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      Barriers to cervical cancer screening in Guatemala: a quantitative analysis using data from the Guatemala Demographic and Health Surveys

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          Abstract

          Objectives

          Examine the association between commonly reported barriers to health care, including discordant spoken languages between patients and providers, and reported previous cervical cancer screening.

          Methods

          Data from the nationally representative Guatemala National Maternal and Child Health Survey from the Demographic and Health Surveys Program were used to explore associations between barriers and screening rates nationwide and in high-risk populations, such as rural and indigenous communities. Negative binomial regressions were run accounting for survey sample weights to calculate prevalence ratios.

          Results

          64.0%, 57.5% and 47.5% of women reported ever screening, in the overall, indigenous, and rural populations, respectively. Overall, never screened for cervical cancer was associated with the following health barriers: needing permission, cost, distance, not wanting to go alone, and primary language not spoken by health providers, even after adjustment for age, ethnicity, and literacy.

          Conclusions

          Offering screening programs alone is not enough to reduce the burden of cervical cancer in Guatemala. Measures need to be taken to reduce barriers to health care, particularly in rural areas, where screening rates are lowest.

          Electronic supplementary material

          The online version of this article (10.1007/s00038-019-01319-9) contains supplementary material, which is available to authorized users.

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          Most cited references14

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          Social desirability bias in family planning studies: a neglected problem.

          Studies on family planning methods traditionally have relied on self-reports of unknown validity and reproducibility. Social desirability bias, a type of information bias, occurs when study participants respond inaccurately - but in ways that will be viewed favorably by others. Several lines of evidence reveal that this bias can be powerful in sexual matters, including reports of coitus, use of contraceptives and induced abortion. For example, studies using vaginal prostate-specific antigen testing reveal underreporting of unprotected coitus and overreporting of barrier contraceptive use. Medication Event Monitoring System studies, which electronically record the time of pill dispensing from a bottle or pack, indicate widespread exaggeration of adherence to pill-taking regimens, including oral contraceptives. Comparisons of provider data and self-reports of induced abortions reveal extensive underreporting of induced abortion. Reliance on self-reported data underestimates contraceptive efficacy. Although techniques to minimize this bias exist, they are infrequently used in family planning studies. Greater skepticism about self-reports and more objective means of documenting coitus and contraceptive use are needed if contraceptive efficacy is to be accurately measured.
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            Acceptability of Human Papillomavirus Self-Sampling for Cervical Cancer Screening in an Indigenous Community in Guatemala

            Purpose Cervical cancer rates in Latin America are higher than those in developed countries, likely because of the lower prevalence of screening. Specifically, less than 40% of women in Guatemala are regularly screened and even fewer women are screened in indigenous communities. Current screening strategies—Pap smears and visual inspection with acetic acid—might not be the most effective methods for controlling cancer in these settings. We thus investigated the potential of self-collection of cervical samples with testing for human papillomavirus (HPV) to help prevent cervical cancer in an indigenous community in Guatemala. Patients and Methods A community representative random sample of 202 indigenous women age 18 to 60 years residing in Santiago Atitlan, Guatemala, were surveyed to assess knowledge of and risk factors for HPV and cervical cancer. Women were then invited to self-collect a cervical sample using HerSwab collection kits to assess the prevalence of HPV and the acceptability of self-sampling. Results Of 202 women who completed the survey, 178 (89%) provided a self-sample. In all, 79% of these women found the test comfortable, 91% found the test easy to use, and 100% reported they were willing to perform the test periodically as a screening method. Thirty-one samples (17%) were positive for at least one of 13 high-risk HPV types, and eight (4.5%) were positive for HPV 16/18. Conclusion HPV testing by using self-collected samples was well accepted, suggesting that it is a plausible modality for cervical cancer screening in indigenous communities. Further studies are needed to assess rates of follow-up after a positive test and to determine whether these findings extend to other indigenous and nonindigenous communities in Guatemala and Latin America.
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              Scaling up proven innovative cervical cancer screening strategies: Challenges and opportunities in implementation at the population level in low- and lower-middle-income countries

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                Author and article information

                Contributors
                annagott@umich.edu
                dpamela.ochoa@gmail.com
                ariveraandrade@gmail.com
                calvrez@umich.edu
                cmendoza@incap.int
                claucamelpnsr@gmail.com
                rmeza@umich.edu
                Journal
                Int J Public Health
                Int J Public Health
                International Journal of Public Health
                Springer International Publishing (Cham )
                1661-8556
                1661-8564
                14 December 2019
                14 December 2019
                2020
                : 65
                : 2
                : 217-226
                Affiliations
                [1 ]GRID grid.214458.e, ISNI 0000000086837370, Department of Epidemiology, School of Public Health, , University of Michigan, ; Ann Arbor, MI USA
                [2 ]PRA Health Sciences, Guatemala City, Guatemala
                [3 ]GRID grid.418867.4, ISNI 0000 0001 2181 0430, Research Center for the Prevention of Chronic Diseases, , Institute of Nutrition of Central America and Panama-INCAP, ; Guatemala City, Guatemala
                [4 ]GRID grid.48336.3a, ISNI 0000 0004 1936 8075, Division of Cancer Epidemiology and Genetics, , National Cancer Institute, ; Bethesda, MD USA
                [5 ]Guatemala Ministry of Health and Social Assistance (MSPAS), Guatemala City, Guatemala
                Article
                1319
                10.1007/s00038-019-01319-9
                7049547
                31838575
                96221d29-d59b-48f0-b9df-9233a25ecb8f
                © The Author(s) 2019

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 8 July 2019
                : 21 November 2019
                : 2 December 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000054, National Cancer Institute;
                Award ID: P30CA046592
                Award ID: T32CA083654
                Award Recipient :
                Categories
                Original Article
                Custom metadata
                © Swiss School of Public Health (SSPH+) 2020

                Public health
                cervical cancer,screening,healthcare barriers,indigenous communities
                Public health
                cervical cancer, screening, healthcare barriers, indigenous communities

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