Validating knowledge and attitude for cervical cancer screening among rural women: A rasch and factor analysis approach

The UCLA Loneliness Scale, containing 20 items, is one of the commonly used loneliness scales. Some shorter versions have been developed using factor analysis. The study aimed to shorten the UCLA Loneliness Scale using Rasch and factor analysis methods and test the psychometric properties of the new scale. The full sample of the study included 719 respondents, divided into three subsamples (205, 324, and 190 for samples 1-3, respectively). The original, 20-item Revised UCLA Loneliness Scale (R-ULS) was shortened using 205 students (sample 1); the shortened scale was then validated for construct and concurrent validity with 324 students (sample 2) and 190 clinical participants (sample 3). Confirmatory factor analysis and Rasch analysis were used for construct validity. Convergent, discriminant, and concurrent validity were assessed by exploring the correlation with other psychological measurements. In sample 1, the R-ULS was shortened to a 6-item scale (RULS-6) that fits the Rasch model. The RULS-6 met the criteria of unidimensionality and local independence without differential item functioning due to age and sex, and good targeting the clinical sample. Person Separation Index (PSI) reflected that reliability from the Rasch perspective was acceptable. However, collapsing categories 2 (sometime) and 3 (rarely) may be required in a clinical sample. When tested in samples 2 and 3, the RULS-6 fits the Rasch measurement model. Convergent and discriminant validity were demonstrated with interpersonal problems and attachment scales. As expected, a positive correlation was found between RULS-6 and anxiety, depression subscale, interpersonal difficulties, and somatization subscales denoting concurrent validity. Cronbach's alpha of the RULS-6 was good (.83). Using Rasch analysis, the proposed RULS-6 constituted a 70% reduction of the number of original items, yet preserved the psychometric properties in independent samples of students and psychiatric outpatients. Statement of contribution What is already known on this subject? The UCLA Loneliness Scale is a common instrument used to gauge loneliness levels. The 20-item revised scale (R-ULS) has acceptable psychometric properties but its construct varies. Due to the length of the questionnaire, administration of R-ULS is not always practical. Short versions vary in items and were developed with classic test theory (e.g., factor analysis). Rasch analysis - providing more accuracy based on measurement theory - could be used instead. What does this study add? Using a Rasch analysis approach, a 6-item scale of loneliness (RULS-6) was created. The RULS-6 was tested in student and clinical samples, meeting Rasch measurement model criteria. The RULS-6 showed promising psychometrics to be used in both non-clinical and clinical samples.

BACKGROUND: Cervical cancer currently ranks the commonest gynecological cancer in Nigeria. This could be attributed to poor performance of screening strategies due to economic and patient factors. HIV (human immunodeficiency virus) infection is associated with increased risk of cervical cancer and there is lack of sufficient data on cervical cancer screening among HIV positive patients in our setting. Inefficient cervical cancer screening is related to late diagnosis and increased mortality associated with cervical cancer in our setting. AIM: This study was to assess the uptake and attitude of HIV positive women in relation to cervical cancer screening. METHODOLOGY: This was a cross-sectional study of women diagnosed with HIV that presented for care at the department of obstetrics and gynecology of Federal Medical Centre Abeokuta. A total of 52 women were recruited from July, 2017 to June, 2018. Knowledge of Pap smear, HPV DNA test and colposcopy were tested among the participants. A pretested questionnaire was given to respondents to assess factors associated with uptake of cervical cancer screening and SPSS version 23 was used for cross tabulation and to perform logistic regression of the factors associated with cervical screening among the subjects. RESULTS: The mean age of the subjects was 36.5±6.8 years. Out a total of 52 respondents, only 15 (29%) were aware of at least one method of cervical cancer screening. Women with tertiary level of educational status comprised 11(78%) of the subjects that are aware of cervical cancer screening. Only 6 (12%) of the HIV positive subjects were aware of the increased risk of cervical cancer associated with HIV infection. Among the 15(29%) of subjects that are aware of cervical cancer screening, 9(17%) were screened because of symptoms and signs of lower genital tract condition. Women between 40 and 50 years of age (OR= 2.41), presence of gynecological symptoms (OR= 2.97), educational attainment (OR=2.54), duration of HIV diagnosis >5yrs (OR=2.99), were strong predictors of uptake of cervical cancer screening in our setting. CONCLUSION: The knowledge and uptake of cervical cancer screening was very poor among HIV positive patients in our setting despite the increased risk associated with HIV infection, incorporation of cervical cancer screening among health education and intervention to improve its uptake by the agencies involved in HIV care will lead to improved uptake and ultimately decrease mortality associated with cervical cancer REFERENCES 1. Zayyan MS, Akpa M, Dawotola DA, Oguntayo AO, Kolawole AO. Quality of life in patients with advanced cervical cancer in Nigeria. Sahel Med J 2018;21:61-9 Note: This abstract was not presented at the meeting. Citation Format: Chibuike F. Chukwunyere, David O. Awonuga. Uptake of cervical cancer screening among HIV positive women at a tertiary healthcare center in Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4002.

