IntroductionThe prevailing inequities in healthcare have been well addressed in previous research, especially screening program participation, but less attention has been paid to how to overcome these inequities. This paper explores a key factor of a successful improvement project: collaboration with local doulas to raise cervical cancer screening participation by more than 40 percent in an area with a large number of foreign-born residents.MethodsData was collected through two focus group discussions with the doulas in order to design interventions and debrief after interventions had been carried out in the community. Various tools were used to analyze the verbal data and monitor the progress of the project.ResultsThree major themes emerged from the focus group discussions: barriers that prevent women from participating in the cervical cancer screening program, interventions to increase participation, and the role of the doulas in the interventions.ConclusionsThis paper suggests that several barriers make participation in cervical cancer screening program more difficult for foreign-born women in Sweden. Specifically, these barriers include lack of knowledge concerning cancer and the importance of preventive healthcare services and practical obstacles such as unavailable child care and language skills. The overarching approach to surmount these barriers was to engage persons with a shared cultural background and mother tongue as the target audience to verbally communicate information. The doulas who helped to identify barriers and plan and execute interventions gained increased confidence and a sense of pride in assisting to bridge the gap between healthcare providers and users.

Organized screening programs have proved effective at reducing cervical cancer in Sweden by offering early detection of precancerous cells. However, participation rates vary across groups of women. The purpose of this paper is to explore how participatory action research contributes to (re)designing cervical cancer screening programs to better meet local residents' needs and expectations. The paper examines the Pap smear testing barriers encountered by foreign-born women. It is also reported how different actors within the healthcare system as well as civil society can work together to address these barriers and improve healthcare services. Moreover, the paper contributes to action research methodology by demonstrating how participatory inquiries benefit from quantitative monitoring of improvement initiatives.

BackgroundIn Sweden, organized screening programs have significantly reduced the incidence of cervical cancer. For cancers overall, however, women with psychiatric diagnoses have lower survival rates than other women. This study explores whether women with psychiatric diagnoses participate in cervical cancer screening programs to a lesser extent than women on average, and whether there are disparities between psychiatric diagnostic groups based on grades of severity.MethodsBetween 2000 and 2010, 65,292 women within screening ages of 23–60 had at least two ICD-10 (International Statistical Classification of Diseases and Related Health Problems – Tenth Revision) codes F20*–F40* registered at visits in primary care or psychiatric care in Region Västra Götaland, Sweden. Participation in the cervical cancer screening program during 2010–2014 was compared with the general female population using logistic regression adjusted for age.ResultsRelative risk for participation (RR) for women diagnosed within psychiatric specialist care RR was 0.94 compared with the general population, adjusted for age. RR for diagnoses outside specialist care was 0.99. RR for psychoses (F20*) was 0.81.ConclusionsWomen with less-severe psychiatric diagnoses participate in the screening program to the same extent as women overall. Women who have received psychiatric specialist care participate to a lesser extent than women overall. The lowest participation rates were found among women diagnosed with psychoses.

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