Changes in geographic variation in the uptake of cervical cancer screening in Taiwan: Possible effects of "leadership style factor"α

Shu Ti Chiou, Tsung Hsueh Lu

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: Wennberg proposed the "practice style factor" to explain the large variations in the use of medical care. As a corollary, we propose the "leadership style factor" of the director of the city/county bureau of public health to explain changes in geographic variation in the uptake of cervical cancer screening. Methods: We first calculated the triennial Pap smear rates for women aged 30-69 years from 1997 through 2010 for each city/county in Taiwan and the rate difference and rate ratio between the highest and the lowest city/county to illustrate the geographic variation in the uptake of cervical cancer screening. We then created an expert panel to conduct a hypothesis generation process to examine the possible effects of "leadership style factors" in explaining the changes. Results: The Pap smear rate in Taiwan as a whole was 35% in 1997 and increased to 56% in 2001, and was then stable until 2010 (55%). In 2002, the geographic variation in the Pap smear rate was the smallest, ranging from 49% in Penghu County to 63% in I-lan County, with a rate ratio of 1.28. Unfortunately, the rate ratio increased to 1.49 in 2010, the rate being lowest in Penghu County (42%) and highest in Tainan City (63%). We identified four cities/counties with unique patterns of change in Pap smear rates, which were highly associated with the leadership style of the director of the city/county bureau of public health. Conclusions: Despite the launch of an organized cancer screening program in Taiwan, geographic variation in the uptake of cervical cancer screening still exists and has increased during the past decade. The "leadership style factor" of the director of the city/county bureau of public health might play a plausible role in explaining the pattern of change in geographic variation in the use of cervical cancer screening in Taiwan.

Original languageEnglish
Pages (from-to)64-70
Number of pages7
JournalHealth Policy
Volume114
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1

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Taiwan
Early Detection of Cancer
Uterine Cervical Neoplasms
Papanicolaou Test
Public Health

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

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title = "Changes in geographic variation in the uptake of cervical cancer screening in Taiwan: Possible effects of {"}leadership style factor{"}α",
abstract = "Objectives: Wennberg proposed the {"}practice style factor{"} to explain the large variations in the use of medical care. As a corollary, we propose the {"}leadership style factor{"} of the director of the city/county bureau of public health to explain changes in geographic variation in the uptake of cervical cancer screening. Methods: We first calculated the triennial Pap smear rates for women aged 30-69 years from 1997 through 2010 for each city/county in Taiwan and the rate difference and rate ratio between the highest and the lowest city/county to illustrate the geographic variation in the uptake of cervical cancer screening. We then created an expert panel to conduct a hypothesis generation process to examine the possible effects of {"}leadership style factors{"} in explaining the changes. Results: The Pap smear rate in Taiwan as a whole was 35{\%} in 1997 and increased to 56{\%} in 2001, and was then stable until 2010 (55{\%}). In 2002, the geographic variation in the Pap smear rate was the smallest, ranging from 49{\%} in Penghu County to 63{\%} in I-lan County, with a rate ratio of 1.28. Unfortunately, the rate ratio increased to 1.49 in 2010, the rate being lowest in Penghu County (42{\%}) and highest in Tainan City (63{\%}). We identified four cities/counties with unique patterns of change in Pap smear rates, which were highly associated with the leadership style of the director of the city/county bureau of public health. Conclusions: Despite the launch of an organized cancer screening program in Taiwan, geographic variation in the uptake of cervical cancer screening still exists and has increased during the past decade. The {"}leadership style factor{"} of the director of the city/county bureau of public health might play a plausible role in explaining the pattern of change in geographic variation in the use of cervical cancer screening in Taiwan.",
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Changes in geographic variation in the uptake of cervical cancer screening in Taiwan : Possible effects of "leadership style factor"α. / Chiou, Shu Ti; Lu, Tsung Hsueh.

In: Health Policy, Vol. 114, No. 1, 01.01.2014, p. 64-70.

Research output: Contribution to journalArticle

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N2 - Objectives: Wennberg proposed the "practice style factor" to explain the large variations in the use of medical care. As a corollary, we propose the "leadership style factor" of the director of the city/county bureau of public health to explain changes in geographic variation in the uptake of cervical cancer screening. Methods: We first calculated the triennial Pap smear rates for women aged 30-69 years from 1997 through 2010 for each city/county in Taiwan and the rate difference and rate ratio between the highest and the lowest city/county to illustrate the geographic variation in the uptake of cervical cancer screening. We then created an expert panel to conduct a hypothesis generation process to examine the possible effects of "leadership style factors" in explaining the changes. Results: The Pap smear rate in Taiwan as a whole was 35% in 1997 and increased to 56% in 2001, and was then stable until 2010 (55%). In 2002, the geographic variation in the Pap smear rate was the smallest, ranging from 49% in Penghu County to 63% in I-lan County, with a rate ratio of 1.28. Unfortunately, the rate ratio increased to 1.49 in 2010, the rate being lowest in Penghu County (42%) and highest in Tainan City (63%). We identified four cities/counties with unique patterns of change in Pap smear rates, which were highly associated with the leadership style of the director of the city/county bureau of public health. Conclusions: Despite the launch of an organized cancer screening program in Taiwan, geographic variation in the uptake of cervical cancer screening still exists and has increased during the past decade. The "leadership style factor" of the director of the city/county bureau of public health might play a plausible role in explaining the pattern of change in geographic variation in the use of cervical cancer screening in Taiwan.

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