Population-based screening coverage for breast and cervical cancer screening in the community is inadequately reported in India. This study assessed screening rates, awareness, and other factors affecting screening, among rural women aged 25-60 years in Vellore, Tamil Nadu. Women aged 25-60 years, from five randomly selected villages of a rural block were included in this cross-sectional study in Vellore, Tamil Nadu. Households were selected by systematic random sampling, followed by simple random sampling of eligible women in the house. A semi-structured questionnaire was used to assess screening practices, awareness, and other factors related to cervical and breast cancer. Although 43.8% and 57.9% were aware of the availability of screening for cervical and breast cancer respectively, screening rates were only 23.4% (95% confidence interval [CI]: 18.4-28.4%) and 16.2% (95% CI: 11.9-20.5%), respectively. Adequate knowledge (score of ≥50%) on breast cancer was only 5.9%, with 27.2% for cervical cancer. Only 16.6% of women had ever attended any health education program on cancer. Exposure to health education (breast screening odds ratio [OR]: 6.89, 95% CI: 3.34-14.21; cervical screening OR: 6.92, 95% CI: 3.42-14.00); and adequate knowledge (breast OR: 4.69, 95% CI: 1.55-14.22; cervix OR: 3.01, 95% CI: 1.59-5.68) were independently associated with cancer screening. Awareness and screening rates for breast and cervical cancer are low among rural women in Tamil Nadu, a south Indian state with comparatively good health indices, with health education being an important factor associated with screening practices.

To examine factors longitudinally associated with cervical cancer screening uptake among rural Chinese women, guided by protection motivation theory (PMT). A large sample of women (n = 2408, aged 35-65 years old) was randomly selected from a rural county in China in 2015 and followed up for 2 years. Data for demographic factors, knowledge of cervical cancer screening, screening outcome, and six PMT constructs measured at the baseline in 2015 were used to predict cervical cancer screening participation at the follow-up in 2017 using structural equation model method. Among the 2408 women at the baseline, 1879 (78.03%) participated in the screening services at the follow-up. In addition to significant direct effect of age, social status and baseline screening outcome, and three (perceived severity, fear arousal and response efficacy) of the six PMT subconstructs, four variables (age, social status, knowledge of cervical cancer screening, and baseline screening outcome) at the baseline were indirectly associated with screening participation, mediated by the three significant PMT subconstructs. Findings of this study indicate that the rate of participating in cervical cancer screening for rural women needs to be further improved. In addition to the commonly reported influential factors, PMT subconstructs play important roles in encouraging rural women in China to participate in cervical cancer screening. These longitudinal findings provided data much needed for future research to develop evidence-based intervention programs to enhance cervical cancer screening among rural women in China.

