Interpretation
Our results support the current literature base regarding the uptake of
cervical cancer screening in young women. Young women face unique
barriers and facilitators in comparison to older groups, necessitating
age-specific interventions. Our studies highlighted age-specific
barriers such as concern about privacy from parents, transportation
difficulties, and continuity of care after moving away for school. In
addition, as this is typically the first invasive procedure that young
women undergo, there were concerns about pain, discomfort, and the
intimacy of the pelvic exam. The young women who participated in these
studies had helpful suggestions regarding age-specific interventions,
such as emailed reminders in comparison to written reminders, or
screening provided on college campuses. Our literature also aligns with
the greater research base regarding young people and low preventative
service use in general, as many young people do not have a consistent
family physician.50,51
When comparing results across internationally, we noticed that many
themes were universally represented across income levels. There were
accessibility concerns, cost concerns, and knowledge gaps in both lower
and higher income countries. However, it is important to note that
screening rates differ across the globe, and even within the same
country for lower income and minority populations. As financial
constraints were cited as a frequent barrier in our included studies, it
is not surprising that women from lower socioeconomic backgrounds have
lower screening rates.52,53 In addition, women from
minority populations may have more strained relationships with the
health system due to discrimination, lack of cultural competence, and
the historic failure of medical systems to be equitable towards minority
groups.54,55 This is particularly relevant to cervical
screening, as the patient’s individual relationship with the health
system was noted as an important barrier or facilitator towards
screening. To increase cervical screening rates, it is important that we
improve health system interactions overall to be more equitable.
Additionally, we noted that cultural barriers were discussed in several
studies, including sex-negative beliefs.23,30,34,36Several studies highlighted a fear of hymen breakage with the pelvic
exam, which has the societal stigma against virginity
loss.21,23,24,31 This concept was not only studied in
Asia and Africa, but also included two studies from the United
States.23,31 It is important to educate about the
concept of virginity as a social construct and improve sexual education
for girls. In higher-income countries, language barriers, health
literacy, and cultural beliefs were also noted as barriers among recent
immigrants. Recent literature has shown that the “healthy immigrant
effect” tends to taper off after several decades in a new country, with
immigrants at higher risk of poor health outcomes and underuse of health
services.56,57 Specific to cervical cancer, immigrant
and minority populations in developed countries are at higher risk,
often due to low screening rates.58,59 Thus,
interventions that target cervical screening uptake should have an
intersectional approach in addressing these issues, rather than a “one
size fits all” approach.
Further research is required to characterize which interventions are the
most effective for different age groups, including a diverse range of
ethnicities, sexual orientations, educational backgrounds, and income
levels. Moreover, we were surprised that none of the studies
specifically targetted the beliefs of non-heterosexual or
non-cisnormative participants, as this has been documented as a growing
public health concern and source of
misinformation.62-65 Studies regarding transgender men
were eligible for study inclusion, but yielded no search results based
on our protocol. Further specific investigation is required to
understand this topic, from both the perspective of the patient and the
physician.