title: Community collaboration to increase foreign-born women's participation in a cervical cancer screening program in Sweden: a quality improvement project.
abstract: BACKGROUND
  The prevailing inequities in healthcare have been well addressed in previous research, especially screening program participation, but less attention has been paid to how to overcome these inequities. This paper explores a key factor of a successful improvement project: collaboration with local doulas to raise cervical cancer screening participation by more than 40 percent in an area with a large number of foreign-born residents.
  
  
  METHODS
  Data was collected through two focus group discussions with the doulas in order to design interventions and debrief after interventions had been carried out in the community. Various tools were used to analyze the verbal data and monitor the progress of the project.
  
  
  RESULTS
  Three major themes emerged from the focus group discussions: barriers that prevent women from participating in the cervical cancer screening program, interventions to increase participation, and the role of the doulas in the interventions.
  
  
  CONCLUSIONS
  This paper suggests that several barriers make participation in cervical cancer screening program more difficult for foreign-born women in Sweden. Specifically, these barriers include lack of knowledge concerning cancer and the importance of preventive healthcare services and practical obstacles such as unavailable child care and language skills. The overarching approach to surmount these barriers was to engage persons with a shared cultural background and mother tongue as the target audience to verbally communicate information. The doulas who helped to identify barriers and plan and execute interventions gained increased confidence and a sense of pride in assisting to bridge the gap between healthcare providers and users.
authors.affiliation: Centre for Equity in Health/Kunskapscentrum för Jämlik Vård, Western Region of Sweden/Västra Götalandsregionen, Regionens Hus, SE-405 44, Göteborg, Sweden. erik.olsson@vgregion.se.|Centre for Healthcare Improvement and Division of Quality Sciences, Chalmers University of Technology, SE-412 96, Göteborg, Sweden. erik.olsson@vgregion.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Olsson
authors.affiliation: Angered Local Hospital/Angereds Närsjukhus, Box 63, SE-424 22, Angered, Sweden. malena.lau@vgregion.se.
authors.forename: Malena
authors.initials: M
authors.lastname: Lau
authors.affiliation: Centre for Healthcare Improvement and Division of Quality Sciences, Chalmers University of Technology, SE-412 96, Göteborg, Sweden. svante.lifvergren@vgregion.se.
authors.forename: Svante
authors.initials: S
authors.lastname: Lifvergren
authors.affiliation: Centre for Healthcare Improvement and Division of Quality Sciences, Chalmers University of Technology, SE-412 96, Göteborg, Sweden. alexander.chakhunashvili@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Chakhunashvili
mesh_terms: D000328:Adult; D003256:Community Participation; D003299:Cooperative Behavior; D003469:Culture; D059037:Doulas; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D058996:Quality Improvement; D013548:Sweden; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
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