Working with patients who face specific barriers

People from culturally and linguistically diverse backgrounds 

Find information and resources on how to engage patients from culturally and linguistically diverse backgrounds in cervical screening.

Resources

For patients

You can provide these resources to patients to help them before, during and post screening. See the full resource library.

    Before screening appointment

    During screening appointment

    Post screening appointment

    For health care providers

    You can use these resources to prepare for an appointment with a patient from a culturally and linguistically diverse background:

    Considerations

    People from culturally and linguistically diverse (CALD) backgrounds are less likely than people from the general population to have Cervical Screening Tests.

    When working with people from CALD backgrounds it’s important to consider their diverse cultures and beliefs, and provide culturally safe, appropriate and inclusive services.

    Assessing your patient’s culture is needed to assist you in caring for them in a culturally sensitive way. Cultural factors can be dynamic and are specific to each person. Factors include: race, gender, religion and ethnicity.

    It’s important to recognise the complexity of your patient’s cultural background and other issues that may affect their life. This includes migration, settlement and socio-economic status.

    If you need to know more about a patient’s beliefs or values, just ask.

    If you work in a mainstream health service, working with women’s ethno- specific, multicultural health and welfare agencies will help you share information and best practices. It will also help you to link your patient to these services for further multilingual information about their health. Bilingual and bicultural health educators have expertise and skills in educating migrant and refugee women, and in promoting health services in general.

    Before a consultation about cervical screening with a patient from a culturally diverse background, ask yourself:

    • Do I need a qualified interpreter?
    • Do I need to access a female interpreter?
    • Has my patient understood the procedure of cervical screening and the screening options available, including self-collection?
    • Should I ask the patient to repeat  what I have explained before they give consent?
    • Are flexible, longer and multiple appointment times available for my patient?
    • Do I know where to refer my patient for sexual and reproductive health education and information?
    • Does the patient understand the appointment is private and confidential?
    • Does the patient know they can have a support person attend the appointment?
    • Do I have educational resources with visuals for the consultation?

    If you require an interpreter, please contact the Translating and Interpreter Service (TIS) on 131 450 or visit their website.

    Consider what information is necessary to guide your consultation:

    • Country of birth and time of arrival to Australia.
    • Previous cervical screening experiences.
    • Is the patient from a country with prevalent practices of female genital cutting (FGM), also known as traditional cutting?
    • Would the patient prefer a female practitioner?
    • Should I explain the concept of confidentiality to the patient who may be concerned about her husband, partner or family knowing why she has visited the doctor?

    Barriers

    There are general barriers that people face in participating in cervical screening. People from CALD backgrounds can face extra barriers relating to:

    • lack of knowledge of the availability, purpose, importance and benefits of cervical screening
    • lack of knowledge on the screening choices available to them (e.g. self-collection or clinician-collection)
    • belief that cervical screening is unnecessary without symptoms
    • misunderstandings about causes of cancer (i.e. cancer is contagious, cancer is a punishment for past behaviour/moral conduct, cervical cancer is caused by promiscuity, cancer equals death)
    • negative cultural perceptions about cancer – for example, fatalistic and superstitious attitudes (i.e. cancer is the will of God, cancer is incurable, cancer is predetermined) causing some people to think cervical screening is unnecessary
    • beliefs in traditional, non-western medicine
    • stigma and taboos around discussing sexual topics
    • fear, shame and stigma associated with cancer
    • fear, modesty and embarrassment around the test
    • difficulties with language, communication and literacy
    • availability of female healthcare providers
    • availability of female interpreters
    • availability of a healthcare provider who speaks their language
    • difficulties accessing and navigating the Australian healthcare system (particularly, newly arrived patients)
    • competing priorities such as employment, housing and family (particularly, newly arrived patients)
    • having multiple complex health problems such as chronic diseases and/or physical and mental health consequences of trauma, violence and sexual abuse (particularly, patients who have newly arrived as refugees)
    • distrust of healthcare providers due to experiences from their originating country.
    • resistance to using local health systems due to perceptions or experiences of culturally insensitive services
    • logistical concerns – lack of transport, difficulties getting to the appointment, organising childcare if necessary
    • cost to see a healthcare provider if bulk-billing is not available.

    Ways to engage

    The following strategies have been shown to be effective in engaging people from CALD backgrounds in cervical screening.

    Strategy

    Details

    Cultural safety training

    Cultural safety training for healthcare providers and practice staff will help to build an understanding of culturally-based attitudes towards:

    • disease
    • the importance of culture and tradition.

    Culturally safe environment
    • Ensure that your health service is culturally safe – including culturally appropriate, translated, easy-to-understand resources.

    Service flexibility
    • Offer flexible appointments.
    • Offer opportunistic screening where possible.

    Choice of provider
    • Provide opportunities for patients to choose between male/female, doctor/nurse, etc. cervical screening providers.

    Choice of screening method
    • Offer the choice of either self-collection or clinician-collection screening options.
    • Explain the pros and cons of each option, including follow-up requirements if HPV is detected on a self-collected vaginal sample.
    • Consider offering home-based self-collection (e.g. via a telehealth consultation) where appropriate.
    • If clinician-collection is chosen some of the below points may assist.
      • Some patients may prefer to insert their own speculum and it can be helpful to offer this option.
      • Providing instructions on calming and deep breathing techniques can also help the patient to relax.
      • A prescription of vaginal oestrogen cream before the appointment can be effective in decreasing pain or discomfort for post-menopausal patients.
      • Provide a mirror in case the patient wants to view their own cervix.

    Appropriate communication
    • Healthcare providers should communicate in clear and respectful language.
    • Disseminate information in the CALD community about services offered.
    • Let the patient know that the appointment is private and confidential.
    • Patients can bring a relative or friend with them to help them feel more comfortable.
    • Patients can ask for a female nurse or doctor.
    Date last updated:
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