Perceptions and implications for cervical screening and self-collection: A qualitative exploration of never and under-screened Queensland women.

BACKGROUND: Over 70% of cervical cancers are detected in women not currently screening. Queensland Health wanted to better understand the drivers of screening to inform our planning and capitalise on self-collection as an option to reach under-screened women. In 2020 Queensland Health commissioned qualitative research to explore barriers and enablers to cervical screening with never-screened and under-screened women in Queensland (with under-screeners defined as having last screened more than 4 years ago and being more than 2 years overdue). Additionally, the research explored the acceptability of self-collection amongst this cohort. METHODS: A mixed methods qualitative approach of online focus groups and in-depth interviews was employed. Online focus groups were conducted with under-screeners. In-depth telephone interviews were conducted with never-screeners due to the anticipated personal nature of their reasons for not screening. RESULTS: A total of 51 Queensland women aged 30 to 50 years participated in the research. CONCLUSIONS: Queensland women cited several negative experiences and aspects of the current program, as well as barriers in their social and personal lives that limited screening intention and behaviour. Barriers and enablers to cervical screening identified in this research have been classified into four categories: structural, knowledge and attitudinal, social, and personal. The research identified more factors associated with nonparticipation than participation. However, the research did uncover a range of potential enablers to encourage screening, some of which related to the program design. SO WHAT?: The concept of self-collection was broadly well accepted by research participants, particularly by never-screeners. Recommendations resulting from this research include communications, systems, and eligibility changes, particularly regarding the availability and benefits of self-collection.

Impact of pay for performance on access at first dialysis in Queensland.

AIM: Commencement of haemodialysis with an arteriovenous fistula (AVF) or arteriovenous graft (AVG) is associated with improved survival compared with commencement with a central venous catheter. In 2011-2012, Queensland Health made incentive payments to renal units for early referred patients who commenced peritoneal dialysis (PD), or haemodialysis with an AVF/AVG. The aim of this study was to determine if pay for performance improved clinical care. METHODS: All patients who commenced dialysis in Australia between 2009 and 2014 and were registered with the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) were included. A multivariable regression model was used to compare rates of commencing dialysis with a PD catheter or permanent AVF/AVG during the pay-for-performance period (2011-2012) with periods prior (2009-2010) and after (2013-2014). RESULTS: A total of 10 858 early referred patients commenced dialysis during the study period, including 2058 in Queensland. In Queensland, PD as first modality increased with time (P < 0.001) but there was no change in AVF/AVG rate at first haemodialysis (P = 0.5). In a multivariate model using the pay-for-performance period as reference, the odds ratio for commencement with PD or haemodialysis with an AVF/AVG in Queensland was 1.02 (95% CI 0.81-1.29) in 2009-2010 and 1.28 (95% CI 1.01-1.61) in 2013-2014. There was no change for the rest of Australia (0.97 95% CI 0.87-1.09 in 2009-2010 and 1.00 95% CI 0.90-1.11 in 2013-14). CONCLUSION: Pay for performance did not improve rates of commencement of dialysis with PD or an AVF/AVG during the payment period. A lag effect on clinical care may explain the improvement in later years.