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Addressing Cervical Cancer Screening Inequity among Newcomer Women via HPV Self-Sampling

This research project sought to build evidence on community-based and culturally sensitive care pathways for promoting HPV self-sampling-based screening for cervical cancer among under/never-screened women within immigrant communities.

Why did we conduct this study?
National and provincial level data in Ontario show that, compared to other groups, immigrants and Indigenous women have lower rates of cervical cancer screening. Some nations (for example, Australia) have shifted from Pap test to HPV self-sampling-based screening for cervical cancer with promising results in reducing screening inequities. There is limited research in Canada on the potentials of HPV-based screening.

We conducted this important study to help build evidence on community-based and culturally sensitive care pathways for promoting HPV self-sampling-based screening for cervical cancer among under/never-screened women within immigrant communities.

Our Project Team Members
This project was led by Saint Elizabeth Health (Erik Yves Landriault, Paolo Korre, Doris Warner) and was a partnership between Women’s College Hospital (Dr. Sacha Bhatia, Dr. James Shaw, Dr. Camille Williams) Access Alliance (Dr. Akm Alamgir, Cliff Ledwos, Neelam Dahal, Gurjit Toor), N’Mninoeyaa Aboriginal Health Access Centre (Richard San Cartier), St. Mike’s Hospital (Dr. Aisha Lofters), and Ryerson University (Dr. Mandana Vahabi). Eve Medical (Jessica Ching, Izabella Kaczmarek) was the technology partner for the study and was responsible for developing the HPV self-sampling kit.

Access Alliance led the Toronto component of the study, which focused on immigrant communities, where Neelam Dehal was the Immigrant Insight Scholar for this project.

Our Research Goals and Methods

This project initially aimed to achieve a two-fold goal while using qualitative methods and an action research framework over two phases. The first phase documented existing knowledge, attitude and practice (KAP) among under/never- screened immigrant women as well as healthcare providers who work closely with these groups about cervical screening (Pap test and HPV). This was done by conducting focus groups and one-on-one interviews with client groups as well as with healthcare providers in Toronto. For this study, we kept the definition of “women” broad and welcomed trans and gender non-confirming people who have or have had a cervix to participate. The second phase was intended to organize collaborative design sessions in which we would review evidence from the focus groups to design pilot interventions/tools geared at overcoming knowledge gaps or institutional/social barriers documented through the focus group (and through the literature review). Due to the shortened project timeline, the final research report addresses the activities and findings from the Focus Group phase only which were used to better understand the barriers and facilitators (cultural, social, physical, economic, etc.) for particular immigrant groups to engage in screening activities.

What We Found

The key goal of this study was to understand the extent to which at-home based HPV self-sampling based screening could overcome institutional and socio-cultural barriers associated with Pap tests (administered by healthcare providers), among immigrant communities. The focus groups identified knowledge gaps, unique barriers and enablers associated with HPV self-sampling based screening as well as cervical cancer screening via Pap tests. 

Most newcomer/immigrant women identified that stigma of sexual health topics from members of their communities, family, religious groups and social circles often caused participants to be discouraged to speak about seeking regular screening. Lack of support and restrictions imposed by male partners were also identified as significant barriers. Many participants often experienced fear and uncertainty of cervical cancer screening as it was linked to a lack of knowledge of cervical cancer, the Canadian healthcare system and the lack of accessible culturally-sensitive and linguistically-available information. Structural issues such as lack of support in the form of language interpretation, childcare/transportation and the consistent availability of female physicians were also stated to be potential barriers. 

This study identified that culturally appropriate HPV self-sampling kits, adequate education and training to develop self-efficacy, and availability of gender-based, culturally-sensitive and trauma-informed healthcare were found as the key enablers for increasing the screening rate for cervical cancer among under-/never-screened immigrant populations. The generated evidence can inform services at community health centres and improve primary care practice to increase cervical cancer screening rates and mitigate screening inequities in Ontario. Focus group participants (client groups and healthcare providers) were also asked to provide their suggestions/recommendations for overcoming these barriers and challenges.

Our Knowledge Mobilization Activities & Products

  1. Read about the project’s key findings and identified promising practices in our Critical Discussion ReportEnglish, French
  2. Download and print our Myths vs Facts about Cervical Cancer Screening tool developed to address knowledge gaps around cervical cancer screening among under/never screened women, as identified through the research.

    Fact sheets are available in the following languages/sizes:

Cervical cancer information resources are available in multiple languages at RIOMIX.ca.  Enter as guest and type “cervical” in the keyword search field.  New materials are being added each week so please check back in for more cervical cancer resources and other health related materials.

 

Our Funders
Health Technologies Fund (HTF)

For more information about this project, please contact research@accessalliance.ca.