Engaging Canadian First Nations Women in Cervical Screening through Education

Cancer Screening Services: What Do Indigenous Communities Want? A Systematic Review

PURPOSE

Indigenous communities experience worse cancer outcomes compared with the general population partly because of lower cancer screening access. One-size-fits-all screening programs are unsuitable for reaching Indigenous communities. In this review, we summarize available evidence on the perspectives of these communities; with a view to informing the improvement of cancer screening services to achieve equitable access.

METHODS

We undertook a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the databases MEDLINE, Scopus, PubMed, and Google Scholar. The search terms used were "Indigenous community or Indigenous communities," "cancer screening," and "facilitators, enablers, desires, or needs." Qualitative studies published up to the August 30, 2022 investigating the perspectives of Indigenous communities on factors encouraging screening participation were included in the study. The included studies were reviewed and analyzed inductively by two independent reviewers, and key themes regarding indigenous access to cancer screening were then extracted.

RESULTS

A total of 204 unique articles were identified from the search. The title and abstracts of these studies were screened, and 164 were excluded on the basis of the exclusion and inclusion criteria. The full texts of the remaining 40 studies were examined and 18 were included in the review. Four key themes were identified pertaining to culturally tailored education and information dissemination, community involvement, positive relationships with health care providers, and individual empowerment and autonomy.

CONCLUSION

Improvements, on the basis of the key themes identified from this review, must be made at all levels of the health care system to achieve equitable screening participation in Indigenous communities. However, we recommend an investigation into the perspectives of the local Indigenous communities before the initiation of cancer screening programs.

Indigenous women's experiences of cervical cancer screening: Incorporating Indigenous ways of knowing into a systematic review and meta-synthesis of qualitative research

Due to historical and contextual factors, cervical cancer is typically detected at a later stage in Indigenous women, and so has higher morbidity and mortality. Increasing participation in cervical cancer screening (CCS) could ameliorate this health inequity by detecting cancer when it is more easily treatable. To understand the perspectives, preferences, and experiences of Indigenous women related to participation in CCS, we conducted a systematic review and meta-synthesis of nine qualitative research studies. To advance decolonised qualitative evidence synthesis approaches, we use a modified version of the Two Row Wampum-Covenant Chain Tradition, a Haudenosaunee two-eyed seeing analytic approach that integrates Western approaches with Indigenous worldviews. Using the metaphor of a network of forest plants, we illustrate the systemic and topical barriers and facilitators to CCS, as reported by Indigenous women. We use this metaphor to reiterate the importance of all levels of change to improve CCS experiences for Indigenous women.

Integrating Indigenous healing practices within collaborative care models in primary healthcare in Canada: a rapid scoping review

OBJECTIVES

In November 2020, a series of reports, In Plain Sight, described widespread Indigenous-specific stereotyping, racism and discrimination limiting access to medical treatment and negatively impacting the health and wellness of Indigenous Peoples in British Columbia, Canada. To address the health inequalities experienced by Indigenous peoples, Indigenous healing practices must be integrated within the delivery of care. This rapid scoping review aimed to identify and synthesise strategies used to integrate Indigenous healing practices within collaborative care models available in community-based primary healthcare, delivered by regulated health professionals in Canada.

ELIGIBILITY CRITERIA

We included quantitative, qualitative and mixed-methods studies conducted in community-based primary healthcare practices that used strategies to integrate Indigenous healing practices within collaborative care models.

SOURCES OF EVIDENCE

We searched MEDLINE, Embase, Indigenous Studies Portal, Informit Indigenous Collection and Native Health Database for studies published from 2015 to 2021.

CHARTING METHODS

Our data extraction used three frameworks to categorise the findings. These frameworks defined elements of integrated healthcare (ie, functional, organisational, normative and professional), culturally appropriate primary healthcare and the extent of community engagement. We narratively summarised the included study characteristics.

RESULTS

We identified 2573 citations and included 31 in our review. Thirty-nine per cent of reported strategies used functional integration (n=12), 26% organisational (n=8), 19% normative (n=6) and 16% professional (n=5). Eighteen studies (58%) integrated all characteristics of culturally appropriate Indigenous healing practices into primary healthcare. Twenty-four studies (77%) involved Indigenous leadership or collaboration at each phase of the study and, seven (23%) included consultation only or the level of engagement was unclear.

CONCLUSIONS

We found that collaborative and Indigenous-led strategies were more likely to facilitate and implement the integration of Indigenous healing practices. Commonalities across strategies included community engagement, elder support or Indigenous ceremony or traditions. However, we did not evaluate the effectiveness of these strategies.

