Emotional and cultural barriers
- Embarrassment about the procedure
- Fear of tests, being diagnosed with cancer and cancer treatment
- Reluctance to screen after a negative past experience such as previous pain or discomfort
- Past history of sexual abuse or sexual violence
- Confidentiality concerns
- Cultural issues (related to circumstances, beliefs, background and inequities in society)
Barriers in knowledge
Lack of knowledge about:
- the purpose of a Cervical Screening Test
- available screening options including self-collection
- the role of screening in prevention
- the risks of cervical cancer
- who needs to be tested
- the accuracy of the test
- cancer or a belief that cancer equals death.
- Not believing cervical cancer is a risk
- Not considering screening to be a priority
- Limited previous experience of prevention or screening programs
- Being asymptomatic
- Perception that HPV vaccinated people do not require screening
- Perception that women who have sex with women, or transgender men, don’t require screening
- Time constraints, including availability of childcare
- Intending to have a test but not getting around to doing it or forgetting when the test is due
- Concerns about cost
- Language issues
- Lack of transport
- Physical, social or practical barriers associated with a disability
- Weight-related barriers (obesity)
- Personal preference for choice of healthcare provider
Health literacy refers to how people understand information about health and healthcare, and how they apply that information to their lives.
In Australia, almost 60% of adults have a low level of health literacy. The proportion of people with low health literacy is even higher for people who speak English as a second language.
Strategies to support improved health literacy include:
- asking the patient to repeat the instructions and information told to them
- expressing directions specifically, e.g. ‘you must take one week off work’ as opposed to ‘you need to rest’
- using plain language rather than medical terms
- sitting face-to-face with patients
- using simple diagrams and pictures, repeating directions multiple times.
You may need to do all of the above– use plain language with graphics, as well as medical terminology. Use it as a teaching opportunity to explain and then get feedback to ensure patient understanding.
Health Literacy – a summary for clinicians – explains how clinicians can help patients to better understand health information (8 pages, Australian Commission on Quality and Safety in Health Care).
Supportive systems for health literacy – provides information on how to strengthen health literacy within health services by improving systems and practices. Strategies include implementing a plain language policy and activities to build patients’ capacities (2 pages, Centre for Culture, Ethnicity & Health).
Women having already had the HPV vaccine
There is an ongoing decline in cervical screening participation among younger people. This may reflect younger HPV-vaccinated people becoming complacent or lacking education about the need for screening.
It is important to tell patients who received the HPV vaccine that they should still have regular Cervical Screening Tests. The vaccine does not protect against all the types of HPV linked to cervical cancer.
Patients who weren’t vaccinated before they began sexual activity may already be exposed to HPV.