Australian Journal of Primary Health

Considerations in the development of an mHealth approach to increase cervical screening participation in primary care in Victoria, Australia

Background Short message service (SMS) messages are an effective means of delivering health interventions, including promoting cancer screening. SMS offers opportunities to remind people about cervical screening and promote the self-collection option available in Australia’s National Cervical Screening Program. This research aimed to explore the acceptability of SMS reminders sent by general practices to eligible patients promoting the option of self-collection for cervical screening. Methods We conducted a cross-sectional survey (n = 221) with women and people with a cervix, and focus group discussions (n = 5) with women aged ≥50 years (n = 7), regional/rural residents (n = 6) and bicultural health educators (n = 10) in Victoria, Australia. We examined awareness of self-collection, current receipt and acceptability of health promotion SMSs, and preferences for SMS content promoting cervical screening. Results Most survey respondents (83%) found SMS reminders for cervical screening acceptable, stating a preference for their first name (71%) and clinic’s name (58%) to be included. Focus group participants had varying awareness of self-collection, with concerns about accuracy, sample collection and accessibility. Clear communication about clinician- and self- collection options was considered crucial. Most participants were hesitant to click embedded links. SMS acceptability may be affected by limited knowledge of self-collection, accessibility for people with disabilities, differing English or digital literacy, and privacy concerns. Conclusion SMS messages appear to be an appropriate way to raise awareness about the choice of self-collection, but SMS may not be suitable as a population-based strategy. Leveraging general practitioner endorsement through SMS may improve participation, particularly for people who may prefer self-collection, but are unaware of this option

Providing a localised cervical cancer screening course for general practice nurses

Cervical cancer screening programs in Australia have been developed to detect early precancerous changes in women with a cervix aged between 25 and 74. Yet, many barriers remain to the uptake of cervical screening. Barriers include a lack of culturally appropriate service provision, physical access, poor health literacy, emotional difficulties, socio-economic disadvantage and not having access to a female service provider. In remote and very remote areas of Australia, additional barriers experienced by Aboriginal or Torres Strait Islander peoples include a distrust of healthcare providers and a lack of services, resulting in a much higher rate of diagnosis and death from cervical cancer. General practice nurses (GPNs) are well placed to conduct cervical screening tests (CSTs) after they have undertaken additional education and practical training. GPNs’ increase in scope of practice is beneficial to general practice as it helps to remove some barriers to cervical screening. In addition, GPNs conducting CSTs reduce GP workload and burnout and increase teamwork. GPNs working in metropolitan clinics have greater access to training facilities, whereas those working in rural and remote clinics are required to travel potentially long distances to complete practical assessments. This highlights the need for training to be made available in rural and remote areas. The aim of this forum paper is therefore to generate further discussion on the need for training programs to be made available in rural and remote areas to aid the upskilling of GPNs.

Incorporation of human papillomavirus self-sampling into the revised National Cervical Screening Program: a qualitative study of GP experiences and attitudes in rural New South Wales

Human papillomavirus self-sampling is part of the revised Australian National Cervical Screening Program for eligible under- or never-screened women. Although research demonstrates self-sampling as an acceptable method from the perspective of women, little is known about GP experiences and perspectives of this new screening alternative. This study sought to explore the experiences and perspectives of rural GPs towards the revised National Cervical Screening Program and the new self-sampling option. Semistructured qualitative interviews were completed with 12 GPs in central west New South Wales. The study found that GPs had limited experience facilitating self-sampling. The limited provision of education, difficulty accessing testing kits, poor availability of accredited laboratories and unclear rebate guidelines hindered their capacity to offer self-sampling. GPs reported uncertainty around patient eligibility and the quality of self-collected samples. GPs explained that self-sampling could increase cervical screening participation among some women, but because it is only available to complete in a general practice, it would not benefit those who are disengaged from health services. Despite GPs’ limited experience with facilitating self-sampling to date, they were optimistic about potential increases in cervical screening rates. Clearer articulation of specific program details and the evidence underpinning the program changes would reduce clinician uncertainty regarding the practicalities of how to incorporate patient-collected sampling into their daily practice, as well as the quality of patient-collected samples compared with clinician-collected samples. GPs must also be supported at a systems level to ensure there are processes in place to enable easy access to kits, laboratories, Medicare rebates and relevant support.

‘I didn’t want to visit a doctor unless it was extremely necessary’: perspectives on delaying access to sexual and reproductive health care during the COVID-19 pandemic in Australia from an online survey

Australians were subject to a series of COVID-19 lockdown restrictions throughout 2020. Although accessing medical care was allowable, concerns were raised that people were avoiding healthcare services. We explored young Australians’ reasons for delaying seeking sexual and reproductive health (SRH) care during the pandemic, using data from two cross-sectional surveys. The surveys included a question asking whether respondents had delayed accessing care during the pandemic. Free-text responses from young Australians (aged 18–29 years) were analysed using conventional content analysis. In all, 1058 under-30s completed a survey, with 262 (24.8%) reporting they had delayed seeking SRH care. Of these, 228 (87.0%) respondents provided a free-text comment. Participants who commented were predominantly female (86.4%) and had a median age of 23 years (interquartile range 20–26 years). Most commonly, respondents delayed testing for sexually transmissible infections, cervical cancer screening, and contraceptive care. Some delayed accessing care despite experiencing symptoms. Participants avoided seeking care due to concerns about contracting COVID-19, uncertainty about accessing care during restrictions and anxiety relating to accessing SRH care. Although some reported a reduced need for SRH care, others required but did not access care. Young people should be reassured that SRH issues are a valid reason to access services, especially when experiencing symptoms.

National Cervical Screening Program renewal in Australia: survey of clinician views and attitudes

From 1 December 2017, the National Cervical Screening Program was renewed in Australia, with updated national cervical screening guidelines released. This study was performed to determine clinicians’ familiarity with the updated guidelines and explore their views and attitudes towards the renewed program. Clinicians providing cervical screening in New South Wales, Australia, were invited to complete an online survey in 2018. Of the 241 clinicians who responded, 91.5% supported the change to 5-yearly human papillomavirus screening from the age of 25 years. However, nearly 13% indicated they did not know where to access the renewed guidelines and 37% had never or rarely accessed them. Open-ended responses highlighted clinicians’ concerns about missed cancers and missed opportunities for health checks. Those raising these concerns accessed the guidelines less frequently. The findings highlight important areas for additional education and support for clinicians in translating guidelines into practice to ensure successful delivery of the renewed program.