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Improving intervention design to promote cervical cancer screening among hard-to-reach women: assessing beliefs and predicting individual attendance probabilities in Bogotá, Colombia

Improving intervention design to promote cervical cancer screening among hard-to-reach women: assessing beliefs and predicting individual attendance probabilities in Bogotá, Colombia
Improving intervention design to promote cervical cancer screening among hard-to-reach women: assessing beliefs and predicting individual attendance probabilities in Bogotá, Colombia
Background

Despite being a preventable disease, cervical cancer continues to be a public health concern, affecting mainly lower and middle-income countries. Therefore, in Bogotá a home-visit based program was instituted to increase screening uptake. However, around 40% of the visited women fail to attend their Pap smear test appointments. Using this program as a case study, this paper presents a methodology that combines machine learning methods, using routinely collected administrative data, with Champion’s Health Belief Model to assess women’s beliefs about cervical cancer screening. The aim is to improve the cost-effectiveness of behavioural interventions aiming to increase attendance for screening. The results presented here relate specifically to the case study, but the methodology is generic and can be applied in all low-income settings.

Methods

This is a cross-sectional study using two different datasets from the same population and a sequential modelling approach. To assess beliefs, we used a 37-item questionnaire to measure the constructs of the CHBM towards cervical cancer screening. Data were collected through a face-to-face survey (N = 1699). We examined instrument reliability using Cronbach’s coefficient and performed a principal component analysis to assess construct validity. Then, Kruskal–Wallis and Dunn tests were conducted to analyse differences on the HBM scores, among patients with different poverty levels. Next, we used data retrieved from administrative health records (N = 23,370) to fit a LASSO regression model to predict individual no-show probabilities. Finally, we used the results of the CHBM in the LASSO model to improve its accuracy.

Results

Nine components were identified accounting for 57.7% of the variability of our data. Lower income patients were found to have a lower Health motivation score (p-value < 0.001), a higher Severity score (p-value < 0.001) and a higher Barriers score (p-value < 0.001). Additionally, patients between 25 and 30 years old and with higher poverty levels are less likely to attend their appointments (O.R 0.93 (CI: 0.83–0.98) and 0.74 (CI: 0.66–0.85), respectively). We also found a relationship between the CHBM scores and the patient attendance probability. Average AUROC score for our prediction model is 0.9.

Conclusion

In the case of Bogotá, our results highlight the need to develop education campaigns to address misconceptions about the disease mortality and treatment (aiming at decreasing perceived severity), particularly among younger patients living in extreme poverty. Additionally, it is important to conduct an economic evaluation of screening options to strengthen the cervical cancer screening program (to reduce perceived barriers). More widely, our prediction approach has the potential to improve the cost-effectiveness of behavioural interventions to increase attendance for screening in developing countries where funding is limited.

Cervical cancer screening, Hard-to-reach women, Health belief model, No-show prediction
1472-6874
212
Barrera Ferro, David
fd5d8392-4ffd-4982-867a-ef38c0ef05eb
Bayer, Steffen
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
Brailsford, Sally
634585ff-c828-46ca-b33d-7ac017dda04f
Smith, Honora
1eaef6a6-4b9c-4997-9163-137b956c06b5
Barrera Ferro, David
fd5d8392-4ffd-4982-867a-ef38c0ef05eb
Bayer, Steffen
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
Brailsford, Sally
634585ff-c828-46ca-b33d-7ac017dda04f
Smith, Honora
1eaef6a6-4b9c-4997-9163-137b956c06b5

Barrera Ferro, David, Bayer, Steffen, Brailsford, Sally and Smith, Honora (2022) Improving intervention design to promote cervical cancer screening among hard-to-reach women: assessing beliefs and predicting individual attendance probabilities in Bogotá, Colombia. BMC Women’s Health, 22 (1), 212, [212]. (doi:10.1186/s12905-022-01800-3).

Record type: Article

Abstract

Background

Despite being a preventable disease, cervical cancer continues to be a public health concern, affecting mainly lower and middle-income countries. Therefore, in Bogotá a home-visit based program was instituted to increase screening uptake. However, around 40% of the visited women fail to attend their Pap smear test appointments. Using this program as a case study, this paper presents a methodology that combines machine learning methods, using routinely collected administrative data, with Champion’s Health Belief Model to assess women’s beliefs about cervical cancer screening. The aim is to improve the cost-effectiveness of behavioural interventions aiming to increase attendance for screening. The results presented here relate specifically to the case study, but the methodology is generic and can be applied in all low-income settings.

Methods

This is a cross-sectional study using two different datasets from the same population and a sequential modelling approach. To assess beliefs, we used a 37-item questionnaire to measure the constructs of the CHBM towards cervical cancer screening. Data were collected through a face-to-face survey (N = 1699). We examined instrument reliability using Cronbach’s coefficient and performed a principal component analysis to assess construct validity. Then, Kruskal–Wallis and Dunn tests were conducted to analyse differences on the HBM scores, among patients with different poverty levels. Next, we used data retrieved from administrative health records (N = 23,370) to fit a LASSO regression model to predict individual no-show probabilities. Finally, we used the results of the CHBM in the LASSO model to improve its accuracy.

Results

Nine components were identified accounting for 57.7% of the variability of our data. Lower income patients were found to have a lower Health motivation score (p-value < 0.001), a higher Severity score (p-value < 0.001) and a higher Barriers score (p-value < 0.001). Additionally, patients between 25 and 30 years old and with higher poverty levels are less likely to attend their appointments (O.R 0.93 (CI: 0.83–0.98) and 0.74 (CI: 0.66–0.85), respectively). We also found a relationship between the CHBM scores and the patient attendance probability. Average AUROC score for our prediction model is 0.9.

Conclusion

In the case of Bogotá, our results highlight the need to develop education campaigns to address misconceptions about the disease mortality and treatment (aiming at decreasing perceived severity), particularly among younger patients living in extreme poverty. Additionally, it is important to conduct an economic evaluation of screening options to strengthen the cervical cancer screening program (to reduce perceived barriers). More widely, our prediction approach has the potential to improve the cost-effectiveness of behavioural interventions to increase attendance for screening in developing countries where funding is limited.

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More information

Accepted/In Press date: 5 May 2022
Published date: 7 June 2022
Additional Information: Funding Information: The first author’s research is partially funded by a PhD scholarship from the healthcare research stream of the program Colombia Científica–Pasaporte a la Ciencia, granted by the Colombian Institute for Educational Technical Studies Abroad (Instituto Colombiano de Crédito Educativo y Estudios Técnicos en el Exterior, ICETEX). Publisher Copyright: © 2022, The Author(s).
Keywords: Cervical cancer screening, Hard-to-reach women, Health belief model, No-show prediction

Identifiers

Local EPrints ID: 468855
URI: http://eprints.soton.ac.uk/id/eprint/468855
ISSN: 1472-6874
PURE UUID: 7e431054-033a-4048-9bf1-cf4b79dfc753
ORCID for Steffen Bayer: ORCID iD orcid.org/0000-0002-7872-467X
ORCID for Sally Brailsford: ORCID iD orcid.org/0000-0002-6665-8230
ORCID for Honora Smith: ORCID iD orcid.org/0000-0002-4974-3011

Catalogue record

Date deposited: 30 Aug 2022 16:44
Last modified: 17 Nov 2022 02:37

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Contributors

Author: David Barrera Ferro
Author: Steffen Bayer ORCID iD
Author: Honora Smith ORCID iD

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