Indigenous Australian women's experiences of participation in cervical screening

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.

Health care provider perspectives on cervical screening for Aboriginal and Torres Strait Islander women: a qualitative study

“…HCPs recognised that shame, fear, previous experiences of trauma, the need for physical and mental preparation, and family and community responsibilities influenced women's screening decisions. These factors are consistent with those reported by Aboriginal and Torres Strait Islander women, 15,17,21,22 and other women in Australia and abroad 23,24 . By taking these factors into account for each woman and offering flexibility and choice where possible, HCPs adopted a person‐centred and culturally safe approach to care that is key to supporting and enhancing women's participation in screening.…”

“…Some Aboriginal and Torres Strait Islander HCPs in our study felt that discussing or providing cervical screening could cross personal or cultural boundaries and that it was more appropriate for cervical screening to be discussed and performed by another female HCP, as previously mentioned elsewhere 37,38 . While Aboriginal and Torres Strait Islander women have reported a preference for an Aboriginal and Torres Strait Islander HCP due to enhanced cultural safety, 17 this finding indicates that respect for community and cultural protocols and customs must be bi‐directional between provider and client, and such complexities must be recognised and understood by the PHCC.…”

“…HCPs emphasised the critical role of trusting and respectful provider–client relationships in supporting women to participate in screening, which provided a foundation for open communication channels about screening, supporting women's control over decisions to screen when they were ready to do so. Such an approach may address Aboriginal and Torres Strait Islander women's experiences of “preaching” about cervical screening from HCPs 17 . In contrast, some HCPs perceived that well‐established provider–client relationships, combined with the intimate nature of the procedure, could cause potential feelings of shame or embarrassment among women, leading to screening avoidance.…”

“…Screening Matters sought to understand the perspectives of Aboriginal and Torres Strait Islander women and HCPs on cervical screening. This paper reports the findings for HCPs; the findings for women are reported elsewhere 17 . The abbreviation HCP collectively refers to study participants who had varying roles in health care provision.…”

“…attitudes, communication among providers and with clients, cultural differences), and community consultation and engagement 14,15 . There are also many factors that shape women's decisions to participate in cervical screening, including feelings of shame, fear and distrust, privacy concerns and competing life priorities 16,17 . Enablers of screening include culturally safe resources and services, flexible service provision, the availability of female and/or Indigenous health practitioners, and positive relationships with health services and staff 14,17 .…”