Predictors of cervical cancer screening for refugee women attending an international family medicine clinic in the United States.

PURPOSE: Cervical cancer screening (CCS) rates are lower for foreign-born women in the United States (U.S.) compared with the overall population. This study aimed to determine the CCS rate and predictors among refugees who were identified as female attending a family medicine clinic. METHODS: A retrospective chart review included refugee individuals aged 21+, seen in the previous 3 years (3/23/2015-3/20/2018), without hysterectomy (n = 525). Lab results determined CCS rate. Chi-square and logistic regression models explored predictors of CCS. RESULTS: Overall, 60.0% were up-to-date (UTD) on CCS. Individuals aged 30-49, married, and with [Formula: see text] 1 child had higher odds of being UTD. Ten or more years living in the U.S. was a significant bivariate predictor of CCS, and approached significance in the multivariate model. CONCLUSION: This study begins to fill gaps in knowledge about cervical cancer control among individuals who resettled in the U.S. as refugees and, given that CCS rates are suboptimal, informs clinical practice improvements and directions for future research.

Feasibility and acceptability of self-collection of Human Papillomavirus samples for primary cervical cancer screening on the Caribbean Coast of Nicaragua: A mixed-methods study.

Background: Cervical cancer is the primary cause of cancer death for women in Nicaragua, despite being highly preventable through vaccination against high-risk genotypes of the Human Papillomavirus (hrHPV), screening for hrHPV, and early detection of lesions. Despite technological advances designed to increase access to screening in low resource settings, barriers to increasing population-level screening coverage persist. On the Caribbean Coast of Nicaragua, only 59% of women have received one lifetime screen, compared to 78.6% of eligible women living on the Pacific and in the Interior. In concordance with the WHO's call for best practices to eliminate cervical cancer, we explored the feasibility and acceptability of self-collection of samples for hrHPV testing on the Caribbean Coast of Nicaragua through a multi-year, bi-national, community-based mixed methods study. Methods: Between 2016 and 2019, focus groups (n=25), key informant interviews (n=12) [phase I] and an environmental scan [phase II] were conducted on the Caribbean Coast of Nicaragua in partnership and collaboration with long-term research partners at the University of Virginia and community-based organizations. In spring 2020, underscreened women on the Caribbean Coast of Nicaragua were recruited and screened for hrHPV, with the choice of clinician collection or self-collection of samples. Results: Over the course of the study, providers and potential patients expressed significant acceptability of self-collection of samples as a strategy to reduce barriers currently contributing to the low rates of screening (phases I and II). Ultimately 99.16% (n=1,767) of women chose to self-collect samples, demonstrating a high level of acceptability of self-collection in this pilot sample (phase III). Similarly, focus groups, key informant interviews, and the environmental scan (phases I and II) of resources indicated critical considerations for feasibility of implementation of both HPV primary screening and subsequently, self-collection of samples. Through phase III, we piloted hrHPV screening (n=1,782), with a 19.25% hrHPV positivity rate. Conclusion: Self-collection of samples for hrHPV testing demonstrated high acceptability and feasibility. Through concerted effort at the local, regional, and national levels, this project supported capacity building in reporting, monitoring, and surveilling cervical cancer screening across the continuum of cervical cancer control.

Health Inequity in Cervical Cancer Control Among Refugee Women in the United States by Country of Origin.

Purpose: To describe cervical cancer control practices from common countries of origin for women who resettle in the United States as refugees to highlight this persistent health inequity. Methods: Describe presence/type of national cervical cancer screening program, screening coverage percentage, and human papillomavirus (HPV) vaccination program presence and coverage. Results: Nine of 15 included countries screen opportunistically. Most do not use high-performing tests, and estimates of screening coverage were limited. Only one country offers HPV vaccination. Conclusion: Countries of origin for refugee women may lack effective national cervical cancer control programs. To meet the World Health Organization (WHO)'s call to eliminate cervical cancer by 2030, focus on culturally tailored education, and continued research are paramount.

Feasibility and Acceptability of Tele-Colposcopy on the Caribbean Coast of Nicaragua: A Descriptive Mixed-Methods Study.

