Face-to-face education and cervical cancer screening in Libya

Face-to-face education and cervical cancer screening in Libya

by Israa Laklouk -
  1. A.   What evidence are you proposing to translate into practice?

Libya, one of the developing countries, lacks sufficient well-organized cervical screening programs. Pap smear has been used as a diagnostic test for the symptomatic women who most likely were diagnosed with invasive carcinoma.

In addition, the Libyan women are not aware about the cervical cancer and the effectiveness of Pap smear to diagnose the early stages of the neoplastic changes 

I propose that face-to-face education by health care providers is an effective interventions aimed at women to encourage the uptake of cervical cancer screening 

  1. Justify that this evidence is “ready for translation.”

Cochrane review was last updated in 2011, the eligible RCT studies support the use of invitation letters and/or telephone calls for increasing the uptake of Pap smears as a screening tool. There was strong evidence to suggest that face-to-face education may also increase Pap smear uptake. 1

  1. Identify a single, key behavior change target for your translational activity.

I think there are two key behavior changes:

  • Health providers:  spend time to educate their female patients about the cervical cancer screen as a secondary prevention method.
  • Target Women: encourage the woman at risk (every sexually active woman ) to  have the Cervical cytology (Pap smear ) least once in their lifetime.
  1. Conduct a “gap analysis” of your target behavior.  Look to diverse sources for “best guess” estimates if specific measures are not available.

The effective cervical cancer screen shows that 70%–80% women at risk should be screened once every five years, or at least once in their lifetime. Besides, all  test-positive cases must receive treatment.2

The screening program needs to be sustainable. Otherwise, the screening program would not effective to decrease incidence of  cervical cancer in the future

  1. B.     What is the quality (performance) gap?

There is no specific data but there is no national screening programs, and the majority of Pap smear done as a diagnostic test 

  1. C.   What is the outcome gap?
  • Missing the early stage of the precancerous changes treatable,
  • High morbidity and mortality form late detection of incisive cancer   

D.  Is there evidence that changing performance will improve health (clinical outcomes)? 

There is strong evidence that increase uptake cervical cancer screen helps reduce  cervical carcinoma  incidence and associated morbidity and mortality.

 

 

References:

1-    Everett T, Bryant A, Griffin MF, Martin-Hirsch PPL, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD002834. DOI: 10.1002/14651858.CD002834.pub2.

2-    Chumworathayi B. Interventions targeted at women to encourage the uptake of cervical screening: RHL commentary (last revised: 1 November 2012). The WHO Reproductive Health Library; Geneva: World Health Organization.

Re: Face-to-face education and cervical cancer screening in Libya

by Nicole Ling -

Hi Israa,

It sounds like there is need, even if not totally documented in the literature (perhaps you are working on establishing this).  I am curious if there is any literature to suggest that this type of intervention would be culturally acceptable to practicing physicians and patients in this community.  I think if there is this acceptance/buy in from the community, that may help you build your case for implementing this intervention.  

It seems like a challenging task to roll out - and I see why you have suggested that sexually active women all receive one pap smear at least once in their lifetime, but in order to fully benefit from intervention (and offset the resources it will take provide this care) I wonder if there should be more frequent screening or finding a certain time in life (age range) that screening will yield to most benefit.

 

Nicole

Re: Face-to-face education and cervical cancer screening in Libya

by Israa Laklouk -

 Hi Nicole

Thank you for your comment!
I do not have evidence to support my opinion, but I think the education about the cancer screen will be widely accepted in the Libyan community. Women awareness about Pap smear test, treatability of cervical cancer and preventability of cervical cancer will improve utilization of Pap smear as a screening test . Therefore, the physicians should provide  sufficient educational information about the befits of the Pap smear as the screening tool to the patients will be the first step to making a change.
I will give an example; there is considerably number of Libyan women in USA have  good health insurance converge form the Libyan government , most of them ( I don’t want to say 100%) have their first pap smear when they came to USA because the physician here would ask  when was the last pap smear . just one question will encourage those women to take the Pap smear. I don’t have evidence to support my opinion but If  this  is the case  even if the same women live in Libya they will accept to have a cervical  cancer screening test  .
I agree with you about the fully benefit of the intervention would be reached with more frequent screening. also  the age rage of the sexually active women at risk is around 20-60 years

Israa