Publicado

2023-03-01

“You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires

"Siempre te quedan dudas": acceso a la información de mujeres VPH positivo en el Gran Buenos Aires

DOI:

https://doi.org/10.15446/rsap.v25n2.102896

Palabras clave:

Papillomavirus humano, tamizaje, servicios preventivos de salud, acceso a la información, barreras de comunicación (es)
Human papillomavirus, screening, preventive health services, access to information, communication barriers (en)

Descargas

Autores/as

Objetivos Las mujeres con resultado positivo de test de Virus de Papiloma Humano (VPH) y resultados negativo o normal de Papanicolau (VPH+/Pap-) presentan un riesgo alto de desarrollar lesiones en el cuello del útero, pero tienen muy bajos niveles de adherencia al seguimiento en Argentina. Este estudio se propuso identificar las necesidades de información, las fuentes de información y las barreras de acceso a la información de mujeres con VPH positivo y Pap normal o negativo luego de haber recibido los resultados del tamizaje.

Métodos Con una estrategia de investigación cualitativa, se realizaron 22 entrevistas virtuales semiestructuradas a mujeres con VPH positivo y Papanicolaou normal o negativo (VPH+/Pap-). Las mujeres elegibles tenían entre 30 y 64 años y residían en un área suburbana de Buenos Aires. Los datos de las entrevistas fueron analizados temáticamente utilizando los módulos de la guía de entrevistas. Se codificaron las categorías emergentes como subtemas, lo cual posibilitó un análisis temático.

Resultados Existen necesidades de información percibidas entre las mujeres con VPH positivo y Papanicolaou normal o negativo. Estas necesidades incluyen información sobre: la transmisión sexual del virus (desmontando la asociación con la infidelidad y considerando la posibilidad de transmisión no sexual), el significado del diagnóstico y su relación con el cáncer, asícomo el seguimiento y la ausencia de tratamiento. Por otro lado, existen necesidades de información no percibidas, como la asociación entre el resultado y otros problemas de salud ginecológicos, y las ideas erróneas socioculturales sobre el VPH. Las fuentes de información comunes para estas mujeres son la visita médica, la consulta en internet y el diálogo con los familiares. Sin embargo, existen barreras que dificultan el acceso a la información, como la información inexacta en internet, la falta de información proporcionada por los profesionales y las dificultades para hacer preguntas durante la consulta médica.

Conclusiones Es fundamental reforzar los procesos de entrega de resultados y considerar nuevos formatos para proporcionar información a las mujeres VPH+, tanto con Pap normal como anormal.

Objective Women who are Human Papillomavirus (HPV) positive with a normal Pap smear (HPV+/normal Pap) present a high risk of developing high-grade lesions but they exhibit very low levels of adherence in Argentina. This study was aimed to identify the information needs, sources of information, and barriers to accessing information among HPV-positive women with normal Pap after receiving their screening results.

Methods We conducted 22 semi-structured virtual interviews with HPV-positive women with normal Pap (HPV+/normal Pap) women using a qualitative research strategy. Eligible women were between 30 and 64 years old and resided in a suburban Buenos Aires area. The interview data was thematically analyzed using the modules of the interview guide. Emergent categories were coded as subthemes, enabling a thematic analysis.

Results Perceived information needs among HPV-positive women with normal Pap smears include understanding: the sexual transmission of the virus (including dismantling the association with infidelity and considering non-sexual transmission possibilities), the meaning of the diagnosis in relation to cancer, and the follow-up procedures despite the absence of treatment. On the other hand, unperceived information needs encompass recognizing the association between an HPV+ result and other gynecological health problems, as well as dispelling socio-cultural misconceptions about HPV (e.g., the misconception that high-risk HPV only affects young women with multiple sexual partners). Common sources of information for these women include medical visits, internet resources, and advice from close relatives. However, barriers to acces- sing information include encountering inaccurate online information, receiving insufficient information from healthcare professionals, and facing difficulties in raising questions and concerns during medical consultations.

Conclusions It is crucial to strengthen the processes for delivering results during the medical consultation. New formats to provide information to HPV-positive women, both with normal and abnormal Pap smear, should also be considered.

