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Women receiving notification of an abnormal Pap smear result: - experiences and impact on health-related quality of life
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0002-1569-6675
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The aim of this thesis was to investigate experiences of receiving notification of an abnormal Pap smear result and its impact on women’s health-related quality of life as well as to investigate women’s awareness of human papillomavirus.

 

Methods: In total, 176 women and 20 healthcare professionals participated. Data were collected through individual interviews (I, II) and a questionnaire (IV) including the instrument Functional Assessment of Chronic Illness Therapy – Cervical Dysplasia (FACIT-CD) and Hospital Anxiety and Depression Scale (HADS). For the translation and cross-cultural adaptation of the FACIT-CD, and for evaluation of its linguistic validity and reliability, cognitive debriefing interviews and a questionnaire consisting of the Swedish instrument FACIT-CD was used. Data were analysed by content analysis (I, II) and by using statistical analysis (III, IV), while one part (III) was analysed according to FACIT translation methodology.  

 

Results: Women receiving notification of an abnormal Pap smear result have good overall HRQoL; they become anxious but not depressed. Reasons for anxiety were mainly that women misinterpreted the result as cancer, which could lead to lower attendance for further investigation, treatment and follow-up. To cope with the anxiety, women sought emotional support and information. They primarily used the Internet for information but also turned to healthcare professionals for information needs. Moreover, women had low awareness of HPV, its sexually transmitted nature, and its relationship to abnormal Pap smear results and cervical cancer. An awareness of HPV as a sexually transmitted infection did not lead to higher level of anxiety or more depression symptoms or worse HRQoL, compared to not being aware. Finally, the Swedish FACIT-CD is equivalent to the English version and linguistically valid and exhibited good internal consistency reliability.

 

Conclusion: Women have low awareness of HPV and abnormal Pap smear results, whereupon they misinterpret their test result as cancer. It is of importance that women understand their test result, in order to minimise anxiety as well as to maintain high attendance for investigation, treatment and follow-up of abnormalities.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press , 2017. , p. 96
Series
Linnaeus University Dissertations ; 294/2017
Keywords [en]
Abnormal Pap smear, human papillomavirus, cervical cancer screening, health-related qualtiy of life, anxiety, depression, HADS, FACIT-CD, translation
National Category
Medical and Health Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-68093ISBN: 978-91-88357-86-1 (print)OAI: oai:DiVA.org:lnu-68093DiVA, id: diva2:1144133
Public defence
2017-10-13, V159, Stagneliusgatan 14, Kalmar, 10:00 (Swedish)
Opponent
Supervisors
Funder
The Kamprad Family Foundation, 20150012Available from: 2017-09-25 Created: 2017-09-25 Last updated: 2017-09-25Bibliographically approved
List of papers
1. Women with abnormal Pap smear result: a qualitative study of Swedish healthcare professionals' experiences
Open this publication in new window or tab >>Women with abnormal Pap smear result: a qualitative study of Swedish healthcare professionals' experiences
2016 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 25, no 6, p. 980-991Article in journal (Refereed) Published
Abstract [en]

A Papanicolaou (Pap) smear can be used to detect pre-cancerous cellular changes, so that they can be treated before they develop into cervical cancer. When the results of a Pap smear test are abnormal, women need further investigation, treatment and follow-up. Healthcare professionals (HCPs) are in a position to care for these women with abnormalities. The aim of this study was to explore the experiences of HCPs in caring for women with abnormal Pap smear results. In total, 20 HCPs from two counties in south-eastern Sweden participated in individual interviews, based on two open-ended questions. Interviews were recorded, transcribed verbatim and analysed using content analysis. The results showed that HCPs experienced that abnormal Pap smear results created anxiety in women, who often sought information from the Internet as a way to cope. Furthermore, the HCPs thought that it was a problem that women chose not to attend investigation, treatment and follow-ups. However, information about the seriousness of abnormal Pap smear results causes women to participate. It is a challenge for HCPs to inform in a reassuring manner. Finally, HCPs should collaborate with women to meet their information needs and to also provide support regarding finding and filtering reliable information on the Internet.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
Abnormal Pap smears, Experience, Healthcare professionals, Qualitative
National Category
Other Medical Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-47091 (URN)10.1111/ecc.12415 (DOI)000393077600006 ()2-s2.0-84948845848 (Scopus ID)
Available from: 2015-11-09 Created: 2015-11-09 Last updated: 2018-11-01Bibliographically approved
2. Women's experiences of abnormal Pap smear results: a qualitative study
Open this publication in new window or tab >>Women's experiences of abnormal Pap smear results: a qualitative study
2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 12, p. 3-8Article in journal (Refereed) Published
Abstract [en]

Objectives

To describe women’s experiences of abnormal Pap smear result.

