title: Determinants of womens participation in cervical cancer screening trial, Maharashtra, India.
abstract: OBJECTIVE
  To determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a randomized controlled trial. The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid, cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra, India.
  
  
  METHODS
  Between October 1999 and November 2003 women aged 30-59 years were randomized to receive one of the three tests or to a control group. Participation was analysed for all three intervention arms. The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100,800 eligible women invited for screening. Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high-grade lesions. Participation in screening and compliance with treatment were also analysed according to the type of test used.
  
  
  RESULTS
  Compared with women who were not tested, screened women were younger (aged 30-39), better educated and had ever used contraception. A higher proportion of screened women were married and a lower proportion had never been pregnant. Of the 932 women diagnosed with high-grade lesions or invasive cancer, 85.3% (795) received treatment. Women with higher levels of education, who had had fewer pregnancies and those who were married were more likely to comply with treatment. There were no differences in rates of screening or compliance with treatment when results were analysed by the test received.
  
  
  CONCLUSIONS
  Irrespective of the test being used, good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services. Communication methods and delivery strategies aimed at encouraging older, less-educated women, who have less contact with reproductive services, are needed to further increase screening uptake.
authors.affiliation: Nargis Dutt Memorial Hospital, Tata Memorial Centre Rural Cancer Extension Project, Barshi, India.
authors.forename: Bhagwan
authors.initials: B
authors.lastname: Nene
authors.forename: Kasturi
authors.initials: K
authors.lastname: Jayant
authors.forename: Silvina
authors.initials: S
authors.lastname: Arrossi
authors.forename: Surendra
authors.initials: S
authors.lastname: Shastri
authors.forename: Atul
authors.initials: A
authors.lastname: Budukh
authors.forename: Sanjay
authors.initials: S
authors.lastname: Hingmire
authors.forename: Richard
authors.initials: R
authors.lastname: Muwonge
authors.forename: Sylla
authors.initials: S
authors.lastname: Malvi
authors.forename: Ketayun
authors.initials: K
authors.lastname: Dinshaw
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: D000328:Adult; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000706:statistics & numerical data; D005260:Female; D020073:Gravidity; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007194:India / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D019035:Rural Health Services / Q000458:organization & administration; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy