Barriers to Cervical Cancer Screening among Enrollees in Georgia's Women's Health Medicaid Program: A Qualitative Analysis 公开

Greathouse, Robert Joseph Michael (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/jw827c15j?locale=zh
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Abstract

Background: In the United States, cervical cancer is the 14th most common cause of cancer
death among women, causing an estimated 4,000 deaths per year. Prevention efforts
centered on early detection and treatment of precancerous lesions have the potential to
drastically improve cervical cancer death rates. Despite the availability of government-
subsidized cervical cancer screening services, Pap test rates among low income,
uninsured/underinsured, and ethnic minority women remain considerably below those of
the general population.
Objective: The purpose of this study was to explore the barriers that inhibit low income,
uninsured or underinsured women from accessing cervical cancer screening services.
Comparisons of such barriers between African American and Caucasian women are of
particular interest, in order to ascertain whether each group experiences similar types of
barriers, and to understand which barriers are more influential within each group.
Methods: The data consisted of 25 interview transcripts of African American and Caucasian
women with cervical pre-cancer or invasive cervical cancer who were currently or previously
enrolled in the Georgia Women's Health Medicaid Program. The transcripts were coded
using MAXqda 10 software, and the data were analyzed using the content analysis approach.
Descriptive analyses were prepared for the factors that both aided and hindered women's
ability to seek cervical cancer screening.
Findings: Three key factors were identified that influenced women's cervical cancer
screening behaviors: the importance of education about HPV screening, the HPV vaccine,
and the link between HPV and cervical cancer, patient perceptions of quality of care in their
interactions with providers, and cultural or personal beliefs that influenced women's ability
to comprehend and internalize the need for screening services. The first and third key
factors were experienced differently
Caucasian women, while both
groups expressed similar sentiments relative to the second key factor.
Discussion: The study's findings may be useful in strengthening community outreach,
secondary screening, and prevention efforts targeted at underserved women, in order to
achieve improved cancer and chronic disease outcomes. These efforts will be of increasing
importance in light of the expansion of Medicaid envisioned in the Patient Protection and
Affordable Care Act.

Table of Contents

TABLE OF CONTENTS

1.0 INTRODUCTION ...............................................................................................................7
1.1 Background and Problem Statement ....................................................................................7
1.2 Purpose Statement ..........................................................................................................9
1.3 Specific Aims ..................................................................................................................10
1.4 Significance Statement .....................................................................................................10
2.0 LITERATURE REVIEW ...................................................................................................... 11
2.1 Cervical Cancer Facts and Statistics ...................................................................................11
2.2 Screening Tests, Policies, and Programs ..............................................................................16
2.3 Cervical Cancer Screening Barriers .....................................................................................23
3.0 METHODOLOGY ............................................................................................................. 30
3.1 Introduction ...................................................................................................................30
3.2 Population and Sample ......................................................................................................31
3.3 Research Design ..............................................................................................................33
3.4 Instruments ...................................................................................................................33
3.5 Data Analysis ..................................................................................................................34
3.6 Limitations .....................................................................................................................37
4.0 RESULTS ........................................................................................................................38
4.1 Introduction ....................................................................................................................38
4.2 Findings ..........................................................................................................................39
5.0 DISCUSSION ...................................................................................................................47
6.0 APPENDIX A: INFORMED CONSENT FORM........................................................................... 54
7.0 APPENDIX B: CERVICAL CANCER INTERVIEW GUIDE ................................... ........................56
8.0 REFERENCES ...................................................................................................................58




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