Research article Topical Sections

Recruitment strategies for cervical cancer screening in three Mediterranean low and middle-income countries: Albania, Montenegro, and Morocco

  • Received: 11 March 2024 Revised: 15 May 2024 Accepted: 23 May 2024 Published: 31 May 2024
  • Introduction

    Cervical cancer (CC) poses a substantial burden in low-and middle-income countries (LMICs), where challenges in implementing effective screening programs and achieving high participation rates persist.

    Aims

    This study sought to compare different strategies for recruiting women for CC screening in Albania, Montenegro, and Morocco, and compared usual care (ongoing invitation method) with an alternative approach (intervention strategy).

    Methods

    Within each country, the following comparisons were made: face-to-face (FF) invitations versus phone calls (PCs) in Albania, PCs versus letter invitations in Montenegro, and FF invitations to women attending healthcare centers versus a combined approach termed “Invitation made in Morocco” (utilizing PC and FF for hard-to-reach women) in Morocco. Questionnaires that assessed facilitators and barriers to participation were administered to women who either attended or refused screening.

    Results

    In Albania, significant differences in the examination coverage were observed between the invitation methods (PC: 46.1% vs. FF: 87.1%, p < 0.01) and between the rural and urban settings (rural: 89.1% vs. urban: 76.3%, p < 0.01). In Montenegro, the coverage varied based on the recruitment method (PC: 17.7% vs. letter invitation: 7.6%; p < 0.01), the setting (urban: 28.3% vs. rural: 13.2%; p < 0.01), and age (<34 years: 10.9% vs. 34+: 9.6%, p < 0.01). In Morocco, no significant differences were observed. Common screening facilitators included awareness of CC prevention and understanding the benefits of early diagnosis, while key barriers included a limited perception of personal CC risk and the fear of testing positive.

    Discussion

    FF appeared to be effective in promoting participation, but its broader implementation raised sustainability concerns. PC invitations proved feasible, albeit necessitating updates to population registries. Restricting FF contacts for hard-to-reach communities may enhance the affordability and equity.

    Citation: Elisa Camussi, Lina Jaramillo, Roberta Castagno, Marta Dotti, Gianluigi Ferrante, Latifa Belakhel, Youssef Chami Khazraji, Alban Ylli, Kozeta Filipi, Đjurđjica Ostojić, Milica Stanisic, Luigi Bisanti, Livia Giordano. Recruitment strategies for cervical cancer screening in three Mediterranean low and middle-income countries: Albania, Montenegro, and Morocco[J]. AIMS Medical Science, 2024, 11(2): 99-112. doi: 10.3934/medsci.2024009

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  • Introduction

    Cervical cancer (CC) poses a substantial burden in low-and middle-income countries (LMICs), where challenges in implementing effective screening programs and achieving high participation rates persist.

    Aims

    This study sought to compare different strategies for recruiting women for CC screening in Albania, Montenegro, and Morocco, and compared usual care (ongoing invitation method) with an alternative approach (intervention strategy).

    Methods

    Within each country, the following comparisons were made: face-to-face (FF) invitations versus phone calls (PCs) in Albania, PCs versus letter invitations in Montenegro, and FF invitations to women attending healthcare centers versus a combined approach termed “Invitation made in Morocco” (utilizing PC and FF for hard-to-reach women) in Morocco. Questionnaires that assessed facilitators and barriers to participation were administered to women who either attended or refused screening.

    Results

    In Albania, significant differences in the examination coverage were observed between the invitation methods (PC: 46.1% vs. FF: 87.1%, p < 0.01) and between the rural and urban settings (rural: 89.1% vs. urban: 76.3%, p < 0.01). In Montenegro, the coverage varied based on the recruitment method (PC: 17.7% vs. letter invitation: 7.6%; p < 0.01), the setting (urban: 28.3% vs. rural: 13.2%; p < 0.01), and age (<34 years: 10.9% vs. 34+: 9.6%, p < 0.01). In Morocco, no significant differences were observed. Common screening facilitators included awareness of CC prevention and understanding the benefits of early diagnosis, while key barriers included a limited perception of personal CC risk and the fear of testing positive.

