title: A qualitative study of provider perspectives of structural barriers to cervical cancer screening among first nations women.
abstract: OBJECTIVE
  In Canada, opportunistic screening programs have successfully reduced mortality from cervical cancer; however, minority or disadvantaged groups, as well as women in northern and rural areas, are inadequately recruited by this approach. Hence, we set out to examine the structural barriers that prevent First Nations women's participation in cervical cancer screening.
  
  
  METHODS
  Using a participatory action research approach and semistructured interview guides, we conducted in-depth interviews with 18 experienced health care professionals, 12 of whom were also community members. These individuals included nurses, nurse practitioners, community health representatives, social workers and physicians who provide care to women in our First Nations partner communities. In the current report, we explored perceived barriers to cervical cancer screening through the lens of service providers.
  
  
  RESULTS
  Structural barriers to cervical cancer screening for First Nations women included shortage of appropriate health care providers, lack of a recall-based screening system, geographic and transportation barriers; health literacy and socioeconomic inequalities, generational effects, and the colonial legacy.
  
  
  CONCLUSIONS
  Existing, opportunistic cervical cancer screening programs do not perform well for First Nations women who experience significant screening-related health inequalities that are largely influenced by structural barriers. Sustainable screening interventions in First Nations communities require approaches that resolve these structural barriers, explore new ways of screening, and provide education for both women and health care providers. Many of the structural barriers are rooted in colonial history. Given the negative impact of the consequences of colonization on indigenous women worldwide, many of our findings strongly resonate with marginalized populations in other countries.
authors.affiliation: Human Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada. mmaar@nosm.ca
authors.forename: Marion
authors.initials: M
authors.lastname: Maar
authors.forename: Ann
authors.initials: A
authors.lastname: Burchell
authors.forename: Julian
authors.initials: J
authors.lastname: Little
authors.forename: Gina
authors.initials: G
authors.lastname: Ogilvie
authors.forename: Alberto
authors.initials: A
authors.lastname: Severini
authors.forename: Jinghao Mary
authors.initials: JM
authors.lastname: Yang
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Zehbe
mesh_terms: D002170:Canada; D055812:Community-Based Participatory Research; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014626:Vaginal Smears