Perceptions and Needs of Women with Low-grade Squamous Intraepithelial Lesion on Cervical Cytology: A Qualitative Descriptive Study

Sarwitree  Pornsinsiriruck; Manee Arpanantikul; Bualuang  Sumdaengrit; Arb-aroon  Lertkhachonsuk; Wendy D. Grube

Authors

Sarwitree Pornsinsiriruck RN, PhD (Candidate), Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital and Faculty of Nursing, Mahidol University, Thailand.
Manee Arpanantikul RN, PhD, Associate Professor, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
Bualuang Sumdaengrit RN, PhD, Associate Professor, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
Arb-aroon Lertkhachonsuk MD, Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Wendy D. Grube PhD, CRNP, Practice Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

Keywords:

Cervical cancer, Low-grade squamous intraepithelial lesions, Feminist approach, Perceptions, Needs, Nursing, Qualitative descriptive, Thailand, Women

Abstract

Each year many women are identified with low-grade squamous intraepithelial lesions through cervical cancer screening. It is important to understand the perceptions and needs of those women to increase self-awareness and women’s self-care. Low-grade squamous intraepithelial lesions can spontaneously resolve if women have good immunity. This study explored the perceptions and needs of Thai women after discovery of such a lesion on cytology results. A qualitative descriptive study with a feminist approach was employed. The study period was February 2020 to June 2021 and ten participants who met the inclusion criteria were recruited. Data were collected through two face-to-face in-depth interviews and transcripts were analyzed using content analysis.
Three main themes were identified: 1) having emotional responses, with three sub-themes (shock, fear, and suspicion); 2) thinking of health behaviors that induce cervical cell changes, with three sub-themes (unhealthy lifestyles, poor personal hygiene, and risky sexual behavior); and 3) needing health care, with three sub-themes (health advice, health appointments, and ways to get health information). The findings of this study reveal how the women felt about having abnormal cells on their cervix, a significant part of feminine identity, as well as how the disorder can occur and what follow-up care is needed. Through a feminist perspective, the findings provide information related to the personal privacy of women and allow nurses to deeply understand their perceptions and needs and empower women’s knowledge after first receiving low-grade squamous intraepithelial lesion cytology results. Nurses can use these findings to help meet women’s needs by designing self-management support programs as well as facilitating continuity of health care by providing advice and arranging critical follow-up appointments.

References

Kengsakul M, Laowahutanont P, Wilailak S. Experiences in the prevention and screening of cervical cancer within Thailand. Int J Gynecol Obstet. 2020;152:48-52. doi: 10.1002/ijgo.13481.

Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287(16):2114-9.doi:10.1001/jama.287.16.2114.

Kingnate C, Tangjitgamol S, Khunnarong J, Manusirivithaya S. Abnormal uterine cervical cytology in a large tertiary hospital in Bangkok metropolis: prevalence, management, and outcomes.Indian J Cancer. 2016;53(1):67-73. doi:10.4103/0019-509X.180827.

World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition [Internet]. 2021. [cited2021 Sept 27]. Available from: https://www.who.int/publications/i/item/9789240030824

Stefani C, Liverani CA, Bianco V, Penna C, Guarnieri T, Comparetto C, et al. Spontaneous regression of low-grade cervical intraepithelial lesions is positively improved by topical bovine colostrum preparations (GINEDIE®):a multicentre, observational, Italian pilot study. Eur Rev

Med Pharmacol Sci. 2014;18:728-33.

Apiwattanasevee W, Jareemit N, Viriyapak B. Spontaneous regression rate of low grade cervical intraepithelial lesions diagnosed from colposcopy. J Health Sci Med Res. 2018;36(3):235-45.

Spring B, King A, Pagoto S, Van Horn L, Fisher J. Fostering multiple healthy lifestyle behaviors for primary prevention of cancer. Am Psychol. 2015;70(2):75-90. doi:10.1037/a0038806.

Mortensen GL, Adeler AL. Qualitative study of women’s anxiety and information needs after a diagnosis of cervical dysplasia. J Public Health. 2010;18:473-82. doi:10.1007/s10389-010-0330-1.

