Primary Health Care Research & Development

‘I’m a bit of a champion for it actually’: qualitative insights into practitioner-supported self-collection cervical screening among early adopting Victorian practitioners in Australia

Abstract Background: Self-collection for cervical screening has been available in the Australian National Cervical Screening Program since 2017 and is now available to all people as an option for cervical screening through a practitioner-supported model. Documenting early adopting practitioner experiences with self-collection as a mechanism to engage people in cervical screening is crucial to informing its continuing roll-out and implementation in other health systems. Aim: This study aimed to describe the experiences of practitioners in Victoria, Australia, who used human papillomavirus (HPV)-based self-collection cervical screening during the first 17 months of its availability. Methods: Interviews (n = 18) with practitioners from Victoria, who offered self-collection to their patients between December 2017 and April 2019, analysed using template analysis. Findings: Practitioners were overwhelmingly supportive of self-collection cervical screening because it was acceptable to their patients and addressed patients’ barriers to screening. Practitioners perceived that knowledge and awareness of self-collection were variable among the primary care workforce, with some viewing self-collection to be inferior to clinician-collected screening. Practitioners championed self-collection at an individual level, with the extent of practice-level implementation depending on resourcing. Concerns regarding supporting the follow-up of self-collected HPV positive patients were noted. Other practical barriers included gaining timely, accurate screening histories from the National Cancer Screening Register to assess eligibility. Practitioners’ role surrounded facilitating the choice between screening tests through a patient-centred approach.

Home self-management experience of gynaecological tumour patients with lower limb lymphoedema: a qualitative study

Abstract Aim: This study aimed to investigate self-management experiences at home among gynaecological cancer patients with lower limb lymphoedema. Background: Lower limb lymphoedema is a common complication following gynaecological tumour treatment, causing physical and psychological distress and significantly impacting patients’ quality of life. Clinical observations reveal that many patients with lower limb lymphoedema following gynaecological tumour treatment exhibit poor compliance with family self-management, leading to complications such as worsening oedema, cellulitis, or erysipelas. This study seeks to gain insight into patients’ actual self-management experiences within their families, offering insights for tailored intervention plans and improved patient self-management compliance in clinical practice. Methods: Employing a phenomenological approach in qualitative research, one-on-one semi-structured interviews were conducted to gather face-to-face data from participants. A total of 16 gynaecological cancer patients with lower extremity lymphoedema were selected via purposive sampling from a tertiary cancer hospital. Semi-structured in-depth interviews took place between February and July 2021, with data analysed via the Colaizzi 7-step analysis method. Findings: Five key themes emerged: inadequate and uneven availability of medical resources for patients with lymphoedema, limited support for patients, deficient home self-management skills, considerable psychological stress during home management, and variations in self-management behaviours. Conclusion: Based on the study findings, increased investment in lymphoedema-related medical care is recommended. Additionally, healthcare professionals can consider promoting family and social support, enhancing patient health education, offering remote psychological counselling, encouraging positive coping behaviours among gynaecological cancer patients with lower limb lymphoedema, and ultimately enhancing their self-management at home.

Analysis of high-risk human papillomavirus infections and cervical intraepithelial neoplasia: factors influencing awareness among women of childbearing age in southwest China

Abstract Background: High-risk Human Papillomavirus (HPV) infections are a leading cause of cervical diseases among Han Chinese women of reproductive age. Despite studies like Mai et al. (2021) addressing HPV prevalence in Southern China, awareness remains low, especially in Southwest China. Our study addresses this gap. Objective: This hospital-based, retrospective study analyzes the prevalence of high-risk HPV and its association with cervical intraepithelial neoplasia (CIN) among Han Chinese women of reproductive age in Southwest China. Methods: Data were collected from 724 women undergoing routine health exams from December 2022 to April 2023. A total of 102 women with high-risk HPV infections were identified. A survey assessed HPV awareness, CIN incidence, and socio-demographic factors influencing awareness. Results: Of the 724 women, 102 (14.1%) were diagnosed with high-risk HPV, with HPV-16 being the most common subtype (22.5%). Awareness was significantly lower among unmarried women (OR: 6.632, p = 0.047), those with high school education or less (OR: 20.571, p = 0.003), and rural residents (OR: 19.483, p = 0.020). HPV-16 was detected in 54.55% of women with high-grade CIN. Conclusion: There is an urgent need for targeted education and HPV vaccination in Southwest China, particularly for women with lower education, rural residents, and older individuals. Subtype-specific strategies are essential for preventing and managing CIN.

Young women’s perceptions of cervical screening in the UK: a qualitative study

Abstract Aim: To understand young women’s views of cervical screening, what obstacles they face, and what encourages them when considering attending their cervical screening. Background: Cervical screening figures have been steadily decreasing in the United Kingdom (UK). There is limited research on this trend, especially around views and knowledge of young women, aged 20–24 years, have before they are eligible for cervical screening. Methods: This qualitative study conducted 15 semi-structured Zoom in-depth interviews to discuss young women’s knowledge and perceptions of cervical screening in 2022. Participants were based in the UK. Thematic analysis was used to systematically manage, analyse, and identify themes including cervical screening knowledge; perceptions of cervical screening; barriers to cervical screening; and facilitators of cervical screening. Findings: The findings demonstrate significant gaps in knowledge and negative perceptions of cervical screening. Barriers to attending cervical screening were perceived pain and embarrassment. Facilitators suggested to promote attendance were ensuring access to appointments, creating pop-up clinics, and utilising incentives. The level of knowledge demonstrated by the participants, their negatively framed perceptions; and the vast number of barriers identified present substantial factors that could affect future attendance to cervical screening. Overall, action needs to be taken to prevent decreasing cervical screening attendance rates and eradicate any barriers women may experience.

Early diagnosis of symptomatic ovarian cancer in primary care in the UK: opportunities and challenges

Abstract Background: Ovarian cancer is the sixth most common cause of cancer-related death in the UK amongst women. Ovarian cancer presents particular challenges for general practitioners (GPs) to diagnose due to its rarity and presentation with non-specific symptoms. Methods: A narrative overview of the literature was conducted by searching PubMed and Researchgate for relevant articles, using keywords such as “ovarian cancer,” “primary care” and “diagnosis.” Results and Discussion: Studies have shown that in the UK, GPs have a lower readiness to refer and investigate potential cancer symptoms compared with their international counterparts; and this has been correlated with reduced survival. Early diagnosis can be facilitated through a people-focussed and system-based approach which involves both educating GPs and using risk algorithms, rapid diagnostic centres/multi-disciplinary centres and being data-driven through the identification of best practice from national audits. Further research is required into the best evidence-based early investigations for ovarian cancer and more effective biomarkers.