Geographic Information Systems and Cervical Cancer Screening: From a Geography-Based to an Evidence-Based Approach to Increase PAP Test Participation

Thursday, 15 July 2010

Lyne Cloutier, RN, PhD
Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
Denis Leroux, PhD
Derpartement of geography, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
Anne-Marie Grenier, MD
Département de Santé publique, Agence de santé et des services sociaux de la Mauricie et du Centre du Québec, Trois-Rivières, QC, Canada

Learning Objective 1: The learner will be able to understand the contribution of a geographical approach to population profiling and participation rate evaluation for cervical cancer screening.

Learning Objective 2: The learner will be able to get knowledge on population-specific recruitment strategies and on the evaluation of these strategies to target low participation rate regions.

One of the means to reduce cervical cancer incidence is to increase cancer screening at early stage. The challenge of developing recruitment strategies is often part of nurses and other health care practitioners’ job. Nurses and health care decision makers need tools to help them target participating/non participating women to PAP tests to better understand where and how recruitment efforts should be invested. Geographic information systems are tools that support the exploration of spatial patterns that otherwise would go unnoticed. It is the case for cancer screening where participation can vary from one geographic area to another. Exploring such geographical variations and linking them to socioeconomics variables can help us to understand socioeconomic characteristics of participating/non participating populations. From such evidence-based information it is possible to develop population-specific recruitment strategies.
This approach has been tested in a Quebec region (Canada) where women participation rates to PAP test are among the lowest in the country. The objectives of this study were to 1) establish and cartography participation rates of women 2) describe socioeconomic characteristics of population participating/not participating to screening tests 3) develop a methodology for evaluating recruitment strategies using a geographical approach.
Data on PAP test for the 2005-2007 period were linked to census databases for analysis. Maps were produced to show high and low participation rates and geostatistics were used to identify areas of significantly lower/higher participation. Specific strategies for recruitment were then put forward to reach population in lower participation rates areas. 
This study has showed that 1) populations participating in PAP tests can be profiled, and geographic areas with low-level participation can be identified 2) These areas can be the object of specific and targeted efforts in recruitment strategies 3) A geographical approach can produce evidence-based information useful to nurses and health care practitioners.