Barriers to adherence to cytology exam: a case study in low-income Colombian women.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Uterine Cervical Neoplasms*/diagnosis ; Uterine Cervical Neoplasms*/prevention & control; Female ; Humans ; Colombia ; Poverty ; Vaginal Smears ; Delivery of Health Care ; Early Detection of Cancer

Background: Cervical cytology is essential for the early detection of cervical cancer. However, in Colombia, only 50% of women with subsidized health insurance were screened in 2019, compared to 100% of women with contributory insurance. This disparity highlights significant barriers that must be addressed. This study aimed to identify the factors that contribute to or hinder adherence to cervical cytology screening among low-income women with subsidized health insurance in a public primary care network in Cali, Colombia, from 2014 to 2018.
Methods: In a qualitative case study, the experience of women and health care and administrative personnel was recovered. Forty-seven women participated in seven focus group discussions. Five other women using the program participated in in-depth interviews. Finally, we interviewed eight people from the healthcare area and the health services administration. The qualitative data collected underwent content analysis, guided by the theoretical framework of Social Determinants of Health. Within this framework, five interconnected dimensions that influence adherence were incorporated.
Results: Adherence is a multifactorial phenomenon, and in relation to attendance at cervical cytology, the analysis delved into the mechanisms that affect it in a low-income context. Barriers to adherence were identified across multiple dimensions, including social and economic factors, health conditions, and patient-related factors, among both adherent and non-adherent women. Among adherent women, barriers and facilitators related to the healthcare team and system, as well as patient-related factors, were identified.
Conclusions: The findings of this research can be useful in developing personalized interventions and strategies to improve adherence and screening outcomes in low-income settings. It is necessary to increase the resources of health insurance entities to establish effective communication channels with women who attend the cervical cancer prevention program.
(© 2023. The Author(s).)

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125189783229, 897/2021 Colombian Ministry of Science, Technology and Innovation; 125189783229, 897/2021 Colombian Ministry of Science, Technology and Innovation; 130100131 Pontificia Universidad Javeriana Cali, Colombia; 130100131 Pontificia Universidad Javeriana Cali, Colombia

Keywords: Cervical neoplasms; Cytology, Treatment Adherence and Compliance, early detection of Cancer; Secondary Prevention

Date Created: 20230725 Date Completed: 20230727 Latest Revision: 20230728

20231215

PMC10369816

10.1186/s12913-023-09700-4

37491282