Effect of a call recall system on uptake of cervical cancer screening among non compliant school teachers in Kuala Lumpur / Fauziah Abdullah

• Main Author: Abdullah, Fauziah
• Format: Thesis
• Published: 2013
• Subjects: R Medicine (General)
• Online Access: http://studentsrepo.um.edu.my/6114/1/Dr_Fauziah_Abdullah_MHC090007_DrPH_Final_Thesis_2013.pdf; http://studentsrepo.um.edu.my/6114/
• Institution: Universiti Malaya

Introduction: The Pap smear has been regarded an important cervical screening tool since the 1940s. However, women’s adherence to screening practices remains unsatisfactory, especially in developing countries. Indeed, the significance of the Pap smear has been overlooked by beneficiaries in Malaysia. Therefore, cervical cancer remains a major public health problem. An opportunistic cervical screening programme was introduced in Malaysia in the 1960s. However, Pap smear coverage is still unsatisfactory, underlining the need to implement an alternative approach. The aims of this study are to determine the effect of a call-recall system regarding Pap smear practices among non-compliant school teachers and to explore both women’s and provider’s perceptions about different cervical screening programmes. Methods: Both quantitative and qualitative methods were applied. A community trial study as a main method was conducted in 40 public secondary schools in Malaysia among 403 female teachers. Schools were selected by cluster random sampling. A cluster randomization method was used in assigning schools to both groups. An intervention group received an organized call-recall programme, while the control group received an opportunistic programme; and followed for 24 weeks. Data were collected from January to November 2010 using pre-tested, self-administered questionnaires. Questionnaires were applied at baseline and post-intervention. The primary outcome measure was Pap smear uptake within 24 weeks. Multivariate logistic regression was performed to determine the impact of intervention programme on Pap smear practices. Participants’ perceptions of screening programmes were investigated based on their satisfaction and experience. In qualitative method, 11 key informant interviews with policy makers and health care providers from the Ministry of Health in Malaysia were conducted from October 2009 to May 2010. Interviewees’ perceptions of different screening programmes were explored based on their expertise and experience. Results: The proportion of women who had Pap smears was significantly higher in intervention than control group (18.1 versus 10.1%). A call-recall system doubled the Pap smear uptake within 24 weeks with an adjusted odds ratio of 2.44 (95% CI 1.29-4.62), and showed 1.5 times more improvement in the changes of motivation stage (95% CI 1.01- 2.26). Participants in both groups perceived a higher satisfaction level in the screening programme, but more with organized programme (94.5 versus 89.4%). In control group, participants perceived opportunistic programme with lack of promotion and recruitment strategy. Conversely, intervention group was perceived as an organized programme with positive effects in informing and reminding women on Pap smear, especially in women with time and attitude barriers. Hence, they have suggested establishing an organized programme. Providers viewed the current programme in Malaysia faces flaws in implementation, monitoring, and evaluation that failed to reduce cervical cancer burden. The main identified weaknesses were poor acceptance, lack of commitment in promoting Pap smear screening by health care providers, and improper follow-up system. Additionally, all interviewees perceived organized programme an alternative approach in terms of both feasibility and acceptability. Conclusion: A call-recall system has shown to have a more positive effect on increasing Pap smear practice among non-compliant women than opportunistic programme. Thus, the current opportunistic programme should be replaced with call-recall system. This would improve the cervical screening coverage and consequently help prevent cervical cancer.