Cervical Cancer-Related Knowledge, Attitudes, and Practices of Health Professionals Working in Brazil's Network of Primary Care Units

Introduction. Brazil's national strategy for cervical cancer screening includes using the Papanicolaou (Pap) test every 3 years among women aged 25-64 years. Comprehensive primary care services are provided through a network of primary health units, but little is known about cervical cancer-related knowledge, attitudes, and practices among health professionals and coordinators working in these facilities. Methods. In 2011, we conducted a cross-sectional nationally representative phone survey of 1,600 primary health care units to interview one unit coordinator and one health care professional per unit (either nurse, physician, or community health worker). Responses were obtained from 1,251coordinators, 182 physicians, 347 nurses, and 273 community health workers. Questionnaires were administered to assess health units' characteristics and capacity for cervical cancer-related services as well as health professionals' perceived effectiveness of the Pap test, preparedness to talk to women about cervical cancer, adherence with screening guidelines, and willingness to recommend human papillomavirus (HPV) vaccination to females. Results. Most units conducted screening (91.9%), used home visits to conduct recruitment and outreach (83.4%), and provided follow-up to women who did not return to discuss Pap test results (88.1%). Approximately 93% of health professionals stated that Pap testing was effective in decreasing death rates from cervical cancer and 65% stated that national guidelines for cervical cancer screening are very influential; 93% of nurses and physicians reported screening women annually and 75% reported beginning to screen women younger than 25 years old. Regarding HPV vaccination, almost 90% of nurses and physicians would recommend the HPV vaccine to their females patients if it were available. A larger proportion of physicians and nurses recommended the HPV vaccine to older girls (13-18 years) and women (19-26 years and even older than 26 years) than to younger girls (12 years or younger). Conclusion. Although Brazil's network of primary care units has significantly increased access to cervical cancer screening, effective strategies are needed to ensure that women get screened at the appropriate ages and intervals. Additionally, this study's baseline data on HPV vaccination may be useful as Brazil embarks on a national HPV vaccination program in 2014.