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Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach

Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach
Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach

The global burden of cervical cancer remains a concern and higher early mortality rates are associated with poverty and limited health education. However, screening programs continue to face implementation challenges, especially in developing country contexts. In this study, we use a mixed-methods approach to understand the reasons for no-show behaviour for cervical cancer screening appointments among hard-to-reach low-income women in Bogotá, Colombia. In the quantitative phase, individual attendance probabilities are predicted using administrative records from an outreach program (N = 23384) using both LASSO regression and Random Forest methods. In the qualitative phase, semi-structured interviews are analysed to understand patient perspectives (N = 60). Both inductive and deductive coding are used to identify first-order categories and content analysis is facilitated using the Framework method. Quantitative analysis shows that younger patients and those living in zones of poverty are more likely to miss their appointments. Likewise, appointments scheduled on Saturdays, during the school vacation periods or with lead times longer than 10 days have higher no-show risk. Qualitative data shows that patients find it hard to navigate the service delivery process, face barriers accessing the health system and hold negative beliefs about cervical cytology.

1932-6203
Barrera Ferro, David
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Bayer, Steffen
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Bocanegra, Laura
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Brailsford, Sally
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Díaz, Adriana
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Gutiérrez-Gutiérrez, Elena Valentina
13369cdc-fa8f-4a8b-8af6-2baa8034c10c
Smith, Honora
1eaef6a6-4b9c-4997-9163-137b956c06b5
Barrera Ferro, David
fd5d8392-4ffd-4982-867a-ef38c0ef05eb
Bayer, Steffen
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
Bocanegra, Laura
034acc30-f756-4b28-8a45-83220c854829
Brailsford, Sally
634585ff-c828-46ca-b33d-7ac017dda04f
Díaz, Adriana
6274f879-f34b-4052-add3-a38a414d027b
Gutiérrez-Gutiérrez, Elena Valentina
13369cdc-fa8f-4a8b-8af6-2baa8034c10c
Smith, Honora
1eaef6a6-4b9c-4997-9163-137b956c06b5

Barrera Ferro, David, Bayer, Steffen, Bocanegra, Laura, Brailsford, Sally, Díaz, Adriana, Gutiérrez-Gutiérrez, Elena Valentina and Smith, Honora (2022) Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach. PLoS ONE, 17 (7), [e0271874]. (doi:10.1371/journal.pone.0271874).

Record type: Article

Abstract

The global burden of cervical cancer remains a concern and higher early mortality rates are associated with poverty and limited health education. However, screening programs continue to face implementation challenges, especially in developing country contexts. In this study, we use a mixed-methods approach to understand the reasons for no-show behaviour for cervical cancer screening appointments among hard-to-reach low-income women in Bogotá, Colombia. In the quantitative phase, individual attendance probabilities are predicted using administrative records from an outreach program (N = 23384) using both LASSO regression and Random Forest methods. In the qualitative phase, semi-structured interviews are analysed to understand patient perspectives (N = 60). Both inductive and deductive coding are used to identify first-order categories and content analysis is facilitated using the Framework method. Quantitative analysis shows that younger patients and those living in zones of poverty are more likely to miss their appointments. Likewise, appointments scheduled on Saturdays, during the school vacation periods or with lead times longer than 10 days have higher no-show risk. Qualitative data shows that patients find it hard to navigate the service delivery process, face barriers accessing the health system and hold negative beliefs about cervical cytology.

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Accepted/In Press date: 14 August 2020
e-pub ahead of print date: 22 July 2022
Additional Information: Funding Information: DBF research is funded by a PhD scholarship (Grant 3929446) 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). There was no additional external funding received for this study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022 Barrera Ferro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Local EPrints ID: 468873
URI: http://eprints.soton.ac.uk/id/eprint/468873
ISSN: 1932-6203
PURE UUID: d8a4c209-1e79-4d1f-b845-c5cfa94fa5db
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

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Date deposited: 30 Aug 2022 17:03
Last modified: 17 Nov 2022 02:37

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Contributors

Author: David Barrera Ferro
Author: Steffen Bayer ORCID iD
Author: Laura Bocanegra
Author: Adriana Díaz
Author: Elena Valentina Gutiérrez-Gutiérrez
Author: Honora Smith ORCID iD

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