Case management intervention in cervical cancer prevention: the Boston REACH coalition women's health demonstration project(1010 Clark CR, Baril N, Hall A, Kunicki M, Johnson N, Soukup J, et al. Case management intervention in cervical cancer prevention: the Boston REACH coalition women's health demonstration project. Prog Community Health Partnersh [Internet]. 2011[cited 2014 Aug 14];5(3):235-47. Available from: http://muse.jhu.edu/journals/cpr/summary/v005/5.3.clark01.html
http://muse.jhu.edu/journals/cpr/summary...
)
|
2011/USA |
Pre and post-intervention/732 |
Case manager |
Increase in the uptake of periodic Pap smear exam |
Increasing participation in cervical cancer screening: telephone contact with long-term non-attendees in Sweden. Results from RACOMIP, a randomized controlled trial(1111 Broberg G, Jonasson JM, Ellis J, Gyrd-Hansen D, Anjemark B, Glantz A, et al. Increasing participation in cervical cancer screening: telephone contact with long-term non-attendees in Sweden: results from RACOMIP, a randomized controlled trial. Int J Cancer [Internet]. 2013[cited 2014 Aug 14];133(1):164-71. Available from: http://onlinelibrary.wiley.com/doi/10.1002/ijc.27985/pdf
http://onlinelibrary.wiley.com/doi/10.10...
)
|
2013/Sweden |
Intervention with control group/8,800 |
Telephone call |
Increase in participation of women in uptake of exam, and at low cost |
Increasing cervical cancer screening for a multiethnic population of women in South Texas(1212 Fornos LB, Urbansky KA, Villarreal R. Increasing cervical cancer screening for a multiethnic population of women in South Texas. J Cancer Educ. 2014;29(1):62-8.)
|
2014/USA |
Cohort/32,807 |
Automated reminder call |
Increase in the uptake of Pap smear exam |
Effectiveness of nursing interventions to increase pap smear test screening(1313 Guvenc G, Akyuz A, Yenen MC. Effectiveness of nursing interventions to increase pap smear test screening. Res Nurs Health [Internet]. 2013[cited 2014 Aug 14];36(2):146-57. Available from: http://onlinelibrary.wiley.com/doi/10.1002/nur.21526/epdf
http://onlinelibrary.wiley.com/doi/10.10...
)
|
2013/ Turkey |
Quasi-experimental/ 2,500 |
Multiple interventions |
Telephone contact was the intervention that facilitated higher adherence to the uptake of Pap smear exam. |
Interventions targeted at women to encourage the uptake of cervical screening(1414 Everett T, Bryant A, Griffin MF, Martin-Hirsch PP, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev [Internet]. 2011[cited 2014 Aug 14];11(5):CD002834. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163962/pdf/emss-57241.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2011 |
Integrative review with randomized and controlled clinical trials |
Invitation letter |
Increase in adherence to cervical cancer prevention programs |
A prospective randomized study of two reminding strategies: telephone versus mail in the screening of cervical cancer in women who did not initially respond(1515 Heranney D, Fender M, Velten M, Baldauf JJ. A prospective randomized study of two reminding strategies: telephone versus mail in the screening of cervical cancer in women who did not initially respond. Acta Cytol [Internet]. 2011[cited 2014 Aug 14];55(4):334-40. Available from: http://www.karger.com/Article/Abstract/327527
http://www.karger.com/Article/Abstract/3...
)
|
2011/ Alsace |
Randomized study/10,662 |
Invitation letter and telephone call |
Both interventions are efficacious, but invitation letter is more affordable and easier to be applied |
Methods to increase participation in organized screening programs: a systematic review(1616 Camilloni L, Ferroni E, Cendales BJ, Pezzarossi A, Furnari G, Borgia P, et al. Methods to increase participation in organized screening programs: a systematic review. BMC Public Health [Internet]. 2013[cited 2014 Aug 14];13:464. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-464
http://bmcpublichealth.biomedcentral.com...
