Health Promotion Journal of Australia

Australian women’s self‐perceived barriers to participation in cervical cancer screening: A systematic review

AbstractBackgroundAustralia has recently introduced a new screening program for cervical cancer. There has also been a decline in participation rates for cervical screening.AimTo complete a systematic literature review of the factors that prevent Australian women from participating in cervical screening.MethodsAuthors searched CINAHL, Medline, SCOPUS and the Cochrane Library to obtain articles discussing Australian women's self‐identified barriers to cervical screening. Quantitative studies published in peer‐reviewed journals after 1991 were considered. PROSPERO Registration Number: CRD42018105028.ResultsThe final search produced 1749 studies, with 13 quantitative papers included in the narrative synthesis after screening by two independent reviewers. No articles were excluded due to bias.DiscussionSelf‐identified barriers to screening were categorised into personal, practitioner, test‐related and logistical factors. The most commonly stated barriers included lack of time, embarrassment, fear of results, irrelevance and male health professionals. The use of HPV triage in cervical screening was not a barrier to screening, however, some women regarded self‐collected HPV testing as a barrier. Barriers to self‐collection included desire for the general practitioner to complete the test, fear of doing the test incorrectly, wishing to include it in a general check‐up and concerns about the test itself.ConclusionA variety of personal, practitioner, test‐related and logistical barriers negatively impact the screening participation of Australian women. Further research into barriers in the Australian population, and women's attitudes towards HPV testing and self‐collection is required to create effective health interventions to improve participation in cervical screening.

The Design and Evaluation of Community‐Informed Video Resources to Promote Safe and Inclusive Cervical Screening for South Australian LGBTIQ+ People With a Cervix

ABSTRACTIssues AddressedLesbian, Gay, Bisexual, Transgender, Intersex, Queer or Questioning, and/or other people with a cervix (LGBTIQ+ people with a cervix) face barriers to cervical screening, leading to lower participation rates. Our study aimed to report on the design and evaluation of community‐informed video resources to promote safe and inclusive cervical screening for South Australian LGBTIQ+ people with a cervix.MethodsTwo videos promoting inclusive cervical screening were developed by Cancer Council SA, SHINE SA and LGBTIQ+ people with a cervix for LGBTIQ+ people with a cervix (Video 1), and healthcare providers (Video 2). Evaluation involved two online surveys with LGBTIQ+ community members (n = 35) and healthcare providers (HCPs, n = 9) about their respective videos. Quantitative data were analysed descriptively in R; qualitative responses were thematically analysed using a general inductive approach.ResultsThe community‐focused video (Video 1) received positive feedback, with LGBTIQ+ people with a cervix feeling represented and expressing increased likelihood and intention to undergo screening. Responding to Video 2, half of the healthcare providers reported increased confidence in interacting with LGBTIQ+ people with a cervix and offering self‐collection.ConclusionsImproving cervical screening participation among LGBTIQ+ people with a cervix is essential to achieving the National Cervical Screening Program targets. This study highlights a respectful, community‐informed and relatively inexpensive approach to promote safe and inclusive cervical screening. The positive feedback from LGBTIQ+ people with a cervix underscores the value of inclusive messaging tailored to community needs.So What?LGBTIQ+ people with a cervix face barriers to cervical screening participation, but self‐collection may alleviate some barriers. Community‐informed resources can effectively support this population to access inclusive cervical screening.

Improving cervical screening rates among sexual minorities: Insights from Aotearoa New Zealand

AbstractIssue AddressedSexual minority women (SMW) experience inequities in health outcomes. The extant literature consistently suggests that SMW are much less likely than their heterosexual peers to engage in cervical screening. Using participant's voices, the focus of this study was to explore the ways in which cervical screening rates for SMW might be improved.MethodsAn online survey was completed by SMW (N = 177) aged 25–69 based in Aotearoa New Zealand and representing a range of sexual identities, ethnicities, and geographical regions. The analysis presented here was derived from open‐ended qualitative responses to a single survey item: What do you think could be done to encourage more SMW (lesbians, wahine takatāpui, bisexual women, etc.) to engage in smear testing?ResultsAnalysis of the data generated three main themes around how public health services could encourage more SMW to engage in cervical screening: Inclusive health services, clarity of information, and targeted health promotion.ConclusionThe analysis showed that the inherent heteronormativity among health care professionals and the lack of clear and consistent information specific to SMW may be key factors contributing to lower rates of engagement in screening.So What?Given that not engaging in screening is the main risk factor for cervical cancer, it is imperative that active consideration is given to these issues with a view to increasing participation rates among SMW.

