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International Journal for Equity in Health

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Open Access 01-12-2016 | Research

The utilization and barriers of Pap smear among women with visual impairment

Authors: Wen-Hui Fang, Chia-Feng Yen, Jung Hu, Jin-Ding Lin, Ching-Hui Loh

Published in: International Journal for Equity in Health | Issue 1/2016

Abstract

Background

Many evidences illustrate that the Pap smear screening successfully reduces if the cervical cancer could be detected and treated sufficiently early. People with disability were higher comorbidity prevalence, and less likely to use preventive health care and health promotion activities. There were also to demonstrate that people with visual impairment has less access to appropriate healthcare services and is less likely to receive screening examinations. In Taiwan, there was no study to explore utilization of Pap smear, associated factors and use barriers about Pap smear screening test among women with visual impairment.

The purpose is to explore the utilization and barriers of using Pap smear for women with visual impairment in Taiwan. To identify the barriers of women with visual from process of receiving Pap smear screening test.

Methods

The cross-sectional study was conducted and the totally 316 participators were selected by stratified proportional and random sampling from 15 to 64 year old women with visual impairment who lived in Taipei County during December 2009 to January 2010. The data was been collected by phone interview and the interviewers were well trained before interview.

Results

The mean age was 47.1 years old and the highest percentage of disabled severity was mile (40.2 %). Totally, 66.5 % of participators were ever using Pap smear and 38.9 % used it during pass 1 year. Their first time to accept Pap smear was 38.8 year old. There was near 50 % of them not to be explained by professionals before accepting the Pap smear. For non-using cases, the top two percentage of barriers were “feel still younger” (22.3 %), the second was “there’s no sexual experience” (21.4 %). We found the gynecology experiences was key factor for women with visual impairment to use Pap smear, especially the experiences was during 1 year (OR = 4).

Conclusions

Associated factors and barriers to receive Pap smear screening test for women with visual impairment can be addressed through interventions aimed at improving on cognitions and attitudes for cervical cancer risk factors. Our study would be as a reference resource for erasing the barriers and inequality among the visually disabled women.

Abdullah AS, Leung TY. Factors associated with the use of breast and cervical cancer screening services among Chinese women in Hong Kong. Public Health. 2001;115(3):212–7. doi:10.1038/sj/ph/1900753.CrossRefPubMed

Adams EK, Breen N, Joski PJ. Impact of the National Breast and Cervical Cancer Early Detection Program on mammography and Pap test utilization among white, Hispanic, and African American women: 1996–2000. Cancer. 2007;109(2 Suppl):348–58. doi:10.1002/cncr.22353.CrossRefPubMed

Armour BS, Thierry JM, Wolf LA. State-level differences in breast and cervical cancer screening by disability status: United States, 2008. Womens Health Issues. 2009;19(6):406–14. doi:10.1016/j.whi.2009.08.006.CrossRefPubMed

Arnold CL, Davis TC, Berkel HJ, Jackson RH, Nandy I, London S. Smoking status, reading level, and knowledge of tobacco effects among low-income pregnant women. Prev Med. 2001;32(4):313–20. doi:10.1006/pmed.2000.0815.CrossRefPubMed

Beatty PW, Hagglund KJ, Neri MT, Dhont KR, Clark MJ, Hilton SA. Access to health care services among people with chronic or disabling conditions: patterns and predictors. Arch Phys Med Rehabil. 2003;84(10):1417–25.CrossRefPubMed

Chang HC, Hsiung HY, Chen SI, Yen AM, Chen TH. Comparison of a community outreach service with opportunity screening for cervical cancer using Pap smears. J Public Health (Oxf). 2007;29(2):165–72. doi:10.1093/pubmed/fdm003.CrossRef

Clarke EA, Anderson TW. Does screening by “Pap” smears help prevent cervical cancer? A case-control study. Lancet. 1979;2(8132):1–4.CrossRefPubMed

Clement S, Ibrahim S, Crichton N, Wolf M, Rowlands G. Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Educ Couns. 2009;75(3):340–51. doi:10.1016/j.pec.2009.01.008.CrossRefPubMed

Dejong G, Palsbo SE, Beatty PW, Jones GC, Knoll T, Neri MT. The organization and financing of health services for persons with disabilities. Milbank Q. 2002;80(2):261–301.CrossRefPubMedPubMedCentral

10.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917. doi:10.1002/ijc.25516.CrossRefPubMed

11.

