Strategies for Increasing Cervical Cancer Screening Amongst First Nations Communities in Northwest Ontario, Canada

Maar, Marion; Wakewich, Pamela; Wood, Brianne; Severini, Alberto; Little, Julian; Burchell, Ann; Zehbe, Ingeborg

doi:10.1080/07399332.2014.959168

Cited by 23 publications

(29 citation statements)

References 37 publications

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“…We reasoned that empowering women to take their own samples may help overcome some of the structural and cultural barriers First Nations women face when attending cervical screening 13 —a re-affirmed notion and deemed to be culturally appropriate by our community informants during the qualitative phase of the ACCSS. 17 18 DNA integrity from self-samples was excellent—an important factor to emphasise when promoting this screening method as some women reported being anxious that they were not taking their self-sample correctly. Greater than 95% of the samples could be HPV-tested and typed, confirming our earlier pilot data.…”

Section: Discussionmentioning

confidence: 99%

Community-randomised controlled trial embedded in the Anishinaabek Cervical Cancer Screening Study: human papillomavirus self-sampling versus Papanicolaou cytology

et al. 2016

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ObjectivesThe incidence of cervical cancer is up to 20-fold higher among First Nations women in Canada than the general population, probably due to lower participation in screening. Offering human papillomavirus (HPV) self-sampling in place of Papanicolaou (Pap) testing may eventually increase screening participation and reduce cervical cancer rates in this population.DesignA community-randomised controlled screening trial.SettingFirst Nations communities in Northwest Ontario, Canada.ParticipantsWomen aged between 25 and 69, living in Robinson Superior Treaty First Nations. The community was the unit of randomisation.InterventionsWomen were asked to complete a questionnaire and have screening by HPV self-sampling (arm A) or Pap testing (arm B).Primary outcome measuresThe number of women who participated in cervical screening.RandomisationCommunity clusters were randomised to include approximately equivalent numbers of women in each arm.Results6 communities were randomised to arm A and 5 to arm B. One community withdrew, leaving 5 communities in each group (834 eligible women). Participation was <25%. Using clustered intention-to-treat (ITT) analysis, initial and cumulative averaged uptakes in arm A were 1.4-fold (20% vs 14.3%, p=0.628) and 1.3-fold (20.6% vs 16%, p=0.694) higher compared to arm B, respectively. Corresponding per protocol (PP) analysis indicates 2.2-fold (22.9% vs 10.6%, p=0.305) and 1.6-fold (22.9% vs 14.1%, p=0.448) higher uptakes in arm A compared to arm B. Screening uptake varied between communities (range 0–62.1%). Among women who completed a questionnaire (18.3% in arm A, 21.7% in arm B), the screening uptake was 1.8-fold (ITT; p=0.1132) or 3-fold (PP; p<0.01) higher in arm A versus arm B.ConclusionsPap and HPV self-sampling were compared in a marginalised, Canadian population. Results indicated a preference for self-sampling. More research on how to reach underscreened Indigenous women is necessary.Trial registration numberISRCTN84617261.

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Section: Discussionmentioning

confidence: 99%

Community-randomised controlled trial embedded in the Anishinaabek Cervical Cancer Screening Study: human papillomavirus self-sampling versus Papanicolaou cytology

et al. 2016

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“…It is also highly accepted by women because it is more discrete and less invasive than physician-obtained samples [45]. Furthermore, self-sampling "has the potential to further empower women to collect their own samples in privacy giving them control over how and when they participate in screening" [46]. HPV test results obtained in self-sampled material are highly concordant with those obtained by physicians [47][48][49][50][51].…”

Section: Modern Screening Methods To Overcome Disparitiesmentioning

confidence: 99%

Universal cervical cancer control through a right to health lens: refocusing national policy and programmes on underserved women

