Indigenous women's experiences of cervical cancer screening: Incorporating Indigenous ways of knowing into a systematic review and meta-synthesis of qualitative research

What factors influence the uptake of bowel, breast and cervical cancer screening? An overview of international research

BACKGROUND

For cancer screening programmes to be effective in early detection it is important that those invited can access screening services and understand the benefits of participation. A better understanding of the factors that matter to potential participants of cancer screening programmes can assist in developing strategies to increase current uptake.

METHODS

We conducted an overview of systematic reviews to answer the question: What factors influence the uptake of cancer screening services (breast, bowel and cervical) in high-income countries? A thematic approach supported by tabular summaries and qualitative heat maps was used to categorize factors, described as 'barriers' or 'facilitators'.

RESULTS

A total of 41 systematic reviews met the criteria for inclusion. The barrier with the greatest number of 'hot spots' across all three screening programmes was a fear of the unknown regarding a possible diagnosis of cancer or abnormal screening results, followed closely by a general lack of knowledge surrounding cancer screening programmes. The greatest collective facilitator to uptake was recommendation by a healthcare provider to attend screening.

CONCLUSION

Across all factors 'trust' and 'building trusted relationships' can be seen as integral to the success of cancer screening programmes and must be reflective of collaborative efforts to mitigate barriers and enhance facilitators to uptake. There is future scope to consider interventions that (i) increase demand for screening services, (ii) reduce barriers to uptake of services and/or (iii) are relevant to the healthcare system and those providing services.

Barriers to Cervical Cancer Screening: A Systematic Review

Cervical cancer remains a significant global health concern, particularly in underserved populations. Despite the availability of effective screening methods, uptake remains suboptimal in many regions. This systematic review aims to synthesize the current evidence on barriers to cervical cancer screening across diverse populations and healthcare settings. A comprehensive search of electronic databases was conducted to identify relevant studies published till June 2024. Studies examining barriers to cervical cancer screening in various populations were included. Data extraction and quality assessment were performed independently by two reviewers. A narrative synthesis approach was used to analyze and present the findings. Seventeen studies met the inclusion criteria, encompassing a wide range of study designs and populations. Common barriers identified across studies included lack of knowledge and awareness, economic constraints, access issues, cultural and religious factors, fear and embarrassment, and distrust in healthcare systems. Population-specific barriers were observed among immigrant and ethnic minority women, individuals in low- and middle-income countries, indigenous women, and LGBQ women. Healthcare system factors, socioeconomic influences, psychological and individual factors, and interpersonal and community dynamics also played significant roles in screening participation. This review highlights the complex and multifaceted nature of barriers to cervical cancer screening. Findings suggest that interventions to improve screening rates should be comprehensive, culturally sensitive, and tailored to specific population needs. Addressing both individual-level and systemic barriers is crucial for enhancing cervical cancer screening uptake globally.

Qualitative factors influencing breast and cervical cancer screening in women: A scoping review

Breast and cervical are top cancers for women globally, but few studies have summarised how gender norms influence screening uptake, given sexual connotations and physical exposure. These beliefs may play a central role in decision-making, and understanding them is crucial to improving screening rates and services. This review scopes international literature for gender-based qualitative factors influencing women’s screening uptake. A systematic search of peer-reviewed English articles in PubMed, Scopus, and CINAHL was conducted from inception until December 2019. Articles were included if they were about breast or cervical cancer screening, had mixed or qualitative methodology, and sampled women from the general population. 72 studies spanning 34 countries were analysed. Eight studies also included healthcare providers’ views. Our narrative thematic analysis summarised primary themes extracted from each study into first-level subthemes, then synthesising second-level and third-level themes: (I) gender socialisation of women, (II) gender inequality in society, and (III) lack of empowerment to women in making screening decisions. Women tended to face sociocultural/role-based constraints, were expected to prioritise family, and keep bodily exposure to their husbands. Women showed low awareness and had fewer opportunities for health education compared to men. Male relations were often gatekeepers to financial resources needed to pay for screening tests. Screening risked community norms about women’s or husbands’ perceived embarrassing sexual behaviours. These findings suggest that interventions targeting unhelpful stigmatising beliefs about women’s cancer screening must concurrently address community general norms, familial role-based beliefs, as well as at male relations who hold the purse-strings.