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The Utilization and Barriers of Pap Smear Among Women with Visual Impairment Wen-Hui Fang1, Chia-Feng Yen2*, Jung Hu3, Jin-Ding Lin4 and Ching-Hui Loh1

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The Utilization and Barriers of Pap Smear Among Women with Visual Impairment Wen-Hui Fang1, Chia-Feng Yen2*, Jung Hu3, Jin-Ding Lin4 and Ching-Hui Loh1 Fang et al. International Journal for Equity in Health (2016) 15:65 DOI 10.1186/s12939-016-0354-4 RESEARCH Open Access The utilization and barriers of Pap smear among women with visual impairment Wen-Hui Fang1, Chia-Feng Yen2*, Jung Hu3, Jin-Ding Lin4 and Ching-Hui Loh1 Abstract Background: Many evidences illustrate that the Pap smear screening successfully reduces if the cervical cancer could be detected and treated sufficiently early. People with disability were higher comorbidity prevalence, and less likely to use preventive health care and health promotion activities. There were also to demonstrate that people with visual impairment has less access to appropriate healthcare services and is less likely to receive screening examinations. In Taiwan, there was no study to explore utilization of Pap smear, associated factors and use barriers about Pap smear screening test among women with visual impairment. The purpose is to explore the utilization and barriers of using Pap smear for women with visual impairment in Taiwan. To identify the barriers of women with visual from process of receiving Pap smear screening test. Methods: The cross-sectional study was conducted and the totally 316 participators were selected by stratified proportional and random sampling from 15 to 64 year old women with visual impairment who lived in Taipei County during December 2009 to January 2010. The data was been collected by phone interview and the interviewers were well trained before interview. Results: The mean age was 47.1 years old and the highest percentage of disabled severity was mile (40.2 %). Totally, 66.5 % of participators were ever using Pap smear and 38.9 % used it during pass 1 year. Their first time to accept Pap smear was 38.8 year old. There was near 50 % of them not to be explained by professionals before accepting the Pap smear. For non-using cases, the top two percentage of barriers were “feel still younger” (22.3 %), the second was “there’s no sexual experience” (21.4 %). We found the gynecology experiences was key factor for women with visual impairment to use Pap smear, especially the experiences was during 1 year (OR = 4). Conclusions: Associated factors and barriers to receive Pap smear screening test for women with visual impairment can be addressed through interventions aimed at improving on cognitions and attitudes for cervical cancer risk factors. Our study would be as a reference resource for erasing the barriers and inequality among the visually disabled women. Keywords: Pap smear screening, Women with visual impairment, Utilization, Barriers Background illustrate that the Pap smear screening successfully re- Cervical cancer is the 3rd most common cancer in duces if the cervical cancer could be detected and women around the world [10]. In Taiwan, cervical treated sufficiently early, the cure rate of cancer can cancer is also the major cause of female cancer death. be as high as 70 to 90 % [1, 2, 7, 37]. The Pap smear Fortunately, Pap smear, the useful screening tool, let screeningtestiscurrentthemostwidelyusedap- the prevention and treatment of cervical cancer stride proach for preventing cervical cancer with three to forward. Through the use of Pap smear screening, we five yearly screening depending on the environment can detect the precancerous lesions furthermore can- [30]. The benefit of Pap smear screening test in pre- cerous lesions at an earlier stage [35]. Many evidences venting cervical cancer has been demonstrated by in countries like United States and Taiwan. Since the use of Pap smear screening test in United States in * Correspondence: [email protected] 2Department of Public Health, Tzu-Chi University, Hualien, Taiwan the mid-20th century, cervical cancer, once the most Full list of author information is available at the end of the article © 2016 Fang et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Fang et al. International Journal for Equity in Health (2016) 15:65 Page 2 of 9 frequent cause of death in women, now ranks for was exempt from review which contacted by the govern- 14th cancer death. In Taiwan, the incidence rate of ment authority to the policy evaluation. The sampling cervical cancer from 50.5 per 100,000 in 1995 drops design was stratified proportional and random sampling to 21.1 per 100,000 in 2010 as well as the standard- (stratified random sampling). The data was been col- ized mortality rate of cervical cancer also from 