title: Barriers to cervical cancer screening in women attending the Family Medical Program in Niterói, Rio de Janeiro.
abstract: BACKGROUND
  The Family Medical Program is a health care system in the Rio de Janeiro state. Women's health services offered by the Family Medical Program include preventive exams and screening, family planning, and prenatal follow-up. Although cervical cancer screening is offered, barriers to care still hinder the full success of the program, and we are attempting to identify these barriers.
  
  
  METHODS
  We undertook a cross-sectional and prospective study involving 351 women who were referred to the Family Medical Program between March 2009 and November 2010. Demographic data were obtained through a structured household questionnaire. The dependent variable was defined as the non-realization of the Pap smear test following the protocol of the Health Ministry. Cervical samples for screening were collected after clinical examination.
  
  
  RESULTS
  Women who had undergone Pap smear testing at least once every 3 years comprised 282 of the participants (80.3 %). Most of the women had normal or inflammatory cytology (96.3 %). Illiteracy and the absence of symptomatic episodes of sexually transmitted disease were independent barriers to having cancer screening at regular intervals. Illiterate women were more likely to be older, not to be using any contraceptive method, and on average had more than two children, more than four pregnancies, and more than two abortions. Embarrassment was the greatest barrier to seeking professional care reported by all women, regardless of level of educational attainment. Other important barriers to seeking care and/or screening included time constraints, due to work or childcare.
  
  
  CONCLUSIONS
  This study indicates that the Family Medical Program effectively provides cervical cancer screening coverage for its eligible population, at the level mandated by the WHO and the Brazilian Health Ministry. Fully 96.3 % of the women in our study had normal or benign inflammation on cytology. Understanding of barriers to care-seeking behavior that limit program adherence is one way to facilitate communication between providers and patients regarding the benefits of cancer screening.
authors.affiliation: Department of Microbiology and Parasitology, Universidade Federal Fluminenese, Rua Prof. Ernani Melo, 101, Niterói, RJ 24210-130, Brazil.
authors.forename: Everton F
authors.initials: EF
authors.lastname: Augusto
authors.forename: Maria L G
authors.initials: ML
authors.lastname: Rosa
authors.forename: Silvia M B
authors.initials: SM
authors.lastname: Cavalcanti
authors.forename: Ledy H S
authors.initials: LH
authors.lastname: Oliveira
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001938:Brazil; D002584:Cervix Uteri / Q000473:pathology; D003268:Contraception Behavior; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004522:Educational Status; D005193:Family Planning Services / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D002575:Uterine Cervicitis / Q000473:pathology; D014626:Vaginal Smears / Q000706:statistics & numerical data; D016387:Women's Health