Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women

Abstract

Cervical cancer screening is uncommon, especially in low-income countries and among lower socioeconomic status people in high-income countries. The aims of this study were to examine the adherence of Sicilian women to Pap testing and to identify the determinants of this in a population with a secondary prevention attitude lower than high-income countries and the national average. A cross-sectional study called “Save Eva in Sicily” was conducted among all women aged 25–64 years, with a sample drawn by the list of general practitioners (GPs), using a proportional sampling scheme, stratified by age and resident population. The study outcome was performing a Pap test within the past three years. The association between the outcome and Pap test determinants was analyzed through a multivariable logistic regression. Among the 365 interviewed women, 66% (n = 243) had a Pap test during the last 3 years. On the other hand, 18% of the other women (n = 66) had performed at least one Pap test previously and 16% (n = 56) had never had a Pap test. In a multivariable model, GPs’ advice (adjusted OR 2.55; 95% CI 1.57–4.14) and perceived susceptibility (adjusted OR 3.24; 95% CI 1.92–5.48) increased the likelihood of the execution of a Pap test. The “Save Eva in Sicily” study identified GP advice and perceived cancer severity as the main correlates of Pap testing among Sicilian women, producing evidence regarding how policy makers can increase compliance. Interventions to increase Pap test adhesion should focus on stimulating GPs to identify patients who regularly do not undergo it and to recommend testing on a regular basis to their patients.

Protection motivation theory in predicting cervical cancer screening participation: A longitudinal study in rural Chinese women

“…First of all, findings of this study suggest the significance of perceived severity (explaining 42% of the variance) in promoting rural Chinese women to participate in cervical cancer screening. This finding is also consistent with studies of women in developed countries such as Sweden and Italy . In addition, women with high‐levels of fear arousal are more likely to participate in cervical cancer screening .…”

“…[6][7][8] That screening rate is particularly lower for women living in rural and remote western areas, 9 compared to women living in developed regions in China, like Beijing (44.19%) and Zhejiang (47.22%) 10,11 ; additionally, it is lower than those in developed countries like America (80.5%) and Italy (79.0%). 12,13 The human papillomavirus (HPV) vaccine, another strategy for cervical cancer prevention was introduced to mainland China in July 2016. However, the high costs associated with HPV vaccine have prevented the adoption of this strategy for women with low socioeconomic status and living in rural and remote areas.…”

“…This finding is also consistent with studies of women in developed countries such as Sweden and Italy. 13,27 In addition, women with high-levels of fear arousal are more likely to participate in cervical cancer screening. 19,27 This finding suggests the importance in cervical cancer prevention and treatment of appropriately conveying the message of cervical cancer threat to women for caregivers in clinical settings and community advocators.…”

“…However, the uptake of the screening services in China is relatively low, varying from 28% to 63% in different regions . That screening rate is particularly lower for women living in rural and remote western areas, compared to women living in developed regions in China, like Beijing (44.19%) and Zhejiang (47.22%); additionally, it is lower than those in developed countries like America (80.5%) and Italy (79.0%) …”

Examining Users’ Adoption of Precision Medicine: The Moderating Role of Medical Technical Knowledge

“…Social influence included four items based on Venkatesh et al [18] and Macedo [35]. Perceived threat of disease included three items drawn from Kahsay, Hiluf, Shamie, Tadesse, and Bazzano [65] and Restivo et al [66]. User's medical technical knowledge included three items derived from Hairong Li, Daugherty, and Biocca [67].…”