22.0 lected by phone interview during 2009 and the inter- per 100,000 in 1995 falls to 8.2 per 100,000 in 2011 viewers were well trained in professional training after the National Pap smear screening test program courses before interview. When we start to interviews, providing since 1995. The policy of Pap smear in we explained all the purposes of this study and related Taiwan is that women who aged 30- year-old or more matters, and provide our contact way to samples for an- should receive once Pap smear screen in 3 years. This swer their doubts. During interviewed, they can go back heathy service is free and its financial supports by at any time and reject the interview, we must respect HPA [12]. their will. The oral informed consent was obtained while People with disability were higher comorbidity initial interview in eligible participant or her legally au- prevalence and medical utilization [22–25, 45], and thorized representatives, which adhered to the guidelines less likely to use preventive health care and health of Declaration of Helsinki. promotion activities [19, 22, 41, 43, 44]. There were also to demonstrate that people with visual impair- Participates ment has less access to appropriate healthcare ser- When sampling error was ±0.05, the representative sam- vices and is less likely to receive screening ples were estimated at the least 308 and then the strati- examinations (Hsu et al., 2009), as with individuals fied proportional and random sampling based on age to with other disable populations [5, 9]. Some of them be employed in this study. We consider the valid re- showed the utilization of Pap smear in women with sponse rate is 50 %, therefore, we oversampling as 616 disability is significantly lower than without [3, 16]. participants. Finally, this study valid response samples Armour, et al. [3] found women with a disability were was 316 who were 15–64 year old women with visual less likely than those without a disability to report re- impairment in Taipei Country [46]. To compare with ceiving a Pap smear screening test during the past the population characteristics, there were no significant 3 years (78.9 % vs. 83.4 %; p < .001) in the 2008 Be- differences in age and seriousness of disability between havior Risk Factor Surveillance System in United our samples and population (p > 0.05) [46]. States. Although the Pap smear utilization rate is much lower among disable population, they are usu- The instrument and data collection ally in health disparity in most studies. The instrument of our study was structured question- In Taiwan, there was no study to explore utilization of naire which included the demographical characteristics, Pap smear, associated factors and use barriers about Pap history of Pap smear test, and the experiences of barriers smear screening test among women with visual impair- for Pap smear using that internal reliability were be- ment. The purposes of the present study are to explore tween 0.72 and 0.92 (Cronbach’s alpha). The experiences the utilization and barriers of using Pap smear for of barriers were parted into the negative attitudes of women with visual impairment in Taiwan. To identify main care giver and environmental barriers. The data the barriers of women with visual from process of re- was been collected by three trained interviewers who ceiving Pap smear screening test can supply the refer- were proficient in Mandarin and Hokkien (Taiwan dia- ences of primary health care strategies to reduce the lect) and phone called at AM 10:00- PM 9:00. If the ac- disparity for them. tual effective sample size was less than the expected estimation, we filled vacancies according to the random Methods sampling rule again until a successful interview. This was a cross-sectional study and the population was 15–64 year old women with visual impairment who were Data analysis officially registered in the Taiwan Disability Eligibility The data were analyzed using the Statistical Package for Determination System in Taipei County which was the the Social Sciences (vers. 20.0, SPSS, Chicago, IL, USA). most populous with vision disability city of Taiwan dur- The differences between the groups were considered sig- ing December 2009 to January 2010. This study con- nificant if P values were 0.05. ducted for the government - Bureau of Health Using a Pearson Chi-square test and a Fisher’s exact Promotion, Department of Health (the ID of plan: test, we compared differences in age, marriage, educa- 9805006A) which aimed to evaluate the health policy ef- tional level, working status, severity of disability, and the fectiveness for the study group 2009. According to the causes of disability between no experience and ever IRB protocol in our institution at that time, this study using Pap smear for cases.
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