Knowledge and Attitudes towards Cervical Cancer Screening and Acceptability of HPV Self-Sampling (HPV-SS) Among Under or Never Screened Racialized Immigrant Women in GTA, Ontario, Canada

Author(s): Mandana Vahabi, Natasha Kithulegoda, Josephine Pui-Hing Wong, Aisha K. Lofters.

Background: Although Cervical cancer (CC) screening with the Papanicolaou (Pap) test has been effective in reducing CC incidence and mortality, the benefits have not equitably been distributed across different social strata. Immigrants and refugees, particularly South Asian (SA) and Sub-Saharan African (SSA) women, are among the most under-screened groups in Ontario. Little is known about the SA and SSA’s beliefs about CC and screening or the acceptability of utilizing HPV self-sampling (HPVSS), an alternative method of screening for CC. This on-line communitybased mixed methods pilot study aimed to address this knowledge gap.

Methods: Thirty under and never screened SA and SSA women 25-69 years old, residing in Greater Toronto Area were recruited by study community champions. Study participants completed an online survey, viewed a short video about HPV-SS and participated in online focus groups.

Results: Participants had limited knowledge and negative attitudes towards CC and screening. Sexually transmitted infections were viewed as a stigmatized concept. Multiple barriers to screening were identified like time constraints, limited availability of female healthcare providers, family beliefs and restrictions imposed by husbands in undergoing screening, and modesty in exposing private parts during a pelvic examination. Participants expressed preference for screening conducted by healthcare professionals for their knowledge and expertise while they were open to HPV-SS due to its convenience and privacy. The need for training about how to conduct the HPV-SS was highlighted.

Conclusion: The results emphasize the urgent need for targeted, familycentred, and culturally safe CC screening awareness campaigns for SA and SSA immigrant women.