Background
Method
Data source
Published Articles | Grey Literature |
---|---|
MEDLINE | Google |
EMBASE | Google Scholar |
CINAHL | Proquest (theses and dissertations) |
PsycINFO | OpenDOAR (institutional repositories) |
Scopus | Health Science Online (HSO) |
EMB Reviews (including Cochrane) | Turning Research into Practice (TRIP) |
Web of Science | Canadian Institute for Health Information (CIHI) |
Family and Society Studies Worldwide | Public Health Agency of Canada (PHAC) |
SocINDEX (with full text) | Health Canada |
Academic Search Complete | National Institutes of Health (NIH) |
Social Work Abstracts |
Keywords for barrier: | |
Barrier* [Keyword]; factor* [Keyword]; risk* [Keyword]; risk [MeSH]; “risk factor*” [Keyword]; risk factors [MeSH]; Prejudice [Keyword, MeSH]; self-conscience* [Keyword]; issue* [Keyword]; attitude* [Keyword]; attitude [MeSH]; “Attitude of Health Personnel” [MeSH]; “Attitude to Health” [MeSH]; “Health Knowledge, Attitudes, Practice” [MeSH]; uncertainty [Keyword, MeSH]; mistrust [Keyword]; obstacle* [Keyword]; hurdle* [Keyword]; difficulty [Keyword]; difficulties [Keyword]; obstruction [Keyword]; impediment [Keyword]; Challenge* [Keyword]; confront* [Keyword]; defy [Keyword]; defiance [Keyword]; object* [Keyword]; contest* [Keyword]; question* [Keyword]; “Health Services Accessibility” [Keyword]; hinder*[Keyword]; inhibitor* [Keyword]; roadblock* [Keyword]; block* [Keyword]; pitfall* [Keyword]; “Physician-Patient Relations” [MeSH]; “Communication Barriers” [MeSH] | |
Keywords for screening: | |
Screening [Keyword]; “Mass Screening” [MeSH]; “preventive test*” [Keyword]; “preventive investigation*” [Keyword]; ‘early diagnosis’ [Keyword]; “Early Diagnosis” [MeSH] | |
Keywords for cervical cancer: | |
“Cervical cancer” [Keyword]; “Uterine Cervical Neoplasms” [MeSH]; “cervical neoplasm” [Keyword]; “Pap smear” [Keyword]; Papanicolaou Test [MeSH]; “Pap test” [Keyword]; “Vaginal Smears” [MeSH]; “vaginal smear*” [Keyword] | |
Keywords for Canada: | |
Canada [Keyword]; Canada [MeSH] |
Study selection
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The study population consisted of immigrant women and healthcare providers and other stakeholders serving immigrant women
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The study was focused on barriers to cervical cancer screening
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The study was original research
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The study was conducted in Canada
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They were about refugee or temporary residents or undocumented migrants or aboriginal populations (as healthcare policies and experiences are different and more complicated for these groups than the general Canadian immigrant population [14])
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They were not related to barriers to cervical cancer screening
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They were conference abstracts, editorials, reviews, case reports, consensus statements, guidelines, or described study design only,.