    Discussion

    FF appeared to be effective in promoting participation, but its broader implementation raised sustainability concerns. PC invitations proved feasible, albeit necessitating updates to population registries. Restricting FF contacts for hard-to-reach communities may enhance the affordability and equity.


    Abbreviations

    CC

    Cervical cancer

    EuMedCN

    European Mediterranean Cancer Network

    FF

    Face-to-face

    HICs

    High-income countries

    HPV

    Human Papilloma Virus

    IMM

    Invitation made in Morocco

    LMICs

    Low-and middle-income countries

    PC

    Phone call

    WHO

    World Health Organization

    加载中


    Author contributions



    Camussi Elisa: statistical analysis, writing, review & editing; Jaramillo Lina: study design, statistical analysis, writing; Castagno Roberta: writing, review & editing; Dotti Marta: writing; Ferrante Gianluigi: writing, review & editing; Belakhel Latifa: study design, writing, review & editing; Chami Khazraji Youssef: study design, writing, review & editing; Ylli Alban: study design, writing, review & editing; Filipi Kozeta: study design, writing, review & editing; Ostojić Đjurđjica: study design, writing, review & editing; Stanisic Milica: study design, writing, review & editing; Bisanti Luigi: writing, review & editing; Giordano Livia: study design, validation, writing, review & editing, supervision. All authors have read and approved the final version of the manuscript for publication.

    Conflict of interest



    The authors report there are no conflicting interests to declare.

