Abstract
Indigenous women have higher rates of cervical cancer and lower rates of Papanicolaou (Pap) smear screening than non-Indigenous in Canada. Healthcare providers are well positioned to address the inequities in access to Pap screening that many Indigenous women continue to experience. The purpose of this study was to explore healthcare providers' experiences and perspectives about Mi'kmaq women's access to Pap smear screening in Eastern Canada, and to consider the broader historical, economic, and sociopolitical contexts that shape healthcare experiences. The methodology is a qualitative, community-based participatory action research approach that embodied Indigenous approaches to knowledge development and post-colonial theoretical perspectives in a two-eyed seeing approach. In-depth semi-structured in-person interviews were conducted with five healthcare providers twice, in two First Nations communities in Nova Scotia. Findings revealed two major overarching themes: a) Understanding the Realities of Indigenous Women's Lives; which involved recognition of the impact of history, and socioeconomic and political factors; and b) Fostering Indigenous Women's Access to Pap Smear Screening, through fostering trusting relationships, cultural safety, addressing confidentiality issues and optimizing processes to improve experiences. Conclusions indicated approaches to foster Mi'kmaq women's access to Pap screening included a social women's day, targeting youth, explaining step-by-step during screening, providing Pap results to women and having nurse practitioners perform screening. Implications for practice comprised addressing confidentiality issues in community health centres, involving the community in Pap screening decision-making, acknowledging the impact of historical trauma on access to screening and optimizing processes to address and improve inequitable access to screening. This study highlights the importance of healthcare providers' participation in understanding and encouraging Indigenous women's access to Pap smear screening. Healthcare providers need to consider a wider view of the realities of Canadian Indigenous women's lives, and acknowledge the impact of historical trauma, socioeconomic factors, and racism on women's accessing of Pap smear screening. Healthcare providers can implement collaborative and culturally safe screening approaches, while acknowledging Indigenous community strengths to improve inequities in healthcare access and health outcomes.
Highlights
Healthcare providers are often the first point of entry to the healthcare system and advocates “for best practices in developing strong Aboriginal1 communities” [8]
Two sub-themes emerged wherein healthcare providers talked about the importance of acknowledging the impact of historical trauma, socioeconomic factors, and racism on women’s accessing of Pap smear screening
The theme, “Fostering Aboriginal Women’s Access to Pap Smear Screening” with four sub-themes, described what healthcare providers in this study considered important and would thereby endorse and recommend as a means of increasing Pap screening
Summary
Healthcare providers are often the first point of entry to the healthcare system and advocates “for best practices in developing strong Aboriginal communities” [8]. Their approaches and interactions with Indigenous people can influence current and future accessing of healthcare services [42], such as Pap smear screening. It is reported that Indigenous women are 2 to 20 times at risk for being diagnosed with cervical cancer in Canada [33] and mortality rates are approximately 2.5 to 10 times higher among this population [10, 20, 29]. The extent to which Pap screening is prioritized in comparison to other health programming initiatives such as diabetes, HIV/AIDS, healthy child development, and immunizations is concerning [23]
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