title: Barriers to cervical cancer screening among ethnic minority women: a qualitative study.
abstract: BACKGROUND
  Ethnic minority women are less likely to attend cervical screening.
  
  
  OBJECTIVE
  To explore self-perceived barriers to cervical screening attendance among ethnic minority women compared to white British women.
  
  
  METHODS
  Qualitative interview study.
  
  
  METHODS
  Community groups in ethnically diverse London boroughs.
  
  
  METHODS
  Interviews were carried out with 43 women from a range of ethnic minority backgrounds (Indian, Pakistani, Bangladeshi, Caribbean, African, Black British, Black other, White other) and 11 White British women. Interviews were recorded, transcribed verbatim and analysed using Framework analysis.
  
  
  RESULTS
  Fifteen women had delayed screening/had never been screened. Ethnic minority women felt that there was a lack of awareness about cervical cancer in their community, and several did not recognise the terms 'cervical screening' or 'smear test'. Barriers to cervical screening raised by all women were emotional (fear, embarrassment, shame), practical (lack of time) and cognitive (low perceived risk, absence of symptoms). Emotional barriers seemed to be more prominent among Asian women. Low perceived risk of cervical cancer was influenced by beliefs about having sex outside of marriage and some women felt a diagnosis of cervical cancer might be considered shameful. Negative experiences were well remembered by all women and could be a barrier to repeat attendance.
  
  
  CONCLUSIONS
  Emotional barriers (fear, embarrassment and anticipated shame) and low perceived risk might contribute to explaining lower cervical screening coverage for some ethnic groups. Interventions to improve knowledge and understanding of cervical cancer are needed in ethnic minority communities, and investment in training for health professionals may improve experiences and encourage repeat attendance for all women.
authors.affiliation: Senior Research Associate, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Laura A V
authors.initials: LA
authors.lastname: Marlow
authors.affiliation: Principal Research Associate, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Waller
authors.affiliation: Professor of Clinical Psychology, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
mesh_terms: D000328:Adult; D001294:Attitude to Health / Q000208:ethnology; D055088:Early Detection of Cancer; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears
keywords: cervical screening; ethnic minority and cultural issues; qualitative research