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. 2018 Aug 22;15(9):1804.
doi: 10.3390/ijerph15091804.

Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women

Vincenzo Restivo  1 , Claudio Costantino  2 , Antonello Marras  3 , Giuseppe Napoli  4 , Sabrina Scelfo  5 , Tiziana Scuderi  6 , Alessandra Casuccio  7 , Achille Cernigliaro  8 , Angela Giusti  9 , Stefania Spila Alegiani  10
Affiliations

Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women

Vincenzo Restivo et al. Int J Environ Res Public Health. .

Abstract

Cervical cancer screening is uncommon, especially in low-income countries and among lower socioeconomic status people in high-income countries. The aims of this study were to examine the adherence of Sicilian women to Pap testing and to identify the determinants of this in a population with a secondary prevention attitude lower than high-income countries and the national average. A cross-sectional study called "Save Eva in Sicily" was conducted among all women aged 25⁻64 years, with a sample drawn by the list of general practitioners (GPs), using a proportional sampling scheme, stratified by age and resident population. The study outcome was performing a Pap test within the past three years. The association between the outcome and Pap test determinants was analyzed through a multivariable logistic regression. Among the 365 interviewed women, 66% (n = 243) had a Pap test during the last 3 years. On the other hand, 18% of the other women (n = 66) had performed at least one Pap test previously and 16% (n = 56) had never had a Pap test. In a multivariable model, GPs' advice (adjusted OR 2.55; 95% CI 1.57⁻4.14) and perceived susceptibility (adjusted OR 3.24; 95% CI 1.92⁻5.48) increased the likelihood of the execution of a Pap test. The "Save Eva in Sicily" study identified GP advice and perceived cancer severity as the main correlates of Pap testing among Sicilian women, producing evidence regarding how policy makers can increase compliance. Interventions to increase Pap test adhesion should focus on stimulating GPs to identify patients who regularly do not undergo it and to recommend testing on a regular basis to their patients.

Keywords: Pap test; cervical cancer; general practitioner; health belief model; prevention; refusal; screening; susceptibility.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of “Save Eva in Sicily” study.
Figure 2
Figure 2
Perceived barriers to Pap test screening for women who did not perform a Pap test during the last three years.
See this image and copyright information in PMC

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