Referencias

Herrero R, Ferreccio C, Salmerón J, Almonte M, Sánchez GI, Lazcano-Ponce E, et al. New Approaches to Cervical Cancer Scree- ning in Latin America and the Caribbean. Vaccine [Internet]. 2008 [cited 2022 Jan 1]; 26:L49–58. Available from: https://doi.org/10.1016/j.vaccine.2008.05.025. DOI: https://doi.org/10.1016/j.vaccine.2008.05.025

Arbyn M, Ronco G, Anttila A, Meijer CJLM, Poljak M, Ogilvie G, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine [Internet]. 2012 [cited 2022 Jan 1]; 30(5): F88-99. Available from: https://doi.org/10.1016/j.vaccine.2012.06.095. DOI: https://doi.org/10.1016/j.vaccine.2012.06.095

Paolino M, Sankaranarayanan R, Arrossi S. Social determinants of dropout from diagnosis and treatment by women with abnormal pap smears in Buenos Aires, Argentina. Rev Panam Salud Pública [Internet]. 2013 [cited 2022 Jan 1]; 34(6):437–445. Available from: https://shorturl.at/hwT13.

Lim JN, Ojo AA. Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review. Eur J Cancer Care (Engl) [Internet]. 2017 [cited 2022 Jan 1]; 26(1). Available from: https://doi.org/10.1111/ecc.12444. DOI: https://doi.org/10.1111/ecc.12444

Datchoua Moukam AM, Embolo Owono MS, Kenfack B, Vassilakos P, Petignat P, Sormani J, et al. Cervical cancer screening: awareness is not enough. Understanding barriers to screening among women in West Cameroon-a qualitative study using focus groups. Reprod Health [Internet]. 2021 [cited 2022 Jan 1]; 18(1):147. Available from: https://doi.org/10.1186/s12978-021-01186-9. DOI: https://doi.org/10.1186/s12978-021-01186-9

Paolino MD, Campanera A, Martiarena SN, Echenique A, Lopez N, Gago JE, et al. Adherencia al triaje en contexto de tamizaje con autotoma del test de virus del papiloma humano en la provincia de Jujuy. Rev Argent Salud Pública. 2019 [cited 2022 Jan 1];10:7–14. Available from: https://shorturl.at/fkpW0.

Garcés-Palacio IC, Ramos-Jaraba SM, Rubio-León DC. Health Belie- fs Associated with the Follow-Up of Pap Smear Abnormalities Among Low-Income Women in Medellín, Colombia. J Cancer Educ [Internet]. 2018 [cited 2022 Jan 1]; 33:417–423. Available from: https://doi.org/10.1007/s13187-017-1172-0. DOI: https://doi.org/10.1007/s13187-017-1172-0

Zapka JG, Puleo E, Taplin SH, Goins KV, Ulcickas Yood M, Mouchawar J, et al. Processes of care in cervical and breast cancer screening and follow-up—the importance of communication. Preventive Medicine [In- ternet]. 2004 [cited 2022 Jan 1]; 39(1):81–90. Available from: https://doi.org/10.1016/j.ypmed.2004.03.010. DOI: https://doi.org/10.1016/j.ypmed.2004.03.010

Szwarc L, Antelo VS, Paolino M, Arrossi S. “Me sentí enfermar”: percepciones y comprensión de las mujeres del resultado positivo de un test de virus del papiloma humano en Jujuy, Argentina. Salud Colect [Internet]. 2021 [cited 2022 Jan 1]; 17:e3572–e3572. Available from: http://dx.doi.org/10.18294/sc.2021.3572. DOI: https://doi.org/10.18294/sc.2021.3572

Sharpe PA, Brandt HM, McCree DH. Knowledge and beliefs about abnormal pap test results and HPV among women with high-risk HPV: results from in-depth interviews. Women Health [Internet]. 2005 [cited 2022 Jan 1]; 42(2):107–133. Available from: https://doi.org/10.1300/J013v42n02_07. DOI: https://doi.org/10.1300/J013v42n02_07

Schoenberg N, Baltisberger J, Bardach S, Dignan M. Perspectives on Pap test follow-up care among rural Appalachian women. Women Health [Internet]. 2010 [cited 2022 Jan 1]; 50(6):580–597. Available from: https://doi.org/10.1080/03630242.2010.516702. DOI: https://doi.org/10.1080/03630242.2010.516702

Larson E, Leslie HH, Kruk ME. The determinants and outcomes of good provider communication: a cross-sectional study in seven African countries. BMJ Open [Internet]. 2017 [cited 2022 Jan 1]; 7(6): e014888. Available from: http://dx.doi.org/10.1136/bmjopen-2016-014888. DOI: https://doi.org/10.1136/bmjopen-2016-014888

Tejeda S, Darnell JS, Cho YI, Stolley MR, Markossian TW, Calhoun EA. Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities. J Womens Health [Internet]. 2013 [cited 2022 Jan 1]; 22(6):507–517. Available from: https://doi.org/10.1089/jwh.2012.3590. DOI: https://doi.org/10.1089/jwh.2012.3590

