Experiences Of Cervical Screening Research Articles

Cervical Cancer Screening Uptake and Experiences of Black African Immigrant Women in Canada

Cervical cancer is one of the leading causes of cancer-related death among African women. Unfortunately, in most sub-Saharan African nations, women are vulnerable if they are unaware that cervical cancer is preventable with frequent screening and early treatment. The aim of this study was to examine Black African immigrant women’s perceptions and experiences of cervical screening in British Columbia, Canada. Twenty Black African immigrant women were interviewed using the qualitative research method Interpretive Description. Data collection approaches included indepth interviews and analytic memos. Data were analyzed using a constant comparative technique guided by a socioecologic framework to capture subjective experiences and perceptions. Four key themes were identified, including confusing conceptualizations about cancer and cancer screening, competing priorities, concerns for modesty, and commitment to culture. The study findings point to the need for more active approaches to promoting cervical screening for this population.

Transgender and non-binary peoples experiences of cervical cancer screening: A scoping review.

To synthesise the literature about transgender and non-binary people's experiences of cervical cancer screening and identify ways to improve screening. Transgender people often face barriers to accessing health services including cervical screening, where transgender people have a lower uptake than cisgender women. A scoping review was undertaken following the Arksey and O'Malley (2005) framework and the PRISMA-ScR checklist. Following database searching of Medline via PubMed, Web of Science, Scopus and CINHAL, 23 papers published between 2008 and 2003 were included. Papers were included if they shared trans and non-binary people's experiences of cervical screening and were written in English. There were no date or geographical data restrictions due to the paucity of research. Transgender people experience barriers to cervical screening including gender dysphoria, a history of sexual trauma, and mistrust in health professionals or health services, which can result in having negative experiences of screening or avoiding screening. Health professionals can help to create a positive experience by informing themselves about best practices for trans+ health. Changes are required to improve transgender people's experiences and uptake of cervical screening. Improving medical education about trans health and updating health systems would help to combat issues discussed. Having an understanding of the reasons why accessing health services can be more difficult for transgender people will help health professionals to provide appropriate care for transgender patients. This paper details this in the context of cervical cancer screening and can be applied to other areas of healthcare. We have adhered to relevant EQUATOR guidelines and used the PRISMA-ScR reporting method. No Patient or Public Contribution.

The acceptability of, and informational needs related to, self-collection cervical screening among women of Indian descent living in Victoria, Australia: A qualitative study.

In July 2022, self-collection became universally available as part of Australia's National Cervical Screening Program. This change aims to address screening inequities experienced among underscreened populations, including women of Indian descent. This study explored experiences of cervical screening, alongside the acceptability of self-collection, among women of Indian descent living in Victoria, Australia. We also aimed to articulate the informational needs to promote self-collection among this population. Five focus group discussions with 39 women living in Victoriawere conducted in English (n = 3) and Punjabi (n = 2). Transcripts were thematically analysed, as informed by the Theoretical Framework of Acceptability. Women were motivated by the choice to self-collect, perceiving the ability to maintain modesty and greater autonomy as key enablers. Healthcare practitioners were seen as central in supporting patient-centred models of care. Perceived barriers to self-collection included concerns around its accuracy and women's confidence in collecting their own sample. Widespread dissemination of culturally tailored promotion strategies communicating concepts such as 'privacy'and 'accuracy'were suggested by women to promote self-collection. Self-collection was highly acceptable among women of Indian descent, particularly when assured of its accuracy, and sociocultural norms and previous screening experiences are considered. This study highlights the huge potential that self-collection can play in increasing equity in Australia's cervical screening programme. Members of the public were involved in focus group discussions. Findings were summarised and disseminated via a poster. A bicultural worker was involved in all stages of the research.

"Knowing that I had HPV, I literally just shut down": A qualitative exploration of the psychosocial impact of human papillomavirus (HPV) in women living with mental health conditions.

Psychological distress after testing positive for human papillomavirus (HPV) at cervical cancer screening is well documented in the general population. However, little is known about the impact of an HPV-positive result on those with pre-existing mental health conditions, who may be at higher risk of experiencing clinically significant distress. This study explored the psychosocial impact of HPV in women with co-morbid mental health conditions, as well as their experience of cervical screening during the COVID-19 pandemic. Semi-structured telephone interviews were conducted with 22 women aged 27-54 who had tested positive for HPV at routine cervical screening in England, and who reported having at least one mental health condition. Data were analysed using thematic analysis. Being informed of an HPV-positive result increased distress and heightened pre-existing psychological challenges. Psychosocial response and duration of HPV-related distress appeared to be influenced by the ability to regulate emotions, number of consecutive HPV-positive results, interactions with health care professionals, and other life stressors. The experience added further complexity to many women's perceptions of self and self-esteem. Women who had received psychological treatment for their mental health condition were best able to self-manage HPV-related distress by applying learned coping skills. Receiving an HPV-positive result at cervical screening appears to be a distressing experience for women with co-morbid mental health conditions. Future hypothesis-driven research is needed to confirm findings and develop effective interventions to reduce psychosocial burden.

