Table 1.
Overview of analyzed studies
| First author and publication year | Methods | Main results |
|---|---|---|
| Experimental studies | ||
| Valanis et al. (2002) [10] | 510 women; RCT, 14-month follow-up; intervention: phone-based discussion + leaflets on multiple barriers | Significant differences in CCS uptake at follow-up. Participating in the intervention increased the likelihood of CCS: OR = 2.9, CI: 1.7–5.9 |
| Fernbach et al. (2002) [11] | 1301 Australian women; CT; mass-media campaign discussing multiple barriers | No significant effects (Cohen's d = 0.08) |
| Corkey et al. (2005) [12] | 17008 Australian women; 6-month follow-up; automated phone message on multiple barriers | Significant effects on CCS: women aged > 50: 0.16% increase; women aged ≥ 50: 1.35% |
| Dietrich et al. (2007) [13] | 1316 women; aged 40 + ; RCT; 6-month follow-up; intervention: individualized phone message on barriers for three types of screening (cervical, colon and breast cancer) | Significant effects at follow-up: OR = 1.86 (CI: 1.1–3.21) |
| Luszczynska et al. (2011) [14] | 1436 Polish women; RCT, post-test; intervention: leaflet on CCS barriers and benefits | Significant increases in CCS intention (Cohen's d = 0.19) |
| Correlational studies | ||
| Peters et al. (1989) [15] | 200 women with CC diagnosis and 200 women without CC diagnosis | A lack of regular CCS associated with embarrassment barriers |
| Mamon et al. (1990) [16] | 290 women of lower socio-economic status | Frequently reported barriers: CCS is not recommended by the primary care physician |
| O'Brien et al. (1990) [17] | 186 women | A lack of regular CCS associated with higher psychosocial barriers |
| Jubelirer et al. (1996) [18] | 134 sexually active girls aged 14–18 | Frequently reported barriers: shame/embarrassment (64%), discomfort during CCS exam (57%), fear about parents being informed (25%), fear of cancer (27%) |
| Barling et al. (1996) [19] | 72 women | Frequently reported barriers: embarrassment, discomfort during CCS exam |
| Price et al. (1996) [20] | 127 women; no regular CCS participation | Frequently reported barriers: forgetting about CCS (32%), not liking CCS examination (32%) |
| Branoff et al. (1997) [21] | 214 women; no CCS in prior 3 years | Frequently reported barriers: financial costs (65%), shame/embarrassment (38%), unclear information about CCS exam (36%) |
| Fitch et al. (1998) [22] | 110 Canadian women | Frequently reported barriers: a lack of communication with physicians, physicians lack communication skills, difficulty in obtaining reliable information about CCS, CCS examination unpleasant |
| Larsen et al. (1998) [23] | 1725 Danish women | Frequently reported barriers: unsatisfactory contacts with physicians, discomfort during CCS examination |
| Kiefe et al. (1998) [24] | 1764 women aged 43 + | Compared to healthy women those with a chronic disease have 20% lower CCS participation |
| Yu et al. (1998) [25] | 650 British women | Frequently reported barriers: embarrassment/discomfort during CCS exam |
| Girgis et al. (1999) [26] | 788 women living in rural Australia | Frequently reported barriers: CCS being performed by a male (28–46%), physician performing CCS is a neighbor/friend (27–34%), long distance to CCS facilities (23–35%), a lack of symptoms (26–35%) |
| Glasgow et al. (2000) [27] | 522 women aged 52 + | CCS barriers reported as most relevant: being overall healthy/no symptoms (26%), embarrassment (22%), time/location inconvenient (26%), “a bad experience” with previous CCS (31%), don't want to know results if they indicate disease (13%), long waiting for CCS exams (13%), family/friends do not perform CCS (9%), it may be anyway too late to apply successful treatment (4%) |
| Egbert et al. (2001) [28] | 260 women from rural regions | CCS related to lower perceived barriers, higher support for CCS from important persons |
| Maxwell et al. (2001) [29] | 33 817 Canadian women | Only 0.6% declared that accessibility is a perceived barrier; among women without regular CCS 53% believed they don't need CCS |
| Savage et al. (2001) [30] | 1200 women aged 50 + | CCS participation related to lower barriers |
| Eaker et al. (2001) [31] | 944 Swedish women | CCS related to lower barriers (i.e., time management, other priorities, other personal issues more important, a lack of symptoms, CCS invitations irritating, being afraid of cancer detection, talking/thinking about cancer increases negative emotions) |
| Eiser et al. (2002) [32] | 70 women aged 20–25 | CCS participation related to lower perceived barriers |
| Owen et al. (2002) [33] | 100 Australian psychiatric patients | Frequently reported barriers: shame/embarrassment (18%), prior CCS was an unpleasant experience (12%), CCS facilities difficult to reach (4%), gender of person performing CCS important (51%) |
| O'Malley et al. (2003) [34] | 12024 women aged 50 + | Among women with lower socioeconomic status key CCS barriers include additional financial costs and distance to CCS facilities |
| Smith et al. (2003) [35] | 68 women | Frequently reported barriers: other priorities, embarrassment, being afraid of cancer detection, disgust, problems with making CCS appointment |
| Finney et al. (2004) [36] | 66425 women, longitudinal study; 3 measurement points (years 1987, 1992, and 2000) | Frequently declared barriers: not sure if in need for CCS (8% in 1987; 11% in 2000); CCS not suggested by primary care physician (3% in 1987; 2% in 2000) |
| Behbakht et al. (2004) [37] | 146 women | Frequently reported barriers: low support for CCS, fatalism, a belief that it may be too late for a successful treatment |
| Hewitt et al. (2004) [38] | 2344 women without CCS in prior 3 years | Frequently reported barriers: seeing no reason for CCS (48%), CCS not recommended by primary care physician (10%), no symptoms (9%), additional financial costs (9%), no need for any examinations (8%) |
| Coronado et al. (2004) [39] | 764 women | Frequently reported barriers: dislike being touched (9–24%), being afraid of cancer detection (19–32%), being afraid of other diseases being detected (19–25%), male physician (31–76%), extra financial costs (37–41%), difficult to leave work earlier (16–22%), transportation (11–22%), long waiting time (17–27%) |
| Markovic et al. (2005) [40] | 62 Serbian women | Frequently reported barriers: a lack of women-friendly clinics, other personal priorities |
| Hoyo et al. (2005) [41] | 144 women aged 45 + | Frequently reported barriers: CCS is painful |
| Walsh et al. (2006) [42] | 1000 women | Barriers related to low CCS participation: CCS is time-consuming, makes me nervous; being afraid before CCS exam |
| Guilfoyle et al. (2007) [43] | 98 women aged 50 + | Frequently reported barriers: embarrassment, fear of pain, transportation, prior experiences with CCS negative |
| Liu et al. (2008) [44] | 630 women aged 40 + | Barriers related with low CCS participation: transportation, other health problems |
| Politi et al. (2008) [45] | 605 women aged 40 + | Barriers related with low CCS: other health problems, transportation, difficulties in organizing childcare |
| Ross et al. (2008) [46] | 204 female physicians | Frequently reported barriers: time management (36%), no gynecologist providing regular consultations (11%), discomfort if CCS performed at workplace (9%) |
| Todorova et al. (2009) [2] | 2152 Bulgarian (BUL) and Romanian (ROM) women | Barriers related to low CCS. Frequently reported barriers: physicians are not interested in CCS (16–45%), CCS not recommended by a family physician (23–44%); examination is unpleasant (32–39%), waiting for a long time for the appointment (25–38%), additional financial costs (36–35%) |
| Waller et al. (2009) [47] | 580 British women | Frequently reported barriers: embarrassment (29%), difficulties in implementing intentions (21%), fear of pain (14%). Barriers related to low CCS: difficulties in making CCS appointment; difficulties in implementing intentions; CSS is not essential; CCS not needed if no sexual activities, low trust in CCS results |
| Spaczynski et al. (2009) [48] | 1638 Polish women aged 25–59 (77.5% with valid CCS) | Participants asked to indicate one key barrier reported: a lack of time (24%), not liking CCS exam (15%), no need for CCS (7%), long distance to CCS facilities (7%), no date/time specified in CCS invitation (6%), physician unknown and thus unacceptable (6%), fear of CCS exam (4%), difficulties in making appointment (4%), male physician (3%), physician is unacceptable (1%) |
| Clark et al. (2009) [49] | 630 women aged 40 + | Barriers related to low CCS: presence of other diseases |
| McAlearney et al. (2010) [50] | 100 women | Frequently reported barriers: additional financial costs |
| Tello et al. (2010) [51] | 200 HIV+ women | Frequently reported barriers: forgetting (61%), other diseases (52%), difficulties in making appointment (31%), fear of bad news (15%) |
| Wall et al. (2010) [52] | 229 Mexican women | Barriers related to low CCS participation: it may be anyway too late to apply successful treatment, a partner does not accept CCS |
| Scarinci et al. (2010) [53] | 130 women previously diagnosed with cervical pathology | Barriers related to low CCS participation: additional costs, difficulties in organizing childcare |
| Tracy (2010) [54] | 225 women | Psychosocial barriers related to low CCS participation |
| Paskett et al. (2010) [55] | 562 women | Barriers related to low CCS participation: high number of stressful events |
| Ulman-Wlodarz et al. (2011) [56] | 250 Polish women | Participants asked to indicate one key CCS barrier reported: fear of pain (39%), no symptoms (18%), own carelessness (15%), shame (12%), CCS not recommended by a physician (11%) fear of bad news (5%) |
Data collected in the U.S., unless indicated otherwise; experimental studies focused on women who did not perform CCS on regular basis; participants of correlation studies were adult women (with or without a recently conducted CCS) through lifespan, unless indicated otherwise
CCS – cervical cancer screening