Background: Cervical cancer, a preventable cancer of disparities, is the primary cause of cancer death for women in Nicaragua. Clinics and personnel in rural and remote Nicaragua may not be accessible to perform recommended screening or follow-up services. Objective: To assess acceptability and feasibility of integrating innovations for high-quality screening and treatment follow-up (tele-colposcopy) into existing pathways on Nicaragua's Caribbean Coast within the context of the National Cervical Cancer Control Program. Methods: Provider focus groups, key informant interviews, and environmental scans were conducted for 13 clinics on the Caribbean Coast of Nicaragua. Topics discussed included a smartphone-based mobile colposcope (MobileODT hardware and mobile platform), mobile connectivity capacity, clinic resources, provider acceptability, and current diagnostic and clinical protocols. We tested device connectivity through image upload availability and real-time video connection and simulated clinical encounters utilizing MobileODT and a low-cost cervical simulator. We developed a database of colposcopic images to establish feasibility of integrating this database and clinical characteristics into the cervical cancer registry. Results: Provider acceptability of integrating tele-colposcopy into existing cancer control efforts was high. Image upload connectivity varied by location (mean = 1 h 9 min). Most clinics had running water (84.6%) and consistent electricity (92.3%), but some did not have access to landline telephones (53.8%). Conclusions: As faster connectivity becomes available in remote settings, Mobile Health tools such as tele-colposcopy will be increasingly feasible to provide access to high-quality cervical cancer follow-up. World Health Organization guidance on integrating technology into existing programs will remain important to ensure programmatic efficacy, local relevance, and sustainability.

Self-collection of samples for HPV testing to increase participation in cervical cancer screening by immigrant women: An integrative review.

OBJECTIVE: To examine methods and results of studies assessing self-collection of cervico-vaginal samples for human papillomavirus (HPV) testing by immigrant women for insights into how future research using this method with unique subpopulations of women may improve the rates of cervical cancer screening (CCS) compared to current strategies. DATA SOURCES: Four electronic databases were systematically searched through March 2020, with no limits applied. A manual review of reference lists was also completed. STUDY SELECTION: The search resulted in 63 articles. After removal of duplicates, 36 were reviewed against inclusion criteria. A manual review of reference lists yielded two additional studies. The final sample included 15 relevant publications representing 13 unique empirical studies. DATA EXTRACTION: Data related to study methodology and empirical results were extracted into table form. DATA SYNTHESIS: The methods of the studies were summarized and synthesized, including diversity of participants, community engagement, including collaboration with public health nurses or community health workers. In addition, methods and findings related to the educational components of the studies, and empirical findings related to various cultural groups, were described. CONCLUSION: To reduce health disparities in CCS, researchers should focus on diverse groups, such as immigrant women, to understand important individual and group-specific factors that may influence screening, including whether self-collection of samples for HPV testing along with appropriate education and support for follow-up will address these factors.

Acceptability and Feasibility of Community-Based, Lay Navigator-Facilitated At-Home Self-Collection for Human Papillomavirus Testing in Underscreened Women.

Objective: Women without regular health care providers or a medical home routinely fail to complete recommended cervical cancer screening. At-home self-collection of samples to test for high-risk strains of human papillomavirus (hrHPV) can improve screening rates. This study documents acceptability and feasibility of community lay navigator (LN)-facilitated at-home self-collection for underscreened women in Appalachian Virginia. Materials and Methods: This study used mixed methods in three phases. Phase I involved focus groups of LNs to ensure cultural acceptability of self-collection, and to enhance recruitment of medically underserved women. An environmental scan of community resources and climate was created in Phase II. During Phase III, underscreened women in Appalachian Virginia (the far southwest corner of Virginia) were recruited to complete hrHPV testing using LN-provided self-collection kits. Results: LN-facilitated at-home self-collection for HPV testing was deemed culturally acceptable and feasible to participants in this community-based pilot study. Self-kit training included 64 LNs, of which 35 engaged in the study and were provided 77 kits and instructions. A total of 59 self-kits were returned, of which 42 were correctly completed with valid HPV results, yielding a 16.6% hrHPV rate. Conclusions: Over a quarter of the women LNs recruited had no medical home, indicating this delivery model may have potential to reach women at increased risk of being underscreened for cervical cancer. Research is needed to identify optimal approaches to increase LN participation in outreach self-collection interventions.

