Awareness of and attitudes towards cervical cancer prevention among migrant Eastern European women in England

Abstract

Objectives It has been hypothesized that, in England, the rise in incidence of cervical cancer and the fall in screening coverage might be attributable in part to the effect of migration of Eastern European born women. We explored the attitudes and behaviours of these women towards cervical cancer prevention strategies. Methods A mixed methods study using quantitative surveys and in-depth semi-structured qualitative interviews was conducted between April 2015 and December 2016. Results In total, 331 surveys and 46 interviews were completed. Native English women had greater knowledge that a smear test is a screening test for pre-cancerous cervical cells (90% vs. 71% p≤0.01), whereas migrant Eastern European women believed that it was conducted as part of a full gynaecological examination (46% vs. 21% p≤0.01) and that the screen interval was annual (18% vs. 4% p≤0.01). Distrust of the English healthcare system resulted in some Eastern European women returning to their country of birth for screening. Poor awareness of cervical cancer prior to migration and lack of information at registration with a general practitioner in England were associated with failure to participate in screening. Conclusions The views and attitudes expressed by the migrant Eastern European women in this study suggest that they are not fully participating in cervical screening in England. Targeted education at the point of contact with healthcare services in England is needed to increase cervical screening participation among these women.

Barriers and Facilitators to Cervical Screening among Migrant Women of African Origin: A Qualitative Study in Finland

“…The total unawareness of the existence of the screening in Finland, as evidenced by the numbers of unscreened women, i.e., those stating that they had never received an invitation to CCS despite their extended stay in the country and having given birth to children in Finland, agrees with earlier studies [ 41 , 43 , 44 ]. Therefore, it is imperative that women be aware of the screening program and understand the information in the invitation letters and the follow-up procedure.…”

“…Many women in our study expressed relatively poor knowledge about CC and its causes; in accordance with previous studies, they revealed misconceptions about CCS practices [ 42 , 43 , 44 , 45 , 51 ]. This might probably be related to the lack of similar schemes in the women’s country of origin or/and unawareness of screening in the host country [ 41 ]. However, most women in our study had heard about the Finnish screening program and were aware of its importance and had participated in screening.…”

“…Several individual-related barriers to CCS participation have been identified, e.g., unmarried, unemployed, illiteracy/lower education level, and language difficulties [ 27 , 31 , 33 , 35 , 37 , 40 ]; women’s lack of knowledge/awareness of cancer/risk factors or screening practices, unpleasant experiences of screening such as pain, embarrassment, and obesity [ 34 , 41 , 42 , 43 , 44 , 45 , 46 ]; and advanced age and no history of pregnancy or birth [ 27 , 30 , 33 , 47 , 48 ]. Other factors have been considered, such as migration-related issues in the host country [ 31 , 33 , 35 , 49 ], women’s fear of cancer or test results, and cultural and religious beliefs [ 43 , 45 , 50 , 51 , 52 , 53 , 54 ].…”

Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study

“…Some individual barriers to cervical cancer screening participation include low socioeconomic status, being unmarried, and unemployed, illiteracy, and limited language skills [11,21,22,25,30,31]; inadequate understanding or unawareness about screening/purpose, cancer risk in the host country/country of origin, and fear of cancer or screening [30][31][32][33][34][35]; cultural/religious beliefs; and unpleasant screening experiences, such as pain, and embarrassment owing to Female Genital Multilation (FGM), and/or obesity [26,[36][37][38][39]. Some other individual barriers are being an older/nulliparous woman, not using healthcare services related to gynecological, reproductive, or pregnancy [21,30,[40][41][42], and issues related to migration and residential areas [22,25,26,33,43].…”

“…Some other individual barriers are being an older/nulliparous woman, not using healthcare services related to gynecological, reproductive, or pregnancy [21,30,[40][41][42], and issues related to migration and residential areas [22,25,26,33,43]. System barriers include women's distrust in healthcare authorities and personnel, unavailability of female screeners, inaccessibility to healthcare, and interpretation services [25,32,33,35,39,43].…”