Data extraction
Results
Characteristics of selected studies
Study | Year | Study Type | Data Source | Location | Size | Age | Sample |
---|---|---|---|---|---|---|---|
Matuk LC [21] | 1996 | Qualitative | Focus group questionnaire, telephone interviews, mail surveys, home visits | Windsor, Ontario, Canada | 186 | Mean 23.6 | Newcomer women from the Eastern world, Central and South America, Eastern Europe, and Africa |
Woloshin et al. [41] | 1997 | Quantitative (cross-sectional study) | In-person interview and survey questionnaire | Ontario, Canada | 22,448 | 18–74 | Mixed Canadian, Western European, Eastern European, Asian, Native American women |
Fitch et al. [32] | 1998 | Qualitative | Focus group interview | Canada | 110 | N/A | Sri Lanka, West Indies |
Bottorff et al. [33] | 2001 | Qualitative | Open-ended interview | Canada | 35 | N/A | Asian, South Asian women |
Gupta et al. [18] | 2002 | Quantitative | Survey questionnaire | Toronto, Ontario, Canada | 124 | 18–60 | South Asian women |
Jackson et al. [26] | 2002 | Qualitative | Unstructured interview, focus group interview | Vancouver, British Columbia, Canada, Seattle, Washington, US | 87 | 29–72 | Chinese women |
Hyman et al. [30] | 2002 | Qualitative and quantitative | Mail-back questionnaires | Toronto, Ontario, Canada | 64 | 29–71 | Physician, 40.6% female |
Hyman et al. [29] | 2003 | Qualitative and quantitative | Mail-back questionnaires | Toronto, Ontario, Canada | 112 | 25–72 | Physicians born in Hong Kong, China, Vietnam, and Canada; 25.7% female |
Hislop et al. [19] | 2003 | Qualitative and quantitative (cross-sectional study) | Focus group interview using survey questionnaire | Vancouver, Richmond, British Columbia, Canada | 512 | 20–79 | Chinese women |
Hislop et al. [20] | 2004 | Qualitative and quantitative | In-person interviews, focus group, survey questionnaire | British Columbia, Canada | 528 | 20–79 | Chinese women |
Steven et al. [37] | 2004 | Qualitative and quantitative | Face-to-face interview | Northwestern Ontario, Canada | 105 | ≥40 | Italian, Ukrainians, Finnish, Ojibwa, Oji-Cree women |
Donnelly TT [34] | 2006 | Qualitative | In-depth ethnographic interviews using a semi-structured questionnaire | A western Canadian metropolitan city | 15 + 6 | 49–78 | Vietnamese women, 4 male physicians, and 2 female community health nurses |
Oelke et al. [31] | 2007 | Qualitative | In-depth interviews focus groups | Canada | 53 | N/A | Sikh women |
McDonald et al. [11] | 2007 | Quantitative (cross-sectional study) | Survey (NPHS and CCHS) | New Brunswick, Quebec, Ontario, Manitoba, British Columbia, Saskatchewan, Alberta, Canada | 105,062 | 21–65 | White, Black, Hispanic, Arab/West Asian, Chinese, Korean, Japanese, South Asian, Southeast Asian, and Filipino women |
Lofters et al. [10] | 2007 | Quantitative (retrospective cohort) | RPDB and administrative data analysis (billing code) | Toronto, Ontario, Canada | 724,584 | 18–66 | N/A |
Donnelly TT [28] | 2008 | Qualitative | In-depth ethnographic interviews using a semi-structured questionnaire | A western Canadian metropolitan city | 6 | N/A | 4 male physicians and 2 female community health nurses |
Donnelly et al. [24] | 2009 | Qualitative | In-depth ethnographic interviews using a semi-structured questionnaire | A western Canadian metropolitan city | 15 + 6 | N/A | Vietnamese women, 4 male physicians, and 2 female community health nurses |
Amankwah et al. [17] | 2009 | Quantitative (cross-sectional study) | CCHS using questionnaire and interview | All Canadian provinces and territories | 76,214 | 18–65 | Chinese, South Asian, Filipino, Other Asian, Black, Latin American, Caucasian, Aboriginals |
Woo et al. [38] | 2009 | Quantitative | Questionnaire | Canada | 584 | 18–60+ | Chinese and Euro-Canadian women |
