TY - JOUR
T1 - Health Service Accessibility and Risk in Cervical Cancer Prevention
T2 - Comparing Rural Versus Nonrural Residence in New Mexico
AU - McDonald, Yolanda J.
AU - Goldberg, Daniel W.
AU - Scarinci, Isabel C.
AU - Castle, Philip E.
AU - Cuzick, Jack
AU - Robertson, Michael
AU - Wheeler, Cosette M.
N1 - Funding Information:
Funding: This effort was supported by U54CA164336 (to CM Wheeler) from the US National Cancer Institute-funded Population-Based Research Optimizing Screening through Personalized Regimens
Funding Information:
This study was reviewed and approved by the University of New Mexico Human Research Review Committee and by the Texas A&M University Institutional Review Board.
Funding Information:
(PROSPR) consortium. The overall aim of PROSPR is to conduct multi-site, coordinated, transdisciplinary research to evaluate and improve cancer screening processes. Yolanda J. McDonald was funded by the UNM Cancer Center Support Grant P30CA118100 and the Texas A&M College of Geosciences.
Publisher Copyright:
© 2016 National Rural Health Association
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Purpose: Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown. Methods: Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P <.05) was used to determine if differences were significant and Cohen's r to measure effect. Findings: Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P <.001). Conclusion: Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).
AB - Purpose: Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown. Methods: Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P <.05) was used to determine if differences were significant and Cohen's r to measure effect. Findings: Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P <.001). Conclusion: Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).
KW - cervical cancer
KW - cervical cancer prevention
KW - geographic accessibility
KW - health care accessibility
KW - health service delivery
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U2 - 10.1111/jrh.12202
DO - 10.1111/jrh.12202
M3 - Article
C2 - 27557124
AN - SCOPUS:85030643719
SN - 0890-765X
VL - 33
SP - 382
EP - 392
JO - Journal of Rural Health
JF - Journal of Rural Health
IS - 4
ER -