Fong CW, Bhalla V, Heng D, Chua AV, Chan ML, Chew SK. Educational inequalities associated with health-related behaviours in the adult population of Singapore. Singapore Med J. 2007;48(12):1091–9.PubMed

12.

Health Promotion Administration, Ministry of Health and Welfare. The national annual report of the cervical cancer 2012. 2012. http://www.hpa.gov.tw/BHPNet/Web/Stat/StatisticsShow.aspx?No=201402180001. [Accessed 07 Apr 2016].

13.

Hewitt M, Devesa SS, Breen N. Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey. Prev Med. 2004;39(2):270–8. doi:10.1016/j.ypmed.2004.03.035.CrossRefPubMed

14.

Hsu YH, Tsai WC, Kung PT. Health examination utilization in the visually disabled population in Taiwan: a nationwide population-based study. BMC Health Serv Res. 2013;13:509. doi:10.1186/1472-6963-13-509.CrossRefPubMedPubMedCentral

15.

Huang CP, Chi LY, Chang HJ, Chou P. Cognition and utilization of Papanicolaou testing after the implementation of National Health Insurance in rural Taiwan. J Formos Med Assoc. 1999;98(1):19–23.PubMed

16.

Huang KH, Tsai WC, Kung PT. The use of Pap smear and its influencing factors among women with disabilities in Taiwan. Res Dev Disabil. 2012;33(2):307–14. doi:10.1016/j.ridd.2011.09.016.CrossRefPubMed

17.

Insinga RP, Glass AG, Rush BB. Diagnoses and outcomes in cervical cancer screening: a population-based study. Am J Obstet Gynecol. 2004;191(1):105–13. doi:10.1016/j.ajog.2004.01.043.CrossRefPubMed

18.

Kapiriri L, Norheim OF. Criteria for priority-setting in health care in Uganda: exploration of stakeholders’ values. Bull World Health Organ. 2004;82(3):172–9.PubMedPubMedCentral

19.

Kung PT, Tsai WC, Li YH. Determining factors for utilization of preventive health services among adults with disabilities in Taiwan. Res Dev Disabil. 2012;33(1):205–13. doi:10.1016/j.ridd.2011.09.006.CrossRefPubMed

20.

Lantz PM, Weigers ME, House JS. Education and income differentials in breast and cervical cancer screening. Policy implications for rural women. Med Care. 1997;35(3):219–36.CrossRefPubMed

21.

LeVine RA, LeVine SE, Rowe ML, Schnell-Anzola B. Maternal literacy and health behavior: a Nepalese case study. Soc Sci Med. 2004;58(4):863–77.CrossRefPubMed

22.

Lin JD, Lin LP, Hsieh M, Lin PY. Preliminary findings of serum creatinine and estimated glomerular filtration rate (eGFR) in adolescents with intellectual disabilities. Res Dev Disabil. 2010;31(6):1390–7. doi:10.1016/j.ridd.2010.06.021.CrossRefPubMed

23.

Lin JD, Lin PY, Lin LP. Universal hepatitis B vaccination coverage in children and adolescents with intellectual disabilities. Res Dev Disabil. 2010;31(2):338–44. doi:10.1016/j.ridd.2009.09.005.CrossRefPubMed

24.

Lin JD, Wu JL, Yen CF. An exploratory study into health care policy for persons with intellectual disabilities in Taiwan. J Intellect Disabil Res. 2004;48(Pt 3):252–61. doi:10.1111/j.1365-2788.2003.00557.x.CrossRefPubMed

25.

Lin LP, Lee JT, Lin FG, Lin PY, Tang CC, Chu CM, et al. Disability and hospital care expenses among national health insurance beneficiaries: analyses of population-based data in Taiwan. Res Dev Disabil. 2011;32(5):1589–95. doi:10.1016/j.ridd.2011.01.057.CrossRefPubMed

26.

Lin YJ, Chen CS, Liu TC, Lin HC. Taiwan’s national health insurance system and the application of preventive care: the case of Pap smear testing. Public Health. 2008;122(9):857–61. doi:10.1016/j.puhe.2007.12.002.CrossRefPubMed

27.

Lu JF, Hsiao WC. Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff (Millwood). 2003;22(3):77–88.CrossRef

28.