Rask M, Swahnberg K, Lindell G, Oscarsson M. Women’s experiences of abnormal Pap smear results-a qualitative study. Sex Reprod Healthc. 2017;12:3-8.

Siseho KN, Omoruyi BE, Okeleye BI, Okudoh VI, Amukugo HJ, Aboua YG. Women’s perception of cervical cancer pap smear screening. Nurs Open. 2022;9(3):1715-22. doi: 10.1002/nop2.1196.

Obermair HM, McCaffery KJ, Dodd RH. “A Pap smear saved my life”: personal experiences of cervical abnormalities shape attitudes to cervical screening renewal. J Med Screen.2020;27(4):223-6.

Srisuttayasathien M, Manchana T. Adherence to follow-up in women with cervical intraepithelial neoplasia grade 1. Taiwan J Obstet Gynecol. 2021;60:56-9. doi:10.1016/j.tjog.2020.11.008.

Petrie KJ, Weinman J. Why illness perceptions matter. Clin Med. 2006;6:536-9.

Phuakpoolpol S, Suwannarurk K, Jaisin K, Punyashthira A, Pattaraarchachai J, Bhamarapravatana K. Anxiety and depression in Thai women with abnormal cervical cytology who attended colposcopic unit in Thammasat University Hospital. Asian Pac J Cancer Prev. 2018;19(10):2985-9.

Thangarajah F, Einzmann T, Bergauer F, Patzke J, Schmidt- Petruschkat S, Theune M, et al. Cervical screening program and the psychological impact of an abnormal Pap smear:a self-assessment questionnaire study of 590 patients. Arch Gynecol Obstet. 2016;293:391-8. doi:10.1007/s00404-015-3821-z.

Changwatchai J. Stress and coping in women with abnormal Papanicolaou Smear [master’s thesis]. [Bangkok]: Mahidol University; 2009 (in Thai).

O’Connor M, O’Leary E, Waller J, Gallagher P, D’arcy T, Flannelly G, et al. Trends in, and predictors of, anxiety and specific worries following colposcopy: a 12-month longitudinal study. Psycho-Oncol. 2016;25:597-604. doi: 10.1002/pon.3980.

Ongtengco N, Thiam H, Collins Z, DeJesus EL, Peterson CE, Wang T, et al. Role of gender in perspectives of discrimination, stigma, and attitudes relative to cervical cancer in rural Sénégal.PLoS ONE. 2020;15(4):e0232291. doi:10.1371/journal.pone.0232291.

Wen KY, Gustafson DH. Needs assessment for cancer patients and their families. Health Qual Life Outcomes.2004;2(11):1-12.

Wutti R, Wachirarattanakornkun P, Kampala N, Nauljun N. Clients’ coping experiences and needs of being informed an abnormal Pap smear result. J Health Sci Res. 2013;7(1):1-9 (in Thai).

Streubert HJ, Carpenter DR. Qualitative research in nursing: advancing the humanistic imperative. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011.

Freijomil-Vázquez C, Gastaldo D, Coronado C, Movilla- Fernández MJ. Asymmetric power relations in gynaecological consultations for cervical cancer prevention: biomedical and gender issues. Int J Environ Res Public Health.2021;18(7850):1-17. doi:10.3390/ijerph18157850.

Green B. Applying feminist ethics of care to nursing practice. J Nurs Care. 2012;1(3):1-4. doi:10.4172/2167-1168.1000111.

Burton CW. The health needs of young women: applying a feminist philosophical lens to nursing science and practice. ANS Adv Nurs Sci. 2016;39(2):108-18. doi:10/1097.ANS0000000000000119.

Alspaugh A, Im EO, Reibel MD, Barroso J. The reproductive health priorities, concerns, and needs of women in midlife: a feminist poststructuralist qualitative analysis. Qual Health Res. 2021;31(4):643-53. doi:10.1177/1049732320970491.

Andrist L. A feminist model for women’s health care. Nurs Inq. 1997;4:268-74.