Methods

Ten women were recruited from a women’s health clinic. Qualitative interviews based on six open-ended questions were conducted, transcribed verbatim, and analyzed by content analysis.

Results

The women believed that their abnormal Pap smear result was indicative of having cancer. This created anxiety in the women, which resulted in the need for emotional support and information. Testing positive with human papillomavirus (HPV) also meant consequences for the relatives as well as concerns about the sexually transmitted nature of the virus. Finally, the women had a need to be treated with respect by the healthcare professionals in order to reduce feelings of being abused.

Conclusions

In general, women have a low level of awareness of HPV and its relation to abnormal Pap smear results. Women who receive abnormal Pap smear results need oral information, based on the individual women’s situation, and delivered at the time the women receive the test result. It is also essential that a good emotional contact be established between the women and the healthcare professionals.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Abnormal Pap smears, Cervical cancer screening, Experience, Content analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-63468 (URN)10.1016/j.srhc.2017.01.002 (DOI)000401884100002 ()28477928 (PubMedID)
Available from: 2017-05-09 Created: 2017-05-09 Last updated: 2018-06-01Bibliographically approved
3. The Swedish translation and cross-cultural adaptation of the Functional Assessment of Chronic Illness Therapy – Cervical Dysplasia (FACIT-CD): linguistic validity and reliability of the Swedish version
Open this publication in new window or tab >>The Swedish translation and cross-cultural adaptation of the Functional Assessment of Chronic Illness Therapy – Cervical Dysplasia (FACIT-CD): linguistic validity and reliability of the Swedish version
2017 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 17, no 1, p. 1-10, article id 24Article in journal (Refereed) Published
Abstract [en]

Background

Cervical dysplasia is a precancerous condition, which has been shown to create anxiety in women. To be able to investigate these women’s health-related quality of life, a disease-specific instrument is required. There does not seem to be a Swedish version of an instrument to screen for this specific disease. Therefore, this study aims to translate and cross-culturally adapt the Functional Assessment of Chronic Illness Therapy – Cervical Dysplasia (FACIT-CD) into a Swedish context and evaluate its linguistic validity and reliability.

Methods

The Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology was used, which consists of several steps including pilot testing of the FACIT-CD instrument through cognitive debriefing interviews. Ten women diagnosed with cervical dysplasia participated in the cognitive debriefing interviews. The internal consistency reliability of the Swedish FACIT-CD was estimated by Cronbach’s alpha coefficient. Homogeneity of the items was evaluated by corrected item-total correlations. The sample consists of 34 women who were diagnosed with cervical dysplasia.

Results

The translation and cross-cultural adaptation went smoothly without any problems for the majority of the items. The cognitive debriefing interviews indicated that the Swedish FACIT-CD consists of relevant items, is easy to understand and complete, and has unambiguous and comprehensive response categories. The translation and cross-cultural adaptation resulted in a Swedish FACIT-CD, which is conceptually and semantically equivalent to the English version and linguistically valid. The total scale of the Swedish FACIT-CD exhibited good internal consistency reliability with a Cronbach’s alpha coefficient of 0.84, and all of the subscales exhibited acceptable value between 0.71 and 0.81 except the Relationships subscale, which had a value of 0.67. Finally, all but four items exceeded the acceptable level for the corrected item-total correlations of ≥ 0.20.

Conclusions

The Swedish FACIT-CD is conceptually and semantically equivalent to the English version and linguistically valid; further, it exhibits good internal consistency reliability.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
FACIT-CD, Health-related quality of life (HRQoL), Translation, Cross-cultural adaptation, Linguistic validity, Reliability
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-63469 (URN)10.1186/s12905-017-0381-3 (DOI)000398317000002 ()28372548 (PubMedID)
Available from: 2017-05-09 Created: 2017-05-09 Last updated: 2017-11-29Bibliographically approved

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