'Exploring the Influence of Social Media Influencers on Intention to Attend Cervical Screening in the UK: Utilising the Theory of Planned Behaviour'.

ObjectivesCervical cancer is 99.8% preventable when detected early; however, uptake of screening in the United Kingdom is at a 20-year low. Recently, a number of social media influencers have video logged about their experiences of cervical screening through narrative communication with their audience. Here we aimed to explore if accessing cervical screening information from a social media influencer can impact the theory of planned behaviour variables and predict intention to attend cervical screening appointments.DesignUtilising a cross-sectional design a volunteer sample of 102 UK women (mean age = 28; SD = 3.10; range = 25–35) took part in an online questionnaire study.ResultsHierarchical regression modelling revealed attitude as a significant predictor of intention to attend a cervical screening appointment and that social media influencers affect attitudes of their audience, indirectly influencing intention to attend.ConclusionHealth messages communicated by social media influencers are effective in promoting positive attitudes but not directly influence intention to attend towards cervical screening. Further research should explore influencer impact on attitudes towards this health behaviour with the ultimate aim of increasing attendance and consequently saving lives.

Education, income and occupation and their influence on the uptake of cervical cancer prevention strategies: A systematic review.

To report a systematic review of the literature exploring how education, income and occupation influence the uptake of cervical screening and HPV vaccination among eligible women in developed countries, including the United Kingdom, United States, Spain, Germany and Norway. Cervical cancer remains a highly prevalent disease despite it being largely preventable through cervical screening and HPV vaccination. Incidence and mortality of cervical cancer are unequally distributed among socioeconomic groups, warranting research into how individual socioeconomic factors contribute to this unbalanced uptake of prevention strategies. Systematic review and narrative synthesis. The PRISMA guidelines (PLoS Medicine, 6, 2009, e1000097) guided the selection of papers. MEDLINE, CINHAL, PsychINFO, Science Citation Index and HMIC were searched. Ten articles were suitable. Key findings were then extracted, and a narrative synthesis was completed, using suitable guidance and the AXIS tool. Obtaining high school or college education is associated with uptake of both cervical screening and HPV vaccination. Total household income and income in respect of the countries' poverty line was measured less frequently than education, but associated with screening and vaccination in some studies. Occupation was infrequently measured in comparison to education and income, limiting conclusions of its association to uptake. Education and income have an association with uptake of cervical screening and HPV vaccination among women. However, evidence is insufficient to affirm a relationship between occupation and uptake of screening and vaccination. Further research would be advised to strengthen these findings. Interventions to promote cervical cancer prevention strategies should be targeted at women and girls with lower education levels and lower income. However, differences are displayed in the relationships between the individual socioeconomic factors and uptake of preventative strategies between countries and populations and so they should be considered separately. Nurses play a considerable role in people's perceptions and experiences of cervical screening and HPV vaccination. The review findings offer new insight that can inform future policy and nursing practice on targeting interventions to promote uptake among women who are underusing cervical cancer prevention programmes.

A Merleau-Ponty Perspective: Body Experiences of Cervical Screening in Taiwan

A Merleau-Ponty Perspective: Body Experiences of Cervical Screening in Taiwan

Acceptability of non-speculum clinician sampling for cervical screening in older women: A qualitative study.

ObjectivesOne reason that women over age 50 report avoiding cervical screening is increased discomfort postmenopause. This study aimed to explore the acceptability of human papillomavirus testing on clinician-collected vaginal samples without a speculum (‘non-speculum’) for cervical screening among older women.MethodsThirty-eight women in England aged 50–64 with a range of cervical screening experience (‘up-to-date’ n = 17, ‘overdue screening’ n = 18, ‘never screened’ n = 3) were identified via a recruitment agency. Women participated in focus groups or interviews about the potential for using clinician-collected samples without a speculum. Discussions were analysed using Framework Analysis.ResultsThe two main themes identified were women’s perceptions of the speculum and attitudes towards non-speculum screening. Many women reported negative experiences with the speculum, including increased pain after the menopause. Women generally had positive attitudes towards non-speculum clinician sampling and felt it would be a less intrusive option, but expressed concern that it could be less accurate than screening with a speculum. Women who were ‘up-to-date’ preferred conventional screening, while overdue and never screened women welcomed the option to be screened without a speculum.ConclusionsHuman papillomavirus testing on non-speculum clinician-collected vaginal samples could be an acceptable alternative cervical screening method for older women. Offering this approach could increase screening uptake in older women who find conventional cervical screening to be less acceptable with ageing or the menopause.