Women's attitudes and understanding of cervical cancer and the new National Cervical Screening Program

AbstractIssues addressedThe new National Cervical Screening Program (NCSP) has recently been implemented. Little research is available on women's attitudes towards the program. This study aims to quantitatively assess Australian women's understanding and attitudes towards the new guidelines and their barriers to screening.MethodAuthors designed a cross‐sectional survey which was piloted and distributed as a waiting room survey to eligible women who attended a private general practice in North Queensland.ResultsOf the respondents, 53.8% had accurate knowledge of the new NCSP. Most participants (75.8%) believed they were not provided sufficient information about the NCSP and 60.2% wished to receive this information from their general practitioner. The screening test itself remains an issue, with embarrassment and discomfort listed as the most common barriers to screening.ConclusionMany women do not have accurate knowledge of the new NCSP. Further health promotion in this area is warranted, where the general practitioner may play a key role.So what?While the new NCSP will lead to further reduction in cervical cancer mortality, it appears from the data that women did not fully understand cervical cancer and its screening. This suggests the need for further health education to women about updated screening guidelines.

Best practice models recommended by Bhutanese refugee women for cervical and breast cancer screening in Australia: A qualitative study

AbstractPurposeThe purpose of this paper was to explore what a refugee women's health screening program would look like if the views of Bhutanese refugee women were incorporated into service design and the approaches to targeting access to cervical and breast cancer screening.MethodsQualitative study, used in‐depth interviews with 30 Bhutanese refugee women resettled in Melbourne, Australia.ResultsTwo practice models were identified by refugee women: a doctor‐initiated model involving opportunistic screening during consultations for other purposes; and a group screening model. Participants emphasised the need for a supportive environment with culturally appropriate services, community education and peer networks to encourage and facilitate their participation in cervical and breast cancer screening services. General practitioners can provide guidance, opportunistic screening that includes education, and advice about follow‐up. The need for the routine use of professional interpreter services was reinforced.ConclusionAvailable cervical and breast cancers screening services are not attuned to refugee women's views where this study focuses attention on the roles and practices of doctors in preventive health care for refugee women. Merging their perspectives with those of providers and policymaker's can fill the existing gaps and support to formulate the new interventions that will improve women's access to such preventative services.So What?Refugee women resettled in high income countries are less likely to attend preventive cancer screening programs than other women, so we need to understand how to motivate them to seek regular check‐ups. In this study Bhutanese refugee women resettled in Melbourne, Australia said that group screening or doctor‐led care would be appealing to them.

Supporting equitable cervical cancer elimination for Australia's culturally and linguistically diverse communities: A call for intersectoral action

AbstractCervical cancer is a preventable disease and is related to persistent health equities. Whilst several priority populations face health inequities related to cervical cancer prevention, my co‐authors and I bring special attention to those who identify as culturally and linguistically diverse (CALD). By reflecting on some of our research and work experiences, we propose four ways that governments and policymakers can enact the community engagement goals of the published and proposed cervical cancer prevention and treatment strategies for CALD communities. This includes: (1) Developing a culturally appropriate approach to collecting and interpreting cultural, ethnic and linguistic data; (2) Building and adapting the effective multicultural community policies and partnerships developed during COVID‐19; (3) Incorporating national strategy recommendations across all relevant government policies and (4) Sustainably resourcing and supporting participatory health promotion activities and interventions. By implementing the recommendations above, Australia will continue to lead the elimination of cervical cancer as a public health problem. It will demonstrate how genuine and authentic CALD partnerships and collaborations can reduce national CALD health inequities.

Barriers and enablers to participation in the National Cervical Screening Program experienced by young women and people with a cervix aged between 25 and 35

AbstractIssue AddressedCervical screening rates for young women aged between 25 and 35 are lower than older Australian women, however, little research has been conducted to understand why. This study aimed to identify and explore the barriers and enablers faced by young Victorians with a cervix to regular cervical screening.MethodsThis study used a mixed method exploratory design consisting of qualitative focus groups and a quantitative online survey. Four focus groups were conducted with 24 Victorians with a cervix aged between 25 and 35. Barriers, enablers and knowledge of cervical screening were explored. Focus groups were recorded and transcribed for thematic analysis of common themes. A supporting online survey was completed by 98 respondents. Summary statistics were analysed for differences in age.ResultsFocus groups and the online survey revealed four main factors that influence young people's cervical screening behaviour. These include past negative screening experiences, practitioner factors, priority placed on cervical screening, and cervical screening knowledge. These factors differ to the opinions of people older than 35, with young people focusing more on the psychological elements of cervical screening compared with practical factors.ConclusionsThis research provides a unique insight into cervical screening barriers faced by women and people with a cervix aged between 25 and 35 as well as what factors motivate them to screen.So What?These findings should be utilised to inform the design of public health campaign messaging targeting this age demographic. Findings can also assist practitioners to improve how they communicate with young people in a clinical setting.