Toolkit for engaging Under-screened and Never-screened women in the National Cervical Screening Program
Barriers to screening
Communication tips that may help when talking with someone with a disability
Healthcare provider resources
Women with disabilities are another group that are less likely to participate in cervical screening. Barriers to their participation are often related to the accessibility of health services, healthcare providers’ perceptions of the priority of cervical screening for women with disabilities and women’s reliance on carers.
Barriers to screeningIn addition to the general barriers women may face in participating in cervical screening, the following barriers have been identified as common for women with disabilities.
Barriers to cervical screening for women with disabilities
- Healthcare provider, caregiver and/or family assumptions that screening is unnecessary because women with a disability are not sexually active
- The assumption that women with disabilities, particularly intellectual disabilities, may not be able to tolerate the procedure
- Lack of suitable screening equipment such as adjustable beds and hoists
- Inaccessible transport and cervical screening facilities
- Short appointment times. Additional time is often needed for a healthcare provider to support women to understand and undertake the procedure.
- Capacity to provide informed consent
- Availability of accessible plain English information and resources in other formats (e.g. video and audio). This includes invitation and recall/reminder letters.
- Low awareness/comprehension of the importance and benefits of cancer screening
- Women may be unable or unwilling to disclose their sexual history because of fear of stigma
- Fear or embarrassment of the test
- History of sexual assault
- Healthcare providers’ lack of training or knowledge related to women with disabilities and how to provide appropriate support
- Caregivers and/or families with low awareness of the importance and benefits of cancer screening for women with disabilities
- Physical, sensory and communication barriers
- Healthcare providers may prioritise a patient’s disability needs and healthcare concerns over preventative health measures
- Reliance on family and carers when going to medical appointments
- The Cervical Screening Test may be painful and/or traumatic for some women due to their disability
- Bad experiences with healthcare providers in the past
Engagement strategiesThe following strategies have been shown to be effective in engaging women with disabilities who have ever been sexually active in cervical screening.
Encourage staff to complete education and training to raise awareness of the importance of cervical screening for women with disabilities and develop effective communication skills.
Make materials available with information designed for women with disabilities (i.e. plain English, Braille, diagrams, large print materials, videos). This should include invitations and recall/reminded letters as well as materials available in the waiting room.
Support women to provide consent. Explain the procedure using appropriate language and visual cues, revisiting points where necessary. If the woman does not have the capacity to consent include the 'person responsible' in the consultation. (See Office of the Public Advocate/Guardian/Trustee in your state/territory)
Ensure the clinic is wheel chair accessible and that height adjustable exam tables and equipment is available.
Identify women with disabilities who are under-screened or never-screened and flag them in the practice database.
Choice of cervical screening provider
Most health services have experience supporting women with disabilities, but if necessary, healthcare providers could refer patients to services which may be better-able to cater for women’s particular needs in relation to cervical screening (for example, a clinic with rooms and/or equipment designed to be accessible for people with disabilities, or to specialised health services for women with disabilities).
Communication tips that may help when talking with someone with a disability1. Ensure you have the person’s attention
- Address the person by name, use eye contact
- Receptive difficulties (e.g. deafness, cognitive impairment, autism spectrum disorder) and/or
- Expressive difficulties (e.g. cerebral palsy, autism spectrum disorder)
- It is more appropriate and respectful to ‘assume competence’ than assume a lack of understanding
- How does s/he say ‘Yes/ No’?
- Does s/he use a communication device or aid?
- Check if an Interpreter is required
- Language: simple, clear words & short uncomplicated sentences
- Visual information: pictures, diagrams, signs, gestures
- Tone & volume: a respectful approach reflects your degree of familiarity with the person, their age and the context of your interaction
- Allow the person time to listen, process what you say and respond. DONT RUSH!
- Check that you have their permission before starting the procedure
- DO NOT simply ask ‘Do you understand?’ Most people will say ‘Yes’!) Remember that receptive language may be better than expressive language (or vice versa).
- e.g. I’m sorry I don’t understand you. NEVER PRETEND to understand!
- Repeat the information using clear simple words and concepts. Say it in a different way with different words and try to use pictures.
- Would you say that again please?
- Is there another way you can think of saying it?
- Could you use another word?
- Could you show me?
- Is there someone who could help us?
- ASK a family member/carer/support worker if appropriate if they can assist you.
- (Included with thanks to the Centre for Developmental Disability Health Victoria)
How to Engage with Women with Intellectual Disabilities about Cervical Screening – Chapter 1
Explaining the Cervical Screening Process – Chapter 2
Conducting the cervical screening test – Chapter 3
Healthcare provider resources
- Working with people with intellectual disabilities in healthcare settings – discusses barriers and strategies for providing good healthcare. Includes information on attitude, communication, working with carers and for providing proactive healthcare. (6 pages, includes summary above) - Centre for Developmental Disability Health
- 5. Consumer resources – includes a range of downloadable resources to support conversations about cervical screening