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      General practitioners can increase participation in cervical cancer screening – a model program in Hungary

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          Abstract

          Background

          Cervical cancer is a preventable disease. Unfortunately, its mortality is high in Hungary: 9.2 deaths /100000 women/year in 2015. The Hungarian organized, nationwide cervical screening program was launched in 2003, but it could improve the coverage rate of cervical cancer screening only by a few percentage points. The vast majority of women still uses opportunistic screening and the organized screening program had little impact on participation by women who never or rarely consult their gynecologists. We assessed whether involving general practitioners in the cervical cancer screening process would increase participation.

          Methods

          The study consisted of two parts: 1. A questionnaire-based health survey was conducted using a representative sample of women aged 25 to 65 years from 11 Hungarian counties, in which we studied where women obtained information about cervical cancer screening. 2. Additionally, a model program and its evaluation were implemented in the practices of general practitioners in one of the 11 counties (Zala county). In this program, general practitioners were informed of their patients’ participation in the cervical cancer screening program, and they motivated those who refused the invitation.

          Results

          Questionnaire-based health survey: A total of 74% (95% confidence interval (CI): 70–77%) of the target population had a screening examination within the previous 3 years. The majority (58, 95% CI: 54–62%) of the target population did not ask for information about cervical cancer screening at all. Only 21% (95% CI: 17–26%) consulted their general practitioners about cancer screening. Evaluation of the model program: the general practitioners effectively motivated 24 out of 88 women (27, 95% CI: 18–38%) who initially refused to participate in the screening program.

          Conclusion

          The majority of Hungarian women are not informed about cervical cancer screening beyond the invitation letter. General practitioners could play a more important role in mobilizing the population to utilize preventive services. The involvement of general practitioners in the organization of the cervical cancer screening program could increase the participation of those women who generally refuse the services.

          Electronic supplementary material

          The online version of this article (10.1186/s12875-018-0755-0) contains supplementary material, which is available to authorized users.

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          Most cited references19

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          Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program.

          The aim of this study was to describe inequalities in the use of breast and cervical cancer screening services according to educational level in European countries in 2002, and to determine the influence of the type of screening program on the extent of inequality. A cross-sectional study was performed using individual-level data from the WHO World Health Survey (2002) and data regarding the implementation of cancer screening programmes. The study population consisted of women from 22 European countries, aged 25-69 years for cervical cancer screening (n =11 770) and 50-69 years for breast cancer screening (n = 4784). Dependent variables were having had a PAP smear and having had a mammography during the previous 3 years. The main independent variables were socio-economic position (SEP) and the type of screening program in the country. For each country the prevalence of screening was calculated, overall and for each level of education, and indices of relative (RII) and absolute (SII) inequality were computed by educational level. Multilevel logistic regression models were fitted. SEP inequalities in screening were found in countries with opportunistic screening [comparing highest with lowest educational level: RII = 1.28, 95% confidence interval (CI) 1.12-1.48 for cervical cancer; and RII = 3.11, 95% CI 1.78-5.42 for breast cancer] but not in countries with nationwide population-based programmes. Inequalities were also observed in countries with regional screening programs (RII = 1.35, 95% CI 1.10-1.65 for cervical cancer; and RII = 1.58, 95% CI 1.26-1.98 for breast cancer). Inequalities in the use of cancer screening according to SEP are higher in countries without population-based cancer screening programmes. These results highlight the potential benefits of population-based screening programmes.
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            The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review.

            To review the scientific evidence on the effectiveness of interventions to promote attendance to breast and cervical cancer screening among lower socioeconomic groups. We performed a computerized literature search looking for relevant papers published between 1997 and 2006. Papers were classified into three groups based on the type of intervention evaluated: (1) implementation of organized population screening programs; (2) different strategies of enhancing attendance within an organized program; (3) local interventions in disadvantaged populations. The available evidence supports the hypothesis that while organized population screening programs are successful in increasing overall participation rates, they may not per se substantially reduce social inequalities. Some strategies were consistently found to enhance access to screening among lower socioeconomic groups, including cost-reducing interventions (e.g. offering free tests and eliminating geographical barriers), a greater involvement of primary-care physicians and individually tailored pro-active communication that addresses barriers to screening. Evidence from studies suggests that the attendance of deprived women to cancer screening can be improved with organized screening programs tailored to their needs. The same may apply to the prevention of adverse outcomes of other health conditions, such as hypertension, hypercholesterolemia, and diabetes. Copyright 2010 Elsevier Inc. All rights reserved.
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              Cancer screening behaviours among South Asian immigrants in the UK, US and Canada: a scoping study.

