Cervical cytology screening. How can we improve rates among First Nations women in urban British Columbia?

OBJECTIVE

To determine Pap smear screening rates among urban First Nations women in British Columbia; to identify facilitators and barriers; and to develop, implement, and evaluate specific interventions to improve Pap smear screening in Vancouver.

DESIGN

Computer records of band membership lists and the Cervical Cytology Screening Program registry were compared to determine screening rates; personal interviews and community meetings identified facilitators and barriers to urban screening programs. A community advisory committee and the project team collaborated on developing specific interventions.

SETTING AND PARTICIPANTS

Purposive sample of British Columbia First Nations women, focusing on women living in Vancouver.

INTERVENTIONS

Poster, art card, and follow-up pamphlet campaign; articles in First Nations community papers; community meetings; and Pap smear screening clinics for First Nations women.

MAIN OUTCOME MEASURES

Pap smear screening rates among BC First Nations women according to residence and reasons for not receiving Pap smears.

RESULTS

Pap smear screening rates were substantially lower among First Nations women than among other British Columbia women; older women had even lower rates. No clear differences were found among First Nations women residing on reserves, residing in Vancouver, or residing off reserves elsewhere in British Columbia. Facilitators and barriers to screening were similar among women residing on reserves and in Vancouver. Many First Nations women are greatly affected by health care providers' attitudes, abilities to provide clear information, and abilities to establish trusting relationships.

CONCLUSIONS

Family physicians are an important source of information and motivation for Pap smear screening among First Nations women.