    [1] Bray F, Laversanne M, Sung H, et al. (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74: 229-263. https://doi.org/10.3322/caac.21834
    [2] Hull R, Mbele M, Makhafola T, et al. (2020) Cervical cancer in low and middle-income countries. Oncol Lett 20: 2058-2074. https://doi.org/10.3892/ol.2020.11754
    [3] Ebrahimi N, Yousefi Z, Khosravi G, et al. (2023) Human papillomavirus vaccination in low- and middle-income countries: progression, barriers, and future prospective. Front Immunol 14: 1150238. https://doi.org/10.3389/fimmu.2023.1150238
    [4] Duncan J, Harris M, Skyers N, et al. (2021) A call for low-and middle-income countries to commit to the elimination of cervical cancer. Lancet Reg Health Am 2. https://doi.org/10.1016/j.lana.2021.100036
    [5] Bruni L, Serrano B, Roura E, et al. (2022) Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis. Lancet Glob Health 10: e1115-e1127. https://doi.org/10.1016/S2214-109X(22)00241-8
    [6] Srinath A, van Merode F, Rao SV, et al. (2023) Barriers to cervical cancer and breast cancer screening uptake in low- and middle-income countries: a systematic review. Health Policy Plan 38: 509-527. https://doi.org/10.1093/heapol/czac104
    [7] Devarapalli P, Labani S, Nagarjuna N, et al. (2018) Barriers affecting uptake of cervical cancer screening in low and middle income countries: a systematic review. Indian J Cancer 55: 318-326. https://doi.org/10.4103/ijc.IJC_253_18
    [8] Petersen Z, Jaca A, Ginindza TG, et al. (2022) Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Womens Health 22: 486. https://doi.org/10.1186/s12905-022-02043-y
    [9] World Health OrganizationGlobal strategy to accelerate the elimination of cervical cancer as a public health problem (2020).
    [10] Giordano L, Bisanti L, Salamina G, et al. (2016) The EUROMED CANCER network: state-of-art of cancer screening programmes in non-EU Mediterranean countries. Eur J Public Health 26: 83-89. https://doi.org/10.1093/eurpub/ckv107
    [11] Union for the MediterraneanThe WoRTH project: women's right to health. Available from: https://ufmsecretariat.org/project/womens-right-to-health-the-worth-project
    [12] Tavasoli SM, Pefoyo AJ, Hader J, et al. (2016) Impact of invitation and reminder letters on cervical cancer screening participation rates in an organized screening program. Prev Med 88: 230-236. https://doi.org/10.1016/j.ypmed.2016.04.019
    [13] Camilloni L, Ferroni E, Cendales BJ, et al. (2013) Methods to increase participation in organised screening programs: a systematic review. BMC Public Health 13: 1-16. https://doi.org/10.1186/1471-2458-13-464
    [14] Staley H, Shiraz A, Shreeve N, et al. (2021) Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 9: CD002834. https://doi.org/10.1002/14651858.CD002834.pub3
    [15] Antinyan A, Bertoni M, Corazzini L (2021) Cervical cancer screening invitations in low and middle income countries: evidence from Armenia. Soc Sci Med 273: 113739. https://doi.org/10.1016/j.socscimed.2021.113739
    [16] Devi S, Joshi S (2023) The effect of multimodal interventions regarding early cervical cancer diagnosis on the women's knowledge, attitude and participation in cervical screening program. Asian Pac J Cancer Prev 24: 3949-3956. https://doi.org/10.31557/APJCP.2023.24.11.3949
    [17] Decker KM, Turner D, Demers AA, et al. (2013) Evaluating the effectiveness of cervical cancer screening invitation letters. J Womens Health 22: 687-693. https://doi.org/10.1089/jwh.2012.4203
    [18] Rees I, Jones D, Chen H, et al. (2018) Interventions to improve the uptake of cervical cancer screening among lower socioeconomic groups: a systematic review. Prev Med J 111: 323-335. https://doi.org/10.1016/j.ypmed.2017.11.019
    [19] Vale DB, Teixeira JC, Bragança JF, et al. (2021) Elimination of cervical cancer in low- and middle-income countries: inequality of access and fragile healthcare systems. Int J Gynaecol Obstet 152: 7-11. https://doi.org/10.1002/ijgo.13458
    [20] Orwat J, Caputo N, Key W, et al. (2017) Comparing rural and urban cervical and breast cancer screening rates in a privately insured population. Soc Work Public Health 32: 311-323. https://doi.org/10.1080/19371918.2017.1289872
    [21] Diendéré J, Kiemtoré S, Coulibaly A, et al. (2023) Low attendance in cervical cancer screening, geographical disparities and sociodemographic determinants of screening uptake among adult women in Burkina Faso: results from the first nationwide population-based survey. Rev Epidemiol Sante 71: 101845. https://doi.org/10.1016/j.respe.2023.101845
    [22] Donovan J, O'Donovan C, Nagraj S (2019) The role of community health workers in cervical cancer screening in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health 4: e001452. https://doi.org/10.1136/bmjgh-2019-001452
    [23] Darj E, Chalise P, Shakya S (2019) Barriers and facilitators to cervical cancer screening in Nepal: a qualitative study. Sex Reprod Healthc 20: 20-26. https://doi.org/10.1016/j.srhc.2019.02.001
    [24] Black E, Hyslop F, Richmond R (2019) Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review. BMC Womens Health 19: 108. https://doi.org/10.1186/s12905-019-0809-z
    [25] Liebermann EJ, VanDevanter N, Shirazian T, et al. (2020) Barriers to cervical cancer screening and treatment in the Dominican Republic: perspectives of focus group participants in the Santo Domingo area. J Transcult Nurs 31: 121-127. https://doi.org/10.1177/1043659619846247
    [26] Zhang M, Sit JWH, Chan DNS, et al. (2022) Educational interventions to promote cervical cancer screening among rural populations: a systematic review. Int J Environ Res Public Health 19: 6874. https://doi.org/10.3390/ijerph19116874
    [27] Zhang D, Advani S, Waller J, et al. (2020) Mobile technologies and cervical cancer screening in low- and middle-income countries: a systematic review. JCO Glob Oncol 6: 617-627. https://doi.org/10.1200/JGO.19.00201
    [28] Uy C, Lopez J, Trinh-Shevrin C, et al. (2017) Text messaging interventions on cancer screening rates: a systematic review. J Med Internet Res 19: e296. https://doi.org/10.2196/jmir.7893
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