Motivational Interview on Having Pap Test Among Middle-Aged Women
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Family Medicine & Primary Care Review 2018; 20(2): 101–105 https://doi.org/10.5114/fmpcr.2018.76457 ISSN 1734-3402, eISSN 2449-8580 ORIGINAL PAPERS © Copyright by Wydawnictwo Continuo Motivational interview on having Pap test among middle-aged women – a counseling service in primary care MASUMEH MAHMOUDI MAJD ABADI1, A, B, KATAYON VAKILIAN2, C–G, VICTORIA SAFARI3, D, E 1 Student in counseling Midwifery, Nursing Midwifery School, Arak University of Medical Sciences, Arak, Iran 2 Nursing Midwifery School, Arak University of Medical Sciences, Arak, Iran 3 School of Medicine, Arak University of Medical Sciences, Arak, Iran A – Study Design, B – Data Collection, C – Statistical Analysis,D – Data Interpretation,E – Manuscript Preparation,F – Literature Search, G – Funds Collection Summary Background. Cognitive and mental factors, such as fear and embarrassment, along with the lack of counseling provision are among important barriers to uptake. Objectives. The aim was to establish whether motivational interview could affect women’s awareness, attitude and uptake of Pap testing. Material and methods. This randomized trial was conducted on 90 middle-aged women visiting the healthcare centers of Shazand county in 2016. Sampling was done in six urban centers. Would-be participants were identified by reviewing the profiles of middle-aged women (between 30 and 59 years) who did not keep up with routine screening and who met inclusion criteria. After obtaining their in- formed consent, the participants were placed in two groups (control and intervention), each with 45 subjects, using randomized block design in two blocks (A and B). Data collection instruments included a researcher-made questionnaire design-based on the research topic. In the intervention group, counseling was provided, using motivational interviewing, in five 90-minute sessions. All participants completed the questionnaire at baseline and two months after the end of the study. Collected data was analyzed with the independent t-test, Fisher’s exact test, Mann–Whitney U test and Wilcoxon test in SPSS 21. Results. Results showed a significant difference between groups in awareness (p = 0.001) and attitude (p = 0.001) at the end of the study. Moreover, 77.8% of women in the intervention and 11.1% in the control groups chose to undergo Pap testing (p = 0.004). Conclusions. Women’s adherence to cervical screening can be enhanced through motivational interviewing. It is also recommended to use this method for other screening tests. Key words: health, neoplasms, primary health care, motivation, interview. Abadi MMM, Vakilian K, Safari V. Motivational interview on having Pap test among middle-aged women – a counseling service in pri- mary care. Fam Med Prim Care Rev 2018; 20(2): 101–105, doi: https://doi.org/10.5114/fmpcr.2018.76457. Background Women with limited knowledge tend to have inaccurate perception of screening [5] and avoid regular uptake that is in Over 5,000,000 new cases of cervical cancer and 260,000 accordance to national standard guidelines [9]. Healthcare pro- related deaths were recorded worldwide in 2012. Cervical can- viders’ failure to offer counseling services has been identified as cer is the fourth prevalent type of cancer, with 90% of its re- a cause of poor adherence among such women [14]. In addition lated deaths occurring in developing countries [1]. Every year, to the lack of counseling provision [14], mental factors, such 80,000 new cases of the disease are diagnosed in Africa where as fear, embarrassment [15] and worry [16], as well as other 250 million women older than 15 years live. In contrast, the rate related issues, such as inherent costs of screening and/or lack is 12,000 in 170 million in America and 9,000 in 96 million in of proper insurance coverage [9], are also important barriers to East Europe. This difference indicates that women have limited uptake. However, considering the higher significance of mental awareness and/or inadequate access to screening services [2] in and psychological barriers compared to socioeconomic factors developing counties [2–5]. [11], counseling methods should be used to motivate women Iran has a large population (75 million people) of which 48% to undertake Pap testing and to overcome barriers to uptake were 15–65-year-old women in 2011 [6]. The incidence rate of [14]. In recent years, with regard to behaviour change, in health cervical cancer in Iran is five per 100,000 women [7]. Although promotion programs, focus has been placed upon motivation. religion plays a role in reducing the incidence rate of this cancer The need to increase motivations to change