Toolkit for engaging Under-screened and Never-screened women in the National Cervical Screening Program
There are many potential barriers that may influence a woman in her decision or ability to participate in cervical screening. Studies into barriers have typically focused on barriers to having a Pap test. Barriers may be related to the patient, healthcare provider or the health system.
Patient-related barriers
Emotional / cultural |
Lack of knowledge about - |
Personal relevance |
Practical |
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Embarrassment about the procedure |
The purpose of a Cervical Screening Test |
Not believing cervical cancer is a risk |
Time constraints, including availability of child care |
Fear - of tests, of being diagnosed with cancer, of further tests or of cancer treatment |
The role of screening in prevention |
Not considering screening to be a priority |
Intending to have a test, but not getting around to doing it or forgetting when the test is due |
Reluctance to screen after a negative past experience such as previous pain or discomfort |
The risks of cervical cancer |
Limited previous experience of prevention or screening programs |
Concerns about cost |
Past history of sexual abuse or sexual violence |
Who needs to be tested |
Being asymptomatic |
Language issues |
Confidentiality concerns |
The accuracy of the test |
Perception that HPV vaccinated women do not require screening |
Lack of transport |
Cultural issues (related to circumstances, beliefs, background and inequities in society) |
Cancer and/or a belief that cancer = death |
Perception that screening is not required for women who have sex with women, or for transgender men |
Physical, social or practical barriers associated with a disability |
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Weight-related barriers (obesity) |
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Personal preference for choice of healthcare provider |
Healthcare provider and system-related barriers
Healthcare provider-related barriers |
System-related barriers |
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Time constraints and pressure to restrict consultation times |
Accessibility of the health service |
Availability of female healthcare providers |
Availability of convenient appointment times |
Lack of practical training in cervical screening (e.g. for international medical graduates who have never performed cervical screening) |
Availability of bulk billing |
The patient knowing the healthcare provider personally |
Services without a culturally sensitive environment |
Interpersonal and communication skills |
Availability of female healthcare providers or any healthcare provider who is a cervical screener |
Age and/or cultural background of the healthcare provider |
Availability of local language resources and patient information |