Mental Health Systems

BackgroundCervical cancer is the primary cause of cancer death for women in Nicaragua, despite being highly preventable through vaccination against high-risk genotypes of the Human Papillomavirus (hrHPV), screening for hrHPV, and early detection of lesions. Despite technological advances designed to increase access to screening in low resource settings, barriers to increasing population-level screening coverage persist. On the Caribbean Coast of Nicaragua, only 59% of women have received one lifetime screen, compared to 78.6% of eligible women living on the Pacific and in the Interior. In concordance with the WHO’s call for best practices to eliminate cervical cancer, we explored the feasibility and acceptability of self-collection of samples for hrHPV testing on the Caribbean Coast of Nicaragua through a multi-year, bi-national, community-based mixed methods study.MethodsBetween 2016 and 2019, focus groups (n=25), key informant interviews (n=12) [phase I] and an environmental scan [phase II] were conducted on the Caribbean Coast of Nicaragua in partnership and collaboration with long-term research partners at the University of Virginia and community-based organizations. In spring 2020, underscreened women on the Caribbean Coast of Nicaragua were recruited and screened for hrHPV, with the choice of clinician collection or self-collection of samples.ResultsOver the course of the study, providers and potential patients expressed significant acceptability of self-collection of samples as a strategy to reduce barriers currently contributing to the low rates of screening (phases I and II). Ultimately 99.16% (n=1,767) of women chose to self-collect samples, demonstrating a high level of acceptability of self-collection in this pilot sample (phase III). Similarly, focus groups, key informant interviews, and the environmental scan (phases I and II) of resources indicated critical considerations for feasibility of implementation of both HPV primary screening and subsequently, self-collection of samples. Through phase III, we piloted hrHPV screening (n=1,782), with a 19.25% hrHPV positivity rate.ConclusionSelf-collection of samples for hrHPV testing demonstrated high acceptability and feasibility. Through concerted effort at the local, regional, and national levels, this project supported capacity building in reporting, monitoring, and surveilling cervical cancer screening across the continuum of cervical cancer control.

Numerous randomized controlled trials (RCTs) with the goal of improving caregiver Quality of Life (QoL) that reflect health and well-being have been conducted. However, it is unclear what type of intervention is most effective. Moreover, participant and intervention characteristics were rarely examined in the studies of caregiver QoL. The aims of this meta-analyses were to (1) evaluate the effectiveness of different types of interventions on the QoL of caregivers of individuals with dementia, and (2) explore participant and intervention characteristics that influence interventions’ effect. A systematic search of MEDLINE, CINAHL, PsycINFO, and Cochrane Library electronic databases was conducted to find RCTs published from 2005 to 2017. A total of 28 RCTs were included. Multicomponent interventions with 898 participants (Hedges G = 0.491; 95% CI = [0.220, 0.762]; p<0.001) and cognitive-behavioral therapy (CBT) with 421 participants (Hedges G = 0.498; 95% CI = [0.129, 0.867]; p= 0.008) showed a moderate and large effect on improving caregiver’s QoL. Older age (β = −0.044; p= 0.004; average age 60.26) and longer duration of intervention (β = −0.021; p= 0.039; average duration 21 weeks) contributed to a smaller effect, and interventions conducted in developing countries showed a larger effect (Qb = 5.12; p=0.024). Interventions addressing complex caregiver needs or reconstructing caregivers’ maladaptive emotion and behaviors may be the most effective methods for enhancing caregiver QoL. Future studies are needed to identify the most effective duration of these intervention and to develop interventions for caregivers who are relatively older ages.