The acceptability of, and informational needs related to, self-collection cervical screening among women of Indian descent living in Victoria, Australia: A qualitative study.

BACKGROUND: In July 2022, self-collection became universally available as part of Australia's National Cervical Screening Program. This change aims to address screening inequities experienced among underscreened populations, including women of Indian descent. This study explored experiences of cervical screening, alongside the acceptability of self-collection, among women of Indian descent living in Victoria, Australia. We also aimed to articulate the informational needs to promote self-collection among this population. METHODS: Five focus group discussions with 39 women living in Victoria were conducted in English (n = 3) and Punjabi (n = 2). Transcripts were thematically analysed, as informed by the Theoretical Framework of Acceptability. RESULTS: Women were motivated by the choice to self-collect, perceiving the ability to maintain modesty and greater autonomy as key enablers. Healthcare practitioners were seen as central in supporting patient-centred models of care. Perceived barriers to self-collection included concerns around its accuracy and women's confidence in collecting their own sample. Widespread dissemination of culturally tailored promotion strategies communicating concepts such as 'privacy' and 'accuracy' were suggested by women to promote self-collection. CONCLUSION: Self-collection was highly acceptable among women of Indian descent, particularly when assured of its accuracy, and sociocultural norms and previous screening experiences are considered. This study highlights the huge potential that self-collection can play in increasing equity in Australia's cervical screening programme. PATIENT OR PUBLIC CONTRIBUTION: Members of the public were involved in focus group discussions. Findings were summarised and disseminated via a poster. A bicultural worker was involved in all stages of the research.

Stakeholder perspectives of immunisation delivery for adolescents with disability in specialist schools in Victoria, Australia: 'we need a vaccination pathway'.

BACKGROUND: Adolescents with disability have lower vaccination rates than the general population, including HPV vaccination. Understanding the multi-level influences on vaccination in specialist schools is crucial to achieve optimal vaccination coverage and vaccination experiences for adolescents living with disability. OBJECTIVE: To identify and improve understanding of the facilitators and barriers of HPV vaccination among adolescents with intellectual disabilities or autism in Victorian specialist schools to inform strategies to increase vaccination acceptance and uptake. METHODS: Qualitative interviews with key stakeholders (adolescents with disabilities, parents, school and council immunisation staff) from six specialist schools in Victoria, Australia. Data were analysed thematically. Inductively derived themes were then deductively mapped across the UNICEF 'Journey to Immunization' model. RESULTS: 32 interviews were conducted with stakeholders (2 adolescents, 7 parents, 13 school staff, 10 council staff). Trust in vaccines was high, but knowledge of the HPV vaccine was limited. Barriers included lack of accessible information for parents, the consent process, behavioural challenges and vaccine-related anxiety among students. The immunisation program in special schools was perceived as convenient, however preparing students for vaccination day and catering to individual student needs were key. Participants expressed a need for more parent information about options and additional support for vaccination outside of the school program. CONCLUSIONS: Our study identified a range of facilitators and barriers to the school immunisation program for students with disabilities in specialist schools. The next phase of this work will use co-design workshops to build on the suggestions for improvement and opportunities that could be leveraged to improve vaccination uptake.

Barriers and enablers to participation in the National Cervical Screening Program experienced by young women and people with a cervix aged between 25 and 35.

ISSUE ADDRESSED: Cervical screening rates for young women aged between 25 and 35 are lower than older Australian women, however, little research has been conducted to understand why. This study aimed to identify and explore the barriers and enablers faced by young Victorians with a cervix to regular cervical screening. METHODS: This study used a mixed method exploratory design consisting of qualitative focus groups and a quantitative online survey. Four focus groups were conducted with 24 Victorians with a cervix aged between 25 and 35. Barriers, enablers and knowledge of cervical screening were explored. Focus groups were recorded and transcribed for thematic analysis of common themes. A supporting online survey was completed by 98 respondents. Summary statistics were analysed for differences in age. RESULTS: Focus groups and the online survey revealed four main factors that influence young people's cervical screening behaviour. These include past negative screening experiences, practitioner factors, priority placed on cervical screening, and cervical screening knowledge. These factors differ to the opinions of people older than 35, with young people focusing more on the psychological elements of cervical screening compared with practical factors. CONCLUSIONS: This research provides a unique insight into cervical screening barriers faced by women and people with a cervix aged between 25 and 35 as well as what factors motivate them to screen. SO WHAT?: These findings should be utilised to inform the design of public health campaign messaging targeting this age demographic. Findings can also assist practitioners to improve how they communicate with young people in a clinical setting.

Cervical screening among LGBTQ people: how affirming services may aid in achieving cervical cancer elimination targets.

To reach cervical cancer elimination targets it is necessary to increase screening rates among underserved populations such as LGBTQ communities. This paper examines rates of attendance and associated factors of cervical screening in LGBTQ communities. Data from 2,424 people aged 25 to 74 years and assigned female at birth were drawn from an online national Australian survey of LGBTQ adults. Over half of the sample had accessed cervical screening in the past 2 years. Using a multivariable logistic regression analysis, significant associations were found between screening, sociodemographic traits and health-care access. Trans men were least likely to access cervical screening, while bisexual, pansexual and queer identified participants were most likely to access screening. People who lived outside inner-suburban areas and those who had a disability were less likely to have had screening. Evidence of trusting relationships with a general practitioner (having a regular GP and GP's knowledge of the individual's LGBTQ identity) increased the likelihood that participants had screened, as did recent access to a medical service that was LGBTQ-inclusive or catered specifically to LGBTQ communities. The findings suggest the importance of training health providers, as well as targeted public health messaging for increasing uptake of cervical screening among LGBTQ people.

Engaging lower screening groups: a field experiment to evaluate the impact of a multiwave national campaign on participation in the National Bowel Cancer Screening Program.

OBJECTIVES: This field study evaluated a multiwave media campaign that aired in 2019 to promote participation in the Australian National Bowel Cancer Screening Program (NBCSP), which provides free biennial mailed-out immunochemical faecal occult blood test (iFOBT) kits to Australians aged 50-74 years. DESIGN: Adjusted negative binomial regression models determined rate ratios of iFOBT kits returned during and following three campaign waves compared with 2018 (baseline). Interaction terms determined whether effects differed by gender×age group, socioeconomic status (SES) and previous participation. SETTING: Australia. PARTICIPANTS: All Australians eligible for the NBCSP (men and women aged 50-74 years) who returned an iFOBT kit between 1 January 2018 and 30 October 2019. INTERVENTIONS: A multiwave national integrated media campaign to promote participation in the NBCSP. MAIN OUTCOME MEASURES: iFOBT kit return rate and number of iFOBT kits returned during and immediately following campaign activity overall and within historically lower screening groups (men, 50-59 years old; lower SES; never participants). RESULTS: The rate of iFOBT kits returned increased significantly during all three campaign waves, with evidence of carry-over effects of the second wave coinciding with a general practitioner mail-out strategy (all p<0.001). At each wave, effects were observed among men and women in the younger (50-59 years old) age group, but were less consistent for the older age group. Each SES group and both never and previous participants had increased return rates at each wave, but increases were stronger among mid-higher SES and those who had never participated. An estimated 93 075 extra iFOBT kits were returned due to the campaign. CONCLUSIONS: The campaign increased participation, especially among those who were younger and never previously screened-key groups to recruit given reparticipation rates of over 80%. Ongoing investment in national integrated media campaigns of sufficient duration and intensity can increase bowel cancer screening and ultimately save lives.