A Qualitative Study of Provider Perspectives of Structural Barriers to Cervical Cancer Screening Among First Nations Women

Maar, Marion; Burchell, Ann; Little, Julian; Ogilvie, Gina; Severini, Alberto; Yang, Jinghao Mary; Zehbe, Ingeborg

doi:10.1016/j.whi.2013.06.005

Cited by 93Indigenous Health, Education, and RightsWomen's cancer prevention and managementCervical Cancer and HPV Research

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A Qualitative Study of Provider Perspectives of Structural Barriers to Cervical Cancer Screening Among First Nations Women

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Maar, Marion, Burchell, Ann, Little, Julian, Ogilvie, Gina, Severini, Alberto, Yang, Jinghao Mary, Zehbe, Ingeborg·2013·Women's Health Issues

DOI 10.1016/j.whi.2013.06.005PMC PMC4111655

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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. Conclusion 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.

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Other screening methods may cause discomfort and embarrassment, unlike HPV self-sampling.
“In addition, major concerns of women with clinic‐based approach are that, women may perceive procedures as unpleasant, embarrassing, preference to be screened by female health care provider, physical, and/or psychological discomfort associated with the test and time off required from work in order to attend screening clinic. 15”
From Acceptability and validity of HPV self‐sampling for cervical cancer screening among women living in different ecological settings in India (2025) · cites this paper as [15]

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Authors: Maar, M., Burchell, A., Little, J., Ogilvie, G., Severini, A., Yang, J. M., & Zehbe, I.
Affiliations: NOSM University (CA)
University of Toronto (CA)
University of Ottawa (CA)
University of British Columbia (CA)
Public Health Agency of Canada (CA)
Thunder Bay Regional Research Institute (CA)
ORCID: Maar, Marion
Burchell, Ann
Little, Julian
Ogilvie, Gina
Severini, Alberto
Zehbe, Ingeborg
Venue: Women's Health Issues
Publisher: Elsevier BV
Published: 2013-09
Volume: 23
Issue: 5
Pages: e319-e325
ISSN: 1049-3867 (ISSN-L)
DOI: 10.1016/j.whi.2013.06.005
PMC: PMC4111655
OpenAlex: W2139707328
Cited by: 93
References: 27
Citations by year: 2026: 3 · 2025: 4 · 2024: 13 · 2023: 5 · 2022: 13 · 2021: 12 · 2020: 4 · 2019: 9 · 2018: 2 · 2017: 5 · 2016: 8 · 2015: 9 · 2014: 6
FWCI: 8.73
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Women s Health Issues (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Canadian Institutes of Health Research (119344_1)
Topics: Social Sciences › Health › Indigenous Health, Education, and Rights
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Keywords: cervical cancer screening, First Nations women, structural barriers, provider perspectives, health workforce shortage, geographic barriers, transportation barriers, health literacy, socioeconomic disparities, generational effects, colonial legacy, opportunistic screening
MeSH terms: Canada, Uterine Cervical Neoplasms, Female, Health Personnel, Health Services Accessibility, Humans, Indians, North American, Interviews as Topic, Health Knowledge, Attitudes, Practice, Middle Aged, Primary Health Care, Socioeconomic Factors, Vaginal Smears, Qualitative Research, Healthcare Disparities, Early Detection of Cancer, Community-Based Participatory Research

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A Qualitative Study of Provider Perspectives of Structural Barriers to Cervical Cancer Screening Among First Nations Women

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