Winnie Kwok Wei So

Determinants of cervical cancer screening utilisation among women in the least developed countries: A systematic review and meta-analysis

Background and aims Globally, cervical cancer is the fourth most common cancer among women, and more than 90% of all cervical cancer-related deaths worldwide are recorded in resource-limited countries. The present review investigated the uptake rate of cervical cancer screening and identified the factors associated with screening service utilisation in the female populations of least developed countries (LDCs). Methods Five electronic databases (EMBASE, Ovid MEDLINE, CINAHL, Cochrane Library, and PubMed) and grey literature were searched for relevant literature using the keywords of the included studies. Both qualitative and quantitative studies were included. Three reviewers performed critical appraisals using the Mixed Methods Appraisal Tool. Meta-analysis was performed to pool the quantitative results from comparable studies. Results A total of twenty-five studies were included in the review. The cervical cancer screening uptake rate in LDCs ranged from 4% to 21%. Multiple factors were associated with screening service utilisation among women in the LDCs, namely socio-demographic characteristics, including employment status (odds ratio (OR): 2.72; 95% CI: 1.97–3.76; p < 0.001); knowledge of cervical cancer and its screening (OR: 3.39; 95% CI: 2.00–5.75; p < 0.001); sexual and reproductive health-related factors such as parity status (OR: 2.73; 95% CI: 1.61–4.64; p = 0.002); healthcare providers’ recommendations (OR: 5.32; 95% CI: 2.44–11.58; p < 0.001); perceived risk of developing cervical cancer (OR: 3.76; 95% CI: 2.62–5.38; p < 0.001); use of media for cervical cancer screening promotion, including radio; cultural factors; and myths and misconceptions about cervical cancer and its screening. Conclusions The uptake of cervical cancer screening among eligible women in the LDCs was notably low. The governments of these countries are advised to invest and allocate additional resources to advance policies and develop cervical cancer prevention programmes that are accessible, affordable, and acceptable.

The Effects of Motivational Interviewing on Promoting Human Papillomavirus Vaccination Initiation and Completion Among South Asian Mother/Daughter Dyads: A Pilot Randomised Controlled Trial

Abstract Background Vaccination against HPV is an effective strategy for the prevention of HPV infection and cervical cancer. Nevertheless, the HPV vaccine uptake rate is low among ethnic minorities in Hong Kong. This study sought to assess the feasibility and acceptability of motivational interviewing among South Asian mother–daughter dyads and to preliminarily examine its effects on knowledge of HPV infection and vaccination, health beliefs, intention to have the daughters vaccinated, and initiation and completion of HPV vaccine series. Methods This was a pilot randomised controlled trial. Forty South Asian mothers with at least one daughter aged 9 to 17 years were recruited. The intervention group received a motivational interviewing intervention whereas the control group received usual care. Structured questionnaires were used to collect data on the participants’ characteristics and selected outcome variables. Bias-corrected Hedges’ g and rate difference together with their 95% confidence intervals were calculated to estimate the effect sizes of the intervention on the outcomes The acceptability was assessed via semi-structured interviews. Results A larger proportion of the daughters of the intervention group participants had received the first dose of HPV vaccine (95% [19 out of 20]) vs 0% [0 out of 20]). The intervention group showed greater improvement in knowledge at 3 months after the intervention (Hedges’ g = 0.77 (95%CI:0.13–1.41)). Most interviewees were satisfied with the intervention. Conclusion The intervention was feasible and acceptable. The intervention can help to increase South Asian mothers’ knowledge and to increase the initiation of HPV vaccine series by their daughters. Trial registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR2100052751) on 5 November 2021.

Effectiveness of motivational interviewing in enhancing cancer screening uptake amongst average-risk individuals: A systematic review

Although cancer is a worldwide public health problem, it can be detected early and prevented through cancer screening. Recommendations for screening methods and screening intervals are currently available for several types of cancer. However, not all average-risk individuals are motivated to undergo cancer screening. To examine the effectiveness of motivational interviewing that targets average-risk individuals regarding their cancer screening intention and uptake and to provide recommendations for the content and format of motivational interviewing based on the existing evidence. A systematic literature search was performed using four databases and a manual search. A combination of keywords including 'motivational interviewing', 'cancer screening', 'screening intention' and 'screening uptake' were used to identify relevant articles. Only randomised controlled trials that examined the effects of motivational interviewing amongst average-risk individuals were included in the review. The Cochrane Risk of Bias Tool was used to appraise the methodological quality of the selected articles. The findings were summarised in narrative and tabular formats. Six randomised controlled trials that used motivational interviewing to enhance cancer screening uptake or intention were included in the review. The findings show that motivational interviewing that used a face-to-face and telephone-based approach or were used together with a tailored or reminder letter enhanced the participants' uptake of breast and cervical cancer screening and their intention to undergo future cervical cancer screening. Mixed results were observed in the effectiveness of single-contact motivational interviewing on colorectal cancer screening. The use of motivational interviewing has demonstrated improvements in the uptake of breast and cervical cancer screening. However, more research is warranted in view of the inconclusive findings noted for colorectal cancer screening. Further studies with more rigorous methods are needed to identify the most effective interventions and to test the feasibility and efficiency of the use of Internet-based information communication technology to deliver motivational interviewing.