Background At least 80% of new cervical cancer cases and deaths occur in low- and middle-income countries. Vietnam is a middle-income country where cervical cancer is the second most common and the deadliest gynecologic cancer. Cervical cancer incidence in Southern Vietnam has been shown to be 1.5-4 times higher than that in Northern Vietnam. However, less than 10% of Southern Vietnamese women have received the Human papillomavirus (HPV) vaccine and only 50% have ever been screened for cervical cancer. No study has examined the perceptions toward cervical cancer prevention and screening in Southern Vietnamese women. Hence, this study aimed to explore cervical cancer awareness, barriers to screening, and acceptability of HPV self-sampling for cervical cancer screening among rural and urban women in Southern Vietnam. Methods In October-November 2021, three focus groups were conducted in the rural district of Can Gio (n=21 participants) and three were conducted in the urban District Four (n=23 participants) in Ho Chi Minh City, Southern Vietnam. All participants were cervical cancer-free women aged 30-65 years. Awareness of, attitudes toward, and experience with cervical cancer prevention and screening were explored using audio-recorded, semi-structured discussions in Vietnamese. During the focus groups, participants also watched four short videos with Vietnamese subtitles and voiceover about cervical cancer screening methods and discussed their views on each. The recordings were transcribed, translated into English, and coded and analyzed using Dedoose 9.0.46. Results Four main themes emerged. First, women showed low awareness, but high acceptance of cervical cancer screening and HPV vaccination. Second, screening barriers were related to logistics (e.g., cost, time, travel distance), psychology (e.g., fear of pain, embarrassment, fear of the test revealing they had cancer), and healthcare providers (e.g., doctors’ impolite manners, male doctors). Third, women were concerned about self-sampling incorrectly and pain, but believed HPV self-sampling to be a feasible screening tool in some circumstances (e.g., during the COVID-19 pandemic, those living in remote areas). Fourth, women related cervical cancer prevention to COVID-19 prevention; they believed strategies that have been successful for COVID-19 control in Vietnam could be applied to cervical cancer. No differences in themes emerged by rural/urban areas. Conclusions Southern Vietnamese women showed low awareness but high acceptance of cervical cancer screening despite barriers. Strategies for successful COVID-19 control in Vietnam, including campaigns to increase public awareness, advocacy from the government and doctors, and efforts to increase access to screening and vaccination, should be applied to cervical cancer control. Health education programs to address HPV self-sampling concerns and promote it as a cervical cancer screening tool are warranted given its potential to improve screening uptake in this low-resource setting. Citation Format: Minh Tung Phung, Pham Le An, Lilah Khoja, Pham Duong Uyen Binh, Hong H.T.C. Le, Karen McLean, Bhramar Mukherjee, Rafael Meza, Alice W. Lee, Celeste Leigh Pearce. Insight into cervical cancer prevention awareness, experiences, and attitudes among Southern Vietnamese women [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A113.

Urban-rural differentials in the uptake of mammography and cervical cancer screening in Kenya

Knowledge about cervical cancer screening and Human papilloma virus (HPV) influence on their awareness to the cervical cancer screening program. Most previous studies found inadequate knowledge and attitude among healthy women affect the low rate of screening. This study aimed to assess knowledge of cervical cancer screening and HPV in women who had abnormal cervical cancer screening in Bangkok. Thai women, aged ≥ 18 years old, who had abnormal cervical cancer screening and scheduled to colposcopy clinics of 10 participating hospitals were invited to participate in this cross-sectional study. The participants were asked to complete a self-answer questionnaire (Thai language). The questionnaire composed of 3 parts: (I) demographic data, (II) knowledge about cervical cancer screening and (III) knowledge about HPV. Among 499 women who answered the questionnaires, 2 had missing demographic data. The mean age of the participants was 39.28 ± 11.36 years. 70% of them had experience of cervical cancer screening, with 22.7% had previous abnormal cytologic results. Out of 14 questions, the mean score of knowledge about cervical cancer screening was 10.04 ± 2.37. Only 26.9% had good knowledge about cervical cancer screening. Nearly 96% of woman did not know that screening should be done. After excluding 110 women who had never known about HPV, 25.2% had good knowledge about HPV. From multivariable analysis, only younger age (≤ 40 years) was associated with good knowledge of cervical cancer screening and HPV. In the conclusion, only 26.9% of women in this study had good knowledge regarding cervical cancer screening. Likewise, 20.1% of women who had ever heard about HPV has good knowledge about HPV. Providing information about cervical cancer screening and HPV should improve the women’s knowledge and better adherence to the screening procedure.

