overseas‐born women had around half the cervical screening participation in the period prior to birth compared to Australian‐born women. It is likely that opportunities to screen these under‐screened groups during the antenatal period, typically a time of repeated health services contact, are missed.