Perehudoff

Vermandere

Williams

et al. 2020

BMC Int Health Hum Rights

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Background: Cervical cancer claims 311,000 lives annually, and 90% of these deaths occur in low-and middleincome countries. Cervical cancer is a highly preventable and treatable disease, if detected through screening at an early stage. Governments have a responsibility to screen women for precancerous cervical lesions. Yet, national screening programmes overlook many poor women and those marginalised in society. Under-screened women (called hard-to-reach) experience a higher incidence of cervical cancer and elevated mortality rates compared to regularly-screened women. Such inequalities deprive hard-to-reach women of the full enjoyment of their right to sexual and reproductive health, as laid out in Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment No. 22. Discussion: This article argues first for tailored and innovative national cervical cancer screening programmes (NCSP) grounded in human rights law, to close the disparity between women who are afforded screening and those who are not. Second, acknowledging socioeconomic disparities requires governments to adopt and refine universal cancer control through NCSPs aligned with human rights duties, including to reach all eligible women. Commonly reported-and chronically under-addressed-screening disparities relate to the availability of sufficient health facilities and human resources (example from Kenya), the physical accessibility of health services for rural and remote populations (example from Brazil), and the accessibility of information sensitive to cultural, ethnic, and linguistic barriers (example from Ecuador). Third, governments can adopt new technologies to overcome individual and structural barriers to cervical cancer screening. National cervical cancer screening programmes should tailor screening methods to under-screened women, bearing in mind that eliminating systemic discrimination may require committing greater resources to traditionally neglected groups.

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“…We conducted interviews (lasting from 40 to 90 minutes) with 18 experienced, younger (under 40 years of age) and middle-aged (above 40 years of age) HCPs from August 2011 to February 2012 (Maar et al, 2013;Maar et al, 2014). We conducted nine focus groups (lasting from 80 to 120 minutes and including between 3 to 11 women at each community site) from May to July 2012 and then two additional ones in April and May 2014 to reach saturation with the focus group data.…”

Section: Participantsmentioning

confidence: 99%

“…We hypothesize that increased, regular screening attendance and follow-up of abnormal screening results would reduce the higher cervical cancer burden in this population. We have previously reported screening recruitment strategies with First Nations women and, based on interviews with health care professionals (HCPs), we have reported that education is one of the key factors for increasing their cervical screening attendance (Maar et al, 2013;Maar et al, 2014). To obtain a more representative and comprehensive understanding of the views held by members of our partner communities, we extended our study to include community members without formal health education to ensure that their voices would be heard in the research.…”

Section: Introductionmentioning

confidence: 99%

Engaging Canadian First Nations women in cervical screening through education

Zehbe

Wakewich

Wood

et al. 2016

International Journal of Health Promotion and Education

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Recognition of the need to decrease cervical cancer rates in Indigenous populations has been ongoing-yet few successful interventions have been reported. In addition, literature addressing the challenges and barriers associated with designing screening programs aimed to specifically reach Indigenous women is limited. Here, we report findings from a mixed methods cervical cancer research project conducted in partnership with 10 First Nations communities in northwest Ontario, Canada. Individual interviews with community health professionals (the majority of whom identified as First Nations) stressed that awareness of cervical screening benefits is lacking. In contrast, focus group participants (women with no formal health education) emphasized the desire to learn more about the science of human papillomavirus (HPV), and that a positive HPV or abnormal Papanicolaou test need not mean a woman will undoubtedly develop cervical cancer. Both the health professionals and the focus group participants highlighted that sexual health education must start early, in schools, preferably before girls are sexually active and that it has to continue throughout life to create a with a focus on women's wellbeing. Both interview and focus group participants highlighted that sexual health education must start early, in schools, preferably before girls are sexually active and that it has to continue throughout life to create a with a focus on women's wellbeing. Health professionals elaborated mainly on special events for whereas focus group participants also recognized the need to include in health education particularly for de-stigmatizing the sexually-transmitted HPV infection.

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Strategies for Increasing Cervical Cancer Screening Amongst First Nations Communities in Northwest Ontario, Canada

Cited by 23 publications

References 37 publications

Community-randomised controlled trial embedded in the Anishinaabek Cervical Cancer Screening Study: human papillomavirus self-sampling versus Papanicolaou cytology

Community-randomised controlled trial embedded in the Anishinaabek Cervical Cancer Screening Study: human papillomavirus self-sampling versus Papanicolaou cytology

Universal cervical cancer control through a right to health lens: refocusing national policy and programmes on underserved women

Engaging Canadian First Nations women in cervical screening through education

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