)
|
2013 |
Systematic review |
Postcard and invitation letter |
Both proved to be efficacious to increase participation in cervical cancer prevention |
Intervenciones educativas para la prevención del cáncer cervicouterino(1717 Riquelme GH. Concha XP, Urrutia MT. Intervenciones educativas para la prevención del cáncer cervicouterino. Rev Chil Obstet Ginecol [Internet]. 2012[cited 2014 Aug 14];77(2):111-5. Available from: http://www.scielo.cl/pdf/rchog/v77n2/art06.pdf
http://www.scielo.cl/pdf/rchog/v77n2/art...
)
|
2012 |
Bibliographic survey |
Educational interventions |
Efficacious in adopting behaviors that prevent cervical cancer |
Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women(1818 Wang X, Fang C, Tan Y, Liu A, Grace XM. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health[Internet]. 2010[cited 2014 Aug 14];19(3):463-9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867551/pdf/jwh.2009.1422.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2010/ USA |
Pre- and post-intervention/ 134 |
Education in health and Internet |
Increase in adherence to Pap smear exam |
Effectiveness of cultivando la salud: a breast and cervical cancer screening promotion program for low-income Hispanic women(1919 Fernandez ME, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W, et al. Effectiveness of Cultivando La Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health [Internet]. 2009[cited 2014 Aug 14];99(5):936-43. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667857/pdf/936.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2009/USA |
Pre- and post-randomized intervention/ 243 |
Educational activities |
Increase in adherence to the uptake of Pap smear exam |
Increasing pap smear utilization among Samoan women: results from a community based participatory randomized trial(2020 Mishra SI, Luce PH, Baquet CR. Increasing pap smear utilization among Samoan women: results from a community based participatory randomized trial. J Health Care Poor Underserved. 2009[cited 2014 Aug 14];20(2Suppl):85-101. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604739/pdf/nihms-452097.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2009/USA |
Randomized intervention/ 398 |
Culturally adapted educational programs |
Increase in adherence to uptake Pap smear exam |
Actividades educativas en Cruce de los Baños sobre prevención del cáncer cervicouterino(2121 Guerra RT, Quiala JT, Lambert SR. Actividades educativas en Cruce de los Baños sobre prevención del cáncer cervicouterino. MEDISAN [Internet]. 2010[cited 2014 Aug 14];14(8):1097-2001. Available from: http://bvs.sld.cu/revistas/san/vol_14_8_10/san08810.htm
http://bvs.sld.cu/revistas/san/vol_14_8_...
)
|
2010/ Cuba |
Randomized intervention/142 |
Educational intervention |
Increase in adherence to the uptake of Pap smear exam |
Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women(2222 Duggan C, Coronado G, Martinez J, Byrd TL, Carosso E, Lopez C, et al. Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women. BMC Cancer [Internet]. 2012[cited 2014 Aug 14];2:170-6. Available from: http://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-12-170
http://bmccancer.biomedcentral.com/artic...
)
|
2012/ USA |
Parallel controlled randomized intervention/600 |
Culturally adapted educational intervention |
Increase in adherence to the uptake of Pap smear exam |
AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women(2323 Byrd TL, Wilson KM, Smith JL, Coronado G, Vernon SW, Fernandez-Esquer ME, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer [Internet]. 2013[cited 2014 Aug 14];1:1365-72. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603549/pdf/nihms724770.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2013/ USA |
Randomized four-component intervention |
Educational interventions |
Increase in adherence to the uptake of Pap smear exam |
ACCISS study rationale and design: activating collaborative cancer information service support for cervical cancer screening(2424 Cofta-Woerpel L, Randhawa V, McFadden HG, Fought A, Bullard E, Spring B. ACCISS study rationale and design: activating collaborative cancer information service support for cervical cancer screening. BMC Public Health [Internet]. 2009[cited 2014 Aug 14];9:444-54. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-444
http://bmcpublichealth.biomedcentral.com...
)
|
2009/ USA |
Randomized prospective experimental intervention/20 |
Focus group with educational interventions |
Increase in knowledge about cervical cancer prevention |
Community health worker intervention to decrease cervical cancer disparities in Hispanic women(2525 O'Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med[Internet]. 2010[cited 2014 Aug 14];25(11):1186-92. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947642/pdf/11606_2010_Article_1434.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2010/ USA |
Randomized study/120 |
Educational intervention with workshops |
Positive association between knowledge about cervical cancer and uptake of exam |
Acciones educativas para la prevención del cáncer cervicouterino en la adolescencia(2626 Nair AGDM, Arroyo MC, Heredia EG, Bahades JB. [Educational actions for the prevention of cervical cancer in adolescents]. MEDISAN [Internet]. 2011[cited 2014 Aug 14];15(2):209-14. Available from: http://scielo.sld.cu/pdf/san/v15n2/san10211.pdf Spanish http://scielo.sld.cu/pdf/san/v15n2/san10...