Developing a Priority Scoring Index for Mobile Mammography Sites: Considerations for Screening Access in Rural and Remote Settings.

Geographic location continues to be an important indicator in incidence of, access to treatment for, and mortality from breast cancer. Disparities in access to screening and early detection persist in Appalachian Virginia. We developed an index to identify sites which would most benefit from increased frequency of mobile mammography visits, based on geographically relevant population-level risk factors (late stage of tumor diagnosis) and accessibility risk factors (access to FDA [US Food and Drug Administration] mammography sites, access of women aged 50+ years to primary care physicians at existing mobile sites). These 4 components for the Priority Index were subsequently standardized and multiplied to importance weights. The percentage of mammograms performed in the target geographic region has increased each year, respectively. This article presents methodological considerations for developing a priority algorithm to increase access to breast cancer early screening and detection for vulnerable women.

Prevalence of lower urinary tract symptoms and social determinants in primary care users in Brazil.

INTRODUCTION AND HYPOTHESIS: Although lower urinary tract symptoms (LUTS) have considerable clinical relevance, few propose evaluating its association with social conditions. Our study aimed to evaluate LUTS prevalence in primary care and its association with the social determinants of health (SDH). METHODS: This is a cross-sectional study conducted with 322 females in the period of June to October 2016 that carried out consultations and screening to prevent gynecological cancer in a primary care unit. RESULTS: The ages ranged from 18 to 85 years (M = 40.53). Storage symptoms had a higher overall prevalence (64.6%), highlighting nocturia (n = 186, 57.8%) and urinary incontinence (n = 120, 37.3%). Storage symptoms were associated with three layers of SDH. The voiding and postmicturition symptoms were only related to operative vaginal delivery. CONCLUSIONS: The findings of this study suggest a relationship between SDH and LUTS. It is important to emphasize that the results not only imply a causal relationship, but also point to the social inequalities existing at a population level.

Beyond Borders: Global Nursing Education for the Future.

Most articles on nursing student study abroad experiences are one-sided case studies focusing on students and faculty from developed countries who travel to less developed countries. This article presents the perspectives of students from theUnited States, Chile, Mexico, and Taiwan, both sides of the international exchange experience. Students described the real-world, hands-on experience of immersion in a different health system and professional culture as transformational and having a significant impact on their nursing career goals. In an era of increasing globalization, cross-cultural experiences have great potential for nursing students on both sides of the exchange.

Provider-Identified Barriers to Cervical Cancer Screening and Perceptions Toward Self-Collection of Human Papillomavirus in Southwest Virginia.

OBJECTIVE: To explore health care workers identified barriers to cervical cancer screening in rural Southwest Virginia. DESIGN AND SAMPLE: A descriptive study utilizing telephone-based structured interviews and conventional content analysis. All free and federally funded health clinics within a 75 mile radius of Virginia's health Districts 1, 2, and 3 were contacted for participation in the study. MEASURES: Organizational information such as composition of clinical staff, services provided, cost of services, recorded compliance with current guidelines, and assessed individual barriers to accessing screening within the community. RESULTS: With a 27% response rate, all but one clinic offered cervical cancer screening. The most common barriers to cervical cancer screening identified were lack of education and cost. The most important efforts to detect unscreened women and increase screening would involve clinic-based tracking, education and advertisements. Seventy percent of respondents felt that self-collection of HPV would be at least somewhat acceptable in their communities. CONCLUSIONS: Public health nursing implications for the barriers of lack of education and high cost were found in this study. In Southwest Virginia, self-collection of HPV was perceived as acceptable by health care workers in the community, and might represent an avenue for increased outreach and education.

Two Models for Public Health Nursing Clinical Education.

