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Fulltext Challenges to cervical screening in a developing country: The case of Malaysia

Othman NH, Rebolj M

Asian Pac J Cancer Prev, 2009;10(5):747-52.
PMID: 20104963

OBJECTIVES: Many developing countries, including Malaysia, will need to continue relying on cervical screening because they will not be able to cover their entire female adolescent populations with HPV vaccination. The aim of this paper was to establish the extent of the health care, informational, financial and psychosocial barriers to cervical screening in Malaysia.

METHODS: A literature search was made for reports on implementation, perceptions and reception of cervical screening in Malaysia published between January 2000 and September 2008.

RESULTS: Despite offering Pap smears for free since 1995, only 47.3% of Malaysian women have been screened. Several factors may have contributed to this. No national call-recall system has been established. Women are informed about cervical screening primarily through mass media rather than being individually invited. Smears are free of charge if taken in public hospitals and clinics, but the waiting times are often long. The health care system is unequally dense, with rural states being underserved compared to their urban counterparts. If the screening coverage was to increase, a shortage of smear-readers would become increasingly apparent.

CONCLUSIONS: Improving screening coverage will remain an important strategy for combating cervical cancer in Malaysia. The focus should be on the policy-making context, improving awareness and the screening infrastructure, and making the service better accessible to women.

Matched MeSH terms: Vaginal Smears/psychology*
Cervical cancer screening attitudes and beliefs of Malaysian women who have never had a pap smear: a qualitative study

Wong LP, Wong YL, Low WY, Khoo EM, Shuib R

Int J Behav Med, 2008;15(4):289-92.
PMID: 19005928 DOI: 10.1080/10705500802365490

Attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.

Matched MeSH terms: Vaginal Smears/psychology*
Fulltext A qualitative exploration of Malaysian cancer patients' perceptions of cancer screening

Farooqui M, Hassali MA, Knight A, Shafie AA, Farooqui MA, Saleem F, et al.

BMC Public Health, 2013;13:48.
PMID: 23331785 DOI: 10.1186/1471-2458-13-48

Despite the existence of different screening methods, the response to cancer screening is poor among Malaysians. The current study aims to examine cancer patients' perceptions of cancer screening and early diagnosis.

Matched MeSH terms: Vaginal Smears/psychology
Fulltext Health Literacy, Knowledge on Cervical Cancer and Pap Smear and Its Influence on Pre-Marital Malay Muslim Women Attitude towards Pap Smear

Baharum NN, Ariffin F, Isa MR, Tin ST

Asian Pac J Cancer Prev, 2020 Jul 01;21(7):2021-2028.
PMID: 32711428 DOI: 10.31557/APJCP.2020.21.7.2021

BACKGROUND: Cervical cancer is preventable. In Malaysia, women are found to have good awareness of the disease and yet, the Pap smear uptake is still poor. Measuring health literacy level could explain this discrepancy. This study aims to determine the relationship between health literacy, level of knowledge of cervical cancer and Pap smear with attitude towards Pap smear among women attending pre-marital course.
METHODS: A cross sectional study was performed in three randomly selected centres that organised pre-marital courses. All Malay Muslim women participants aged 18 to 40 years old were recruited while non-Malaysian, illiterate, and had hysterectomy were excluded. Validated self-administered questionnaires used were European Health Literacy Questionnaire (HLS-EU-Q16 Malay) and Knowledge and attitude towards Cervical Cancer and Pap Smear Questionnaire. The mean percentage score (mean± SD) was calculated, with higher scores showed better outcomes. Multiple linear regression was used to measure the relationship of independent variables with attitude towards Pap smear.
RESULTS: A total of 417 participants were recruited with a mean age of 24.9 ± 3.56 years old. Prevalence of awareness of cervical cancer was 91.6% (n=382, 95% CI: 89.0%, 94.2%) and mean percentage score was 74.7%±7.6. Prevalence of awareness of Pap smear was 59.0% (n=246, 95% CI: 54.2%, 63.8%) and mean percentage score was 80.2% ± 6.5. The health literacy mean score was 13.3±3.6, with minimum score 0 and maximum score 16. The mean percentage score of attitudes towards Pap smear was 64.8%±9.3. Multiple linear regression analysis demonstrated significant relationship between health literacy (p=0.047) and knowledge of Pap smear (p<0.001) with attitude towards Pap smear.
CONCLUSION: A higher health literacy with high knowledge of Pap smear improves the attitude towards Pap smear. Pre-marital course is an opportunistic platform to disseminate information to improve health literacy and knowledge of cervical cancer and Pap smear screening.