Knowledge about cervical cancer screening and Human papilloma virus (HPV) influence on their awareness to the cervical cancer screening program. Most previous studies found inadequate knowledge and attitude among healthy women affect the low rate of screening. This study aimed to assess knowledge of cervical cancer screening and HPV in women who had abnormal cervical cancer screening in Bangkok. Thai women, aged ≥ 18 years old, who had abnormal cervical cancer screening and scheduled to colposcopy clinics of 10 participating hospitals were invited to participate in this cross-sectional study. The participants were asked to complete a self-answer questionnaire (Thai language). The questionnaire composed of 3 parts: (I) demographic data, (II) knowledge about cervical cancer screening and (III) knowledge about HPV. Among 499 women who answered the questionnaires, 2 had missing demographic data. The mean age of the participants was 39.28 ± 11.36 years. 70% of them had experience of cervical cancer screening, with 22.7% had previous abnormal cytologic results. Out of 14 questions, the mean score of knowledge about cervical cancer screening was 10.04 ± 2.37. Only 26.9% had good knowledge about cervical cancer screening. Nearly 96% of woman did not know that screening should be done. After excluding 110 women who had never known about HPV, 25.2% had good knowledge about HPV. From multivariable analysis, only younger age (≤ 40 years) was associated with good knowledge of cervical cancer screening and HPV. In the conclusion, only 26.9% of women in this study had good knowledge regarding cervical cancer screening. Likewise, 20.1% of women who had ever heard about HPV has good knowledge about HPV. Providing information about cervical cancer screening and HPV should improve the women's knowledge and better adherence to the screening procedure.

Background: Visual inspection of the cervix under acetic acid is the most cost-effective method for the control of cervical cancer in sub-Saharan Africa. The region bears about 90% of the global burden of the disease accounting for about 85% of new disease and more than 90% of the mortality. The WHO piloted a largely successful community-based cervical screening in six African countries including Nigeria between 2009 and 2012. Community-based cervical screening was subsequently adopted in Nigeria as a major strategy for preventing cervical cancer. An evaluation of the community-based cervical screening in two rural local government areas in Ogun state, Nigeria, however, revealed that more than 95% of sexually active women had never had cervical screening done despite availability of the services. A substantial number of these women would not want to have cervical screening done because of the fear of a positive cervical screening result. Aim: The current study explored the characteristics of women who are unwilling to have cervical screening because of the fear of a negative result in two rural local government areas in Nigeria. Methods: A post hoc analysis of data collected for the evaluation of community-based cervical screening in two rural LGAs in Nigeria. The analysis described the characteristics of 700 sexually active women aged 25 to 64 years who declined to have cervical screening. The socio-demographic characteristics, perception (0 to 6) and knowledge scores (0 to 36) of the participants were fitted into a multivariate logistic regression model to predict the fear of an unfavorable cervical screening result. Results: About 81% (567) of the women were unwilling to get a cervical screening due to the fear of a negative result. Age, gravidity, knowledge, and perception about cervical cancer and screening were associated with the women declining cervical screening due to the fear of a negative result. On multivariate logistic regression analysis age (OR: 0.968, P = 0.007) and knowledge score (OR: 0.914, P < 0.001) were found to predict the fear of a negative result. The adjusted outcome variable model showed fair discrimination (AUC = 0.67) and good calibration ( P = 0.416). Conclusion: Many women in rural Nigeria decline to have cervical screening mainly because of the fear of a negative result which is in turn predicted by younger age and poorer knowledge scores about cervical cancer and screening. There is a need for further qualitative research to explore the dimensions of fear as it relates to refusal to have cervical screening among rural women in Nigeria.

Background: Cervical cancer is the 2nd commonest cancer among women worldwide and the most common cancer among women in developing countries like Nigeria. Though preventable by screening for premalignant and early cervical lesions, this is predicated on the knowledge and practice of a cervical screening. Objective: To assess the knowledge and practice of cervical cancer screening among women in Orlu, Local Government Area(LGA) Imo State, Nigeria. Materials & Methods: A community based cross-sectional study with the use of 502 interviewer – administered questionnaires was conducted among women in Orlu LGA of Imo State. All the women in the communities attending the annual August Meeting who consented were recruited for this study. Results: The study showed that the mean age of the respondents was 42±2.8years. Furthermore, 82.3% of respondents attained postsecondary school educational level, 61.8% & 21.1% were multiparous and grand multiparous respectively. Also, 80.5% of respondents have heard about cervical cancer screening. Majority (67.5%) of these respondents heard it from health care providers. There was a positive statistically significant relationship between educational status and the likelihood of having knowledge of cervical cancer screening, (p< 0.01). The level of practice of cervical cancer screening was very low among the respondents(13.5%).Though majority of the respondents have high level of educational attainment this did not reflect their practice of cervical cancer screening. Conclusion: There was high knowledge of cervical cancer and cervical screening modalities among women in Orlu but their practice of cervical cancer screening was very low. There is an urgent need to educate and encourage women on the benefits of cervical cancer screening. Key words: cervical cancer, knowledge, Practice, Orlu women, Screening.

BackgroundCervical cancer is detectable and preventable in premalignant stages. In 2013, a population-based cervical cancer screening (CCS) programme was set up in Flanders (Belgium) promoting screening by means of sending reminder letters. Yet, in 2021, only a CCS coverage of 63.6% has been reached, which is just a bare increase since the implementation of the programme (62.7% in 2013) (Jaarrapport 2022, Centrum voor Kankeropsporing (CvKO), 2022; Jaarrapport 2015, Centrum voor Kankeropsporing (CvKO), 2015).ObjectivesTo explore the characteristics of under- and neverscreened women in Flanders and to gain a better understanding of the barriers that prevent these women from attending CCS as well as factors that may facilitate CCS uptake.MethodsTwelve in-depth interviews and six focus group discussions were conducted with gynaecologists, general practitioners, community health workers and stakeholders providing support to women belonging to potentially underscreened population groups. Reported barriers and facilitators were subsequently classified using the Socio-Ecological Model (SEM). Finally, a causal loop diagram was constructed to visualise the dynamic interrelations among the barriers and facilitators.ResultsStakeholders and healthcare professionals confirm the vulnerability for cervical cancer screening in women with a substance use disorder and women with a migration background. The participation in screening among female sex workers is contingent upon their specific work environment. The group of never- or underscreened women is very heterogeneous and includes many women who are either unaware of CCS or have other priorities. A lack of focus on prevention is the most commonly reported barrier at the healthcare system level. Increasing awareness about cervical cancer (screening) and creating more opportunities for healthcare workers to offer prevention services are the primary facilitators.ConclusionTo improve screening participation in Flanders, different screening strategies tailored to a diversity of women are needed.

Background:Cervical cancer is the second most common cancer among women in the Philippines. Cervical cancer screening is an effective method to reduce incidence. However, screening utilization is limited. This study aims to assess human papillomavirus (HPV) and cervical cancer knowledge, perceptions, and screening utilization, and to investigate factors influencing screening utilization among rural women in the Philippines. Methods:This cross-sectional community-based study was conducted among 338 rural women aged 20–50 years, with a child under 5 years old registered in one of four public rural health centers in Tacao Island, Masbate Province in October 2017. A questionnaire administered via face-to-face interviews elicited information about demographic characteristics, knowledge, perceived susceptibility and perceived severity of HPV and cervical cancer, and cervical cancer screening utilization. Results:Mean age of participants was 32.5 years. Only 13.9% of participants had ever had cervical cancer screening. Although most women had heard of cervical cancer screening, their knowledge about the cause, risk factors, and preventive measures of HPV and cervical cancer was limited. Older age and higher education status were significantly associated with screening utilization. However, knowledge and perceived susceptibility and severity showed no association. The main reason for having screening was due to a health professional’s request or recommendation, and the reasons for not having screening were cost, not having symptoms, and fear of pain or discomfort and/or embarrassment during the procedure. Conclusions:Health education must increase knowledge about HPV and cervical cancer and screening among women, including the nature and progression of cervical cancer, benefits of screening, screening cost, and screening procedure. Health care providers have an important role in educating and motivating women to undergo screening.

