***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To determine cervical cancer screening coverage and the knowledge , attitudes and barriers toward screening tests among women in rural and urban areas of Tanzania , as well as explore how they view the acceptability of the HPV vaccine and potential barriers to vaccination . Setting A cross-sectional study using interview-administered question naires was conducted using multistage r and om sampling within urban and rural areas in Kilimanjaro Region , Tanzania . Participants Women aged 18–55 were asked to participate in the survey . The overall response rate was 97.5 % , with a final sample of 303 rural and 272 urban dwelling women . Primary and secondary outcome measures Descriptive and simple test statistics were used to compare across rural and urban strata . Multivariate logistic regression models were used to estimate ORs and 95 % CIs . Results Most women ( 82 % ) reported they had heard of cervical cancer , while self-reported cervical cancer screening among women was very low ( 6 % ) . In urban areas , factors associated with screening were : older age ( OR=4.14 , 95 % CI 1.86 to 9.24 for ages 40–49 , and OR=8.38 , 95 % CI 2.10 to 33.4 for > 50 years ) , having health insurance ( OR=4.15 , 95 % CI 1.52 to 11.4 ) , and having knowledge about cervical cancer ( OR=5.81 , 95 % CI 1.58 to 21.4 ) . In contrast , among women residing in rural areas , only condom use ( OR=6.44 , 95 % CI 1.12 to 37.1 ) was associated with screening . Women from both rural and urban areas had low vaccine-related knowledge ; however , most indicated they would be highly accepting if it were readily available ( 93 % ) . Conclusions The current proportion of women screened for cervical cancer is very low in Kilimanjaro Region , and our study has identified several modifiable factors that could be addressed to increase screening rates . Although best implemented concurrently , the availability of prophylactic vaccination for girls may provide an effective means of prevention if they are unable to access screening in the future AIMS The aims of this study were ( 1 ) to estimate what proportion of rural females had received cervical screening  , ( 2 ) to assess knowledge , beliefs , attitudes , and demographics that influence cervical screening , and ( 3 ) to predict  cervical screening accessibility based on demographic factors , knowledge , beliefs , and attitudes that influence cervical screening . METHODS The study sample consisted of r and omly selected , sexually active , rural females between 12 and 84 years of age . Five hundred fourteen females responded to an individually administered question naire . RESULTS Of the 514 participants , 91 % had never had cervical screening and 81 % had no previous knowledge of cervical screening tests ; 80 % of the group expressed positive beliefs about cervical screening tests after an educational intervention . Females who were financially independent were 6.61 % more likely to access cervical screening compared with those who were dependent on their husb and s. Females in mining villages were 4.47 % more likely to access cervical screening  than those in traditional rural reserve villages . Females in resettlement villages were 20 % less likely to access cervical screening than those in traditional rural reserve villages . CONCLUSIONS Accessibility of screening services could be improved through planning and implementation of screening programs involving community leaders and culturally appropriate messages . The government should incorporate the human papillomavirus ( HPV ) vaccine in its immunization program for adolescents , and health education should be intensified to encourage women and their partners to comply with diagnostic and treatment regimens 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 prospect i ve 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 question naire . The dependent variable was defined as the non-realization of the Pap smear test following the protocol of the Health Ministry . Cervical sample s 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 . Conclusion This study indicates that the Family Medical Program effectively provides cervical cancer screening coverage for its eligible population , at the level m and ated by the WHO and the Brazilian Health Ministry . Fully 96.3 % of the women in our study had normal or benign inflammation on cytology . Underst and ing 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 Objectives . Community based breast cancer screening has decreased breast cancer mortality in women . This study examined the predictors of nonattendence for invitational breast cancer screening in relation to socioeconomic status in the city of Manisa , in western Turkey . Study Design . For the evaluation of the reasons for refusing to participate in the study , two districts were selected . 446 women aged between 50 and 69 years were selected from the program data base by systematic r and om sampling . Methods . The question naire consisted of sociodemographic variables and the adapted version of Champion 's Health Belief Model Scale . Univariete and multivariete logistic regression analysis were performed throughout the data analysis . Results . Being from an urban district and being from the western region were the risk factors for not participating in the screening program  ( P = 0.014 , P = 0.023 ) . A statistical significance was found between mammography-benefit , mammography-barrier and program participation ( P = 0.044 , P = 0.006 ) . Although there were many more barriers for not participating in the screening program for the women of the slum district , the attendence rate of the slum district was higher than that of the urban district . Conclusions . Increased attendance may be achieved through enhancement of breast cancer awareness and by reducing some of the modifiable barriers Background To date , because of limited budgets and lower incidence of breast cancer , the majority of Asian countries do not have population -based screening programmes , but instead offer opportunistic screening . However , there have been few studies which have assessed the motivators for women attending such programmes and the appropriateness of the programmes in terms of targeting women at risk . Methods We conducted a prospect i ve cross-sectional study of 1,619 women aged 40 to 74 years attending a subsidized opportunistic screening mammogram from October 2011 to October 2013 at a private hospital in Malaysia .  