OBJECTIVES: To evaluate the impact of two baccalaureate public health nursing (PHN) clinical education models, that vary on level of engagement with community agencies, on student perceptions of PHN. DESIGN AND SAMPLE: Two group, pretest/posttest design. Two cohorts of baccalaureate nursing students (traditional n = 62, accelerated n = 64) were included. The traditional students worked with one agency over an 8-week period. The accelerated students worked with several agencies over the same period. Eighty-seven students provided complete data at both time points, and were included in analyses. MEASURES: Students answered questions at the beginning and end of the Spring 2014 semester to assess knowledge, confidence, satisfaction, and career intention related to PHN. RESULTS: At baseline, traditional students reported significantly higher confidence working independently and less intention to choose PHN as a career. Both cohorts reported a significant increase in knowledge and independence from pretest to posttest. At posttest, the accelerated group showed a significant decline in likelihood of choosing a PHN career. CONCLUSIONS: In developing PHN clinical curriculum, careful consideration should be given to the level of engagement with the community and faculty. Future work should continue exploring different PHN clinical education models to ensure students are effectively prepared in this area of nursing.

HPV vaccination series completion and co-vaccination: Pairing vaccines may matter for adolescents.

Very little is known about the effect of concurrent co-vaccination on HPV series completion. This study utilized a retrospective review of a Clinical Data Repository to assess whether concurrent vaccination had an impact on HPV vaccination series completion, and whether there were differences based on age. 3371 patients who received the HPV vaccine at a single academic medical center between the years 2009-2013 were included in this analysis. The adjusted odds ratio (aOR) for effect of concurrent vaccination on series completion for the age group 9-18 was 1.32 (95% CI 1.09, 1.60). Although not statistically significant, the aOR for effect of concurrent vaccination on completion changed direction for the 19-25 age group and was 0.44 (95% CI 0.17, 1.12). This study provides preliminary evidence that pairing the HPV vaccine with one or more co-vaccines may yield a higher HPV vaccination completion rate among adolescents age 9-18.

Cruise ships and bush medicine: globalization on the Atlantic Coast of Nicaragua and effects on the health of Creole women.

OBJECTIVES: Global health research into the relationship between health, economic inequalities, and globalization is necessary to address increasing health disparities in low income countries. Nicaragua has high levels of poverty and extreme poverty when compared with other Central and South American Countries. DESIGN AND SAMPLE: Photovoice and ethnographic research methods were used to explore health experiences of Creole women in Bluefields, Nicaragua and the intersections between culture, socioeconomic status, and gender. Twelve Creole women participants, ages 18-45. MEASURES: After initial focus groups, participants used disposable cameras to document health experiences. Follow-up interviews were conducted about the meaning of each photo. Participants then selected photos to be included in a city-wide photoshow. RESULTS: In initial focus groups, participants described great distress over changes they perceived in Creole culture and how these changes affect the health of the next generation. Participants related most of these changes to the economy and globalization. Photos taken were primarily of aspects of Creole culture, including household practices and traditional remedies from Creole culture. CONCLUSIONS: Findings on the relationships between culture, disease, and community-identified health risks in this minority population can help health care providers and public health policymakers develop and sustain culturally appropriate health interventions.

The Acceptability of Clean Delivery Kits on the Atlantic Coast of Nicaragua: A Focused Ethnography.

Anecdotal reports suggest rates of puerperal sepsis/umbilical cord infection in the Southern Atlantic Autonomous Region (RAAS) of Nicaragua are high, as maternal/infant mortality rates are. Clean delivery kits (CDKs; sealed containers, clean razor blades, soap, string to tie umbilical cords, and clean plastic sheeting) have been shown to decrease perinatal infection rates in low-income countries. Participant observation, focus groups, and key informant interviews with parties involved in delivery practices and policies were conducted in this focused ethnography to determine the cultural acceptability of CDKs for midwives in the RAAS. The CDKs were acceptable in their contents, although remain controversial. Although evidence points to deliveries taking place at home without the use of sterile equipment, the Ministry of Health policy is for deliveries to take place in hospitals/health clinics.

Rural health nursing research review: global perspectives.

The CINAHL and MEDLINE databases were used to conduct a review of international rural nursing research published between 2003 and 2007. In total, 41 articles were reviewed and organized based on the United Nations Human Development Index, which categorizes countries based on development status. Critical review of international rural nursing research yielded three major organizational themes: clinical issues, aspects of nursing practice, and nursing and health policy research. Despite the variety in international locale of the research, these themes and other common findings emerged. The need for increased access to specialized nursing knowledge, resources, and support is an ongoing issue facing nurses in rural and remote settings.