title: Influence of Spirituality and Modesty on Acceptance of Self-Sampling for Cervical Cancer Screening.
abstract: BACKGROUND
  Whereas systematic screening programs have reduced the incidence of cervical cancer in developed countries, the incidence remains high in developing countries. Among several barriers to uptake of cervical cancer screening, the roles of religious and cultural factors such as modesty have been poorly studied. Knowledge about these factors is important because of the potential to overcome them using strategies such as self-collection of cervico-vaginal samples. In this study we evaluate the influence of spirituality and modesty on the acceptance of self-sampling for cervical cancer screening.
  
  
  METHODS
  We enrolled 600 participants in Nigeria between August and October 2014 and collected information on spirituality and modesty using two scales. We used principal component analysis to extract scores for spirituality and modesty and logistic regression models to evaluate the association between spirituality, modesty and preference for self-sampling. All analyses were performed using STATA 12 (Stata Corporation, College Station, Texas, USA).
  
  
  RESULTS
  Some 581 (97%) women had complete data for analysis. Most (69%) were married, 50% were Christian and 44% were from the south western part of Nigeria. Overall, 19% (110/581) of the women preferred self-sampling to being sampled by a health care provider. Adjusting for age and socioeconomic status, spirituality, religious affiliation and geographic location were significantly associated with preference for self-sampling, while modesty was not significantly associated. The multivariable OR (95% CI, p-value) for association with self-sampling were 0.88 (0.78-0.99, 0.03) for spirituality, 1.69 (1.09-2.64, 0.02) for religious affiliation and 0.96 (0.86-1.08, 0.51) for modesty.
  
  
  CONCLUSIONS
  Our results show the importance of taking cultural and religious beliefs and practices into consideration in planning health interventions like cervical cancer screening. To succeed, public health interventions and the education to promote it must be related to the target population and its preferences.
authors.affiliation: Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Eileen O
authors.initials: EO
authors.lastname: Dareng
authors.affiliation: Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Elima
authors.initials: E
authors.lastname: Jedy-Agba
authors.affiliation: Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria; Department of Nursing Services, National Hospital, Abuja, Nigeria.
authors.forename: Patience
authors.initials: P
authors.lastname: Bamisaye
authors.affiliation: Department of Medical Microbiology and Parasitology, National Hospital, Abuja, Nigeria.
authors.forename: Fatima
authors.initials: F
authors.lastname: Isa Modibbo
authors.affiliation: Mother and Child Hospital Ondo, Ondo, Nigeria.
authors.forename: Lawal O
authors.initials: LO
authors.lastname: Oyeneyin
authors.affiliation: Mother and Child Hospital Ondo, Ondo, Nigeria.
authors.forename: Ayodele S
authors.initials: AS
authors.lastname: Adewole
authors.affiliation: Department of Obstetrics and Gynaecology, National Hospital, Abuja, Nigeria.
authors.forename: Olayinka B
authors.initials: OB
authors.lastname: Olaniyan
authors.affiliation: Institute of Human Virology Nigeria (IHVN), Abuja, Nigeria.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Dakum
authors.affiliation: Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Pharoah
authors.affiliation: Department of Epidemiology and Public Health; Institute of Human Virology and Greenebaum Cancer Centre, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America.
authors.forename: Clement A
authors.initials: CA
authors.lastname: Adebamowo
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D009549:Nigeria; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D029181:Spirituality; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*