Understanding barriers to cervical screening uptake in trans men: an exploratory qualitative analysis

BackgroundCervical cancer is one of the most frequently encountered gynaecological malignancies that is highly preventable through screening. Therefore, screening for cervical cancer is a public health priority. No recommendations exist for screening lesbian or bisexual women or for female to male transgender individuals. Evidence suggests that trans men attend cervical screening far less than cisgendered women and also are more likely to receive an inadequate cervical smear test. We aimed to explore barriers to cervical screening uptake in trans men. MethodsQualitative interviews were carried out with trans men who had an intact cervix and were eligible for cervical screening. Recruited through trans organisations, seven participants based in London and Manchester were interviewed or took part in a focus group. Because of the sensitive nature of the research, there were few expressions of interest for the study, so every request was highly valued. Interview and group discussions were audio-recorded, transcribed verbatim, and analysed by thematic analysis. Ethics approval was granted from London Metropolitan University. FindingsFour themes emerged. The trans men reported the importance of social and peer support in providing motivation to seek health care. The need for their gender identity, post-transition, to be accepted by health-care professionals was crucial in influencing the decision for screening uptake. Despite the participants' understanding of the importance of cervical screening on their health, previous negative experiences deterred attendance. There was a recognition that education about the importance of screening within the trans community was needed. InterpretationTrans men need sensitive and respectful cervical screening experiences. Promotion of cervical screening through provision of education for trans men and health-care professionals is essential to increase awareness and understanding of the importance of screening in this group and to develop sensitive environments for screening to take place. Although we interviewed a small sample, our findings are novel and valuable. Future research is needed to develop interventions to increase understanding and awareness, promote screening attendance, and create a trans friendly environment. Guidelines for delivering appropriate services are warranted. FundingNone.

Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis.

ObjectiveAs uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call–recall programme, in order to understand the barriers to informed uptake.MethodsWe searched nine databases for English language peer‐reviewed publications reporting on qualitative data from screening‐eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call–recall programme. Evidence was integrated using thematic synthesis.ResultsThirty‐nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action.ConclusionsThe variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study

ObjectivesTo explore self-reported cervical screening history and barriers to attendance among women who have been sexually abused and to identify measures to improve the experience of cervical screening for these...

Exploring women's knowledge, experiences and perceptions of cervical cancer screening in an area of social deprivation

Despite the strong evidence that cervical screening does save lives, evidence suggests that the uptake for cervical screening for women from socially deprived areas still remains low. A qualitative approach using four focus groups was undertaken with 48 women living in socially deprived areas who had accessed a mobile screening unit to receive cervical screening. Analysis of the data was undertaken using thematic content analysis. The women's knowledge of cervical cancer including associated risks, and preventative factors were extremely limited. The women expressed a negative attitude towards their experiences of cervical screening, describing negative feelings of 'fear', 'embarrassment' and feeling 'stigmatised'. Practical issues such as the timing of the appointments, issues of time and having to find child care were identified as the main barriers to screening for this group. This study highlights that practices and beliefs about screening are variable and access to health care is poorly tailored to meet the needs of the socially deprived. There is a need for accessible targeted information and strategies in order to enhance knowledge and awareness of cervical cancer and screening for women living in socially deprived areas.

Cervical screening result communication: a focus-group investigation of English women’s experiences and needs

Objective:To explore English women’s experiences of cervical screening result communication.Design:Qualitative study consisting of seven focus groups conducted between May 2005 and April 2006.Participants:33 women with a range of screening results...

Do cervical cancer screening patient information leaflets meet the HPV information needs of women?

