Despite cervical cancer being one of the leading causes of cancer-related deaths among women in Peru, cervical Pap smear coverage is low. This article uses findings from 185 direct clinician observations in four cities of Peru (representing the capital and each of the three main geographic regions of the country) to assess missed opportunities for health education on Pap smears and other preventive women’s health behaviors during women’s visits to a health care provider. Various types of health establishments, provider settings, and provider types were observed. Opportunities for patient education on the importance of prevention were rarely exploited. In fact, health education provided was minimal. Policy and programmatic implications are discussed.
Agurto, I., Bishop, A., Sánchez, G., Betancourt, Z., & Robles, S. ( 2004). Perceived barriers and benefits to cervical cancer screening in Latin America. Preventive Medicine, 39, 91-98.
2.
Albujar, P. ( 1995). Cobertura citológica de la población femenina a riesgo de cancer cérvico uterino en la región La Libertad [Cytological coverage for cervical-uterine cancer risk for the female population in the La Libertad region]. Acta Cancerol, 3, 113-115.
3.
Alliance for Cervical Cancer Prevention. ( 2004). Planning and implementing cervical cancer prevention and control programs: A manual for managers. Seattle, WA : Author.
4.
Arrossi, S., Sankaranarayanan, R., & Parkin, D.M. ( 2003). Incidence and mortality of cervical cancer in Latin America . Salud Pública de México, 45(Suppl.3), S306-S314.
5.
Asociación de Médicos Ex-Residentes del Instituto Nacional de Enfermedades Neoplásicas. (1994). Magnitud de la Detección de Cáncer de Cuello Uterino y Mamario a Nivel Nacional, Perú, 1993 [Magnitude of the detection of cervical and breast cancer at the national level, Peru, 1993]. Report presented at the XVII Peruvian Cancer Event in Huaraz, Peru.
6.
Bessler, P., Aung, M., & Jolly, P. ( 2007). Factors affecting uptake of cervical cancer screening among clinic attendees in Trelawny, Jamaica. Cancer Control , 14, 396-404.
7.
Bingham, A., Bishop, A., Coffey, P., Winkler, J., Bradley, J., Dzuba, I., & Agurto, I. ( 2003). Factors affecting utilization of cervical cancer prevention services in low-resource settings. Salud Pública de México, 45(Suppl. 3), S408-S416.
8.
Chin-Quee, D.S., Cuthbertson, C., & Janowitz, B. ( 2006). Over-the-counter pill provision: Evidence from Jamaica . Studies in Family Planning, 37, 99-110.
9.
Coalición Multisectorial Perú Contra el Cáncer. (2007). Plan Nacional para el Fortalecimiento de la Prevención y Control del Cáncer [National plan for strengthening the prevention and control of cancer]. Lima, Perú : Perú Contra el Cáncer.
10.
Ferlay, J., Bray, F., Pisani, P., & Parkin, D.M. ( 2004). GLOBOCAN 2002: Cancer incidence, mortality and prevalence worldwide (International Agency for Cancer Research CancerBase No. 5,version2). Lyon, France: IARC Press.
11.
Forbes, C., Jepson, R., & Martin-Hirsch, P. (2002). Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Systematic Review, 3:CD002834.
12.
Garcia, P.J., Chavez, S., Feringa, B., Chiappe, M., Li, W., Jansen, K.U., . . . Holmes, K.K. ( 2004). Reproductive tract infections in rural women from the highlands, jungle and coastal regions of Peru. Bulletin of the World Health Organization, 82, 483-492.
13.
Glanz, K., Rimer, B.K., & Lewis, F.M. ( 2002). Health behavior and health education: Theory, research, and practice (3rd ed.). San Francisco, CA: Jossey-Bass.
14.
Guest, G., Bunce, A., & Johnson, L. ( 2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59-82.
15.
Harrison, J.A., Mullen, P.D., & Green, L.W. ( 1992). A meta-analysis of studies of the Health Belief Model with adults. Health Education Research, 7(1), 107-116.
16.
International Planned Parenthood Federation/Western Hemisphere Region. (2000). Manual to evaluate quality of care from a gender perspective. New York, NY: Author.
