Nicoleta‐Monica Pașca

Exploring Emotional and Cognitive Perceptions of Cervical Cancer Screening and Self‐Sampling Among Vulnerable Romanian Women: A Qualitative Study

ABSTRACT Introduction This study aimed to explore the emotional and cognitive perceptions of cervical cancer screening (CCS), with a focus on self‐sampling for human papillomavirus (HPV) by vulnerable Romanian women. Methodology Eighteen semi‐structured individual interviews were conducted with vulnerable women, defined by their low socioeconomic status (SES), residence in rural areas and membership in ethnic minorities. Participants were recruited using snowball sampling. Interviews followed a guide designed to assess constructs from the Health Belief Model (knowledge, barriers, evaluation of vulnerability) as they relate to women's views of prevention, the healthcare system and CCS. A Think Aloud protocol was used with a subsample of six women to identify potential barriers, opportunities and attitudes related to the use of self‐sampling kits. A reflexive thematic analysis was conducted to identify the primary themes related to with women's perceptions of CCS and self‐sampling. Results Four major themes emerged: (a) risk, fear and other emotional experiences; (b) women's perception of barriers; (c) knowledge, personal control and cues to action; and (d) women's perception of self‐sampling. Participants unravelled emotional and logistical barriers to CCS and self‐sampling. Limited health literacy, fear and shame influenced risk perceptions, hindering CCS participation. Logistical challenges and financial constraints further impeded access, while women often prioritized the needs of their families over their own health. The Think Aloud protocol revealed that initial concerns regarding self‐sampling could be alleviated by having clear instructions, highlighting the importance of support during the decision‐making process. Conclusion This study identified diverse barriers preventing vulnerable Romanian women from engaging in CCS, including logistical challenges, financial constraints and emotional factors. Patient or Public Contribution Patients or the public were not involved in the design, conduct, analysis or interpretation of the study.

Factors influencing human papillomavirus vaccination uptake in European women and adolescents: A systematic review and meta‐analysis

AbstractObjectiveCervical Cancer (CC) lingers as a severe public health issue due to low vaccination coverage and poor screening addressability. Hence, this systematic review explored psychological factors influencing the Human Papilloma Virus (HPV) vaccination uptake in European women.MethodsAs of September 2022, PubMed, EMBASE, Scopus, and Web of Science were systematically searched to include English studies assessing diverse factors influencing vaccination uptake in European women. Only studies comparing vaccinated with unvaccinated women were included. Quality assessment, publication attrition assessment, and sensitivity analyses were performed.ResultsEighteen studies were included, totaling a population of 18,611 participants. Results indicated that knowledge about HPV infection could positively influence vaccination rates with an Odds Ratio (OR) of 1.82 and a confidence interval (CI) between 1.27 and 2.61, showing statistical significance at aZvalue of 3.24 with ap‐value of 0.001. Neither knowledge about HPV vaccination (OR = 1.39, CI: 0.73–2.65,Z = 1.01,p = 0.31) nor knowledge about CC screening (OR = 1.05, CI: 0.55–1.98,Z = 0,14,p = 0.89) seem to affect vaccination rates. Regardless, intention to undertake CC screening (CCS) showed an OR = 1.68 in favor of the group intending to perform it, with a CI between 1.37 and 2.07, showing statistical significance at aZ = 4.94 andp = 0.00001. Other aspects affecting vaccination uptake were fear of side effects, insufficient information, and belief that chances of being infected are low.ConclusionsResults demonstrated that diverse aspects could affect the vaccination intent, while personalized interventions focusing on population and country characteristics need to be assembled to mitigate vaccination coverage.

How can cervical screening meet the needs of vulnerable women? A qualitative comparative study with stakeholder perspectives from seven European countries

Objective This study explored and compared stakeholder perspectives on enhancements to cervical cancer screening for vulnerable women across seven European countries. Design In a series of Collaborative User Boards, stakeholders were invited to collaborate on identifying facilitators to improve cervical cancer screening. Setting This study was part of the CBIG-SCREEN project which is funded by the European Union and targets disparities in cervical cancer screening for vulnerable women ( www.cbig-screen.eu ). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. Participants Represented stakeholders at various levels, including user representatives (vulnerable women), healthcare professionals, social workers, programme managers and decision makers. Methods 14 meetings lasting 2 hours each were held in these seven countries between October 2021 and June 2022. The meetings were audio or video recorded, transcribed and translated into English for qualitative framework analysis. Results We engaged 120 participants in the Collaborative User Boards. Proposed solutions targeted both provider and system levels. In all countries, fostering trusting relationships between vulnerable women and social or healthcare professionals, coupled with community outreach for awareness and access to testing was a consistent recommendation. Participants in Estonia, Denmark, France, Italy, Portugal and Romania advocated for tailoring healthcare services to meet the unique needs of vulnerable populations through a holistic approach. In Bulgaria and Romania, participants advocated for the need to secure free access, from screening to follow-up, and emphasised the need for organised screening with target population screening registries. Conclusion The study offers insights into stakeholders' recommendations for enhancing cervical cancer screening services for vulnerable women across seven European countries. Despite variations in the implementation level of population-based screening programmes, the imperative to optimise outreach and proximity work to improve cervical cancer screening resonated across all countries.

What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries

Objectives The aim of this study was to map and compare stakeholders’ perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries. Design In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening. Setting The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women ( www.cbig-screen.eu ). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. Participants Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers. Methods Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis. Results 120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers’ lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women’s fear, shame and lack of priority to preventive healthcare were identified as psychological barriers. Conclusion The study provides an overview of stakeholders’ perceived barriers towards vulnerable women’s cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women’s psychological barriers had several similarities.