Breast cancer risk was estimated using the Gail Model and two-step cluster analysis was used to examine the motivators of attending screening . Results Although Malaysia comprises 54.5 % Malay , 24.5 % Chinese and 7.3 % Indian , the majority of women in the MyMammo Study were Chinese ( 70.1 % ) and 99.2 % had a < 2 % ten-year risk of breast cancer . The most commonly cited barriers were the perception of not being at risk and fear of painful mammography . We found that highly educated women , cited doctors , family and friends as their main motivators . Of those with only secondary school education , their main motivators were doctors . Conclusions Taken together , our results suggest the women attending opportunistic mammography screening in Asia are at low risk of breast cancer and this poses challenges to cost-effective and equitable strategies for cancer control . We propose that to improve uptake of screening mammography , awareness programmes should target both doctors and members of the public The purpose was to examine breast cancer screening behavior in Turkish women , the reasons for not doing screening and the relationship between health beliefs and levels of self-esteem , body perception , and hopelessness . This research was conducted as a descriptive , correlational study in an area covered by three neighborhood primary health care clinics in Bornova , Izmir . The data were collected between April and November 2006 from 382 women over 40 years of age who were selected using a stratified r and om sampling method and a descriptive information form , Champion 's Health Belief Model Scale ( CHBMS ) , the Rosenberg Self-Esteem Scale ( RSES ) , the Body Cathexis Scale ( BCS ) and the Beck Hopelessness Scale ( BHS ) . The breast cancer screening methods used by women participating in the research were , respectively , mammography ( 34 % ) , clinical breast examination ( 14.1 % ) , breast self-examination ( BSE ) ( 59.4 % ) . The reasons why women did not do breast cancer screening methods were determined to be : not having any symptoms , neglect , not sensing the need , and not knowing how BSE is done . In the examination of the women 's CHBMS subscale score means and RSES , BCS and BHS score mean a statistically significant relationships were determined between Benefits -BSE , Barriers-BSE , Confidence , Health motivation , Benefits -mammography and barriers-mammography subscale score means and RSES , BCS and BHS mean scores ( p<0.01 ) . It was found out that women with high level of self-esteem , high level of hope for the future and with a positive body perception have more positive health beliefs on breast cancer screening INTRODUCTION Cervical cancer is the third most common cancer among Malaysian women . However , the uptake of cervical cancer screening -- Pap smear -- by women in Malaysia has been low and remains a challenge . This study was conducted to assess the cervical screening practice s of rural women in Malaysia and to examine the factors associated with such practice s. METHODS A cross-sectional survey was conducted in five rural districts in Perak , Malaysia . 1,000 households were selected through multistage r and om sampling . Women aged 20 - 64 years were interviewed by trained enumerators using structured question naires . Binomial logistic regression was used to identify predictors of cervical screening through univariate and multivariate analyses . RESULTS Among the 959 respondents , only 48.9 % had undergone Pap smear at least once in the past three years . Women in the age group 40 - 49 years ( odds ratio 3.027 , 95 % confidence interval 1.546 - 5.925 ; p < 0.005 ) were found to be significantly more likely to attend  cervical cancer screening  as compared to those in the age group 20 - 29 years . Other significant predictors were being married with children , having knowledge of cervical cancer symptoms , receiving relevant information regarding cervical cancer from health personnel or campaigns , being engaged in family planning and receiving encouragement from husb and s. CONCLUSION Efforts to boost the uptake of Pap smear screening among the rural population should be targeted toward the predictors of positive uptake BACKGROUND Success of cervical screening initiatives depends on high participation of the target population , which in turn is determined by the women 's perceptions , health orientation and other socio-cultural issues . The present study identifies the immediate social and cultural barriers that prevent women to attend cervical screening facilities . METHODS Women non-compliant to a community-based cervical screening program were identified . From them 500 were r and omly selected for interview using a structured question naire that was design ed on the basis of feedbacks received from several focused group discussion s. Question naire listed 24 possible reasons for non-compliance . The women were asked to select the most pertinent reason(s ) for her non-attendance or to reveal if they had any reason other than the listed ones . RESULTS A total of 469 non-compliant women were interviewed . They had significantly lower literacy rate compared to the compliant women ( OR=2.25 ; 95 % CI : 1.23 - 4.13 ) . Nearly half of the interviewed women responded that they themselves opted to stay away from the program . Most common reasons cited for non-attendance in this group were reluctance to go for medical test in the absence of any symptoms and apprehension to have a test that detects cancer . Second major group of responders comprised of women who were willing , yet could not attend due to various hurdles . Most common hurdles were inability to leave household chores , pre-occupation with family problems and lack of approval from husb and s. CONCLUSIONS Modification of health behavior through education and social empowerment of women are essential for a population based cervical screening program to succeed in India BACKGROUND In India , breast cancer is the leading malignancy among women in a majority of the cancer registries . Therefore it is important to underst and screening practice s and its predictors , including in rural areas with high female literacy and good health indices . MATERIAL S AND METHODS A cross-sectional study with multistage sampling was conducted in Vypin Block , Ernakulam district , Kerala , India . Four Panchayats ( self administration units ) were r and omly chosen and a woman in every second household was invited to participate from the tenth ward of each . Thus a total of 809 women were interviewed . RESULTS The majority of the repondents ( 82.1 % ) were 
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Lack of knowledge about CCa and BCa , and underst and ing of the role of screening were the key barriers to CCa and BCa screening in LMICs .
Conclusions : Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and underst and ing of CCa and BCa and screening to asymptomatic women .