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