Objective New human papillomavirus (HPV) DNA technologies for the detection and prevention of cervical cancer have led to exciting changes in cervical cancer screening worldwide. Their introduction, however, has left many women with unanswered medical and psychosocial HPV questions. This study considered the degree to which women's own HPV questions were addressed in Australian cervical cancer screening patient information leaflets. Methods Based on previous qualitative research that asked women to identify their own HPV information needs, categories of interest were identified and a coding framework was developed. Manifest content analysis was conducted by counting the number of times a category of interest was stated in the text of the patient information leaflets ( n = 75). Latent content analysis methodology was employed to assess the underlying and embedded meaning within the leaflets. Results Women's medical questions were addressed more frequently than psychosocial ones. Leaflets were designed for specific target audiences (Aboriginal, lesbian, older women, women with disabilities, HPV-specific, cervical cancer-specific and general Pap screening) and the type and amount of HPV information varied by group. Merging the manifest and latent results, we identified three broad themes for discussion: the medicalisation of women's cervical screening experience, the purpose and target audience of cervical screening leaflets and HPV as a community versus women's health issue. Conclusions Women's questions on HPV were inconsistently and often inadequately answered. Practice implications In order that women's information needs are met, more accurate and balanced representations of medical and psychosocial HPV information should be provided in patient information leaflets.

Cervical Cancer Screening-"For Better or Worse???"

In Sweden, the population-based cervical cancer screening program has been in progress since the 1970s and is directed toward women between 23 and 60 years of age. The aim of this study was to explore women's experience of cervical screening after being diagnosed with cancer. A qualitative study inspired by Grounded Theory was used. Eleven women were interviewed. The interviews were analyzed using the constant comparative method. "Screening-For Better or Worse..." was identified as the core category, around which the categories "Unawareness," "Trust," "Search for Understanding," and "Making the Invisible Visible" were integrated and on which the conceptual model was built. The experience of screening had both a positive and a negative dimension for the women stricken by cervical cancer. The women had a positive experience of screening as such and they believed in its benefits. However, many women felt deceived and, because of their unawareness, questions arose for which they searched for understanding. The women requested adequate and understandable information. Their trust remained because the contact with healthcare professionals involved in screening and in the follow-up program had been reassuring.

Screened Out: Women with Disabilities and Preventive Health

This paper explores the lived experience of women with disabilities in relation to preventative health. It is based on qualitative research in Australia involving 25 individual interviews and 4 focus groups with women with disabilities about their experience of cervical screening (Pap tests), 16 interviews and 2 focus groups with service providers and advocacy organizations and an audit of 4 Pap Test Services by a researcher with a disability. The research identified three kinds of barrier that prevented some women from accessing cervical screening: societal barriers, individual living circumstances, and the way the women and those around them constituted their subjectivity. This paper outlines briefly the key findings from the study, focussing particularly on barriers relating to subjectivity.

Cervical screening in HIV‐positive women: characteristics of those who default and attitudes towards screening

To determine the characteristics of HIV-positive women who undergo cervical screening and to identify negative attitudes and experiences of these women to screening and the factors associated with these. We compared the Royal Free Cohort data from 59 newly diagnosed HIV-infected women, 31 of whom did and 28 of whom did not attend for cervical screening in 2001, and from 227 women under active cervical screening follow-up (at least one cervical screen since June 2001) and 88 HIV-infected women lost to follow-up (not screened since January 2001). Attitudes to screening were investigated with the aid of a questionnaire given to all women attending clinic who had had a previous colposcopy. Of the 59 newly HIV diagnosed women, 31 (53%) underwent cervical screening. These 31 women were more likely to be heterosexual (100 vs 89%, P=0.05), to have lower median viral loads (< 50 vs 3210 HIV-1 RNA copies/mL) and to be receiving antiretrovirals (ARVs) (74 vs 54%, P=0.1) than those not screened. Of the 315 women who had at least one screen, 72% returned for further follow-up. There were no differences in age or ethnicity between these groups. Those under active follow-up had a higher CD4 count (P=0.04) and lower viral load (P=0.0001) at their last visit. They were also more likely to be on highly active antiretroviral therapy (HAART) (68 vs 52%, P=0.006). A total of 78 of 104 questionnaires (75%) were returned. Women participating in the questionnaire study were mainly of back ethnicity (68%), did not speak English as their first language (59%) and were taking ARVs (76%). Most agreed that regular smears and colposcopy were valuable. Women of white ethnicity, and those speaking English as a first language, were more likely to dislike colposcopy compared with those of nonwhite ethnicity (87 vs 25%, respectively, P=0.0007) and not speaking English as a first language (74 vs 26%, respectively, P=0.002). Those of white ethnicity were more likely to find smears and colposcopy painful (60 and 73%) compared with those of black ethnicity (46 and 51%, P=0.47 and 0.28, respectively). Our results suggest that women on HAART with better disease control, older women, and those of black African ethnicity are more likely to take up cervical screening. Cervical screening experience varies by ethnicity and language.

