title: Early detection of cervical cancer according to the discourses of primary care midwives in Segovia, Spain.
abstract: OBJECTIVE
  To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program.
  
  
  METHODS
  A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology.
  
  
  RESULTS
  Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, women's experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator.
  
  
  CONCLUSIONS
  The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Program's infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.
authors.affiliation: Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, España. laotero@isciii.es
authors.forename: Laura
authors.initials: L
authors.lastname: Otero
authors.forename: Belén
authors.initials: B
authors.lastname: Sanz
authors.forename: Teresa
authors.initials: T
authors.lastname: Blasco
mesh_terms: D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008880:Midwifery; D011320:Primary Health Care; D036301:Qualitative Research; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D013030:Spain; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control