Promoting cervical screening among women experiencing homelessness and socio‐economic disadvantage in Sydney

Abstract

Issue Addressed: Australia's national cervical screening program has reduced rates of cervical cancer morbidity and mortality. However, these benefits have not been experienced by all women. A Cervical Cancer Screening Project was implemented with lay health educators to address inequitable screening access by women experiencing socioeconomic disadvantage. Methods: Resources and a training program were developed and piloted with the specialist homelessness services workforce in Sydney, NSW. Data was collected to inform their development and evaluation through interviews, focus groups, self-administered surveys and analysis of NSW Pap Test Register data. Results: Women reported low familiarity with the term 'cervical screening'. They identified a good patient-doctor relationship, and seeing a female practitioner, as screening enablers. While the majority reported having cervical screening before, NSW Pap Test Register data showed only 74% had screened previously and of those, 69% were overdue. Homelessness service workers expressed interest in talking with clients about cervical screening, and reported increased knowledge and confidence following training. Conclusion: The homelessness sector is an appropriate venue to access women who are disadvantaged and under-screened. However, increasing workforce capacity to discuss screening does not lead to increased screening for women accessing these services. Further efforts are required. So What?: Access to cervical screening by women experiencing disadvantage remains a challenge. Sustained multi-faceted health promotion efforts are required to increase access. These should be informed by additional research exploring barriers and enablers for this group of women.

Optimising outcomes for complex trauma survivors: assessing the motivators, barriers and enablers for implementing trauma informed practice within a multidisciplinary health setting

“…It also aligns with findings outside of the TIP research field, whereby the ways in which health systems are financed is frequently reported as a barrier across the healthcare setting [ 2 , 7 ]. This is particulary evident in regrds to providing accessible and appropriate prevention, treatment and recovery services for those who experience disadvantage, including complex trauma [ 35 , 36 ].…”

“…Clients with experience of complex trauma can fail to attend appointments, or when they do find it difficult to engage with clinicians and may require flexible or longer appointments, and additional case management or care coordination [ 18 , 28 , 35 ]. Front-line clinicians and managers therefore argue for increased flexibility in service delivery and greater attention to the needs of disadvantaged or minority populations [ 11 ].…”

Equity, gender and health: A cross road for health promotion

“…A new screening program for cervical cancer has recently been introduced in Australia and there has been a decline in the partication rates for cervical screening finding as a variety of personal, practitioner, test‐related and logistical barriers negatively impact cervical screening. Lovell et al, 33 suggested that although there has been benefits not all women have experienced this. Women experiencing homelessness and socio‐economic disadvantage in Sydney benefited from increasing workforce capacity in this sector so sustained mulitfacedted health promotion efforts are required to increase access for these women.…”

Perceptions and implications for cervical screening and self‐collection: A qualitative exploration of never and under‐screened Queensland women

“…20 It is also known that women from lower socio-economic backgrounds have lower screening participation and may not have access to a bulk-billing provider to avoid the visit fee gap associated with cervical screening. 21 Participation in cervical screening is highest in inner regional areas and lowest in very remote areas and there is a clear positive association between participation and living in a higher socioeconomic area. 22…”