Trucchi C, Restivo V, Amicizia D, Fortunato F, Manca A, Martinelli D, et al. Italian Health Care Workers’ Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Infection and Prevention. Int J Environ Res Public Health [Internet]. 2020 [cited 2022 Jan 1]; 17(15): E5278. Available from: https://doi.org/10.3390/ijerph17155278. DOI: https://doi.org/10.3390/ijerph17155278

Jeong SJ, Saroha E, Knight J, Roofe M, Jolly PE. Determinants of ade- quate follow-up of an abnormal Papanicolaou result among Jamaican women in Portland, Jamaica. Cancer Epidemiol [Internet]. 2011 [cited 2022 Jan 1]; 35(2):211–216. Available from: https://doi.org/10.1016/j.canep.2010.07.004. DOI: https://doi.org/10.1016/j.canep.2010.07.004

Thind A, Liu Y, Maly RC. Patient satisfaction with breast cancer follow-up care provided by family physicians. J Am Board Fam Med [Internet]. 2011 [cited 2022 Jan 1]; 24(6):710–716. Available from: https://doi.org/10.3122/jabfm.2011.06.100288. DOI: https://doi.org/10.3122/jabfm.2011.06.100288

Anhang R, Goodman A, Goldie SJ. HPV communication: review of existing research and recommendations for patient education. CA Cancer J Clin [Internet]. 2004 [cited 2022 Jan 1]; 54(5):248-259. Available from: https://doi.org/10.3322/canjclin.54.5.248. DOI: https://doi.org/10.3322/canjclin.54.5.248

León-Maldonado L, Allen-Leigh B, Lazcano-Ponce E. Consejería en la detección de VPH como prueba de tamizaje de cáncer cervical: un estudio cualitativo sobre necesidades de mujeres de Michoacán, México. Salud Públ Méx [Internet]. 2014 [cited 2022 Jan 1]; 56(5):519–527. Available from: https://shorturl.at/fjmr2. DOI: https://doi.org/10.21149/spm.v56i5.7377

Arrossi S, Thouyaret L, Paul L. Prevención del cáncer cervicouterino: recomendaciones para el tamizaje, seguimiento y tratamiento de muje- res en el marco de programas de tamizaje basados en el test de VPH: actualización 2015. Ciudad Autónoma de Buenos Aires, Argentina: Instituto Nacional del Cáncer; 2015.

Forss A, Tishelman C, Widmark C, Sachs L. Women’s experiences of cervical cellular changes: an unintentional transition from health to liminality? Sociol Health Illn [Internet]. 2004 [cited 2022 Jan 1]; 26(3):306– 325. Available from: https://doi.org/10.1111/j.1467-9566.2004.00392.x. DOI: https://doi.org/10.1111/j.1467-9566.2004.00392.x

Rajaram SS, Hill J, Rave C, Crabtree BF. A biographical disruption: The case of an abnormal pap smear. Health Care Women Int. 1997 [cited 2022 Jan 1]; 18(6):521–531. Available from: https://doi.org/10.1080/07399339709516308. DOI: https://doi.org/10.1080/07399339709516308

McCaffery K, Irwig L. Australian women’s needs and preferences for information about human papillomavirus in cervical screening. J Med Screen [Internet]. 2005 [cited 2022 Jan 1]; 12(3):134–141. Available from: https://doi.org/10.1258/0969141054855238. DOI: https://doi.org/10.1258/0969141054855238

O’Connor M, Costello L, Murphy J, Prendiville W, Martin CM, O’Leary JJ, et al. Influences on human papillomavirus (HPV)-related information needs among women having HPV tests for follow-up of abnormal cervical cytology. J Fam Plann Reprod Health Care [Internet]. 2015 [cited 2022 Jan 1]; 41(2):134–141. Available from: http://dx.doi.org/10.1136/jfprhc-2013-100750. DOI: https://doi.org/10.1136/jfprhc-2013-100750

Tiro JA, Betts AC, Kimbel K, Buist DSM, Mao C, Gao H, et al. Understanding Patients’ Perspectives and Information Needs Following a Positive Home Human Papillomavirus Self-Sampling Kit Result. J Womens Health (Larchmt) [Internet]. 2019 [cited 2022 Jan 1]; 28(3):384– 392. Available from: https://doi.org/10.1089/jwh.2018.7070. DOI: https://doi.org/10.1089/jwh.2018.7070

Albuquerque CLF de, Costa M da P, Nunes FM, Freitas RWJF de, Azevedo PRM de, Fernandes JV, et al. Knowledge, attitudes and practices regarding the Pap test among women in northeastern Brazil. Sao Paulo Med J [Internet]. 2014 [cited 2022 Jan 1]; 132(1):3–9. Available from: https://doi.org/10.1590/1516-3180.2014.1321551. DOI: https://doi.org/10.1590/1516-3180.2014.1321551

Instituto Nacional de Estadística y Censos (INDEC). Censo nacional de población, hogares y viviendas 2010: censo del Bicentenario: resultados definitivos. Buenos Aires: INDEC; 2012.

