title: Social determinants of health associated with cervical cancer screening among women living in developing countries: a scoping review.
abstract: BACKGROUND
  Thousands of women living in many middle and low-income countries are unnecessarily dying from cervical cancer, partly due to limited screening coverage.
  
  
  OBJECTIVE
  To identify social determinants of health (SDH) associated with cervical screening for women living in middle and low-income countries, to inform responses to improve SDH and screening coverage, and to identify research gaps.
  
  
  METHODS
  A scoping literature review. We located original research articles on SDH associated with cervical cancer screening through bibliographic databases, supplemented by hand searching (n=166+4). Included were those conducted in middle and low-income countries and published in English, Portuguese and Spanish academic journals between January 2000 and June 2011 (n=37). Excluded were those from high-income countries or focusing on screening-diagnostic techniques or HPV vaccine. Narrative synthesis examined the results in relation to a SDH framework.
  
  
  RESULTS
  A number of factors influence access along the pathway to cervical cancer screening. Structural (cultural and societal values, socioeconomic position, ethnicity), intermediary (geographic location, health seeking behaviours, psychosocial factors, nature of the health system), and cross-cutting (social cohesion) SDH were all important. No single factor could entirely explain the observed cervical screening patterns.
  
  
  CONCLUSIONS
  Cervical cancer screening among women living in middle and low-income countries are influenced by the interaction among several different SDH. The majority of researchers studying cervical cancer screening focused on exploring single socio-demographic variables, which is typical of positivist, biomedical and epidemiological research. An inter-sectionality approach may provide a richer understanding of the complexities that influence women's pathways to cervical cancer screening and assist design of international programmes and policies from a social justice perspective.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, University Health Network, Princess Margaret Hospital, Rm 18-727, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. leslie.williams2@uhn.on.ca
authors.forename: Leslie
authors.initials: L
authors.lastname: Williams-Brennan
authors.forename: Denise
authors.initials: D
authors.lastname: Gastaldo
authors.forename: Donald C
authors.initials: DC
authors.lastname: Cole
authors.forename: Lawrence
authors.initials: L
authors.lastname: Paszat
mesh_terms: D003469:Culture; D003906:Developing Countries; D055088:Early Detection of Cancer / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D010342:Patient Acceptance of Health Care; D012944:Social Support; D012945:Social Values; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*