Determinants of women's participation in cervical cancer screening trail, Maharashtra, India
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OBJECTIVE: To determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a randomized controlled trial. The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid, cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra, India. METHODS: Between October 1999 and November 2003 women aged 30-59 years were randomized to receive one of the three tests or to a control group. Participation was analysed for all three intervention arms. The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100,800 eligible women invited for screening. Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high-grade lesions. Participation in screening and compliance with treatment were also analysed according to the type of test used. FINDINGS: Compared with women who were not tested, screened women were younger (aged 30-39), better educated and had ever used contraception. A higher proportion of screened women were married and a lower proportion had never been pregnant. Of the 932 women diagnosed with high-grade lesions or invasive cancer, 85.3% (795) received treatment. Women with higher levels of education, who had had fewer pregnancies and those who were married were more likely to comply with treatment. There were no differences in rates of screening or compliance with treatment when results were analysed by the test received. CONCLUSIONS: Irrespective of the test being used, good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services. Communication methods and delivery strategies aimed at encouraging older, less-educated women, who have less contact with reproductive services, are needed to further increase screening uptake.
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Studies from India have identified barriers to cervical cancer screening on several socioecological levels, including lack of knowledge, personal disbelief in prevention of cancer, lack of care-seeking when asymptomatic, lack of money for treatment, and reduced access to healthcare services.
“Studies from India have identified barriers on several socioecological levels such as lack of knowledge, personal disbelief in prevention of cancer, lack of care-seeking when asymptomatic, lack of money for treatment, and reduced access to healthcare services [6–8].”
From A community‐based, cross‐sectional study of hr<scp>HPV DNA</scp> self‐sampling‐based cervical cancer screening in rural Karnataka, India (2019) · cites this paper as [6]
The Introduction and Discussion identify lack of knowledge, unfamiliarity with prevention, and economic and geographic barriers to cervical cancer screening. The paper does not specifically identify failure to seek care when asymptomatic or lack of money for treatment as barriers; the Discussion says treatment in this study was free and economic barriers were unlikely to explain reduced follow-up. (LLM, conf=0.86)
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- Authors
- Nene, B.
- Affiliations
- Tata Memorial Hospital (IN)
- Corresponding author
- Nene, Bhagwan
- Venue
- Bulletin of the World Health Organization
- Publisher
- WHO Press
- Published
- 2007-04-01
- Volume
- 85
- Issue
- 4
- Pages
- 264-272
- ISSN
- 0042-9686 (ISSN-L)
- PMC
- PMC2636321
- OpenAlex
- W2128210106
- Cited by
- 154
- References
- 41
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 12 · 2023: 8 · 2022: 14 · 2021: 12 · 2020: 8 · 2019: 3 · 2018: 6 · 2017: 6 · 2016: 10 · 2015: 14 · 2014: 11 · 2013: 13 · 2012: 7
- FWCI
- 2.53
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Bulletin of the World Health Organization (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, screening uptake, visual inspection with acetic acid, Pap smear, HPV testing, medication adherence, sociodemographic factors, high-grade cervical lesions, rural women, Maharashtra
- MeSH terms
- Adult, Uterine Cervical Neoplasms, Diagnostic Techniques, Obstetrical and Gynecological, Female, Health Services Accessibility, Humans, India, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Pregnancy, Socioeconomic Factors, Rural Health Services, Gravidity, Papillomavirus Infections
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