              South Asian (SA) immigrants settled in the United Kingdom (UK) and North America [United States (US) and Canada] have low screening rates for breast, cervical and colorectal cancers. Incidence rates of these cancers increase among SA immigrants after migration, becoming similar to rates in non-Asian native populations. However, there are disparities in cancer screening, with low cancer screening uptake in this population. We conducted a scoping study using Arksey & O'Malley's framework to examine cancer screening literature on SA immigrants residing in the UK, US and Canada. Eight electronic databases, key journals and reference lists were searched for English language studies and reports. Of 1465 identified references, 70 studies from 1994 to November 2014 were included: 63% on breast or cervical cancer screening or both; 10% examined colorectal cancer screening only; 16% explored health promotion/service provision; 8% studied breast, cervical and colorectal cancer screening; and 3% examined breast and colorectal cancer screening. A thematic analysis uncovered four dominant themes: (i) beliefs and attitudes towards cancer and screening included centrality of family, holistic healthcare, fatalism, screening as unnecessary and emotion-laden perceptions; (ii) lack of knowledge of cancer and screening related to not having heard about cancer and its causes, or lack of awareness of screening, its rationale and/or how to access services; (iii) barriers to access including individual and structural barriers; and (iv) gender differences in screening uptake and their associated factors. Findings offer insights that can be used to develop culturally sensitive interventions to minimise barriers and increase cancer screening uptake in these communities, while recognising the diversity within the SA culture. Further research is required to address the gap in colorectal cancer screening literature to more fully understand SA immigrants' perspectives, as well as research to better understand gender-specific factors that influence screening uptake.
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                Author and article information

                Contributors
                gyulai.aniko@foh.unideb.hu
                nagy.attila@sph.unideb.hu
                vera.z.pataki@gsk.com
                doratonte@yahoo.co.uk
                adany.roza@sph.unideb.hu
                36-1-372-2500 , 6399 , voko@tatk.elte.hu
                Journal
                BMC Fam Pract
                BMC Fam Pract
                BMC Family Practice
                BioMed Central (London )
                1471-2296
                19 May 2018
                19 May 2018
                2018
                : 19
                : 67
                Affiliations
                [1 ]ISNI 0000 0001 1088 8582, GRID grid.7122.6, Department of Public Health, Faculty of Health, , University of Debrecen, ; Sóstói u. 2-4, Nyíregyháza, H-4400 Hungary
                [2 ]ISNI 0000 0001 1088 8582, GRID grid.7122.6, Department of Preventive Medicine, Faculty of Public Health, , University of Debrecen, ; Kassai út 26, Debrecen, H-4028 Hungary
                [3 ]GlaxoSmithKline Hungary Ltd., Csörsz u. 43, Budapest, H-1124 Hungary
                [4 ]ISNI 0000 0001 2294 6276, GRID grid.5591.8, Department of Health Policy & Health Economics, Institute of Economics, Faculty of Social Sciences, , Eötvös Loránd University, ; Pázmány Péter sétány 1/a, Budapest, H-1117 Hungary
                Author information
                http://orcid.org/0000-0002-1004-1848
                Article
                755
                10.1186/s12875-018-0755-0
                5960501
                29778099
                581d0415-c968-433c-85a5-0d2ff8961897
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 July 2017
                : 1 May 2018
                Funding
                Funded by: National Research and Development Program Hungary
                Award ID: NKFP-1/0003/2005
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Medicine
                cervical cancer screening,general practitioner,health communication,health behavior,hungary

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