Background: Globally, cervical cancer is one of the most common cancers among women. The risk of invasive cervical cancer remains high among sub-Saharan African immigrant (SSAI) women in the US despite being a preventable cancer. Women's knowledge about cervical cancer risk factors and preventive behaviors has been found to be related to the uptake of Pap screening and engagement in other healthy behaviors. Given the high prevalence of human papillomavirus (HPV) infection and other cervical cancer risks among SSAI women, it is critical that SSAI women be well informed and knowledgeable regarding their cervical cancer risk and prevention. The purpose of this study is to assess SSAI women's knowledge of cervical cancer risk factors, HPV, and cervical cancer screening. Methods: This study was a quantitative analysis of cross-sectional survey of 108 English-speaking SSAI women aged 21 and above recruited from Lexington and Frankfort, Kentucky, between October and December 2016. Information on demographics, screening behavior, and cervical cancer knowledge was collected. A knowledge scale including 14 questions about facts and common myths related to cervical cancer and HPV was used. Total knowledge scores were calculated for participants. Analysis was conducted to identify factors associated with knowledge scores. Results: Participants' mean age was 34 ± 9 years, 56% had a college degree, 65% reported that their income was adequate, and 54% had lived in the U.S for more than 5 years. The composite knowledge score was 7.8 ±3.6 with a maximum score of 14. In bivariate analysis, length of residence in the U.S (P= 0 .001), ever had Pap screening (P < 0.001), health insurance (P < 0.001), having primary provider (P = 0.020), and health provider recommendation for cervical cancer screening (P = 0.006) were associated with knowledge. In multiple regression analysis, longer length of residence in the U.S (P = 0.044) and ever having a Pap screening (P = 0.007) remained significantly associated with cervical cancer knowledge. Conclusions: Findings show a limited knowledge of cervical cancer risk factors and the role of HPV in cervical cancer. Future research should further explore and understand how length of residence in the US and having had a Pap screening are related to cervical cancer risks knowledge. The gaps in women's knowledge points to the need for targeted educational interventions to address knowledge needs of SSAI women to encourage cervical cancer screening prevention and timely detection. Citation Format: Adebola Adegboyega, Adaeze Aroh, Jennifer Hatcher. Knowledge of cervical cancer risk factors and screening among sub-Saharan African immigrant women [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B097.

Adolescent Sexuality

Cervical cancer is the 4^th most prevalent cancer among women worldwide. The incidence rate of cervical cancer is low in Australia. Despite the use of vaccinations and cervical screening programs in Australia, migrant women living in Sydney still face significant health disparities when accessing cervical cancer screening services. Overall, there are limited studies that explore the barriers and facilitators that migrant women are exposed to when accessing cervical screening tests. The aim of this study is to describe the attitudes, beliefs, knowledge and awareness of cervical cancer screening and screening practices amongst migrant women aged 25 and above living in Sydney, Australia for more than one year with no history of cervical cancer. Fifty-two women (30 South-East Asian, 12 Middle Eastern & 10 African) were recruited using two non-probabilistic sampling methods, convenience and snowball sampling. Data was collected through Focus Group Discussions (FGDs). In total, 5 FGDs were conducted in homogenous groups of 8-12 participants. Each FGD was audio-recorded and verbatim transcribed. The data were analysed using thematic analysis. Results show that average age of the participants were 38 years, majority were from South East Asia (58%), married (87%), unemployed (65%), had tertiary education (67%), were in low income categories (84%), and a third (35%) living in Australia for < 5 years. Results further show that migrant women living in Sydney displayed a lack of awareness and knowledge about cervical cancer and screening practices. Individual and system-level barriers and facilitators that influenced screening attendance were identified. Factors such as lack of knowledge, emotional barriers, cultural and religious barriers, psychological barriers, and organisational factors influence screening practices. Furthermore, results also revealed that African migrants were less likely to be aware of cervical cancer and screening compared to South-East Asian and Middle Eastern women. Our study also reported that short-term migrants had an overall lack of awareness about cervical screening and therefore, differences in migration status must be considered when administering health education programs. Understanding migrant women’s experiences, facilitators, and barriers to accessing cervical screening is essential in assisting health care professionals and policy makers to provide culturally appropriate services. Provision of training or programs to increase culturally appropriate health services amongst health care providers is also recommended. To increase cervical cancer screening uptake of migrant women living in Sydney, culturally appropriate education programs and health promotion strategies targeted towards different ethnic groups need to be administered.