Impact of Educational Intervention at the Inflammatory Bowel Disease Preconception and Pregnancy Clinic on Adherence to Cervical Cancer Screening
Date
2022-01-07
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Adherence to cervical cancer screening (CCS) is critical for decreasing cervical cancer incidence and related mortality. Repeating Pap tests every three years in women with a population-based risk of cervical cancer and annually in high-risk patients, as a risk-appropriate approach, is highly recommended. Women with Inflammatory Bowel Disease (IBD) and exposed to immunosuppressive medications are considered high-risk patients. Promoting adherence to CCS by educational intervention has been studied previously; however, the extent of the impact among IBD patients is still unclear. Our study aims to assess the association between receiving health education, by physicians in the IBD pregnancy clinic, and adherence to CCS. A total of 190 individuals with IBD who visited the IBD pregnancy clinic between 2012 and 2016 were recruited. A one-group pretest-posttest study design was conducted. Data of Pap testing between 2007 and 2020 were collected and compared before (baseline) and after educational intervention by McNemar’s Test. Prior to the intervention, 29.47% (95% CI, 23.37 – 36.4) of participants had adherence to risk-appropriate CCS for two screening cycles before the health education. Importantly, participation in risk-appropriate screening immediately after receiving the health education increased significantly to 47.36% (proportion difference= 0.18, 95% CI, 0.08 – 0.27) (p<0.001). Long-term adherence to the population-based CCS was observed in 38.42% (95% CI, 31.72 – 45.6) of participants before the intervention and 34.74% (95% CI, 28.25 – 41.84) after the intervention. McNemar’s test result indicated no significant change in adherence to CCS for more than one cycle after the intervention (p=0.45). This study demonstrated that the participation rate in CCS among IBD patients, particularly those on immunosuppressive therapy, was less than the target rate determined by the provincial health care system. The participation rate in the first risk-appropriate CCS improved significantly after receiving the educational intervention. However, the longevity of behaviour change was not determined. The finding may be due to the small sample size and diverse Pap testing intervals recommendations in different versions of guidelines. Further investigations are required to address the exact reasons for these findings and design an intervention that translates into prolonged behaviour changes.
Description
Keywords
cervical cancer screening, cervical cancer, inflammatory bowel disease, adherence, educational intervention, McNemar's Test, pretest-posttest, pretest and post-test
Citation
Ehteshami Afshar, E. (2022). Impact of Educational Intervention at the Inflammatory Bowel Disease Preconception and Pregnancy Clinic on Adherence to Cervical Cancer Screening (Master thesis). University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca .