Table 1
Inclusion and exclusion criteria of study selection.
| INCLUSION CRITERIA | EXCLUSION CRITERIA |
|---|---|
| Original papers describing all methods of CC screening in rural areas among women aged 20 to 70 years old | Studies falling outside the scope of the review’s aim. |
| Original papers describing HPV vaccination in rural areas | Studies examining CC screening and HPV vaccination without the place of residence specification |
| Articles published between January 1, 2004 to December 31, 2021 | Studies on HPV vaccination among boys |
| Full text articles | Studies examining HPV infection |
| Studies investigating vaccines other than HPV | |
| Unavailability of full text studies | |
| Duplicate of papers |
Figure 1
Article selection flowchart.
Table 2
International experience on implementation of CC screening programs in rural areas: major problems and possible solutions.
| AUTHORS(YEAR OF PUBLICATION) | COUNTRY | STUDY POPULATION | TYPE OF CC SCREENING | STUDY DESIGN | KEY FINDINGS | PROPOSED SOLUTIONS |
|---|---|---|---|---|---|---|
| Liu et al (2017) [9] | China | Women aged 35–64 years | Population-based cervical cancer screening (National Cervical Cancer Screening Program in Rural Areas) | Survey | The vast majority of women (96,0%) expressed positive attitudes towards screening. Still, many respondents reported low awareness of the screening program, and more than a third (36,3%) had never taken part in the program | Information campaigns among target population group. Teaching medical personnel about C identification via screening. Mechanisms to ensure the continuity of health education should be envisaged. |
| Thompson et al (2017) [14] | Latin America | 3 years after the age of initiation of sexual activity | Population-based cervical cancer screening | Randomized controlled trial with educational interventions | Women living in rural areas, low socioeconomic status and high enclave areas have 12.7 times higher rates of invasive CC than those who live in areas of high socioeconomic status and low enclave areas. More than 60% of late-stage cancers are found in the areas with low health care and under-examined groups of women. | women residing in rural areas |
| Ndejjo et al (2016) [24] | Uganda | Women aged 25–49 (VIA, 3 years); 30–49 (HPV) | National Cervical Cancer Screening recommendations | Survey | Of the 900 women, only 43 (4.8%) had ever been screened for CC. Barriers to cervical cancer screening were negative individual perceptions 553 (64.5%) and health facility related challenges 142 (16.6%). | Increase access to cervical cancer screening in rural areas and engage health workers to discuss the CC disease with women. |
| Ruddies et al (2020) [22] | Ethiopia | Women aged 30–49 years | No organized or opportunistic cervical cancer screening program | Survey | Only eight women (2.3%) had been screened before. Although 240 women (70.4%) had the intention to be screened, only 107 (31.4%) said that they had access to a screening facility. Living in an urban setting made it 3.35 times more likely to have a positive attitude towards cervical cancer screening as compared with women living in rural areas. | Special emphasis should be put on training of health care providers with a focus on cervical cancer and its screening, |
| Rosser et al (2015) [29] | Kenya | Women aged 25–49 (VIA, 5 years); 25–30 (cytology, 5 years); 30–49 (HPV test, 5 years) | National Cervical Cancer Screening Program. Pilot implementation of self-sampling HPV testing | Survey | The main obstacles in providing services were a lack of sufficient staff (62%), inadequate training or a shortage of trained personnel (60%), low staff motivation (25%), insufficient space for screening activities (35%), and difficulty with supplies (31%) or autoclaving (9%). Also, low community mobilization as a problem within the population | Additional health care providers training, increased community mobilization by educational campaigns and training for both groups |
| Gottschlich et al (2021) [30] | Guatemala | Women aged 25–29 (cytology, 3 years); 50–54 (cytology, 3 years); 30–49 (cytology, 3 years); 30–39 (HPV test, 5 years); 40–49 (VIA, 3 years) | National Cervical Cancer Screening Program. | Qualitative, in-depth interview | Barriers to screening included ancillary costs, control by male partners, poor provider communication and systems-level resource constraints, like shortages of tests and long wait times | Discussions with women who have been screened for cervical cancer, health campaigns, self-screening for HPV |
Table 3
Knowledge of HPV and HPV vaccination in rural different population groups across the globe.
