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      Barriers to cervical cancer screening among ethnic minority women: a qualitative study

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          Abstract

          Background

          Ethnic minority women are less likely to attend cervical screening.

          Aim

          To explore self-perceived barriers to cervical screening attendance among ethnic minority women compared to white British women.

          Design

          Qualitative interview study.

          Setting

          Community groups in ethnically diverse London boroughs.

          Methods

          Interviews were carried out with 43 women from a range of ethnic minority backgrounds (Indian, Pakistani, Bangladeshi, Caribbean, African, Black British, Black other, White other) and 11 White British women. Interviews were recorded, transcribed verbatim and analysed using Framework analysis.

          Results

          Fifteen women had delayed screening/had never been screened. Ethnic minority women felt that there was a lack of awareness about cervical cancer in their community, and several did not recognise the terms ‘cervical screening’ or ‘smear test’. Barriers to cervical screening raised by all women were emotional (fear, embarrassment, shame), practical (lack of time) and cognitive (low perceived risk, absence of symptoms). Emotional barriers seemed to be more prominent among Asian women. Low perceived risk of cervical cancer was influenced by beliefs about having sex outside of marriage and some women felt a diagnosis of cervical cancer might be considered shameful. Negative experiences were well remembered by all women and could be a barrier to repeat attendance.

          Conclusions

          Emotional barriers (fear, embarrassment and anticipated shame) and low perceived risk might contribute to explaining lower cervical screening coverage for some ethnic groups. Interventions to improve knowledge and understanding of cervical cancer are needed in ethnic minority communities, and investment in training for health professionals may improve experiences and encourage repeat attendance for all women.

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          Most cited references 14

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          Breast cancer awareness and barriers to symptomatic presentation among women from different ethnic groups in East London

          Background: During 2001 to 2005, 1-year breast cancer survival was low in ethnically diverse East London. We hypothesised that this was due to low breast cancer awareness and barriers to symptomatic presentation, leading to late stage at diagnosis in women from ethnic minorities. We examined ethnic differences in breast cancer awareness and barriers to symptomatic presentation in East London. Methods: We carried out a population-based survey of 1515 women aged 30+ using the Cancer Research UK Breast Cancer Awareness Measure. We analysed the data using logistic regression adjusting for age group and level of deprivation. Results: South Asian and black women had lower breast cancer awareness than white women. South Asian women, but not black women, reported more emotional barriers to seeking medical help than white women. White women were more likely than non-white women to report worry about wasting the doctor's time as a barrier to symptomatic presentation. Conclusion: Interventions to promote early presentation of breast cancer for South Asian and black women should promote knowledge of symptoms and skills to detect changes, and tackle emotional barriers to symptomatic presentation and for white women tackle the idea that going to the doctor to discuss a breast symptom will waste the doctor's time.
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            Awareness of cancer symptoms and anticipated help seeking among ethnic minority groups in England

            Objective: Little is known about ethnic differences in awareness of cancer-warning signs or help-seeking behaviour in Britain. As part of the National Awareness and Early Diagnosis Initiative (NAEDI), this study aimed to explore these factors as possible contributors to delay in cancer diagnosis. Methods: We used quota sampling to recruit 1500 men and women from the six largest minority ethnic groups in England (Indian, Pakistani, Bangladeshi, Caribbean, African and Chinese). In face-to-face interviews, participants completed the newly developed cancer awareness measure (CAM), which includes questions about warning signs for cancer, speed of consultation for possible cancer symptoms and barriers to help seeking. Results: Awareness of warning signs was low across all ethnic groups, especially using the open-ended (recall) question format, with lowest awareness in the African group. Women identified more emotional barriers and men more practical barriers to help seeking, with considerable ethnic variation. Anticipated delay in help seeking was higher in individuals who identified fewer warning signs and more barriers. Conclusions: The study suggests the need for culturally sensitive, community-based interventions to raise awareness and encourage early presentation.
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              Uptake for cervical screening by ethnicity and place-of-birth: a population-based cross-sectional study.

              Previous research indicates low screening uptake among South Asian women. We aimed to generate contemporary evidence of uptake by ethnicity using the screening records of eligible women resident in Manchester (n = 72613). Uptake among South Asians was lower than among other women, a difference explained by area- and practice-level confounding. A higher proportion of South Asians were recorded as 'never screened', an effect only partially explained by confounding. In practices with relatively large South Asian populations, uptake was higher among South Asians. Women born in a diverse range of overseas countries had uptake rates below 60 per cent and approximately a third of women born overseas were recorded as 'never screened'. If comprehensive coverage is to be achieved in inner city areas attention should now focus on the needs of a diverse range of ethnic minority groups other than South Asians. The routine collection of ethnicity data in primary care is also indicated.
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                Author and article information

                Journal
                J Fam Plann Reprod Health Care
                J Fam Plann Reprod Health Care
                familyplanning
                jfp
                The Journal of Family Planning and Reproductive Health Care
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1471-1893
                2045-2098
                October 2015
                12 January 2015
                : 41
                : 4
                : 248-254
                Affiliations
                [1 ]Senior Research Associate, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London , London, UK
                [2 ]Principal Research Associate, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London , London, UK
                [3 ]Professor of Clinical Psychology, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London , London, UK
                Author notes
                [Correspondence to ] Dr Laura Marlow, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK; l.marlow@ 123456ucl.ac.uk
                Article
                jfprhc-2014-101082
                10.1136/jfprhc-2014-101082
                4621371
                25583124
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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