Xiong et al. [39] | 2010 | Quantitative (cross-sectional study) | CCHS | Canada | 64,604 | 18–60+ | Asian immigrant (Korean, Filipino, Japanese, Chinese), South Asian (East Indian, Pakistani) |
Lofters et al. [23] | 2010 | Quantitative | Administrative data | Ontario, Canada | 2,273,995 | 25–69 | N/A |
Lofters et al. [16] | 2011 | Quantitative (cohort) | Administrative data analysis (billing code) | Ontario’s CMA (Census Metropolitan Area), Canada | 455,864 | N/A | Women from East Asia and Pacific, Eastern Europe and Central Asia, Latin America and Caribbean, Middle East and North Africa, South Asia, Sub Saharan Africa, USA, Australia and New Zealand, Western Europe |
Redwood-Campbell et al. [36] | 2011 | Qualitative | Focus group interview | Hamilton, Ontario, Canada | 77 | 35–69 | Arabs, Chinese, Afghan, Other Asian, Somalian, Spanish women |
Black et al. [35] | 2011 | Qualitative | Focus group interview | New Westminster, Surrey, Burnaby, Coquitlam, Victoria, and Vancouver, British Columbia, Canada | 80 | 20–29 | Qualitative |
Chang et al. [40] | 2013 | Qualitative | Focus group interview | Vancouver, British Columbia, Canada | 13 | Mean 53 | Chinese women |
Schoueri N [22] | 2013 | Qualitative and quantitative | Survey (CCHS) | Ontario, Canada | 2904 | 18–69 | N/A |
Lobb et al. [15] | 2013 | Qualitative and quantitative | Concept mapping by brainstorming session | Brampton and Mississauga, Ontario, Canada | 53 | 53 | Potential decision makers, program implementers, and program participants |
Vahabi et al. [27] | 2016 | Qualitative | Questionnaire, focus group interviews | Ontario, Canada | 30 | 21–69 | West Asia (Iran) and South Asia (Pakistan and India) |
Characteristics associated with lower screening rates in immigrant women
Thematic analysis of barriers to cervical cancer screening faced by immigrant women in Canada
Theme | Barriers | N | Reference(s) |
---|---|---|---|
Sociodemographic factors associated with under screening | Extreme age groups (older/ younger) | 4 | |
Lower educational attainment | 10 | ||
Less acculturation | 2 | ||
Being single | 4 | ||
Economic barriers | Costs (transportation/ child care/ time off work) | 5 | |
Low income/ socioeconomic status | 8 | ||
Frequent moving of immigrants | 2 | ||
Intervention not adequately reimbursed | 4 | ||
Healthcare system-related barriers | No regular doctor | 4 | |
Lack of appropriate reminder system | 3 | ||
Dissatisfaction with patient/provider interaction | 3 | ||
Lack of physician recommendation/consult | 9 | ||
Heavy workloads of physicians | 1 | [34] | |
Dearth of acceptable health care provider/ female provider | 15 | ||
Long waiting time | 3 | ||
Service is inconvenient/difficult to access | 4 | ||
Lack of appropriate services/referral pattern | 1 | [15] | |
Lack of appropriate educational materials/services | 4 | ||
Difference in the institutionalization of healthcare | 1 | [40] | |
Cultural barriers | Cultural differences/religious belief | 10 | |
Stigma | 6 | ||
Embarrassment/modesty | 11 | ||
Preference for traditional/alternative care | 1 | [40] | |
Patriarchy | 2 | ||
Physician-patient hierarchy | 2 | ||
Language barriers | Language/communication difficulties | 12 | |
Lack of interpretation/translation services | 2 | ||
Knowledge-related barriers | Lack of information about how to access/navigate services | 6 | |
Lack of preventive health concept/knowledge of screening tests | 9 | ||
Lack of cancer literacy | 8 | ||
Belief that screening is not necessary/ ineffective | 9 | ||
Physicians unaware of screening guideline | 1 | [15] | |
Individual-level barriers | Lack of time | 6 | |
It is not a priority/self-sacrifice | 4 | ||
Not getting around to it/procrastination | 3 | ||
Concern about cancer diagnosis/ prognosis | 4 | ||
Concern about side effects of treatment | 1 | [15] | |
Fear of procedure (pain/discomfort) | 6 | ||
Sense of confidentiality/privacy | 4 | ||
Limited support/ encouragement | 2 |