Matched MeSH terms: Vaginal Smears/psychology*
Fulltext Factors affecting uptake of cervical cancer screening among African women in Klang Valley, Malaysia

Nwabichie CC, Manaf RA, Ismail SB

Asian Pac J Cancer Prev, 2018 Mar 27;19(3):825-831.
PMID: 29582641

Introduction: Cervical cancer is a health concern among women worldwide, presently ranking as the second to fourth common cancer type among women in different parts of the world. Human papillomaviruses (HPV) 16 and 18 are the main causative agents of cervical cancer. However, prevention is possible with early and regular cervical cancer screening.
Objective: This study aimed to identify the cervical cancer screening practices and factors affecting the screening status of African immigrant women attending selected church services in Klang Valley, Malaysia.
Methodology: A cross-sectional study among 320 randomly selected respondents between ages 18-69 was conducted in three different churches with high numbers of African participants. A self-administered questionnaire was distributed among the respondents. To ensure a good understanding, the questionnaire was written and self-explained in English language, because English is the general spoken language among the study population. Three levels of analysis were conducted using SPSS 21, involving descriptive analysis, chi square and multiple logistic regression.
Results: The response rate was 98.2%, the majority (68.1%) of the respondents being aged 31-50 years and married. The prevalence of screening among the respondents over the past 3 years was 27.2%. Using a p-value of 0.05 as the significance level, the final model showed that marital status (p=0.004), knowledge (p=0.035), perceived barriers (p=0.003), and having a regular health care provider (p<0.001) were the only significant predicting factors of uptake of cervical screening among African immigrant women in Klang Valley, Malaysia.
Conclusion: The findings revealed that the uptake of cervical cancer screening among the African women was very low. Marital status, knowledge, perceived barriers and having a regular health care provider were the predictive factors. Specific awareness programs to increase uptake should be designed and implemented by the relevant authorities.

Matched MeSH terms: Vaginal Smears/psychology*
Fulltext Opinions of the Urban Women on Pap test: Evidence from Bangladesh

Mustari S, Hossain B, Diah NM, Kar S

Asian Pac J Cancer Prev, 2019 06 01;20(6):1613-1620.
PMID: 31244279 DOI: 10.31557/APJCP.2019.20.6.1613

Each year, many countries from developed world publishes reports on early cancer detection; which is absolutely
absent in most developing countries like Bangladesh.Very limited evidence is found on the role and acceptance of Pap
test among the women of Bangladesh in determining cervical cancer. More research and updates are needed relating Pap
test in early detection of cervical cancer. Thus the purpose of this study is set to assess the opinions of Bangladeshiurban
womentowardsthe Pap test. A questionnaire-based survey of 400 Bangladeshi urban women was evaluated by on their
socio-demographic characteristics, knowledgeand attitudes towards Pap testing. In general, the findings reveal that
respondents havea good understanding of thepurpose of Pap test screening with 3.92 (Mean score). With 3.54 Mean
score,the respondents believed that Pap tests are recommended to women who are married and with 3.45 mean score
women believed that Pap tests arerecommended only to those who have children. Generally, respondents possess good
knowledge of Pap test and its purpose. These findings can be used in identifying prospect cervical cancer screening
significance populations and trend for future intrusion.

Matched MeSH terms: Vaginal Smears/psychology*
Fulltext Barriers to cervical cancer screening among immigrant Yemeni women in Malaysia

Ba-Alawi E, Azzani M, Alsaidi NA, Atroosh WM, Anaam BT, Roslan D, et al.

