Barreiras na busca pelo rastreio de lesões precursoras do câncer do colo uterino: um estudo sobre as relações da violência íntima em usuárias da Saúde da Família

Abstract

Changes in the morbidity and mortality profile of the female population made the malignant neoplasms occupy the top positions on death causes among this group. Among these types of cancers, the cervical neoplasia is especially noteworthy due to its high chances of successful cure in the event of early detection. Nonetheless, even women who can easily access the screening test do not take it as often as desirable. Negative feelings about these practices can be related to broader issues of gender, including intimate violence. Victims of violence do not always manage to receive support within their social group and have access to certain health services. Under this perspective, this study aims to assess the influence of intimate violence on access to screening services of precursor lesions for cervical cancer in women users of the ESF. In order to achieve the aforementioned objectives, we decided to conduct a case-control study with a sample of 640 women users of the ESF in the municipality of Nova Iguaçu. The source of the study sample comprised women aged between 25 and 64 years old, resident in the coverage area of this ESF. Women who had not performed the Pap test in the three years prior to this study were considered the case group. The control group comprised women who had performed the examination, sampling proportion of 3:1. The collection instrument contemplated distal (socio-demographic characteristics) and intermediate dimensions (life habits, intimate violence, alcohol abuse, health beliefs and gynaecological-obstetrical background), as well as the outcome itself (not performing the test), from what was proposed in a Theoretical-Conceptual Model. The analysis plan was first marked by descriptive analyses, aiming at unveiling and establishing the reality of the sample studied. Then, their respective Odds Ratio (OR) crude and adjusted were calculated. The Confidence Intervals of 95, the Chi-square test, and the Likelihood-ratio test in a multivariate model were calculated. Prevalence of violence perpetrated against women was 21.0 (CI95:17.924.3) for physical form, 90.7 (CI95:88.593.0) for psychological form, and 39.1 (CI955:36.043.6) in the event of sexual abuse. Regarding demographic characteristics, age seems to contribute directly as a barrier to carrying out the examinations (p-value 0.009), reaching its maximum in the age group over 60 years old (OR3.2; CI95:1.57.0). On the other hand, school background revealed itself as a protective factor (OR0.5; IC95: 0.40.8). It was found, after applying the adjustment model, a relationship between not performing the examination with the forms of several/less physical violence and less sexual abuse. In any case, it is recommended to conduct other studies with a similar method to evaluate the presence of this association in other scenarios and populations, as recommended by the causality criteria.