The Evaluation of Outcomes and Determinants of Cervical Cancer Screening Programme Using Pap Smear and Visual Inspection with Acetic Acid in Thailand during 2005 - 2009

Abstract

             Cervical cancer has been the major health problem among Thai women. There was an attempt to establish cervical cancer screening in Thailand for 40 years in order to reduce its incidence and mortality. Prior to the year 2005, the low coverage rate of the screening was observed. As a result, the cervical cancer screening programme in Thailand was initiated and implemented on the national level since the 2005. The purpose of this study was to assess this screening programmes in terms of service coverage, efficiency, and barriers to the service utilization from the women’s and health care providers’ perspective. A cross-sectional household survey was conducted between September 2009 and May 2010 in 12 provinces. Target population was randomly selected by stratified four-stage sampling (n=4,640) and face-to-face structured interviews were conducted among women aged 30-  60 years. Sets of questionnaires were mailed to every public health employees and health administrators who were involved in the cervical screening programmes (n=3,526). Descriptive statistics and multivariate logistic regression were employed. It was found that, 68 percent of targeted women underwent cervical cancer screening at least once in the past 5 years (response rate 97%). It rose significantly during the past 2 years (2008- 2009) and 88 percent of those who received screening underwent Pap smear while only 7 percent VIA. Reportedly half of popular venues for obtaining the screening were health centers. Statistical analysis was used to indicate the supporting and impeding factors of the screening service seeking behavior. It was found that women, who were more likely to seek the screening, services were 40- 50 years of age, resided in urban areas, worked in agriculture, had experience of child-bearing, received cervical cancer and screening information, positive attitude with information from public media and family members. Meanwhile, respondents who were less likely to obtain the screening tests, were Muslim women, cigarette smokers, misunderstanding with the need of re-screening or screening tests were provided only in hospital settings. From the providers’ aspect (response rate 55%), most of them ranked cervical cancer as a highly important public health problem. Nevertheless, some healthcare providers expressed concern regarding constraints on the budget allocation for the cervical screening programmes, numbers of frontline staff as well as training and monitoring. The findings of this study suggest that the service coverage can be significantly improved by enhancing the communication strategy regarding the knowledge and perception of the screening, tailoring the interventions to suit sub-groups of population where cultural differences exist, clarify the national policy, sufficient staff and adequate budget allocation in service system are needed as well as creating effective monitoring and evaluation of quality improvement and conducive motivation.

Key words: cervical cancer, screening, program evaluation