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      Cervical screening among migrant women: a qualitative study of Polish, Slovak and Romanian women in London, UK

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          Abstract

          Objective

          To explore awareness of and participation in cervical screening services in women from Poland, Slovakia and Romania living in London, UK.

          Methods

          Three qualitative studies were carried out in London in 2008–2009: an interview study of professionals working with Central and Eastern European migrants ( n=11); a focus group study including three Polish, one Slovak and one Romanian focus group; and an interview study of Polish ( n=11), Slovak ( n=7) and Romanian ( n=2) women.

          Results

          Awareness of the cervical screening programme was good, but understanding of the purpose of screening was sometimes limited. Some women were fully engaged with the UK screening programme; others used screening both in the UK and their countries of origin; and a third group only had screening in their home countries. Women welcomed the fact that screening is free and that reminders are sent, but some were concerned about the screening interval and the age of the first invitation.

          Conclusions

          Migrant women from Poland, Slovakia and Romania living in London vary in their level of participation in the National Health Service Cervical Screening Programme. More needs to be done to address concerns regarding screening services, and to ensure that language is not a barrier to participation.

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          Most cited references 33

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          Screening for cervical cancer: a review of women's attitudes, knowledge, and behaviour.

           F Fylan (1998)
          The United Kingdom (UK) cervical screening programme has been successful in securing participation of a high proportion of targeted women, and has seen a fall in mortality rates of those suffering from cervical cancer. There remains, however, a significant proportion of unscreened women and, of women in whom an abnormality is detected, many will not attend for colposcopy. The present work reviews the psychological consequences of receiving an abnormal cervical smear result and of secondary screening and treatment, and examines reasons for women's non-participation in the screening programme. Psychological theories of screening behavior are used to elucidate women's reactions and to suggest methods of increasing participation, of improving the quality of the service, and of reducing women's anxiety. A literature search identified studies that examine factors influencing women's participation in the screening programme, their psychological reaction to the receipt of an abnormal cervical smear result, and experiences of colposcopy. Reasons for non-participation include administrative failures, unavailability of a female screener, inconvenient clinic times, lack of awareness of the test's indications and benefits, considering oneself not to be at risk of developing cervical cancer, and fear of embarrassment, pain, or the detection of cancer. The receipt of an abnormal result and referral for colposcopy cause high levels of distress owing to limited understanding of the meaning of the smear test; many women believe the test aims to detect existing cervical cancer. The quality of the cervical screening service can be enhanced by the provision of additional information, by improved quality of communication, and by consideration of women's health beliefs. This may result in increased participation in, and satisfaction with, the service.
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            Variation in health services utilization among ethnic populations.

            Although racial and ethnic disparities in health services utilization and outcomes have been extensively studied in several countries, this issue has received little attention in Canada. We therefore analyzed data from the 2001 Canadian Community Health Survey to compare the use of health services by members of visible minority groups and nonmembers (white people) in Canada. Logistic regression was used to compare physician contacts and hospital admissions during the 12 months before the survey and recent cancer screening tests. Explanatory variables recorded from the survey included visible minority status, sociodemographic factors and health measures. Respondents included 7057 members of visible minorities and 114,255 white people for analysis. After adjustments for sociodemographic and health characteristics, we found that minority members were more likely than white people to have had contact with a general practitioner (adjusted odds ratio [OR] 1.28, 95% confidence interval [CI] 1.14-1.42), but not specialist physicians (OR 1.01, 95% CI 0.93-1.10). Members of visible minorities were less likely to have been admitted to hospital (OR 0.83, 95% CI 0.70- 0.98), tested for prostate-specific antigen (OR 0.64, 95% CI 0.52-0.79), administered a mammogram (OR 0.68, 95% CI 0.59-0.80) or given a Pap test (OR 0.47, 95% CI 0.39-0.56). Use of health services in Canada varies considerably by ethnicity according to type of service. Although there is no evidence that members of visible minorities use general physician and specialist services less often than white people, their utilization of hospital and cancer screening services is significantly less.
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              Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders

              Background Changing immigration trends pose new challenges for the UK's open access health service and there is considerable speculation that migrants from resource-poor countries place a disproportionate burden on services. Data are needed to inform provision of services to migrant groups and to ensure their access to appropriate health care. We compared sociodemographic characteristics and impact of migrant groups and UK-born patients presenting to a hospital A&E/Walk-In Centre and prior use of community-based General Practitioner (GP) services. Methods We administered an anonymous questionnaire survey of all presenting patients at an A&E/Walk-In Centre at an inner-city London hospital during a 1 month period. Questions related to nationality, immigration status, time in the UK, registration and use of GP services. We compared differences between groups using two-way tables by Chi-Square and Fisher's exact test. We used logistic regression modelling to quantify associations of explanatory variables and outcomes. Results 1611 of 3262 patients completed the survey (response rate 49.4%). 720 (44.7%) were overseas born, representing 87 nationalities, of whom 532 (73.9%) were new migrants to the UK (≤10 years). Overseas born were over-represented in comparison to local estimates (44.7% vs 33.6%; p < 0.001; proportional difference 0.111 [95% CI 0.087–0.136]). Dominant immigration status' were: work permit (24.4%), EU citizens (21.5%), with only 21 (1.3%) political asylum seekers/refugees. 178 (11%) reported nationalities from refugee-generating countries (RGCs), eg, Somalia, who were less likely to speak English. Compared with RGCs, and after adjusting for age and sex, the Australians, New Zealanders, and South Africans (ANS group; OR 0.28 [95% CI 0.11 to 0.71]; p = 0.008) and the Other Migrant (OM) group comprising mainly Europeans (0.13 [0.06 to 0.30]; p = 0.000) were less likely to have GP registration and to have made prior contact with GPs, yet this did not affect mode of access to hospital services across groups nor delay access to care. Conclusion Recently arrived migrants are a diverse and substantial group, of whom migrants from refugee-generating countries and asylum seekers comprise only a minority group. Service reorganisation to ensure improved access to community-based GPs and delivery of more appropriate care may lessen their impact on acute services.
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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 Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1471-1893
                2045-2098
                October 2012
                4 January 2012
                : 38
                : 4
                : 229-238
                Affiliations
                [1 ]PhD Student, Psychobiology Group, Department of Epidemiology and Public Health, University College London, London, UK
                [2 ]Senior Research Associate, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
                [3 ]Director, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
                [4 ]Research Assistant, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
                [5 ]Associate Research Professor, Trauma, Health & Hazards Center, University of Colorado, Colorado Springs, CO, USA and Warsaw School of Sciences and Humanities, Warsaw, Poland
                [6 ]Senior Research Associate, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
                Author notes
                [Correspondence to ] Dr Jo Waller, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK; j.waller@ 123456ucl.ac.uk
                Article
                jfprhc-2011-100144
                10.1136/jfprhc-2011-100144
                3970719
                22219504
                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 Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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