Women's perspectives on the acceptability of risk-based cervical cancer screening

Maali-Liina Remmel (Corresponding Author), Kadri Suija, Riina Raudne, Anna Tisler, Anda Ķīvīte-Urtāne, Mindaugas Stankūnas, Mari Nygård, Gunvor Aasbø, Laura Maļina, Anneli Uusküla

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Abstract

BACKGROUND: The increased knowledge of cervical cancer (CC) risk factors and suboptimal performance of present screening programs has generated interest in shifting from a universal screening approach to one based on individual risk assessment. To inform the future development of risk-based CC screening programs, it is crucial to gain insight into the factors influencing the acceptability of such approach among screening target group women. The aim of this study was to prospectively investigate the acceptability of risk-based CC screening and to identify potential barriers.

METHODS: In this qualitative study, one-to-one semi-structured interviews were conducted with a purposeful sample including women aged 30-65 years to explore women's perspectives on the acceptability of risk-based CC screening. The study was conducted in Estonia, and interviews were conducted from March to September 2023. Potential participants were approached in person by a member of the study team or by their healthcare providers at primary care or gynaecology clinics. The interview guides were developed based on the concept of acceptability of healthcare interventions.

RESULTS: Twenty participants (mean age 44.5, SD = 8.6) with diverse backgrounds were interviewed. The seven components of acceptability (affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, self-efficacy, and intervention coherence) were explored as key themes. Generally, women supported risk-based screening. However, we identified several factors that may compromise the acceptability of risk-based screening. The participants were reluctant to accept less intense screening for low-risk women and anticipated that if risk-based approach was implemented, more frequent testing would remain an option. Providing in-person clinician support was expected, requiring additional healthcare resources. Knowledge gaps in CC prevention highlighted the need for accessible information and education. Most women were unworried about sensitive data inclusion in risk score calculations. However, some participants were concerned about potential confidentiality breaches by healthcare workers.

CONCLUSION: This study indicates that risk-based CC screening is acceptable, except for testing low-risk women less frequently. Our findings underscore the necessity for comprehensive understanding of the needs and concerns of the target group women for program development. Healthcare organizations are required to proactively address these needs by implementing comprehensive information dissemination and efficient communication approaches.

Original languageEnglish
Article number1314
JournalBMC Cancer
Volume24
Issue number1
DOIs
Publication statusPublished - 25 Oct 2024

Keywords*

  • Humans
  • Female
  • Uterine Cervical Neoplasms/diagnosis
  • Middle Aged
  • Adult
  • Early Detection of Cancer/psychology
  • Patient Acceptance of Health Care/psychology
  • Aged
  • Qualitative Research
  • Prospective Studies
  • Mass Screening/methods
  • Risk Assessment/methods
  • Health Knowledge, Attitudes, Practice
  • Estonia
  • Risk Factors

Field of Science*

  • 3.3 Health sciences

Publication Type*

  • 1.3. Anonymously reviewed scientific article published in a journal with an international editorial board and is available in another indexed database

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