132 Chapter 5 Invitation approaches The participants of the study were recruited from several locations: 29 participants in homeless shelters, eight participants in a shelter for undocumented women, nine participants in a day shelter for homeless and undocumented people, eight participants in a shelter for sexual human trafficking victims, 15 participants in sex clubs combined with STI screening, and five participants at sex-worker walk-in location combined with STI screening. Out of the 74 participants, 68 (92%) women were recruited via the direct invitation approach. The remaining six participants were recruited by an indirect invitation approach. Of the indirect approach, five women were recruited through appointments made by their care providers, and one woman chose to participate after reading the website announcement. Several women declined to participate in the study. Some were willing to tell their reasons, which mainly met one of the exclusion criteria. In a number of cases, still being virgin was mentioned. Discussion This cross-sectional intervention study, conducted in a large city of the Netherlands, showed that marginalized women have an increased risk on (pre)cancerous cervical abnormalities compared with women screened by the Dutch CSP, with a PR of 4.4. Subsequently, a direct pro-active approach was found to be the most effective to stimulate screening participation among marginalized women. The findings of this study are in line with the results of two earlier US-studies among homeless women, showing higher incidence rates of abnormal smears and cervical cancer.11,12 This emphasizes on the special needs for screening marginalized women on cervical cancer. The literature called for new and innovative approaches in order to engage homeless women in cervical screening programs.11 Being pro-active and making use of close care providers seemed crucial to engage in addressing this specific population. During the study peer influence proved invaluable. Several participants became so convinced of the importance of screening they encouraged other women to participate in cervical cancer screening. This mechanism is to be acknowledged as a powerful tool for further enhancing screening uptake among this population; and has been described as being effective among other minority groups.18,19
RkJQdWJsaXNoZXIy MTk4NDMw