Barriers and Facilitators of Utilising Cervical Cancer Screening in the Papua New Guinea: A Narrative Review
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Background: Melanesian countries in the Pacific have the highest incidence of cervical cancer worldwide. In Papua New Guinea (PNG), 1,500 cervical cancer deaths of women are reported each year, and the country has the highest estimated cervical cancer burden in the Pacific. Although primary and secondary cervical cancer screening (CCS) methods are available, women’s participation remains low. Aim: This narrative review aims to identify barriers and facilitators of women’s utilisation of CCS in PNG and the wider Pacific. Method: A narrative review of the literature from the Pacific was conducted, and data was synthesised from qualitative, quantitative, and mixed method studies. Five data bases were electronically searched for articles published between 1990 and 2020. Given the paucity of literature in PNG and the Pacific pertaining the topic, the review included bibliographies of grey materials and key journal articles. Twenty-three journal articles and government reports that focused on barriers and facilitators of CCS uptake were included in the review. Results: The literature identified multifaceted barriers and facilitators of CCS uptake by women in PNG and the wider Pacific. Factors that were barriers to CCS uptake included: (i) lack of awareness and understanding; (ii) cultural-religious taboos and practices; (iii) Concerns about indirect costs of CCS uptake and poor socio-economic status; (iv) suboptimal healthcare delivery; and (v) geographical impediments limiting access to CCS services. Facilitators of CCS were multifaceted and interrelated, including: (i) culturally centred interventions for CCS; (ii) affordability of and accessibility to CCS services; and (iii) health insurance protection. Culturally centred approaches coupled with affordable and accessible cervical screening methods were found to have the potential to enhance cervical screening uptake. Conclusion: While cervical screening is the initial step in detecting human papillomavirus (HPV) in women, the findings in this review highlight the urgent need to address factors beyond individual knowledge and attitude influencing Pacific women’s CCS behaviour. Future studies should assess the actual availability, accessibility, affordability, and acceptability of CCS methods through a wider understanding of contextual factors. This study is relevant to policy makers, international development partners and non-government organisations in guiding them in working collaboratively to address the barriers while also understanding the contextual influences on CCS uptake by Pacific women.