Perceptions of Inuit Women and Non-Inuit Healthcare Providers on the Implementation of Human Papillomavirus Self-Sampling as an Alternative Cervical Cancer Screening Method in Nunavik, Northern Quebec

Abstract

Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on CC screening services and the possible implementation of HPV self-sampling. We held 10 group discussions with 28 Inuit women and 10 semi-structured interviews with 20 HCPs. The thematic analysis extracted themes reflecting one barrier and seven facilitators to accessing CC screening and the implementation of HPV self-sampling in Nunavik. Themes included, though not limited to, language and communication in health settings, access to culturally responsive educational resources on CC, and the noninvasive nature of HPV self-sampling. This study may serve to contribute to the co-development of a strategy for implementation that is designed according to the needs and priorities of the communities.

Cancer Screening Services: What Do Indigenous Communities Want? A Systematic Review

“… 35 , 41 , 49 , 51 This was noted to be of particular importance with cervical cancer, as taboo and embarrassment around sexual health were seen as barriers, preventing access to screening. 41 , 49 The involvement of the partner or spouse in raising cervical cancer awareness and education was viewed as important in addressing this issue. 49 Moreover, framing cervical screening as either cancer prevention or a part of routine care, rather than insinuating an association with sexually transmitted infections, was thought to be helpful.…”

“… 49 Moreover, framing cervical screening as either cancer prevention or a part of routine care, rather than insinuating an association with sexually transmitted infections, was thought to be helpful. 49 …”

“…The involvement of the patient in the decision-making process with an active role was viewed as an important facilitator of screening access. 34 , 41 , 45 , 49 , 50 The screening tests for colorectal, cervical, and breast cancers involve intimate areas of the body, which foster a sense of vulnerability and shame, and being actively involved in decision-making processes with regards to their care was viewed positively, as affirming bodily autonomy. 34 , 45 , 47 For example, with cervical screening, many individuals indicated a preference for administering the test themselves as opposed to being tested by a health care provider to maintain privacy, 34 , 41 , 49 but some preferred the latter as they were concerned with injury and incorrect technique.…”

“… 34 , 41 , 45 , 49 , 50 The screening tests for colorectal, cervical, and breast cancers involve intimate areas of the body, which foster a sense of vulnerability and shame, and being actively involved in decision-making processes with regards to their care was viewed positively, as affirming bodily autonomy. 34 , 45 , 47 For example, with cervical screening, many individuals indicated a preference for administering the test themselves as opposed to being tested by a health care provider to maintain privacy, 34 , 41 , 49 but some preferred the latter as they were concerned with injury and incorrect technique. 41 One study within the Aboriginal and Torres Strait Islander community found that fecal occult blood testing was associated with shame and embarrassment, 43 while a similar sentiment was expressed by the First Nations community, as they expressed a preference for a colonoscopy over fecal occult blood testing.…”

“…47 Nevertheless, the empowerment of the individuals to make decisions within the screening process wherever possible was considered to be much more important than the sampling method itself. 41 , 45 , 47 , 49 …”