Designing a Culturally Appropriate HPV Screening Program with Communities

This action research project seeks 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 and Indigenous communities.

Why are we conducting 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 are conducting 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 (Toronto study site) and Indigenous communities (North Shore Tribal Council area study site)

Our Project Team Members
This project is led by St Elizabeth (Erik Yves Landriault, Paolo Korre, Doris Warner) and is 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 (Eve Medical: Jessica Ching, Izabella Kaczmarek) is the technology partner for the study and is responsible for developing the HPV self-sampling kit.
Neelam Dehal is the Immigrant Insight Scholar for this project and will lead the Toronto component of the study.

Our Research Goals and Methods
This project has a twofold goal and uses qualitative methods and an action research framework over two phases. The first phase is to document current knowledge, attitude and practice (KAP) among under/never- screened immigrant/Indigenous people as well as healthcare providers who work closely with these groups about cervical screening (Pap test and HPV). We will do so by conducting focus groups with client groups as well as with healthcare providers in Toronto (focused on immigrant client groups) and North Shore Tribal Council in the Sudbury Area of Northern Ontario (with First Nations, Inuit, and Métis client groups). For this study, we have kept the definition of “women” broad and welcome trans and gender non-confirming people who have or have had a cervix to participate.

Specifically, the key goal of this first phase is to understand the extent to which home-based HPV self-sampling screening could overcome institutional and socio-cultural barriers associated with Pap tests administered by healthcare providers. The focus groups will also seek to document knowledge gaps as well as unique/new barriers and challenges associated with HPV self-sampling-based screening. Focus group participants (client groups and healthcare providers) will be asked to provide their suggestions/recommendations for overcoming these barriers and challenges.

Following this, we will organize collaborative design sessions in which we will review evidence from the focus groups to design some pilot interventions/tools geared at overcoming knowledge gaps or institutional/social barriers documented through the focus group (and through the literature review). These interventions/tools can include culturally sensitive HPV screening flyers and films for target client groups (translated in multiple languages), training workshops for healthcare providers, patient education scripts for medical secretaries, etc. These interventions/tools will then be implemented within partner agencies.

The post-intervention phase will then assess the response and effectiveness of these interventions/tools through follow up focus groups and interviews with client groups and healthcare providers. Evidence from this phase will then be used to fine tune and enhance the interventions/tools. In this phase, we will also conduct key informant interviews with decision makers within the healthcare sector to explore potentials for system integration, spread and scaling up of these pilot interventions and HPV self-sampling-based cervical cancer screening.

Project Timeline
This is a 21 month long project, starting on September 2018.

Our Funders
Health Technologies Fund (HTF)

For more information about this project, please contact the Research and Evaluation Department at