Lu JF, Leung GM, Kwon S, Tin KY, Van Doorslaer E, O’Donnell O. Horizontal equity in health care utilization evidence from three high-income Asian economies. Soc Sci Med. 2007;64(1):199–212. doi:10.1016/j.socscimed.2006.08.033.CrossRefPubMed

29.

Makuc DM, Freid VM, Kleinman JC. National trends in the use of preventive health care by women. Am J Public Health. 1989;79(1):21–6.CrossRefPubMedPubMedCentral

30.

Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121(4):829–46. doi:10.1097/AOG.0b013e3182883a34.CrossRefPubMed

31.

National Health Insurance Administration, Ministry of Health and Welfare. The Business Executive Report 2006–2015. 2015. http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1023&WD_ID=1043&webdata_id=815. [Accessed 01 Jan 2016].

32.

Owens GM. Gender differences in health care expenditures, resource utilization, and quality of care. J Manag Care Pharm. 2008;14(3 Suppl):2–6.PubMed

33.

Rodriguez MA, Ward LM, Perez-Stable EJ. Breast and cervical cancer screening: impact of health insurance status, ethnicity, and nativity of Latinas. Ann Fam Med. 2005;3(3):235–41. doi:10.1370/afm.291.CrossRefPubMedPubMedCentral

34.

Rudan I, Gibson J, Kapiriri L, Lansang MA, Hyder AA, Lawn J, et al. Setting priorities in global child health research investments: assessment of principles and practice. Croat Med J. 2007;48((5):595–604.

35.

Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012;137(4):516–42. doi:10.1309/ajcptgd94evrsjcg.CrossRefPubMed

36.

Seldom CR, Zorn M, Ratzan SC, Parker RM. Current bibliographies in medicine/health literacy. Bethesda: National Library of Medicine; 2000.

37.

Sigurdsson K. Effect of organized screening on the risk of cervical cancer. Evaluation of screening activity in Iceland, 1964–1991. Int J Cancer. 1993;54(4):563–70.CrossRefPubMed

38.

Smith RA, Cokkinides V, Eyre HJ. Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects. CA Cancer J Clin. 2007;57(2):90–104.CrossRefPubMed

39.

Vaidya V, Partha G, Howe J. Utilization of preventive care services and their effect on cardiovascular outcomes in the United States. Risk Manag Healthc Policy. 2011;4:1–7. doi:10.2147/rmhp.s15777.CrossRefPubMedPubMedCentral

40.

Wang PD, Lin RS. Sociodemographic factors of Pap smear screening in Taiwan. Public Health. 1996;110(2):123–7.CrossRefPubMed

41.

Wu CL, Lin JD, Hu J, Yen CF, Yen CT, Chou YL, et al. The effectiveness of healthy physical fitness programs on people with intellectual disabilities living in a disability institution: six-month short-term effect. Res Dev Disabil. 2010;31(3):713–7. doi:10.1016/j.ridd.2010.01.013.CrossRefPubMed

42.

Yang CH, Huang YT, Hsueh YS. Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study. Int J Equity Health. 2013;12:13. doi:10.1186/1475-9276-12-13.CrossRefPubMedPubMedCentral

43.

Yen CF, Hsu SW, Loh CH, Fang WH, Wu CL, Chu CM, et al. Analysis of seasonal influenza vaccine uptake among children and adolescents with an intellectual disability. Res Dev Disabil. 2012;33(2):704–10. doi:10.1016/j.ridd.2011.11.011.CrossRefPubMed

44.

Yen CF, Lin JD. Factors for healthy food or less-healthy food intake among Taiwanese adolescents with intellectual disabilities. Res Dev Disabil. 2010;31(1):203–11. doi:10.1016/j.ridd.2009.09.003.CrossRefPubMed

45.

Yen CF, Lin JD, Loh CH, Shi L, Hsu SW. Determinants of prescription drug use by adolescents with intellectual disabilities in Taiwan. Res Dev Disabil. 2009;30(6):1354–66. doi:10.1016/j.ridd.2009.06.002.

46.

Ministry of Health and Welfare (2009). Statistics of People with Disability. http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4198. [Accessed 01 Feb 2009].

Title: The utilization and barriers of Pap smear among women with visual impairment
Authors: Wen-Hui Fang
Chia-Feng Yen
Jung Hu
Jin-Ding Lin
Ching-Hui Loh
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI: https://doi.org/10.1186/s12939-016-0354-4

At a glance: The STEP trials

Springer Medicine

The utilization and barriers of Pap smear among women with visual impairment

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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