Knowledge, attitudes, beliefs, intentions and behaviours of Australian Indigenous women from NSW in response to the National Cervical Screening Program changes: a qualitative study

Abstract

Background: Indigenous women in New South Wales Australia are nearly four times more likely to die from cervical cancer than non-Indigenous women due to lower screening rates. We aimed to understand Indigenous women's cervical screening awareness, behaviours, knowledge, perceptions, motivators and barriers since the December 2017 National Cervical Screening Program changed to HPV testing, new screening age and screening interval, and introduced the new self-collection test.Methods: A qualitative study was conducted with 94 Indigenous women 25 to 74 years of age across metropolitan, regional and remote New South Wales. A team of six specialist researchers conducted the fieldwork, analysis and reporting. All data were coded thematically.Findings: Participants showed limited awareness of the renewed cervical screening program and the role of cervical screening in cervical cancer prevention, with most having a strong negative attitude towards cervical screening. Several motivators and behavioural barriers to screening were identified into four audience segments based on key characteristics. Most participants eligible to self-collect were unwilling to, due to concerns they would administer it incorrectly, injure themselves or have to return for a more invasive test.Interpretation: This study demonstrates the complex and heterogenous nature of attitudes and behaviours, among Indigenous women and highlights the intrinsic negative attitudes and social norms that are currently shaping community discourse and ultimately limiting screening. Our findings support the need for enhancing positive sentiment and community advocacy.

Aboriginal and Torres Strait Islander women's views of cervical screening by self‐collection: a qualitative study

“…This strongly related to fears that women would collect the sample incorrectly or that they would hurt themselves. Overall, our study findings were consistent with research with Aboriginal and Torres Strait Islander women 23,24 and other Australian women 18,25,38,39 suggesting that self‐collection is acceptable, although some women still hold reservations 40,41 . Internationally, other Indigenous women report similar benefits and concerns 33,34,36 …”

“…Overall, our study findings were consistent with research with Aboriginal and Torres Strait Islander women 23,24 and other Australian women 18,25,38,39 suggesting that self-collection is acceptable, although some women still hold reservations. 40,41 Internationally, other Indigenous women report similar benefits and concerns. 33,34,36 Understanding that women compare the self-collection test to the clinician-collected sample in terms of quality, accuracy and physical sensation will help HCPs to explain the differences while emphasising current evidence that self-collected samples show comparable sensitivity to clinician-collected.…”

“…45 This was reflected in our study, as most of the women were unaware of the availability of self-collection, similarly to other Australian women. 25,41 This is concerning given the way in which self-collection can help to overcome barriers to cervical screening. It highlights the need to ensure that clinicians are aware of self-collection and are confident in recommending it to their clientele.…”

Facilitating uptake of cervical screening among Indigenous women to achieve equitable and timely elimination of cervical cancer

“…Understanding how the changes impacted on Indigenous women, including on their attitudes and access to screening is needed. Findings from Moxham and colleagues (DOI: 10.1016/j.lanwpc.2021.100195) [7] in this issue of The Lancet Regional Health -Western Pacific provide important information on this topic.…”

“…Moxham and colleagues conducted qualitative interviews and focus groups with 94 Indigenous women across New South Wales, a state where approximately 33% of Indigenous peoples live [7] . The findings from Moxham and colleagues, as well as previous research with Indigenous women in Australia [8] , suggest there are potential avenues to facilitate uptake of cervical screening among Indigenous women.…”