Barriers to and Facilitators of Cervical Cancer Screening among Women in Southeast Asia: A Systematic Review

Abstract

In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection and treatment. Existing reviews on CCS have limited insights into the barriers and facilitators for SEA. Hence, this study aims to identify key barriers and facilitators among women living in SEA. A systematic literature review was conducted on Pubmed, Embase, PsycINFO, CINAHL, and SCOPUS. Primary qualitative and quantitative studies published in English that reported barriers and facilitators to CCS were included. The Mix Methods Appraisal Tool was used for the quality assessment of the included studies. Among the 93 included studies, pap smears (73.1%) were the most common screening modality. A majority of the studies were from Malaysia (35.5%). No studies were from Timor-Leste and the Philippines. The most common barriers were embarrassment (number of articles, n = 33), time constraints (n = 27), and poor knowledge of screening (n = 27). The most common facilitators were related to age (n = 21), receiving advice from healthcare workers (n = 17), and education status (n = 11). Findings from this review may inform health policy makers in developing effective cervical cancer screening programs in SEA countries.

Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review

“…Low-risk perception and education status were also relevant, as women with higher education are more aware of how to independently access reliable information on CC [ 23 , 38 , 40 , 47 , 50–52 , 55 , 57 , 58 , 61–63 ]. The significance of education, knowledge and awareness of CC and related screening services is a frequently observed demand-side barrier and facilitator across research on CC screening in LMICs including in Southeast Asia, which affirms the findings of our review [ 12 , 66 ]. However, it also underlines the persistent global focus on women in research as a main source for low CC screening uptake, without contextualising uptake within broader structural issues of the respective health system.…”

“…This pattern is also apparent in the published research on this topic focused on LMICs more generally. The tendency to focus research on individual-based (demand side) factors that prevent was also noted in a recent systematic review of 2021 on barriers and facilitators to CC screening in Southeast Asia [ 12 , 65 , 66 ]. The imbalance in focus of individual behavioural factors has also be observed within other research areas as demonstrated in a recent systematic review on NCDs by Schröders et al (2017) [ 3 ], which noted a focus on risk factors on the individual level for the management of NCDs rather than a more efficient public health approach within Indonesia [ 3 ].…”

“…However, we also identified a lack of trained HCPs as a common supply-side barrier [ 39 ]. The importance of the availability of skilled HCPs who can counsel women on CC appropriately in order to facilitate screening uptake has been noted in other LMICs [ 66 , 71 , 72 ]. Effective and culturally appropriate training on CC screening for HCPs is essential and research on training interventions for HCPs within Indonesia is recommended.…”

“…Lack of confidence can be a consequence of negative prior experiences of screening, unavailability of quality services and a lack of trust in HCPs [ 31 , 57 , 59 , 73 ]. Other research in Southeast Asia has identified negative experiences with HCPs as a common barrier to CC screening uptake [ 66 , 74 ].…”

“…Women experienced shame due to genital exposure and the invasive nature of CC screening, especially if the HCP was male [ 40 , 41 ]. The invasive nature of CC screening and the exposure of the genitals leads to diverse sociocultural challenges for many women and presents a frequent demand-side barrier for many women in LMICs [ 66 , 73 , 74 ]. We recommend to further investigate women’s preferences with respect to CC screening to increase their comfort during screening.…”