Indigenous Australian women's experiences of participation in cervical screening

PLoS One. 2020 Jun 15;15(6):e0234536. doi: 10.1371/journal.pone.0234536. eCollection 2020.

Abstract

Aboriginal and Torres Strait Islander (collectively, Indigenous Australian) women experience a higher burden of cervical cancer than other women. The National Cervical Screening Program (NCSP) is failing to meet the needs of Indigenous Australian women, resulting in many women not regularly participating in cervical screening. However, one third of Indigenous Australian women do participate in cervical screening. The reasons that some women in this population commence and continue to screen remain unheard but could provide insights to support women who currently do not participate. We aimed to describe Indigenous Australian women's experiences and views of participation in cervical screening by yarning (a culturally-appropriate interview technique) with 50 Indigenous Australian women aged 25-70 years who had completed cervical screening in the past five years, recruited via Primary Health Care Centres (PHCCs) from three jurisdictions. Aboriginal or Torres Strait Islander women researchers conducted the interviews. Thematic analysis identified six themes: screening as a means of staying strong and in control; overcoming fears, shame, and negative experiences of screening; needing to talk openly about screening; the value of trusting relationships with screening providers; logistical barriers; and overcoming privacy concerns for women employed at PHCCs. Despite describing screening as shameful, invasive, and uncomfortable, women perceived it as a way of staying healthy and exerting control over their health. This ultimately supported their participation and a sense of empowerment. Women valued open discussion about screening and strong relationships with health providers. We identified logistical barriers and specific barriers faced by women employed at PHCCs. This study is strengthened by a research approach that centred Indigenous Australian women's voices. Understanding the experiences of Indigenous Australian women who participate in screening will help screening providers support women to start and continue to screen regularly. Recommendations for practice are provided.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Australia / epidemiology
  • Early Detection of Cancer*
  • Female
  • Health Services Accessibility
  • Health Services, Indigenous
  • Humans
  • Maternal Health Services
  • Middle Aged
  • Native Hawaiian or Other Pacific Islander
  • Pregnancy
  • Primary Health Care*
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / epidemiology*
  • Uterine Cervical Neoplasms / pathology

Grants and funding

This study was supported by the National Health and Medical Research Council (NHMRC) funded Centre of Research Excellence (CRE) in Targeted Approaches To Improve Cancer Services for Aboriginal and Torres Strait Islander Australians (TACTICS; #1153027), the NHMRC-funded CRE in Discovering Indigenous Strategies to improve Cancer Outcomes Via Engagement, Research Translation and Training (DISCOVER-TT; #1041111), and the Cancer Council NSW Strategic Research Partnership to improve cancer control for Indigenous Australians (STREP Ca-CIndA; SRP 13-01, with supplementary funding from Cancer Council WA). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed in this publication are those of the authors and do not necessarily reflect the views of the funder. TB was supported by an Australian Research Council Discovery Australian Aboriginal and Torres Strait Islander Award (#IN190100050) funded by the Australian Government. KA, JCo, JB, SM, JM, EW, and CM received no specific funding for this work. GG and LJW were funded by NHMRC Early Career Fellowships (#1105399 and #1142035, respectively). JCu was funded by an NHMRC Research Fellowship (#1058244). AT was supported by a NHMRC Career Development Fellowship (#1106716).