Vector Volume 11 Issue 1 - 2017
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
does not allow for the provision of strongly evidencebased<br />
interventions into migrant health, especially as data<br />
is not available as to the amount of ARC funding allocated<br />
specifically to cervical cancer screening.[22] Nonetheless,<br />
using available Australian data supplemented with some<br />
international publications, the following conclusions can be<br />
drawn about the effectiveness of past interventions and<br />
discussion of what is required for future success.<br />
Educational Campaigns<br />
Migrant women state that they largely receive information<br />
about cervical cancer from health professionals and public<br />
media campaigns. Therefore, the lack of awareness about<br />
pap smears must be targeted in both health and community<br />
settings; through general practice, migrant resource centres<br />
and community centres.[8] General practitioners play a key role<br />
in advocating for cervical cancer screening in consultations<br />
and through reminder letters, as migrant women who have<br />
never had a pap smear may not be comfortable asking for<br />
the test.[7,8,23] Similarly, the use of nurses in community,<br />
refugees health, women’s health, and child and family health<br />
is key in facilitating discussions regarding cancer screening<br />
amongst the migrant population.[8]<br />
The Ethnic Communities Council of Queensland (ECCG)<br />
created the Pilot Cancer Screening Education Program<br />
(PCSEP) which identified cervical cancer screening levels in<br />
various migrant populations before and after their program.<br />
In this program, 76% of participants participated in cervical<br />
cancer screening and this increased to 91% after the PCSEP.<br />
[24] Yet as this result was not statistically significant, we<br />
cannot confirm that this target program would be successful<br />
in increasing cervical cancer screening rates in migrant<br />
populations.<br />
Cultural Sensitivity<br />
As cultural factors play a key role in the decreased<br />
screening rate amongst migrant women, it is essential for<br />
Australian doctors to undertake cultural sensitivity training.<br />
This may improve understanding of factors affecting women<br />
from certain cultures such as modesty and fatalistic views of<br />
health.[7] This will allow health practitioners to appropriately<br />
tailor their consultations and the way that they promote<br />
cervical cancer screening with their migrant patients.<br />
There may also be reduced rates of cancer screening<br />
referrals from migrant doctors to patients of their own<br />
nationality. A study of Korean American doctors showed<br />
that there were reduced referral rates of colorectal cancer<br />
screening for their Korean patients. This was because they<br />
understood the cultural sensitivities surrounding cancer<br />
screening and perceived that compliance would be lower<br />
amongst their Korean patients.[25] It is key for doctors<br />
providing carer to patients of the same nationality to undergo<br />
training in cancer screening. The significance of bilingual<br />
health practitioners cannot be underestimated, as migrants<br />
prefer to see practitioners of the same nationality.[7,23] In<br />
the Vietnamese community, information sessions for bilingual<br />
practitioners about cervical cancer has been documented,<br />
but the effectiveness of this intervention has not been<br />
assessed.[23]<br />
Use of ethnic media<br />
Previous interventions have used ethnic media as a health<br />
promotion strategy to increase cervical cancer screening in<br />
various migrant populations.[23,26] Between 1991 and 1994,<br />
Pap Test Victoria conducted three sets of interventions in<br />
ethnic media outlets for over 12 migrant groups including<br />
Vietnamese, Chinese, Arabic and Turkish populations.<br />
During these interventions, the respective ethnic media<br />
outlets conducted live interviews, paid announcements and<br />
competitions with prizes. These three interventions led to an<br />
increase in screening compliance by 6.7% (95% CI 4.4-9.2).<br />
[26] As ethnic media can be utilised for health promotion and<br />
appears to be an effective method of increasing screening<br />
uptake, funding should be allocated for a nationwide ethnic<br />
media campaign on cervical screening.<br />
Conclusion<br />
Lower rates of cervical cancer screening in migrant<br />
women is a multifaceted issue. Factors contributing to these<br />
lower rates include lack of knowledge, cultural differences,<br />
limited acculturation and logistical issues. While research has<br />
been undertaken to understand the cause of the decreased<br />
participation of migrant women in regular pap smears, there<br />
have not been sufficient evidence-based interventions to<br />
address the issue. Although the government has redesigned<br />
the NCSP to reflect current medical research, there has<br />
been little evaluation of the cultural appropriateness of the<br />
current NCSP and the effectiveness of previous interventions<br />
to increase participation amongst the migrant population.<br />
The renewal of the NCSP should parallel the increased<br />
number of research projects that occurred during its initial<br />
implementation, as this is necessary to provide updated<br />
information on cervical cancer screening to migrant<br />
women. This will then allow for the application of evidencebased<br />
interventions to increase pap smear rates in this<br />
underscreened population.<br />
Acknowledgements<br />
None<br />
Conflict of Interest<br />
None declared<br />
References<br />
1. Aminisani N, Armstrong BK, Egger S, Canfell K. Impact of<br />
organised cervical cancer screening on cervical cancer incidence and<br />
mortality in migrant women in Asutralia. BMC Cancer. 2012;12(1):491-501.<br />
2. Australian Institute of Health and Welfare. Cerivcal screening in<br />
Australia 2012-2013. [Internet]. 2015 [updated 2015 May 1; cited <strong>2017</strong><br />
May 20]. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.<br />
aspx?id=60129550872.<br />
3. Simonella L, Canfell K. The impact of a two- versus three-yearly<br />
cervical screening interval recommendation on cervical cancer incidence<br />
and mortality: an analysis of trends in Australia, New Zealand, and England.<br />
Cancer Causes Control. 2013;24(9):1727-1736. doi: 10.1007/s10552-013-<br />
0250-9.<br />
4. Shader RI. The PAP test and the pap smear. Clin Ther.<br />
38