title: Disseminating a cervical cancer screening program through primary physicians in Hong Kong: a qualitative study.
abstract: BACKGROUND
  Organized screening programs are more effective and equitable than opportunistic screening, yet governments face challenges to implement evidence-based programs. The objective of this study was to identify reasons for low levels of adoption among primary care physicians of a government sponsored Cervical Screening Program (CSP).
  
  
  METHODS
  We conducted in-depth interviews with a snowball sample of primary care private and public primary care physicians in Hong Kong. Rogers' theory of diffusion of innovation was used to understand the factors that influenced the physicians' practice decisions.
  
  
  RESULTS
  Our study found that Hong Kong physicians made the decision to encourage cervical screening and to participate in the CSP based primarily upon their clinical and business practice needs rather than upon the scientific evidence. The low rates of adoption of the CSP can be attributed to the physicians' perceptions that the program's complexity and incompatibility exceeded its relative advantages. Furthermore, women's knowledge, attitudes and practices, identified as barriers by physicians, were also barriers to physicians adopting the CSP.
  
  
  CONCLUSIONS
  In both private and public health care systems, screening programs that rely on physicians must align program incentives with the physicians' motivators or pursue additional demand creation policies to achieve objectives.
authors.affiliation: School of Public Health, University of Hong Kong, 5th Floor, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China. csfabrizio@gmail.com.
authors.forename: Cecilia S
authors.initials: CS
authors.lastname: Fabrizio
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Shea
mesh_terms: D001291:Attitude of Health Personnel; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D058007:Physicians, Primary Care / Q000523:psychology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*