A Qualitative Study of Provider Perspectives of Structural Barriers to Cervical Cancer Screening Among First Nations Women

Abstract

Objective-In Canada, opportunistic screening programs have successfully reduced mortality from cervical cancer; however, minority or disadvantaged groups, as well as women in northern and rural areas, are inadequately recruited by this approach. Hence, we set out to examine the structural barriers that prevent First Nations women's participation in cervical cancer screening.Methods-Using a participatory action research approach and semistructured interview guides, we conducted in-depth interviews with 18 experienced health care professionals, 12 of whom were also community members. These individuals included nurses, nurse practitioners, community health representatives, social workers and physicians who provide care to women in our First CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptNations partner communities. In the current report, we explored perceived barriers to cervical cancer screening through the lens of service providers.Results-Structural barriers to cervical cancer screening for First Nations women included shortage of appropriate health care providers, lack of a recall-based screening system, geographic and transportation barriers; health literacy and socioeconomic inequalities, generational effects, and the colonial legacy.Conclusion-Existing, opportunistic cervical cancer screening programs do not perform well for First Nations women who experience significant screening-related health inequalities that are largely influenced by structural barriers. Sustainable screening interventions in First Nations communities require approaches that resolve these structural barriers, explore new ways of screening, and provide education for both women and health care providers. Many of the structural barriers are rooted in colonial history. Given the negative impact of the consequences of colonization on indigenous women worldwide, many of our findings strongly resonate with marginalized populations in other countries.

Understanding Barriers to Retention after a Clinical Treatment Trial Drop Out: Translating Qualitative Research and Theory to Practice

“…This study identifies many of the same barriers found in the literature that categorize Latino clinical trial retention barriers: familial relationships and issues [22], lack of transportation, employment interferences [23], economic stress [24] and financial costs [25], insufficient caregiving resources to meet demands [26], practical barriers [24,27], like interference with other top priorities of life such as work and family obligations [26], and systems barriers [28][29][30]. Andersen and Newman's [16] framework helps illuminate new and important Predisposing "Psychological Coping" Belief barriers specific to this co-morbid population, that are not specifically indicated in the literature (i.e., "feeling better;" "not interested;" "emotional stress;" grief over "loss;" untreated panic attacks; and anxiety over fertility issues).…”

Policies and Programs for Cervical Cancer Prevention and Control in Public Health Services

“…Six studies were carried out in Brazil [13,14,15,16,17,18] and four in the United States [19,20,21,22] . There was only one article from each of the following countries: Argentina [23] , Australia [24] , Canada [25] , England [26] , Italy [27] , Malawi [28] , Zambia [29] and United Kingdom [30] . Thus, the final sample comprised 18 articles.…”

“…components focused on preventing cervical cancer such as health education, screening, treatment and palliative care when they analyzed data related to programs, guidelines and the legislation about the topic in their country [28] . On the other hand, Maar et al (2013) (CA) identified lack of indigenous women description as special population in the country's policy [25] .…”

“…The lack of access to health services and of active search, as well as socio-demographic, economic and race differences between target populations, physical and structural barriers, and lack of health education and promotion were factors evidenced in three (3) Brazilian studies [13,17,16] , in three (3) American ones [20,21,22] , in one Canadian research [25] and in one Australian article [24] . One of the main crossroads in one of the Brazilian studies concerns services' structural accessibilities such as lack of gynecology outpatient clinics in all health services [13] .…”

Assessing Patient Understanding of the ACOG Abnormal Pap Smear Pamphlet: A Randomized Controlled Trial

“…Although the Pap smear is the most widely used and accepted screening tool, it requires strict follow up to be effective. Patient communication, understanding, and health literacy are some of several structural barriers that are key elements of adherence to this screening test [6,7]. While studies show that educational interventions promote utilization of pap smears and adherence to testing, there is a paucity of published data regarding the efficacy of available educational material [8].…”