Evaluation of a Web-Based Culturally Sensitive Educational Video to Facilitate Informed Cervical Cancer Screening Decisions Among Turkish- and Moroccan-Dutch Women Aged 30 to 60 Years: Randomized Intervention Study

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Abstract

Background

In the Netherlands, since 1996, a national cervical cancer (CC) screening program has been implemented for women aged 30 to 60 years. Regional screening organizations send an invitation letter and information brochure in Dutch to the home addresses of targeted women every 5 years. Although this screening is free of charge, Turkish- and Moroccan-Dutch women, especially, show low screening participation and limited informed decision-making (IDM). As Turkish- and Moroccan-Dutch women indicated their need for information on the practical, emotional, cultural, and religious aspects of CC screening, we developed a culturally sensitive educational video (CSEV) as an addition to the current information brochure.

Objective

In this study, we aimed to evaluate the added effect of the CSEV on IDM regarding CC screening participation among Turkish and Moroccan women aged 30 to 60 years in the Netherlands through a randomized intervention study.

Methods

Initial respondents were recruited via several social media platforms and invited to complete a web-based questionnaire. Following respondent-driven sampling, respondents were asked to recruit a number of peers from their social networks to complete the same questionnaire. Respondents were randomly assigned to the control (current information brochure) or intervention condition (brochure and CSEV). We measured respondents’ knowledge and attitude regarding CC screening and their intention to participate in the next CC screening round before and after the control or intervention condition. We evaluated the added effect of the CSEV (above the brochure) on their knowledge, attitude, intention, and IDM using intention-to-treat analyses.

Results

The final sample (n=1564) included 686 (43.86%) Turkish and 878 (56.14%) Moroccan-Dutch women. Of this sample, 50.7% (793/1564) were randomized to the control group (350/793, 44.1% Turkish and 443/793, 55.9% Moroccan) and 49.3% (771/1564) to the intervention group (336/771, 43.6% Turkish and 435/771, 56.4% Moroccan). Among the Turkish-Dutch women, 33.1% (116/350) of the control respondents and 40.5% (136/336) of the intervention respondents consulted the brochure (not statistically significant). Among Moroccan-Dutch women, these percentages were 28.2% (125/443) and 37.9% (165/435), respectively ( P=.003). Of all intervention respondents, 96.1% (323/336; Turkish) and 84.4% (367/435; Moroccan) consulted the CSEV. The CSEV resulted in more positive screening attitudes among Moroccan-Dutch women than the brochure (323/435, 74.3% vs 303/443, 68.4%; P=.07). Women, who had never participated in CC screening before, showed significantly more often a positive attitude toward CC screening compared with the control group ( P=.01).

Conclusions

Our short and easily implementable CSEV resulted in more positive screening attitudes, especially in Moroccan-Dutch women. As the CSEV was also watched far more often than the current brochure was read, this intervention can contribute to better reach and more informed CC screening decisions among Turkish- and Moroccan-Dutch women.

Trial Registration

International Clinical Trial Registry Platform NL8453; https://tinyurl.com/2dvbjxvc