)
|
2011/ Venezuela |
Intervention/65 |
Educational intervention |
Increase in knowledge about cervical cancer |
Interventions that increase use of Pap tests among ethnic minority women: A meta-analysis(2727 Han HR Kim J, Lee JE, Hedlin HK, Song H, Song Y, et al. Interventions that increase use of Pap tests among ethnic minority women: a meta-analysis. Psychooncology [Internet]. 2011[cited 2014 Aug 14];20(4):341-51. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741532/pdf/nihms491176.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2011/ USA |
Meta-analysis |
Multiple interventions |
Community education proved to be efficacious to increase the uptake of Pap smear associated to easy access to health care service |
Overcoming barriers to cervical cancer screening among Asian American women(2828 Fang CY, Ma GX, Tan Y. Overcoming barriers to cervical cancer screening among Asian American women. N Am J Med Sci (Boston) [Internet]. 2011[cited 2014 Aug 14];4(2):77-83. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115728/pdf/nihms285936.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2011 |
Review |
Educational intervention using community members |
Favored an increase in screening rates |
Impact of media reporting of cervical cancer in a UK celebrity on a population-based cervical screening programme(2929 MacArthur GJ, Wright M, Beer H, Paranjothy S. Impact of media reporting of cervical cancer in a UK celebrity on a population-based cervical screening programme. J Med Screen[Internet]. 2011[cited 2014 Aug 14];18(4):204-9. Available from: http://msc.sagepub.com/content/18/4/204.long
http://msc.sagepub.com/content/18/4/204....
)
|
2011/ United Kingdom |
Ecological/ 33,000 |
Media reports about celebrities |
Showed a transitory increase in Pap smear exams rate |
Using entertainment-education to promote cervical cancer screening in Thai women(3030 Love GD, Tanjasiri SP. Using entertainment-education to promote cervical cancer screening in Thai women. J Cancer Educ[Internet]. 2012[cited 2014 Aug 14];27(3): 585-90. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372047/pdf/nihms-666670.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2012/ USA |
Quasi-experimental |
Thematic soap opera and educational flyers |
Increase in knowledge and adherence to Pap smear exam |
Building a cervical cancer screening intervention for public health practice(3131 Smith JL, Wilson KM, Orians CE, Byrd TL. AMIGAS: Building a cervical cancer screening intervention for public health practice. J Womens Health[Internet]. 2013[cited 2014 Aug 14];22(9):718-23. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603539/pdf/nihms724775.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2013/ USA |
Randomized study |
Community based educational intervention |
Increase in cervical cancer screening |
Adherence to cervical and breast cancer programs is crucial to improving screening performance(3232 Mauad EC, Nicolau SM, Moreira LF, Haikel Junior RL, Longatto-Filho A, Baracat EC. Adherence to cervical and breast cancer programs is crucial to improving screening performance. Rural Remote Health[Internet]. 2009[cited 2014 Aug 14];9:1241. Available from: http://www.rrh.org.au/publishedarticles/article_print_1241.pdf
http://www.rrh.org.au/publishedarticles/...
)
|
2009/Brazil |
Intervention/ 5,759 |
Home visit by community health agent |
Increase in adherence to Pap smear exam |
Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women(3333 Taylor VM, Jackson C, Yasui Y, Nguyen TT, Woodall E, Acorda E, et al. Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women. Am J Public Health[Internet]. 2010[cited 2014 Aug 14];100(10):1924-9. Available from: http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.190348
http://ajph.aphapublications.org/doi/ful...
