Interventions for encouraging sexual lifestyles and behaviours intended to prevent cervical cancer.
BACKGROUND
Cervical cancer is one of the most common cancers affecting women world-wide. Prevention falls into two main categories - primary and secondary. Primary prevention is characterised by health promotion to promote lifestyles and behaviours minimising risk of cervical cancer. Interventions to promote the use of condoms for sexual intercourse (especially early intercourse amongst young women), sexual partner reduction, and negotiated safer sex strategies has been recommended as one approach to limit the spread of Human Papilloma Virus (HPV), one of the major risk factors for cervical cancer.


OBJECTIVE
To determine the effectiveness of health education interventions to promote sexual risk reduction behaviours amongst women in order to reduce transmission of HPV.


METHODS
Electronic searching of EMBASE, ERIC, MEDLINE, PsycLIT, Social Science Citation Index and the CCTR were undertaken using a highly sensitive search strategy. Hand-searching took place of selected journals and reference lists.


METHODS
Studies were included if they evaluated educational interventions targeting women only, and measured the impact on : either a behavioural outcome such as condom use for sexual intercourse, partner reduction, or abstinence; or a clinical outcome such as incidence of a sexually transmitted disease (STD).


METHODS
Data were extracted and methodological quality was assessed independently by two reviewers and any discrepancies were resolved between them. Ten per cent of the total number of studies were reviewed additionally by a third reviewer as a quality check and differences in judgement were resolved accordingly.


RESULTS
Thirty trials met the inclusion criteria for the review. All of them had the primary aim of preventing HIV and other STDs rather than cervical cancer. Four core methodological qualities were present in 10 of the 30 studies and constitute the subset from which potentially reliable conclusions may be drawn. Each of the 10 studies showed a statistically significant positive effect on sexual risk reduction, typically with increased use of condoms for vaginal intercourse. This positive effect was generally sustained up to three months after intervention.


CONCLUSIONS
Educational interventions targeting socially and economically disadvantaged women in which information provision is complemented by sexual negotiation skill development can encourage at least short-term sexual risk reduction behaviour. This has the potential to reduce the transmission of HPV, thus possibly reduce the incidence of cervical carcinoma.
Shepherd
J
J
NCCHTA, Wessex Institute for Health Research and Development, University of Southampton, Boldrewood, Bassett Crescent East, Southampton, Hants, UK, SO16 7PX. jps@soton.ac.uk
Weston
R
R
Peersman
G
G
Napuli
I Z
IZ
D005260:Female; D006801:Humans; D012725:Sexual Behavior; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*