Factors Associated With Cervical Cancer Screening Participation Among Retired Women In Hongkou District, Shanghai

BACKGROUNDCervical cancer is one of the most common gynecologic malignant tumors. In Shanghai,the incidence of cervical cancer is 6.65/100,000 in 2005, and the mortality is 2.54/100,000.The experience of developed countries have shown that organized screening program could decrease the morbidity and mortality of cervical cancer significantly.There is limited policy or program for cervical cancer screening at national level in China.The implementation of "People's Republic of China Law on the Protection of Women' s Rights" in Shanghai formulate that any enterprise and public institution should arrange all the female employee to receive a gynecological screening which is including cervical cancer screening every 2 years.Now the cervical cancer screening participating rate of in Shanghai is only 40%.A lot of studies have shown that,the cervical cancer screening participation is influenced by variety of factors,such as individual factors:the knowledge and attitude of cervical cancer screening,self efficacy,et al.Social and physical environment factors:race,age, education,marital status,et al.Retired women are vulnerable groups and their economic level is low,it is impossible for them to get the free screening organized by enterprise.The influencing factors of screening participation are more complicated in this population.Whether just providing free screening will satisfy them and how to promote them to seek health service are still urgent issues to be solved.OBJECTIVETo understand the current cervical cancer screening participation among community women;to explore the factors associated with participation;and to provide the possible recomandation for effective intervention strategies. METHODS1.Quantitative survey:By using self-efficacy scale and 2 self-designed questionnaires,502 retired women in Hongkou District of Shanghai were interviewed.The questionnaires' content was designed according to social cognitive theory(SCT).2.Qualitative survey:By using self-designed semi-structure questionnaires,10 retired women aged under 65 with different screening participation behaviors in Quyang community,Hongkou District of Shanghai were in-depth interviewed.RESULTSQuantitative survey showed that 83.9%of the study subjects had been screened,and 46.5%(39.0%in all) of them had been screened in last 3 years.Results from multivariate analysis,showed that the following SCT factors were associated with cervical cancer screening participation: organized screening at working place;marrital status;doctor' s recommendations;peers and ralatives' influence,and all these factors have positive effect.The factors associated with cervical cancer screening participation in last 3 years wre organized screening in community,years of retiring;doctors' recommendations,knowledge and attitude about cervical cancer and screening of individual;self efficacy, and all the factors were positive except years of retiring.Qulitative study confirmed the association found by quantitative survey;In addition to that,this stuy showed that reinforcement could increase the possibility for women to participate cervical cancer screening.A handbook for advocacy and mobilizing women to participate cervical cancer screening was designed according to the findings of quantitative and qualitative survey and pratical guidelines form WHO and other developed countries.CONCLUSION AND RECOMMENDATIONThe cervical cancer screening participation of retired women in Hongkou District in last 3 years is still low.Their knowledge level of cervical cancer and screening is insufficient.Retired women still face variety obstacles to participate cervical cancer screening.The working place-based and community-based screenings are imperfect.We recommand that all people' s awareness of cervical cancer and screening should be promoted,community mobilization should be fully developed before any screening project to eliminate their misgivings;the knowledge and skills about cervical cancer prevention of health care providers should be trained,so that they could recommend women to participate cervical cancer screening at appropriate opportunity;Compare to opportunistic screening, organized screening could reach more women at risk,so the working place-based and community-based screenings should be improved in order to be combined effectively,and cost-effect should be fully considered during designing of a screening project.