BMC Cancer, 2025 Jan 07;25(1):4.
PMID: 39762830 DOI: 10.1186/s12885-024-13310-6

BACKGROUND: Cervical cancer is preventable cancer through pap test screening. Despite the benefits of cervical cancer screening, immigrant women have markedly lower use of Pap smear testing. Hence, this study aims to determine the barriers to cervical cancer screening among Yemeni female immigrants in Malaysia and the factors related to these barriers.
METHODS: A cross-sectional survey was carried out among immigrant Yemeni women staying in Selangor and Kuala Lumpur, Malaysia. Data were collected using a validated modified Arabic version of the Cervical Cancer Awareness Measure (Cervical CAM). Descriptive and inferential analyses were utilized. Adjusted binary logistic regression was performed to find out the factors that increase the probability of facing barriers to the Pap test.
RESULTS: A total of 370 questionnaires were collected. Cognitive barriers were the highest recognized type of barrier to undertaking the Pap test among study participants (74.9%) followed by emotional barriers (13%). Unemployed women were significantly less likely than employed to report an emotional barrier to the Pap test (OR = 0.17, 95% CI: 0.03-0.95). Higher educated women (OR = 3.11, CI: 1.02-9.48) and those still studying (OR = 3.11, CI: 1.02-9.48) were significantly more likely to report practical barriers. Regarding the cognitive barriers, women with tertiary education were significantly less likely than those with primary education to have cognitive barriers (OR = 0.41, CI: 0.19-0.90).
CONCLUSION: access to health services among immigrant women, including screening for cervical cancer, is a complex issue involving a wide range of barriers. Cognitive barriers associated with sexual activity and the absence of symptoms are the main reason for the decision to not undergo cervical cancer screening. To address this, we recommend adopting a comprehensive approach that integrates education, community engagement, accessibility, and cultural sensitivity to promote the uptake of cervical cancer screening within the Yemeni immigrant community.

Matched MeSH terms: Vaginal Smears/psychology
Cervical cancer screening in Malaysia: Are targeted interventions necessary?

Dunn RA, Tan AKG

Soc Sci Med, 2010 Sep;71(6):1089-93.
PMID: 20685019 DOI: 10.1016/j.socscimed.2010.06.016

This study examines the determinants of Papanicolaou Smear Test (PST) screening for cervical cancer among women in Malaysia. Attention is focused on the reasons different population subgroups give for non-screening. We find that Indian women are the least likely to have had a PST and also the least likely to know the reasons why one is screened. Malay women are less likely than Chinese women to have received a PST and are more likely to report embarrassment as the reason for not being tested. Urban women are less likely than rural women to have been tested and more likely to state lack of time as the reason. These results suggest targeted interventions may be necessary to increase screening rates in Malaysia.
Study name: Malaysia Non-Communicable Disease Surveillance-1 (MyNCDS-1) survey

Matched MeSH terms: Vaginal Smears/psychology*
Health-care providers' perceptions, attitudes towards and recommendation practice of cervical cancer screening

Hweissa NA, Lim JN, Su TT

Eur J Cancer Care (Engl), 2016 Sep;25(5):864-70.
PMID: 27350095 DOI: 10.1111/ecc.12537

In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women.

Matched MeSH terms: Vaginal Smears/psychology
Fulltext The Acceptability and Preference of Vaginal Self-sampling for Human Papillomavirus (HPV) Testing among a Multi-ethnic Asian Female Population

Khoo SP, Lim WT, Rajasuriar R, Nasir NH, Gravitt P, Woo YL

Cancer Prev Res (Phila), 2021 01;14(1):105-112.
PMID: 32917643 DOI: 10.1158/1940-6207.CAPR-20-0280

Vaginal self-sampling for human papillomavirus (HPV) testing can potentially increase cervical screening coverage. This study aimed to investigate the acceptability of vaginal self-sampling for HPV testing and factors that might influence a woman's preference for this as a cervical screening method. This was a cross-sectional study that recruited 725 women from the urban and suburban areas of Selangor, Malaysia. All study participants were instructed to self-collect vaginal sample using a dry flocked swab before responding to a detailed questionnaire documenting their experience and preference for self-sampling. Most of the study participants (>80%) perceived vaginal self-sampling as easy, convenient, not embarrassing, comfortable, and were confident in performing the test. This suggests high acceptability toward vaginal self-sampling for HPV testing. Of the 725 women, 83% preferred self-sampling HPV testing over healthcare personnel sampling HPV testing and Pap test. Women with higher household income and full-time employment status were more likely to prefer self-sampling. Those who had not undergone Pap test also expressed preference for self-sampling HPV testing. Convenience and women's confidence in performing a vaginal self-sampling for HPV testing were the independent key factors that influenced the preference for self-sampling method. Vaginal self-sampling for HPV testing is highly acceptable among Malaysian women. It is the preferred choice as a primary cervical screening method and serves as an alternative to healthcare-acquired sample for Pap test. PREVENTION RELEVANCE: Organized cervical cancer screening remains unachievable in many countries. Self-sampling HPV testing is an evidence-based method that can remove barriers to cervical screening. This is particularly important for developing countries in order to achieve the WHO global strategy to accelerate cervical cancer elimination.

Matched MeSH terms: Vaginal Smears/psychology