Use of a Linguistically Appropriate Decision Aid for Cervical Cancer Screening of South Asian Ethnic Minority Women in Hong Kong: A Pilot Randomised Controlled Trial

Decision aids have been shown to be effective in assisting the decision-making process in healthcare settings. This study aimed to examine the feasibility and acceptability of a linguistically appropriate printed decision aid for cervical cancer screening in South Asian women and to preliminarily estimate its effects on decisional conflicts, clarity of values, risk perception, the screening decision and screening uptake. This was a pilot randomised controlled trial. Forty-eight South Asian women aged 25 to 64 years were recruited and allocated to either the intervention group or control group. The participants in the intervention group read a linguistically appropriate printed decision aid. All of the participants in the intervention group agreed that the decision aid was useful in aiding their decision-making. These participants showed significantly greater improvement in decisional conflicts, clarity of values and risk perceptions than those in the control group (all p < 0.05). The screening uptake rate was significantly higher in the intervention group than in the control group (p < 0.001). The decision aid was feasible and acceptable among South Asian women, and it resulted in reduced decisional conflict and increased screening uptake compared with usual care. To improve the convenience of using decision aids, they could be developed in various forms, such as printed and mobile application forms, to meet individual requirements. The trial was registered at the Chinese Clinical Trial Registry on 23 October 2021 (ChiCTR2100052225).

Influential barriers perceived by South Asians in Hong Kong to undergoing cervical cancer screening

To report the uptake rate of cervical cancer screening (the Papanicolaou [Pap] test) and identify the perceived barriers associated with screening uptake among South Asian women in Hong Kong. This cross-sectional study involved a structured survey of 776 South Asian women aged 21 and above, recruited from the community. The participants' demographic characteristics, Pap test uptake and responses to a validated 14-item scale of perceived barriers to screening was collected. The data were analysed using descriptive statistics and logistic regression. The Pap test uptake rate was 40.3%. Multivariate analysis identified two perceived barriers significantly associated with the participants' Pap test uptake: (1) not knowing where to have the test and (2) the belief that they did not need a test if they felt well. Although language problems and embarrassment are commonly reported barriers to screening by South Asians, the participants were more concerned about where to have the test and whether they needed it. Future interventions should thus focus on enhancing their access to the service and clarifying their understanding of the need.

Exploring the Barriers and Facilitators Influencing Human Papillomavirus Vaccination Decisions Among South Asian and Chinese Mothers: a Qualitative Study

Human papillomavirus (HPV) vaccines are safe and effective in preventing HPV infection and HPV-related cancers. However, the HPV vaccine uptake rate is lower among the ethnic minority population than in the majority population. This qualitative study explored the barriers and facilitators influencing South Asian minority and Chinese mothers' decisions to vaccinate their daughters against HPV in Hong Kong. South Asian and Chinese mothers with at least one daughter aged 9 to 17 years were recruited to this study. Twenty-two semi-structured focus group interviews were conducted, and the transcripts were analysed via content analysis. Two barriers and three facilitating factors were common among South Asian and Chinese mothers: inadequate knowledge of cervical cancer, HPV or the HPV vaccine and high perceived barriers to HPV vaccination due to vaccine cost, the receipt of reliable information from schools or the government, high perceived benefits of HPV vaccination to health, and the presence of vaccination programme arranged by school or government. Despite these commonalities, South Asian mothers experienced more barriers to making the decision to vaccinate than Chinese mothers. Particularly, obtaining family support was an important factor for South Asian mothers. The vaccination decision was considered a joint decision between the mother and father, and the father's agreement was of particular importance to Pakistani mothers. This study identified the factors that hindered and facilitated South Asian and Chinese mothers' decisions to vaccinate their daughters against HPV. The comparison between groups improves our understanding of the distinct needs of South Asian in Hong Kong.