Understanding knowledge, beliefs, values and barriers towards cervical cancer screening and self-sampling amongst migrant Muslim women in Southwest London: an in-depth qualitative interview study

TL;DR

This study explores migrant Muslim women's views on cervical cancer screening and self-sampling in London, finding that while acceptable, barriers like cultural taboos and language gaps need addressing.

Contribution

The study provides novel insights into the acceptability of HPV self-sampling among migrant Muslim women and identifies culturally specific barriers and solutions.

Findings

44% of migrant Muslim women preferred self-sampling over healthcare worker-taken samples due to concerns about technique.

Participants showed increased openness to self-sampling after experiencing respiratory swabs during the pandemic.

Cultural taboos and lack of understanding about HPV and screening were identified as major barriers.

Abstract

Novel screening methods are needed to increase access to cervical screening, and migrant Muslim women in the UK are particularly at risk of screening non-attendance. In anticipation of the introduction of high-risk human papillomavirus (hrHPV) self-sampling into the UK programme, this study explored views of migrant Muslim women in southwest London on understanding of cervical screening, barriers and motivators to engagement and acceptability of vaginal self-sampling.

Qualitative in-depth semi-structured individual interviews were carried out via MS Teams video call of 18 Muslim migrant women, with purposive and snowball recruitment. Framework analysis was carried out using NVivo 14 and coding matrix developed using MS Excel.

Migrant Muslim women felt that self-sampling for hrHPV was likely acceptable and beneficial for some women in their community. Only 44% preferred self-sampling over healthcare worker (HCW)–taken samples because of concerns over technique and inadequate results. There was a lack of understanding of the screening programme, role of HPV and cultural taboo of sexual activity outside of marriage. These barriers may be mitigated by evidence-based information in their own language by a trusted HCW or community champion. Taking their own respiratory swabs during the COVID-19 pandemic made participants more open-minded to self-sampling.

Low vaginal self-sampling is acceptable to migrant Muslim women; however, over half may still prefer HCW-taken samples. Key strategies for overcoming barriers to self-sampling are prioritising linguistically appropriate materials, partnership with community leaders, flexible access points to screening and confidential modes of result delivery.