Human Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
Womens Health Issues. 2013 Sep-Oct;23(5):e319-25. doi: 10.1016/j.whi.2013.06.005.
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.
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.
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.
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.
在加拿大，机会性筛查计划成功降低了宫颈癌死亡率；然而，少数族裔或弱势群体，以及北部和农村地区的妇女，通过这种方法的招募效果并不理想。因此，我们着手研究阻止第一民族妇女参与宫颈癌筛查的结构性障碍。
我们采用参与式行动研究方法和半结构化访谈指南，对 18 名经验丰富的医疗保健专业人员进行了深入访谈，其中 12 名也是社区成员。这些人包括在我们的第一民族合作伙伴社区为妇女提供护理的护士、执业护士、社区卫生代表、社会工作者和医生。在本报告中，我们通过服务提供者的视角探讨了宫颈癌筛查的感知障碍。
第一民族妇女宫颈癌筛查的结构性障碍包括合适的医疗保健提供者短缺、缺乏基于召回的筛查系统、地理和交通障碍；健康素养和社会经济不平等、代际影响以及殖民遗留问题。
现有的机会性宫颈癌筛查计划对第一民族妇女的效果不佳，她们在筛查方面存在显著的健康不平等，这主要受到结构性障碍的影响。在第一民族社区中实施可持续的筛查干预措施需要解决这些结构性障碍的方法，探索新的筛查方法，并为妇女和医疗保健提供者提供教育。许多结构性障碍都源于殖民历史。鉴于殖民化后果对全球土著妇女的负面影响，我们的许多发现与其他国家的边缘化群体产生了强烈共鸣。