Geertz C. The Interpretation of Culture. Selected Essays. New York, USA: Basis Books; 1973.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol [Internet]. 2006 [cited 2022 Jan 1]; 3(2):77–101. Available from: https://doi.org/10.1191/1478088706qp063oa. DOI: https://doi.org/10.1191/1478088706qp063oa

Verhoeven V, Baay MFD, Baay PE, Lardon F, Van Royen P, Vermorken JB. Everything you always wanted to know about HPV (but could not ask your doctor). Patient Educ Couns [Internet]. 2010 [cited 2022 Jan 1]; 81(1):101–105. Available from: https://doi.org/10.1016/j.pec.2009.12.006. DOI: https://doi.org/10.1016/j.pec.2009.12.006

Philips Z, Avis M, Whynes DK. Women's interpretation of cervical smear test results. Cytopathology [Internet]. 2004 [cited 2022 Jan 1]; 15(3):142-147. Available from: https://doi.org/10.1111/j.1365-2303.2004.00137.x. DOI: https://doi.org/10.1111/j.1365-2303.2004.00137.x

Er Güneri S, Şen S. Women’s experiences after abnormal Pap smear results: a qualitative study. J Psychosom Obstet Gynaecol [Internet]. 2020 [cited 2022 Jan 1]; 41(1):22–29. Available from: https://doi.org/10.1016/j.srhc.2017.01.002. DOI: https://doi.org/10.1080/0167482X.2019.1657090

Blomberg K, Forss A, Ternestedt BM, Tishelman C. From ‘silent’ to ‘heard’: Professional mediation, manipulation and women’s experiences of their body after an abnormal Pap smear. Soc Sci Med [Internet]. 2009 [cited 2022 Jan 1]; 68(3):479–486. Available from: https://doi.org/10.1016/j.socscimed.2008.11.007. DOI: https://doi.org/10.1016/j.socscimed.2008.11.007

Concha P X, Urrutia S T, Riquelme H G. Creencias y virus papiloma humano. Rev Chil Obstet Ginecol [Internet]. 2012 [cited 2022 Jan 1]; 77(2): 87–92. Available from: http://dx.doi.org/10.4067/S0717-75262012000200002. DOI: https://doi.org/10.4067/S0717-75262012000200002

Sundstrom B, Smith E, Delay C, Luque JS, Davila C, Feder B, et al. A reproductive justice approach to understanding women’s experiences with HPV and cervical cancer prevention. Soc Sci Med [Internet]. 2019 [cited 2022 Jan 1]; 232:289–297. Available from: https://doi.org/10.1016/j.socscimed.2019.05.010. DOI: https://doi.org/10.1016/j.socscimed.2019.05.010

Arrossi S, Ramos S, Paolino M, Sankaranarayanan R. Social inequality in Pap smear coverage: identifying under-users of cervical cancer screening in Argentina. Reprod Health Matters [Internet]. 2008 [cited 2022 Jan 1]; 16(32):50–58. Available from: https://doi.org/10.1016/S0968-8080(08)32410-0. DOI: https://doi.org/10.1016/S0968-8080(08)32410-0

Revuelta G. Comportamiento de la ciudadanía respecto a la información sobre salud: exposición, acceso y usos = The behavior of citi- zens regarding health information: exposure, access and uses. Rev Esp Com Sal [Internet]. 2019 [cited 2022 Jan 1]; 10(1):9–20. Available from: https://doi.org/10.20318/revhisto.2019.4448. DOI: https://doi.org/10.20318/revhisto.2019.4448

Bayer AM, Nussbaum L, Cabrera L, Paz-Soldan VA. Missed opportu- nities for health education on Pap smears in Peru. Health Educ Behav [Internet]. 2011 [cited 2022 Jan 1]; 38(2):198–209. Available from: https://doi.org/10.1177/1090198110379580. DOI: https://doi.org/10.1177/1090198110379580

