Cervical awareness from a race equity perspective
My name is Denise Coles and I am an Equity, Diversity, and Inclusion Officer with race specialism. I have worked in and taught health and social care for over 20 years, and I am deeply interested in health disparities, wellbeing, and outcomes for groups from marginalised backgrounds. These groups are over-represented yet often do not receive interventions to meet their needs.
In this blog, I will be sharing my opinions and research on cervical screening uptake amongst racialised minority groups and why this uptake is lower in comparison to white counterparts.
All women and people with a cervix between the ages of 25-64 are recommended to go for regular cervical screening. Cervical screening (a smear test) checks the health of the cervix and is a test to prevent cancer. However, of all the people eligible for screening, approximately 1/5 of those have never been screened. Ethnicity is associated with lower attendance for cervical screening, and the research exploring reasons for this is minimal, though it does indicate a mistrust in the health system due to previous negative experiences.
Barriers to screening
To address these questions, it is important to focus attention on the lives and lived experiences of people of racialised minority groups and how these experiences are borne out in the health system. A system that frequently does not address the needs of these groups. For example the disproportionate Covid-19 deaths of health care staff from racialised minority groups, the fact that black women are five times more likely to die in childbirth, or the lack of mental health service provision for transgender and non-binary black and minority ethnic people.
Below is an outline of some of the barriers that have been identified with lower uptake of screening amongst racialised minority groups:
- Communication is not tailored to audiences from different cultural backgrounds
Health messaging about cervical screening needs to consider the cultural context and norms of the target audiences, and where they may prevent screening at certain times eg awareness of Eid, Nine Nights and other cultural events can help with promoting and offering alternative testing times amongst culturally diverse groups.
This could be fear of the test result or fear of being labelled irresponsible for not attending previous screenings.
- Language barriers
Information about testing has not been communicated in the service user’s language, or there is limited access to multilingual staff who can explain the procedure in the person’s first language.
For some service users, the procedure is seen as embarrassing due to a variety of reasons including body shape, a stranger seeing private parts or the stigma that testing will be associated with loose sexual behaviours resulting in avoidance of testing.
- Lack of knowledge/awareness
This can be related to key terms such as screening, smear, and HPV not being understood.
- Lack of Trust
Negative experiences within healthcare settings can result in avoidance of interacting with healthcare professionals.
When barriers are viewed in a culturally ethnic-specific context, it is possible to design culturally sensitive interventions to address lower uptake rates of cervical screening in racialised minority groups. Supportive, approachable care where information is clear and culturally relevant allows for ease of navigating the system. The above barriers transcend all racialised minority groups. However, lower uptake of testing is more pronounced in groups from lower socio-economic backgrounds and fewer years of formal schooling. So, this points to greater investment in training professionals on how to work positively with groups where attendance to screening appointments is lower and how to raise awareness and understanding of cervical screening and cervical cancer.
Also, where possible I would advise people in the community to join the GP surgery advisory board where you can use knowledge and understanding of cervical screening and racialised minority groups to inform patient care.
If you would like to know more about race ethnicity and smear testing or race ethnicity and health outcomes, some online resources for further reading have been provided below.
- How culture-specific education can improve cervical screening uptake – Hospital Times
- Encouraging cervical screening uptake in ethnic minority women and trans and non-binary communities – Local Government Associations
- The safety of healthcare for ethnic minority patients: A systematic review – International Journal for Equity in Health
- Public health messaging for communities from different cultural backgrounds
- Black and Asian doctors still face discrimination when applying for jobs in the NHS – The bmj
Equality, Diversity and Inclusion
Reflections, comments, discussion and opinion on EDI topics from Loughborough University staff and students