Analysis of Notable Barriers
There were numerous barriers cited by the young women and adolescents regarding cervical cancer screening. The barriers can be grouped into three large groups: lack of knowledge/awareness, negative perceptions of testing, and practical barriers.
i) Lack of Knowledge/Awareness
Most notably, 26/36 (72.2%) of studies reported lack of knowledge or awareness in young women regarding cervical cancer prevention. Three studies20-22 noted lack of physician recommendation, while one noted low overall health literacy of participants.23
Misinformation included beliefs that young women were not susceptible in 4/36 studies,20,24-26 that screening was not necessary if not currently experiencing symptoms,27 and that the Pap test was not effective/reliable for screening cervical cancer.28,29 Other misconceptions included that a male partner’s circumcision prevented their need for cervical cancer screening.30 In four studies, there was a fear that pelvic exams could “take one’s virginity,” reported in Ghana, Malaysia, and the United States.21,23,24,31
ii) Negative Perceptions of Testing
A large number of young women had fears and anxieties regarding the screening experience. Ten studies cited a fear of pain/discomfort during Pap smears, with 13/36 studies noting embarrassment of the intimate examination. Three studies noted the invasiveness of the procedure being of particular concern.32-34 Male gender of physicians was also noted to impede motivation for screening in two studies.32,35
Stigma around cervical cancer was noted in 4 studies,23,30,33,36 with two of the studies reporting stigma around the general act of visiting a gynecologist’s office.23,33 Confidentiality was a concern noted in three studies,37-39 with two specifically noting privacy from parents.37,39
Two studies discussed fear of side effects or complications from screening.36,40 Five studies discussed fear regarding potential diagnosis of cancer as a barrier to screening.34,38,39,41,42
iii) Practical Barriers to Testing
There were a number of logistical barriers noted to accessing cervical cancer screening.
Six studies discussed low accessibility to services.22,23,26,32,37,41 Participants reported difficulties in finding a consistent healthcare provider, especially after moving away for work or school.26,32Difficulties were also noted in rural areas with only a single provider24 or locations with reduced access to female physicians.32
Transportation was noted as a barrier in two studies.39,43 Cost of screening services and financial constraints were noted as a barrier in six studies,20,21,24,37-39 with two studies located in lower income countries (Ghana, Malaysia) and the remainder in the United States.
Time constraints were cited in three studies.20,24,26One study noted that participants preferred to schedule their appointments according to their menstrual cycle, which posed further limitations.26