Related collections

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More than ever, clinicians need regularly updated reviews given the continuously increasing amount of new information regarding innovative cervical cancer prevention methods. A summary is given from recent meta-analyses and systematic reviews on 3 possible clinical applications of human papillomavirus (HPV) testing: triage of women with equivocal or low-grade cytologic abnormalities; prediction of the therapeutic outcome after treatment of cervical intraepithelial neoplasia (CIN) lesions, and last not but not least, primary screening for cervical cancer and pre-cancer. Consistent evidence is available indicating that HPV-triage with the Hybrid Capture(®) 2 assay (Qiagen Gaithersburg, Inc., MD, USA [previously Digene Corp.] (HC2) is more accurate (higher sensitivity, similar specificity) than repeat cytology to triage women with equivocal Pap smear results. Several other tests show at least similar accuracy but mRNA testing with the APTIMA(®) (Gen-Probe Inc., San Diego, CA, USA) test is similarly sensitive but more specific compared to HC2. In triage of low-grade squamous intraepithelial lesions (LSIL), HC2 is more sensitive but its specificity is substantially lower compared to repeat cytology. The APTIMA(®) test is more specific than HC2 without showing a loss in sensitivity. Identification of DNA of HPV types 16 and/or 18, or RNA from the five most carcinogenic HPV types allow selecting women at highest risk for CIN3+ but the sensitivity and negative predictive value of these markers are lower than full-range high-risk HPV (hrHPV) testing. After conservative treatment of cervical pre-cancer, HPV testing picks up more quickly, with higher sensitivity and not lower specificity, residual or recurrent high-grade CIN than follow-up cytology. Primary screening for hrHPV generally detects more CIN2, CIN3 or cancer compared to cytology at cut-off atypical squamous cells of undetermined significance (ASC-US) or LSIL, but is less specific. Combined HPV and cytology screening provides a further small gain in sensitivity at the expense of a considerable loss in specificity if positive by either test is referred to colposcopy, in comparison with HPV testing only. Randomised trials and follow-up of cohort studies consistently demonstrate a significantly lower cumulative incidence of CIN3+ and even of cancer, in women aged 30 years or older, who were at enrollment hrHPV DNA negative compared to those who were cytologically negative. The difference in cumulative risk of CIN3+ or cancer for double negative (cytology & HPV) versus only HPV-negative women is small. HC2, GP5+/6+ PCR (polymerase chain reaction), cobas(®) 4800 PCR (Roche Molecular Systems Inc., Alameda, CA, USA) and Real Time PCR (Abbott Molecular, Des Plaines, IL, USA) can be considered as clinically validated for use in primary screening. The loss in specificity associated with primary HPV-based screening can be compensated by appropriate algorithms involving reflex cytology and/or HPV genotyping for HPV16 or 18. There exists a substantial evidence base to support that HPV testing is advantageous both in triage of women with equivocal abnormal cytology, in surveillance after treatment of CIN lesions and in primary screening of women aged 30 years or older. However, the possible advantages offered by HPV-based screening require a well organised program with good compliance with screening and triage policies. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012. Copyright © 2012 Marc Arbyn. Published by Elsevier Ltd.. All rights reserved.

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Author and article information

Contributors

Nora Hamdiui:

ORCID: https://orcid.org/0000-0003-2861-7072

National Coordination Centre for Communicable Disease ControlCentre for Infectious Disease ControlNational Institute for Public Health and the EnvironmentPostbus 1Bilthoven, 3720 BANetherlands31 088 689 7000nora.hamdiui@rivm.nl

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J Med Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: October 2022

Publication date (Electronic): 26 October 2022

Volume: 24

Issue: 10

Electronic Location Identifier: e35962

Affiliations

[1 ] National Coordination Centre for Communicable Disease Control Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven Netherlands

[2 ] Department of Primary and Community Care Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen Netherlands

[3 ] Leiden University Medical Centre Centre for Infectious Diseases Leiden Netherlands

[4 ] Department of Health Promotion Care and Public Health Research Institute Maastricht University Maastricht Netherlands

[5 ] Center for Media & Health Gouda Netherlands

[6 ] Athena Institute for Research on Innovation and Communication in Health and Life Sciences Free University Amsterdam Amsterdam Netherlands

[7 ] Program Prevention and Care Pharos: Dutch Centre of Expertise on Health Disparities Utrecht Netherlands

Author notes

Corresponding Author: Nora Hamdiui nora.hamdiui@ 123456rivm.nl

Author information

Nora Hamdiui https://orcid.org/0000-0003-2861-7072

Mart L Stein https://orcid.org/0000-0003-0502-7993

Jim van Steenbergen https://orcid.org/0000-0002-3652-5146

Rik Crutzen https://orcid.org/0000-0002-3731-6610

Martine Bouman https://orcid.org/0000-0002-4961-7250

Abresham Khan https://orcid.org/0000-0002-3065-6006

Miyase N Çetin https://orcid.org/0000-0003-3922-598X

Aura Timen https://orcid.org/0000-0002-5793-5443

Maria van den Muijsenbergh https://orcid.org/0000-0002-4994-4008

Article

Publisher ID: v24i10e35962

DOI: 10.2196/35962

PMC ID: 9647450

PubMed ID: 36287585

SO-VID: f2f4d293-4acc-4ae8-b904-3842ce44692e

Copyright © ©Nora Hamdiui, Mart L Stein, Jim van Steenbergen, Rik Crutzen, Martine Bouman, Abresham Khan, Miyase N Çetin, Aura Timen, Maria van den Muijsenbergh. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.10.2022.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 24 December 2021

Date revision requested : 13 May 2022

Date revision received : 18 May 2022

Date accepted : 19 May 2022

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