behavior is con- in Iran [8], studies have shown increasing rates of late diagno- sidered the key for successful healthy behaviors. According to sis and deaths in the country [9, 10]. Increased incidence and research, although training methods increase knowledge and death rates also depend on screening method, starting age and attitudes about the screening behaviors, in many cases, they do screening interval [11]. Domestic studies have highlighted that not result in continuous healthy practices. In addition, ways of Iranian women have limited knowledge about cancer screen- behavior change, such as encouragement were found to be not ing tests, including cervical screening [12, 13]. Herein, their low easy to achieve and professionals have often faced difficulties adherence to routine screening appointments can also be par- in overcoming prejudices. One of the difficulties in this regard tially attributed to their lack of access to healthcare system and arises when the recognised authorities are uncertain about or follow-up [9]. resist against change. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/). 102 M.M.M. Abadi, K. Vakilian, V. Safari • Motivational interview on having Pap test In addition to stimulating people’s motivation to change, Table 1. The structure and content of the motivational motivational interviewing has special purposes, i. e. reduction of interview in the intervention group ambivalence about change and enhancement of intrinsic moti- The first Introduction and preliminary discussions vation for change. When people suffer from a subject, the prob- session Introducing group regulations (session schedule lem is not always the lack of motivation; rather, there is an am- and confidentiality matters) bivalence toward the desired change: while they want change, Informing of counseling session objectives they also do not want it. Motivational interviewing can over- Change cycle: determining the position of each come the ambivalence and guide individuals toward the desired subject based on her current behavior change [17]. Consulting in the form of motivational interviewing creates an atmosphere where Medical professionals rather than The second Exploring positive and negative facets of main- session taining or changing behavior (not having Pap counselors are the advocates and the primary factors of change. testing) Furthermore, motivational interviewing acts based on the pre- Brainstorming the advantages and disadvantages -assumption that many clients seeking treatment have an am- of a behavior: risks of not having Pap testing bivalence state regarding change, and motivation may subside during treatment and need be re-increased and re-established. The third Defining values and practicing value prioritization Therefore, clinicians should coordinate themselves with these session Determining the conflict between values and cur- changes and rather than acting against them, they should facili- rent behavior: effect of behavior on values tate them and adjust interventions based on motivation. The fourth Investigating the intrinsic and extrinsic motivation Motivational interviewing is a client-directed method that session for change strengthens and enhances the intrinsic motivation of individu- Triggering personal capabilities of clients (ac- als, and discovers, identifies and resolves uncertainties and tivities showing the importance of health for ambivalence so as to induce behavior change. This strategy has clients) been extended from addiction treatment to the fields of health, Practicing decision-making to balance intrinsic health promotion, psychotherapy, to education and to chronic and extrinsic motivation disease treatment. The major objective of motivational inter- Reframing and defining failures of clients from view is to investigate and resolve the sense of uncertainty and their own views to trigger patient behavior change [17, 18]. The fifth Summarizing practices provided in previous ses- session sions within perspective practice and prepara- Objectives tion for change This study sought to determine whether motivational in- Materials terview could affect women’s awareness, attitude and intent to undertake Pap testing. A two-part questionnaire was used for data collection. The first part collected demographic information, fertility informa- tion and family history of cancer. The second part focused on Material and methods the individual’s awareness (17 items), attitude (10 items), in- tention (one item) and adherence to Pap testing (one item). Methods The questionnaire was developed based on the review of the available literature. Its content validity was then assessed by Study design 10 qualified instructors in the fields of midwifery and fertility This randomized clinical