)
|
2010/ USA |
Intervention/ 234 |
Home visit by health agent |
Increase in adherence to Pap smear exam |
Evaluating the efficacy of lay health advisors for increasing risk-appropriate pap test screening: a randomized controlled trial among Ohio Appalachian women(3434 Paskett ED, McLaughlin JM, Lehman AM, Katz ML, Tatum CM, Oliveri JM. Evaluating the efficacy of lay health advisors for increasing risk-appropriate pap test screening: a randomized controlled trial among Ohio Appalachian women. Cancer Epidemiol Biomarkers Prev[Internet]. 2011[cited 2014 Aug 14];20(5):835-43. Available from: http://cebp.aacrjournals.org/content/20/5/835.long
http://cebp.aacrjournals.org/content/20/...
)
|
2011/ USA |
Randomized study/286 |
Home visit, telephone calls and postcard |
Improvement of adherence to the exam |
Refinement of an educational toolkit to promote cervical cancer screening among hispanic immigrant women in rural southern Georgia(3535 Watson-Johnson LC, Bhagatwala J, Reyes-Garcia C, Hinojosa A, Mason M, Meade CD, et al. Refinement of an educational toolkit to promote cervical cancer screening among hispanic immigrant women in rural southern Georgia. J Health Care Poor Underserved [Internet]. 2012[cited 2014 Aug 14];23(4):1704-11. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676893/pdf/nihms-473438.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2012/ USA |
Intervention |
Educational toolkits and community health agents |
Reduction in cultural barriers and increase in adherence to cervical cancer prevention |
Kin Keeper SM: design and baseline characteristics of a community-based randomized controlled trial promoting cancer screening in Black, Latina, and Arab women(3636 Williams KP, Roman LA, Meghea CI, Penner L, Hammad A, Gardiner J. Kin Keeper SM: design and baseline characteristics of a community-based randomized controlled trial promoting cancer screening in Black, Latina, and Arab women. Contemp Clin Trials [Internet]. 2013[cited 2014 Aug 14];34(2):312-9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594085/pdf/nihms431768.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2013/ USA |
Controlled randomized study/514 |
Education in health through community health agents |
Increase of adherence to Pap smear exam |
Increasing cervical cancer screening in the United States-Mexico border region(3737 Thompson B, Vilchis H, Moran C, Copeland W, Holte S, Duggan C. Increasing cervical cancer screening in the United States-Mexico border region. J Rural Health [Internet]. 2014[cited 2014 Aug 14];30(2):196-205. Available from: http://onlinelibrary.wiley.com/doi/10.1111/jrh.12044/abstract
http://onlinelibrary.wiley.com/doi/10.11...
)
|
2014/ USA |
Intervention/ 162 |
Education in health through community health agents |
Good adherence to Pap smear exam |
Cervical cancer prevention: new tools and old barriers(3838 Scarinci IC, Garcia FAR, Kobetz E, Partridge EE, Brandt HM, Bell MC, et al. Cervical cancer prevention: new tools and old barriers. Cancer [Internet]. 2010[cited 2014 Aug 14];116(11):2531-42. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876205/pdf/nihms179540.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2010/ USA |
Intervention |
Partnership between the university and community |
Reduction in social barriers and increase in adherence to Pap smear exam |
Increasing cervical cancer screening in a hispanic migrant farmworker community through faith-based clinical outreach(3939 Luque JS, Tyson DM, Markossian T, Lee JH, Turner R, Proctor S, et al. Increasing cervical cancer screening in a hispanic migrant farmworker community through faith-based clinical outreach. J Low Genit Tract Dis [Internet]. 2011[cited 2014 Aug 14];15(3):200-4. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735442/pdf/nihms319444.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2011/ USA |
Review |
Partnership of health services with faith-based entities |
Increase in adherence to Pap smear exam |
Innovative approaches to promoting cervical health and raising cervical cancer awareness by use of existing cultural structures in resource-limited countries: experiences with traditional marriage counseling in Zambia(4040 Kapambwe S, Parham G, Mwanahamuntu M,Chirwa S, Mwanza J, Amuyunzu-Nyamongo M. Innovative approaches to promoting cervical health and raising cervical cancer awareness by use of existing cultural structures in resource-limited countries: experiences with traditional marriage counseling in Zambia. Glob Health Promot [Internet]. 2013[cited 2014 Aug 14];20(4 Suppl):57-64. Available from: http://ped.sagepub.com/content/20/4_suppl/57.long
http://ped.sagepub.com/content/20/4_supp...