Lesbians' experiences of cervical screening

Issues addressed: Lesbians have historically been advised that they are at little risk of cervical cancer because they do not engage in heterosexual sex. Recently the human papilloma virus (HPV) has been implicated as a central etiologic factor, present in more than 99.7% of cervical carcinomas. As HPV is the most frequently sexually transmitted infection in women, lesbians should participate in regular two-yearly screening. The aim of the study was to investigate cervical screening practice within the lesbian community. Method: Four hundred and nine lesbians completed a self-report survey at Victoria's Midsumma Carnival Day, an annual gay and lesbian community event, assessing their cervical screening history and experience. Results: Sixty six per cent of respondents were well screened, 22% were under-screened, and 12% had never had a Pap test. Women were more likely to be well screened if they were aged 40+ years, if their health care provider knew they were lesbian and was aware of lesbian-specific health issues, and if they had never been advised as ineligible. Compared with well-screened women, a greater proportion of under-screened women found deciding to have a Pap test, choosing a practitioner, and making an appointment as barriers to screening. Conclusion: Similar rates of reported cervical screening and cervical abnormalities in the general population and this sample indicate similar risk of cervical cancer. (author abstract)

Thoughts on the patient–doctor relationship in obstetrics and gynecology

The relationship of women to their gynecologists starts very often with some difficulty, with unease or incomprehension in that the request for help, and consequently the symptoms put forward by the patient, do not represent her real need. It is up to the gynecologist then to decode the female code and understand the woman's request, by putting aside personal points of view and one's own medical code [ 2 Sichel M.P Women and the gynecologist. Difficulties in comprehension. Clin Exp Obstet Gynecol. 1991; 18: 57-59 PubMed Google Scholar ]. The expectancy of female patients differs according to the cause why the respective medical consultation is sought for: a patient suffering pains is requesting immediate relief from her doctor, another patient has no actual complaints but may be stricken by fear of suffering from a serious or even a life-threatening disease as cancer. It is therefore that she primarily desires reassurance rather than immediate action; and she will foremost expect the caring-abilities shown by her physician, even if she has eventually to be referred to someone with higher diagnostic or better trained curative skills. However, the price may be that medical help can only be achieved there in a somehow distancing attitude than with compassion, with honesty and warm humaneness experienced by the first doctor known for long. A good surgeon, for example, has to be at a certain degree unconcerned of the complex entanglements of an actual patient on the table. The doctor's approach to the patient is differing whether or not he/she is a generalist referring further to special diagnostic methods and treatment by a subspecialist, or if he/she is the subspecialist him-, or herself who sees many more patients for roughly the same type of disease or dysfunction. The generalist, however, deals with fewer patients, who are known to him with their background and full history, but they all present themselves at times with a variety of medical problems, from contraception to pregnancy, from problems with STD (sexual transmitted disease) to infertility counseling, from HRT (hormonal replacement therapy) after the menopause to cancer screening [ 58 Schwartz M Savage W George J Emohate L Women's knowledge and experience of cervical screening: a failure of health education and medical organization. Community Med. 1989; 11: 279-289 PubMed Google Scholar ].

Balancing the equation: The significance of professional and lay perceptions in the promotion of cervical screening amongst minority ethnic women

Studies of minority ethnic women and cancer screening have, in the past, suffered from many theoretical and methodological weaknesses. In addition, no attempts have been made to study the complexity of the issue involved in the intercultural context, or the possible contribution of women's experiences to low uptake rates. In order to further our understanding of the issues, an alternative approach, participatory action research (PAR), was adopted to identify factors that might have contributed to the persistently low participation of minority ethnic women in the cervical screening programme, and address them collaboratively. This paper presents the key findings of the ‘problem identification' phase of the project. Using mainly the focus-group method, it explores both smear takers' and minority ethnic women's perceptions and experiences of cervical screening. Data suggest that there was a divergence in perceptions held by these groups regarding cervical screening, which contributed to negative experiences for both groups. There is also clear evidence of dysfunctional clinical communication arising from these differing perceptions. Opportunistic screening at post-natal examination adopted by many general practices appeared to have perpetuated the perceptions that the majority of minority ethnic women held about the purpose of the smear test. Compounded by language differences, the majority of women who had undergone smear testing understood neither the purpose of screening programme nor the procedure of the test. This has clear implications for promoting regular uptake, and more importantly for informed consent and choice.