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Journal of Public Health Advance Access originally published online on March 27, 2007
Journal of Public Health 2007 29(2):165-172; doi:10.1093/pubmed/fdm003
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© The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Comparison of a community outreach service with opportunity screening for cervical cancer using Pap smears



Huan-Cheng Chang, Lecturer in Health Care Management and President of Li-Shin Hospital1,2

Hui-Yin Hsiung, Chair of Training and Research Center3

Shu-I Chen, Project Officer3

Amy Ming-Fang Yen, Assistant Professor4,6

Tony Hsiu-Hsi Chen, Professor4,5,6,
1 Department of Health Care Management, Chang-Gung University, Taoyuan, Taiwan
2 Department of Community Medicine, Li Shin Hospital, Taoyuan, Taiwan
3 Training and Research Center, Li Shin Hospital, Tao-Yuan, Taiwan
4 Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
5 Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University
6 Centre of Biostatistics Consultation, College of Public Health, National Taiwan University

Address correspondence to Tony Hsiu-Hsi Chen, E-mail: chenlin{at}ntu.edu.tw


  Abstract

We sought to compare the take-up of cervical screening with Pap smears in a new outreach and pre-existing hospital-based setting (1) to assess the extent to which the two means of provision would overlap; (2) to establish how the utilization rate is influenced by demographic features and geographical distance from the point of provision; and (3) to access whether an outreach service would lead to increased utilization. We used a pre-test–post-test design and used multiple linear regression to assess the effect an outreach service has on utilization after adjusting for participants age, education and martial status. We found that the outreach service independently provided screening to 89% of eligible women and that coverage was inversely associated with distance from the pre-existing hospital provision. After controlling for age, education and martial status, there was a statistically significant increase (53%; 95% CI: 25, 80%) in utilization. There was little overlap between the outreach and hospital-based cervical screening services so that overall accessibility was enhanced, particularly for the elderly, widowed and less well educated. The outreach service also reduced inequalities due to geography.

Keywords: cervical cancer screening, accessibility, preventive service utilization


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