Cervical cancer screening among immigrant women in Norway- The healthcare providers’ perspectives

Kathy Ainul Møen,Laura Terragni,Bernadette Kumar,Esperanza Diaz

doi:10.1080/02813432.2018.1523986

Abstract

Objective: To explore health care providers’ (HCPs) experiences regarding cervical cancer screening (CCS) among immigrant women, their strategies to facilitate these consultations and their need for further information.Design: Exploratory qualitative design.Setting: HCPs who perform CCS: general practitioners, midwives and private gynaecologists, working in Oslo, Norway.Subjects: We interviewed 26 general practitioners, 3 midwives and 3 gynaecologists.Method: Both focus groups and personal in depth semi structured interviews. Interview transcripts were analysed using a thematic analysis approach.Results: Some of the HCPs’ experiences related to CCS were common for all women regardless of their immigrant background, such as the understanding of routines and responsibilities for prevention. Aspects specific for immigrant women were mainly related to organization, language, health literacy levels, culture and gender. Several strategies targeting organizational (longer consultations), language (using interpreters), health literacy (using anatomy models to explain) and culture (dealing with the expression of pain) were reported.Most HCPs had not previously reflected upon specific challenges linked to CCS among immigrant women, thus the interviews were an eye-opener to some extent. HCPs acknowledged that they need more knowledge on immigrant women’s’ reproductive health.Conclusion: HCPs’ biases, stereotypes and assumptions could be a key provider-level barrier to low uptake of CCS test among immigrants if they remained unexplored and unchallenged. HCPs need more information on reproductive health of immigrant women in addition to cultural awareness.Key PointsThe participation rate of immigrant women to cervical cancer screening in Norway is low, compared to non-immigrants. This might be partly attributed to health care system and provider, and not only due to the women’s preferences. Our focus groups and interviews among health care providers show, that in addition to cultural competence and awareness, they need knowledge on reproductive health of immigrants. We recommend an intervention targeting health care providers to close the gap in cervical cancer screening.

Highlights

In 2017, immigrant women comprised 11% of the European female population [1]
A typical comment at the beginning or the end of the interviews was: I have never thought about this before – that immigrant women do not come for cervical cancer screening test or that they might have different prevalence/risk for cervical cancer GP2(F2FG1)
Despite the lack of attention given by health care providers’ (HCPs) to possible challenges in gynaecological consultations and cancer screening (CCS) among immigrant women, several experiences were shared through focus group reflections by all three professions

Summary

Introduction

In 2017, immigrant women comprised 11% of the European female population [1]. The majority of these women have migrated from Africa, Latin America and Asia, and the proportion of non-European immigrants continues to increase [2]. There are more similarities than differences in the disease profiles of migrants and nonmigrants, the prevalence of different types of cancer could be related to migrants’ background [4,5]. This is the case for cervical cancer, with a higher prevalence among some groups of immigrants, those

Methods

Results

Discussion

Conclusion