| AUTHORS (YEAR OF PUBLICATION) | COUNTRY | STUDY POPULATION | STUDE DESIGN | AWARENESS ABOUT HPV VACCINATION SS |
|---|---|---|---|---|
| Ping Wong et al (2010) [38] | Malaysia | Young women residing in rural areas in Malaysia were interviewed using a standard questionnaire (N = 449). | Survey | The mean total knowledge score (14-item questionnaire) was 2.37 (SD±1.97). Although many respondents never heard of the HPV vaccine, two-thirds professed an intention to receive the HPV vaccine. Intention to receive the vaccine was significantly associated with knowledge of cervical screening and cervical cancer risk factors. |
| Thomas et al (2012) [58] | USA | African American parents or caregivers with children 9–13 years of age completed a survey (N = 400). | Survey | Perceived vulnerability (knowledge about HPV) constituted 40.4%, while perceived severity (awareness that HPV can cause a CC) equaled 45.6%. |
| Feng et al (2012) [37] | China | Women attending the checkup clinics were invited to complete a questionnaire-guided interview (N = 1432). | Qualitative, interview | 39.1% of women living in urban areas and 27.1% of women in rural areas were aware about HPV, whereas 23.7% and 15.1%, respectively, heard of the HPV vaccine. The mean score of HPV knowledge was 3.75 in residents of urban areas and 3.18 in residents of rural areas. |
| Blake et al (2015) [59] | USA | National Cancer Institute’s 2013 Health Information National Trends Survey of USA adult, civilian, non-institutionalized people (N = 3185). | Survey | People living in rural areas were significantly less likely to know that HPV causes cervical cancer as compared with those living in urban areas. |
| Nasritdinova et al (2016) [43] | Kazakhstan | Population of four regions of Kazakhstan took part in anonymous survey (N = 5338) | Survey | 66% of respondents were aware about existence of HPV vaccine. No significant difference between urban and women residing in rural areas was detected. |
| Boyd e al (2018) [41] | USA | Vaccinated and non-vaccinated adolescents aged 11–18 years and their caregivers from three rural counties of south Alabama participated in individual interviews (N = 48). | Qualitative, interview | 75% of caregivers and 33% of adolescents heard about HPV and 62.5% of adolescents were aware that HPV can lead to cervical cancer as compared with 55.6% of the caregivers. 60% of caregivers of non-vaccinated adolescents and 33.3% caregivers of non-vaccinated adolescents heard about the HPV vaccine. |
| Mohammed et al (2018) [40] | USA | Respondents older than ≥18 years completed the Health Information National Trends Survey 2013–2017 (N = 10147). | Survey | 55.8% and 58.6% of rural residents were aware of HPV and HPV vaccine, respectively. As compared with urban residents, rural residents were less likely to be aware of HPV and HPV vaccine. Rural residents were less likely to know that HPV causes cervical cancer, and that HPV can be transmitted through sexual contact. |
| Degarege et al (2018) [36] | India | Parents of school-going adolescent girls completed a self-administered questionnaire (N = 1609). | Survey | Urban parents were more likely to believe that both HPV infection and CC could cause serious health problems. Parents’ belief that HPV vaccination will make girls sexually active was lower among urban parents as compared with rural. There was no significant difference between urban and rural parents in beliefs about susceptibility of their daughters to HPV infection or cervical cancer, and beliefs about the safety and ability of HPV vaccine to protect against cervical cancer. |
| Touch and Oh (2018) [54] | Cambodia | Women aged 20–69 years who lived in Kampong Speu Province participated in the survey (N = 440). | Survey | Only 2% of women were aware that HPV infection is a risk factor for cervical cancer; 8.6% of women were aware that HPV is a sexually transmitted infection; 35.2% of women knew that cervical cancer can be prevented by vaccination; and 62% of women were willing to receive vaccination for themselves as well as for their daughters. |
| Qin et al (2020) [39] | China | Women aged 20–45 years from rural areas of Hunan Province in China completed the anonymous self-administered questionnaire (N = 2101). | Survey | 21.6% of women were aware of HPV as a risk factor of CC and 50.28% of women knew about HPV vaccine. |
| Banik et al (2020) [46] | Bangladesh | Women of reproductive age living in rural areas of Bangladesh were interviewed with a semi-structured questionnaire (N = 600). | Survey | 55.2% of respondents identified HPV infection as a risk factor for CC, and 48.3% knew that HPV vaccine can prevent CC. |
| Kadian et al (2020) [60] | India | Women of urban and rural background aged 18–65 years completed the questionnaire (N = 1500) | Survey | 55% of women had little knowledge about cervical cancer, and 87.5% were informed about HPV infection, while 95% were aware about HPV vaccine. Good knowledge about HPV infection and HPV vaccination was very low in both rural (6.25% and 1.25%, respectively) and urban (14.3% and 4.3%, respectively) areas. |
Figure 2
Strategies to overcome the infrastructure, communication, and cost-related barriers in rural areas.