Monsalve-Páez S, Valderrama-Vega D, Castillo-Zamora MF, Guzmán-Sabogal YR, Amaya-Guío J. Experiencia de las pacientes frente a citología cérvico-vaginal reportada como ASCUS o LEI de bajo grado en dos instituciones de Bogotá (Colombia), 2014. Rev Colomb Obstet Ginecol [Internet]. 2015 [cited 2022 Jan 1]; 66(1):14–21. Available from: https://doi.org/10.18597/rcog.3. DOI: https://doi.org/10.18597/rcog.3

Vamos CA, Calvo AE, Daley EM, Giuliano AR, López Castillo H. Knowledge, Behavioral, and Sociocultural Factors Related to Human Papillomavirus Infection and Cervical Cancer Screening Among Inner-City Women in Panama. J Community Health [Internet]. 2015 [cited 2022 Jan 1]; 40(6):1047–1056. Available from: https://doi.org/10.1007/s10900-015-0030-4. DOI: https://doi.org/10.1007/s10900-015-0030-4

Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla-Fernández MJ. Health care informational challenges for women diagnosed with cervical intraepithelial neoplasia: a qualitative study. BMC Womens Health [Internet]. 2019 [cited 2022 Jan 1]; 19(1):112. Available from: https://doi.org/10.1186/s12905-019-0811-5. DOI: https://doi.org/10.1186/s12905-019-0811-5

Cómo citar

APA

Szwarc, L., Sánchez Antelo, V., Paolino, M. y Arrossi, S. (2023). “You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires. Revista de Salud Pública, 25(2), 1–7. https://doi.org/10.15446/rsap.v25n2.102896

ACM

[1]
Szwarc, L., Sánchez Antelo, V., Paolino, M. y Arrossi, S. 2023. “You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires. Revista de Salud Pública. 25, 2 (mar. 2023), 1–7. DOI:https://doi.org/10.15446/rsap.v25n2.102896.

ACS

(1)
Szwarc, L.; Sánchez Antelo, V.; Paolino, M.; Arrossi, S. “You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires. Rev. salud pública 2023, 25, 1-7.

ABNT

SZWARC, L.; SÁNCHEZ ANTELO, V.; PAOLINO, M.; ARROSSI, S. “You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires. Revista de Salud Pública, [S. l.], v. 25, n. 2, p. 1–7, 2023. DOI: 10.15446/rsap.v25n2.102896. Disponível em: https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/102896. Acesso em: 18 ago. 2024.

Chicago

Szwarc, Lucila, Victoria Sánchez Antelo, Melisa Paolino, y Silvina Arrossi. 2023. «“You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires». Revista De Salud Pública 25 (2):1-7. https://doi.org/10.15446/rsap.v25n2.102896.

Harvard

Szwarc, L., Sánchez Antelo, V., Paolino, M. y Arrossi, S. (2023) «“You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires», Revista de Salud Pública, 25(2), pp. 1–7. doi: 10.15446/rsap.v25n2.102896.

IEEE

[1]
L. Szwarc, V. Sánchez Antelo, M. Paolino, y S. Arrossi, «“You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires», Rev. salud pública, vol. 25, n.º 2, pp. 1–7, mar. 2023.

MLA

Szwarc, L., V. Sánchez Antelo, M. Paolino, y S. Arrossi. «“You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires». Revista de Salud Pública, vol. 25, n.º 2, marzo de 2023, pp. 1-7, doi:10.15446/rsap.v25n2.102896.

Turabian

Szwarc, Lucila, Victoria Sánchez Antelo, Melisa Paolino, y Silvina Arrossi. «“You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires». Revista de Salud Pública 25, no. 2 (marzo 1, 2023): 1–7. Accedido agosto 18, 2024. https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/102896.

Vancouver

1.
Szwarc L, Sánchez Antelo V, Paolino M, Arrossi S. “You are always left with doubts”: information access among HPV-positive women in Greater Buenos Aires. Rev. salud pública [Internet]. 1 de marzo de 2023 [citado 18 de agosto de 2024];25(2):1-7. Disponible en: https://revistas.unal.edu.co/index.php/revsaludpublica/article/view/102896

Descargar cita

CrossRef Cited-by

CrossRef citations0

Dimensions

PlumX

Visitas a la página del resumen del artículo

234

Descargas

Los datos de descargas todavía no están disponibles.

Licencia

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.

Esta revista provee acceso libre inmediato a su contenido bajo el principio de que hacer disponible gratuitamente investigación al publico apoya a un mayor intercambio de conocimiento global.

Todos los contenidos de esta revista, excepto dónde está identificado, están publicados bajo una Licencia Creative Commons Atribución 4.0.