Perceptions of cervical cancer prevention among a group of ethnic minority women in Denmark—A qualitative study

Abstract

Background Cervical cancer screening (CCS) and human papillomavirus vaccination (HPVV) are effective measures against cervical cancer (CC). Attendance in HPVV and CCS provides the greatest protection, while combined non-attendance in HPVV and CCS provides little to no protection. It is hence concerning that some large ethnic minority groups show considerably lower HPVV and CCS attendance than other women–especially women from Middle-Eastern and North African (MENA) countries and Pakistan. Little is, however, known about the reasons for this low combined attendance pattern n. Aim To explore perceptions of and barriers to HPVV and CCS, among MENA and Pakistani women in Denmark. Method Focus group interviews were conducted. Data was transcribed verbatim, and analysed using systematic text condensation. Findings Seventeen long-term resident women originating from six major MENA countries and Pakistan were included. Mean age was 36 years. We found that these women, across different age groups and descent, had sparse knowledge and understanding about CC, and their perceived relevance of disease prevention was low. Compared to HPVV, their barriers to CCS were more fixed and often linked to socio-cultural factors such as taboos related to female genitals and sexuality. Moreover, they presented unmet expectations and signs of mistrust in the healthcare system. However, at the end of the interviews, participants became more attentive toward CC prevention, particularly toward HPVV. Conclusion Elements of insufficient knowledge and understanding of CC and its prevention were found among a group of MENA and Pakistani women. Their socio-cultural background further represents a barrier particularly towards CCS. Additionally, negative experiences and unmet expectations lessen their trust in the healthcare system. All of which underlines the need for new tailored CC preventive strategies for this group. Based on our findings we suggest that future studies develop and evaluate interventions aiming to improve HPVV and CCS, including user-involvement.

Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature

“…The studies were from Norway, Sweden, Romania, and Finland, with two from Denmark, and four from the UK. Mistrust predominantly manifested as reputational concern about service quality or personal of experiences using the service, often involving discrimination ( 23 , 24 , 30 , 31 , 37 , 39 , 42 , 44 , 48 – 50 , 52 , 64 ). Conversely, previous positive health system experiences and perceptions of the system valuing women’s health were identified as facilitators in Sweden ( 36 ).…”

“…While these problems affected many groups, migrant populations and those in ethnic and sexual minority groups appeared particularly affected. It follows that provision of targeted ( 30 , 50 ) and accessible information ( 38 ) disseminated in appropriate formats and languages ( 23 , 27 , 41 , 48 ) were highlighted as facilitators, with examples of good practice from Denmark, Finland, Romania, Sweden, Netherlands, Norway, and the UK.…”

“…Concerning routes of access, multiple studies identified screening care integration with other services ( 30 , 40 , 48 ), including enabling access through midwifery and multi-disciplinary care environments, as a facilitator of care.…”

“…The final meso-level theme for barriers and facilitators related to interactions with screening staff. Several studies, not specific to any particular group or geographic area, highlighted uptake barriers relating to previous traumatic and negative care experiences ( 24 , 28 ), embarrassment about the private nature of the examination ( 26 , 30 – 34 , 36 – 38 , 41 , 47 , 49 , 50 ) and perceptions of discrimination and stigma ( 23 , 25 , 27 – 30 , 36 – 38 , 41 , 44 , 50 ).…”

“…Many barriers related to awareness involved a lack of understanding about cervical cancer and associated risk factors ( 24 , 30 , 32 , 33 , 38 , 39 , 41 , 47 – 49 ), and a lack of awareness of cervical screening and available screening services ( 23 , 26 , 27 , 29 , 31 , 32 , 35 , 37 , 38 , 41 – 44 , 47 – 50 , 52 , 63 ). These affected many groups, in particular migrant and ethnic minority groups, older women, transgender men, people who inject drugs (PWID) and those in socioeconomically deprived groups.…”