Under-screened Aboriginal and Torres Strait Islander women's perspectives on cervical screening

PLoS One. 2022 Aug 31;17(8):e0271658. doi: 10.1371/journal.pone.0271658. eCollection 2022.

Abstract

Aboriginal and Torres Strait Islander women have lower participation in Australia's National Cervical Screening Program than other Australian women. Under-screened (including never screened) women's voices are rarely heard in research evidence, despite being a priority group for interventions to increase cervical screening participation. This study aimed to describe under-screened Aboriginal and Torres Strait Islander women's perspectives on cervical screening. Participants were 29 under-screened (women who had either never screened, had not screened in the previous five years or had recently screened in the past three months after more than five years) Aboriginal and Torres Strait Islander women from five communities across three states/territories. Female Aboriginal and Torres Strait Islander researchers Yarned with women about why they did not participate in screening and how to improve screening. Yarning is an Indigenous qualitative research method in which relationships and trust facilitate culturally safe conversation. Transcripts were analysed thematically. The proportion of eligible women who screened within 30 days after the Yarn was calculated. We identified four themes describing how the harms outweighed the benefits of cervical screening for under-screened women. These were: 1) distress, discomfort, and trauma; 2) lack of privacy and control; 3) complicated relationships with health care providers (HCPs); and 4) pressured, insensitive, and/or culturally unsafe communication from HCPs. Under-screened women who had recently screened had maintained privacy and control through self-collection and had experienced trauma-informed and empathetic care from their HCPs. While we cannot unequivocally attribute women's subsequent participation in screening to their involvement in this study, it is notable that one third of eligible under-screened women were screened within 30 days after the Yarn. Enhancing privacy, implementing trauma-informed approaches to care and sensitivity to the clinician-client relationship dynamics could enhance women's sense of comfort in, and control over, the screening procedure. The opportunity to Yarn about cervical screening and self-collection may address these issues and support progress toward cervical cancer elimination in Australia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia / epidemiology
  • Early Detection of Cancer
  • Female
  • Health Services, Indigenous*
  • Humans
  • Native Hawaiian or Other Pacific Islander
  • Uterine Cervical Neoplasms* / diagnosis

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 1301, with supplementary funding from Cancer Council WA). The views expressed in this publication are those of the authors and do not necessarily reflect the views of the funders. TB was supported by an Australian Research Council Discovery Australian Aboriginal and Torres Strait Islander Award (#IN190100050) funded by the Australian Government. LJW was funded by a NHMRC Early Career Fellowship (#1142035) and a NHRMC Investigator Grant (#2009380). JCu was funded by a NHMRC Research Fellowship (#1058244). GG was funded by a NHMRC Investigator Grant (#1176651). AT was supported by a NHMRC Career Development Fellowship (#1106716). NL, KA, JB, JCo, SM, CM, JM, and EW received no specific funding for this work. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.