Reasons for cervical cancer screening participation among Turkish- and Moroccan-Dutch: focus groups

Abstract

Abstract Background Cervical cancer (CC) is ranked fourth most frequently diagnosed cancer in women worldwide. Compared to the 79% CC screening participation rate of native Dutch women, the rate of 64% among Turkish- and 53% among Moroccan-Dutch women is considerably lower. Our aim was to explore reasons for CC screening (non)participation of Turkish- and Moroccan-Dutch women, and their attitude towards self-sampling. Methods Six focus groups were conducted in March and April 2019 with Turkish (n = 25) and Moroccan (n = 20) women in the Netherlands, aged 30-60 years. Questions were based on an extended Health Belief Model. Discussions were transcribed verbatim and thematically analysed. Results We found that women lack knowledge and awareness about CC. Barriers for screening were lack of a good command of the Dutch language, having a male as general practitioner, fatalism, shame and taboo related to the intimate procedure, and the association of CC with lack of femininity and infertility. Other barriers were fears of the test result, cancer, suffering, death, and leaving their children behind after death. Facilitators were perceived severity of disease, social support, and short procedure time. Additional religious facilitators included the responsibility to take care of one’s own health using medical facilities that God provided. Differences were found between Turkish and Moroccan women, such as lack of a good command of the Dutch language. Conflicting attitudes were found regarding self-sampling. Although perceived easy and accessible, women were hesitant whether they could sample correctly. Overall, women preferred a physician-taken smear to a self-sample. Conclusions Several barriers and facilitators for CC screening participation were identified that can be used to design tailored information materials. Women’s doubts about incorrect self-sampling should be taken into account to encourage self-sampling among nonparticipating Turkish and Moroccan women. Key messages Important barriers and facilitators were identified that can be used to well-inform Turkish and Moroccan women. To promote self-sampling, women’s attitudes on their self-efficacy should be explored.