)
|
2013/ Africa |
Intervention/70 |
Partnership of health services with faith-based entities |
Increase in adherence to Pap smear exam |
Adaptation of a cervical cancer education program for african americans in the faith-based community, Atlanta, Georgia, 2012(4141 Haynes V, Escoffery C, Wilkerson C, Bell R, Flowers L. Adaptation of a cervical cancer education program for african americans in the faith-based community, Atlanta, Georgia, 2012. Prev Chronic Dis [Internet]. 2014[cited 2014 Aug 14];11:130271. Available from: http://www.cdc.gov/pcd/issues/2014/pdf/13_0271.pdf
http://www.cdc.gov/pcd/issues/2014/pdf/1...
)
|
2014/ USA |
Methodological |
Educational intervention associated to churches |
Increase in adherence to cervical cancer prevention |
Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program(4242 Palencia L, Espelt A, Rodrıguez-Sanz M, Puigpinós R, Pons-Vigués M, Pasaríns MI, et al. Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol [Internet]. 2010[cited 2014 Aug 14];39:757-65. Available from: http://ije.oxfordjournals.org/content/39/3/757.long
http://ije.oxfordjournals.org/content/39...
)
|
2010/ 22 European countries |
Cross-sectional |
Population-based screening |
Showed more efficiency than opportunistic screening |
A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women(4343 Lu M, Moritz S, Lorenzetti D, Sykes L, Straus S, Quan H. A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women. BMC Public Health [Internet]. 2012[cited 2014 Aug 14];12:413-29. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-413
http://bmcpublichealth.biomedcentral.com...
)
|
2012 |
Systematic review |
Multiple interventions |
Combination of group education and availability of exam uptake is more efficacious |
Updated recommendations for client- and provider-oriented interventions to increase breast, cervical, and colorectal cancer screening(4444 Fielding JE, Rimer BK, Calonge N, Clymer JM, Glanz K, Goetzel RZ, et al. Updated recommendations for client- and provider-oriented interventions to increase breast, cervical, and colorectal cancer screening. Am J Prev Med [Internet]. 2012[cited 2014 Aug 14];43(1):92-6. Available from: http://www.ajpmonline.org/article/S0749-3797%2812%2900256-5/abstract)
|
2012/ USA |
Descriptive |
Multiple interventions |
Group education, dissemination in media, and reduction of structural barriers to health services are efficacious |
Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: an implementation guideline(4545 Brouwers MC, Vito CD, Bahirathan L, Carol A, Carroll J, Cotterchio M, et al. Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: an implementation guideline. Implement Sci [Internet]. 2011[cited 2014 Aug 14];6:112-20. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222606/pdf/1748-5908-6-112.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2011 |
Methodological |
Multiple interventions |
Reminders and reduction in health service barriers are efficacious to enhance screening |
Influencing women's actions on cervical cancer screening and treatment in Karawang District, Indonesia(4646 Kim YM, Ati A, Kols A, Lambe FM, Soetikno D, Wysong M, et al. Influencing women's actions on cervical cancer screening and treatment in Karawang District, Indonesia. Asian Pac J Cancer Prev [Internet]. 2012[cited 2014 Aug 14];13(6):2913-21. Available from: http://www.apocpcontrol.org/paper_file/issue_abs/Volume13_No6/2913-21%205.31%20Young-Mi%20Kim.pdf
http://www.apocpcontrol.org/paper_file/i...
)
|
2012/Asia |
Qualitative research |
Multiple interventions |
Increase in adherence by disseminating information, paying home visits, and providing free exams |
What implementation interventions increase cancer screening rates? a systematic review(4747 Brouwers MC, Vito CD, Bahirathan L, Carol A, Carroll J, Cotterchio M, et al. What implementation interventions increase cancer screening rates? a systematic review. Implement Sci [Internet]. 2011[cited 2014 Aug 14];6:111-28. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197548/pdf/1748-5908-6-111.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
)
|
2011 |
Systematic review |
Multiple interventions |
Increase in adherence with reminders, dissemination in the media, education in health, and reduction in health service barriers |