17.
Lara, D., Abuabara, K., Grossman, D., & Díaz-Olavarrieta, C. (2006). Pharmacy provision of medical abortifacients in a LatinAmerican city. Contraception , 74, 394-399.
18.
Leiva, A., Shaw, M., Paine, K., Manneh, K., McAdam, K., & Mayaud, P. ( 2001). Management of sexually transmitted diseases in urban pharmacies in The Gambia. International Journal of STD & AIDS, 12, 444-452.
19.
León, F.R., Monge, R., Zumarán, A., García, I., & Ríos, A. (2001). Length of counseling sessions and the amount of relevant information exchanged: A study in Peruvian clinics . International Family Planning Perspectives, 27, 28-33, 46.
20.
Leonard, K., & Masatu, M.C. ( 2006). Outpatient process quality evaluation and the Hawthorne Effect. Social Science & Medicine, 63, 2330-2340.
21.
Lewis, M.J. ( 2004). A situational analysis of cervical cancer in Latin America and the Caribbean. Washington, DC: Pan American Health Organization.
22.
Ministerio de Salud. (2000). Manual de normas y procedimientos para la prevención del cáncer del cuello uterino [Manual of norms and procedures for the prevention of cervical cancer]. Dirección de Programas Sociales, Programa Nacional de Planificación Familiar.
23.
Patton, M.Q. ( 2002). Qualitative Research and Evaluation Methods. Thousand Oaks, CA: SAGE Publications.
24.
Paz Soldan, V.A., Lee, F., Carcamo, C., Holmes, K.K., Garnett, G., & Garcia, P. ( 2008). Who is getting Pap smears in urban Peru?International Journal of Epidemiology, 37, 862-869.
25.
Pbert, L., Fletcher, K., Flint, A., Young, M., Druker, S., & DiFranza, J. ( 2006). Smoking prevention and cessation intervention delivery by pediatric providers, as assessed with patient exit interviews. Pediatrics, 118, e810-e824.
26.
Solidoro, A., Olivares, L., Castellano, C., Barriga, O., Galdos, R., & Caceres, E. ( 2004). Cáncer de cuello uterino en el Perú. Diagnostico, 43, 29-33.
27.
Ulin, P.R., Robinson, E.T., & Tolley, E.E. ( 2005). Qualitative methods in public health: A field guide for applied research. San Francisco: Jossey-Bass.
28.
U.S. Census Bureau. (2008). Country summary: Peru. International data base. Washington, DC: U.S. Census Bureau, Population Division. Retrieved from http://www.census.gov/ipc/www./idb/country/peportal.html
29.
Winkler, J., Bingham, A., Coffey, P., & Handwerker, W.P. (2008). Women’s participation in a cervical cancer screening program in northern Peru. Health Education Research, 23, 10-24.
30.
Wolfe, K. ( 2005). Youth friendly pharmacies and partnerships: The CMS-CELSAM experience. Bethesda, MD: Private Sector Partnerships-One project, Abt Associates Inc..
31.
World Health Organization. (2002). Cervical cancer screening in developing countries, report of a WHO consultation . Programme on Cancer Control and Department of Reproductive Health and Research of the World Health Organization, Geneva, Switzerland. Retrieved from http://www.who.int/reproductive-health/cancers/cervical.html
32.
World Health Organization/Institut Catala d’Oncologia Information Centre on HPV and Cervical Cancer (HPV Information Centre). ( 2007). Summary report on HPV and cervical cancer statistics in Peru. Retrieved from www.who.int/hpvcentre
33.
Youssef, H., Hassan, E.O., & Nawar, L. ( 2001). Expanding improved post-abortion care in Egypt. Egyptian Society of Obstetrics and Gynecology, 27, 237-251.
34.
Zhou, W., Shi, W.D., Chen, Z.D., Wei, S.B., & Zhao, P.F. ( 2002, July). STI care for female sex workers: What roles for the standardized STI clinic in the 100% condom use programme in Wuhan, China?Paper presented at the 14th International Conference on AIDS, Barcelona, Spain.