Campbell JC, Bunting S. Voices and paradigms: perspectives on critical and feminist theory in nursing. Adv Nurs Sci.1991;13(3):1-15.

Doyle L, McCabe C, Keogh B, Brady A, McCann M. An overview of the qualitative descriptive design within nursing research. J Res Nurs. 2020;25(5):443-55. doi: 10.1177/1744987119880234.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-51.

Westbrook L, Fourie I. A feminist information engagement framework for gynecological cancer patients: the case of cervical cancer. J Doc. 2015;71(4):752-74. doi:10.1108/JD-09-2014-0124.

Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks, CA: Sage; 1994.

Weaver R, O’Connor M, Ngune I, Smith RC, Phillips J, Halkett G. Perspectives of the sarcoma clinical nurse consultant role: a qualitative study. Collegian. 2021;28:422-30. doi:10.1016/j.colegn.2020.12.006.

Guest G, Namey E, Chen M. A simple method to assess and report thematic saturation in qualitative research. PLoSONE, 2020;15(5):e0232076. doi:10.1371/journal.pone.0232076.

Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills,CA: Sage; 1985.

Hounsgaard L, Augustussen M, Møller H, Bradley SK, Møller S. Women’s perspectives on illness when being screened for cervical cancer. Int J Circumpolar Health. 2013;72:21089.doi:10.3402/ijch.v72i0.21089.

Güneri SE, Şen S. Women’s experiences after abnormal Pap smear results: a qualitative study. J Psychosom Obstet Gynecol. 2020;41(1):22-9. doi:10.1080/0167482X.2019.1657090.

Arpanantikul M. Application of feminist theory as a framework for women’s health nursing. Rama Nurs J. 2006;12(3):215-34 (in Thai).

Solbrække KN, Bondevik H. Absent organs—Present selves: exploring embodiment and gender identity in young Norwegian women’s accounts of hysterectomy. Int J Qual Stud Health Well-being. 2015;10:26720. doi:10.3402/qhw.v10.26720.

Phonrat B, Ruengkris T, Naksrisook S, Intalapaporn K, Jirakorbchaipong P, Pitisuttithum P. Psychosocial burden of women with abnormal Pap smears. Southeast Asian J Trop Med Public Health. 2009;40(3):593-601.

Jerachotechueantaveechai T, Charoenkwan K, Wongpakaran N. Prevalence and predicting factors for anxiety in Thai women with abnormal cervical cytology undergoing colposcopy. Asian Pac J Cancer Prev. 2015;16(4):1427-30. doi:10.7314 /APJCP.2015.16.4.1427.

Song D, Li H, Li H, Dai J. Effect of human papillomavirus infection on the immune system and its role in the course of cervical cancer. Oncol Lett. 2015;10:600-6. doi:10.3892/o1.2015.3295.

Lasselin J, Alvares-Salas E, Grigoleit JS. Well-being and immune response: a multi-system perspective. Curr Opin Pharmacol.2016;29:34-41. doi:10.1016/j.coph. 2016.05.003.

Agodi A, Barchitta M, Quattrocchi A, Maugeri A, Canto C, Marchese AE, et al. Low fruit consumption and folate deficiency are associated with LINE-1 hypomethylation in women of a cancer-free population. Genes Nutr. 2015;10(30):1-10.

Ghaljaei F, Rezaee N, Salar A. Identifying self-care behaviors in middle aged women: a qualitative study. Electron Physician. 2017;9(11):5800-5. doi:10.19082/5800.

Welsh T. The affirmative culture of healthy self-care: a feminist critique of the good health imperative. IJFAB.2020;13(1):22-44.

Moodley J, Constant D, Botha MH, van der Merwe FH, Edwards A, Momberg M. Exploring the feasibility of using mobile phones to improve the management of clients with cervical cancer precursor lesions. BMC Women’s Health. 2019;19(2):1-10. doi:10.1186/s12905-018-0702-1.

Zlatolas LN, Hrgarek L, Welzer T, Hölbl M. Models of privacy and disclosure on social networking sites: a systematic literature review. Mathematics. 2022;10:146.doi:10.3390/math10010146.