HPV vaccine: uptake and understanding among global Indigenous communities - a qualitative systematic review

BACKGROUND

Indigenous populations have a high prevalence of Human Papillomavirus (HPV) infection and a high incidence of HPV associated cancers, such as cervical and oropharyngeal cancer. There is an effective HPV vaccination program in almost all developed countries to prevent the incidence of cervical cancer, but reports suggest that the uptake of these vaccinations by Indigenous populations is low. The objective of this qualitative systematic review was to explore the knowledge and beliefs of global Indigenous populations regarding HPV vaccines. This review was performed to identify the barriers faced by Indigenous peoples and to provide evidence for more effective and acceptable execution of vaccination policies for Indigenous peoples.

METHODS

Two investigators independently searched MEDLINE, PubMed, SCOPUS, and Web of Science databases using a pre-specified search strategy to identify qualitative studies on narratives of Indigenous peoples regarding HPV vaccine awareness, knowledge and experiences across all geographic and income-level settings.

RESULTS

After performing the literature search and quality appraisals 5 papers were included in the final review. Three core synthesised findings were identified: reasons for acceptance or hesitancy, and areas for improvement. Lack of correct knowledge and mistrust in the healthcare system were important categories observed in all papers included in the review. Other categories within the conceptual model included prioritising disease prevention, health professional guidance, family support and supportive community environment.

CONCLUSION

Qualitative systematic reviews are an excellent means of exploring the gaps in current healthcare practices. Indigenous healthcare research should be grounded in community experiences and feedback. This review provides insights into HPV vaccination understanding and acceptance amongst Indigenous populations, from which recommendations for increasing resonance of vaccination strategies with Indigenous communities can be formed.

Highlighting strengths and resources that increase ownership of cervical cancer screening for Indigenous communities in Northern British Columbia: Community-driven approaches

Objective

To examine the unique and diverse strengths held by rural and remote Indigenous communities in northern British Columbia, including multi‐generational support systems in health and wellness, profound connections to the land, and strong cultural foundations, and harness these strengths, allowing communities to engage in innovative and empowering health and wellness programs.

Methods

Building on these pre‐existing and fundamental strengths, an alternative option to cervical cancer screening was introduced to nine Carrier Sekani health centers located in northern interior British Columbia in response to disparities in screening rates. Introduced in 2019, CervixCheck uses a self‐collection approach that is private, safe, convenient, and offered at local community health centers by trained and supportive health staff.

Results

Using a strengths‐based and community directed and descriptive approach, the process was outlined for a successful and ongoing health screening opportunity that is put into the hands of community members within Indigenous communities in the region of northern British Columbia.

Conclusion

Through collaborative partnerships, in‐person engagement sessions, and the utilization of pre‐existing infrastructure and health and wellness teams, this project was successfully integrated into primary care centers using culturally safe and community‐based approaches.

Building on inherent strengths within rural and remote Indigenous communities leads to successful development and implementation of cervical cancer screening alternatives.

A systematic review and meta-analysis of the prevalence of human papillomavirus infection in Indigenous populations - A Global Picture

BACKGROUND AND AIM

Recent trends have shown a decline in the rates of human papillomavirus (HPV)-associated cervical cancer in the vaccinated population but there has been a spike in the HPV-associated oropharyngeal, anal and penile cancers in the majority of the unvaccinated population which are young and middle-aged males. Indigenous populations at an international level carry a disproportionate burden of most diseases. The aim of this meta-analysis was to ascertain the worldwide prevalence of HPV infection in Indigenous populations stratified by sex and site and to document the most commonly reported HPV types.

METHODS

Published articles on HPV infection in Indigenous populations from PubMed, Scopus, EMBASE and Web of Science were systematically searched from inception until 23 December 2019.

RESULTS

A total of 41 studies were included in the final analysis. The pooled worldwide prevalence of HPV infection (for both oral and genital sites, both males and females) in Indigenous populations was 34.2% (95% CI: 28.9%-39.8%). Subgroup analysis (geographical) showed that the pooled prevalence for African Indigenous, American Indigenous and Asian-Oceanic Indigenous populations were 33.0% (95% CI: 12.8%-57.1%), 33.0% (95% CI: 27.4%-38.9%) and 33.3% (95% CI: 0.17.5%-51.3%), respectively.

CONCLUSION

There are not enough data on the burden of the infection carried by males especially with respect to highly suspicious sites like oropharynx. Also, we conclude an overall high prevalence of HPV infection in the Indigenous populations and increasing their susceptibility to benign and malignant manifestations of HPV.

Self-administered versus provider-directed sampling in the Anishinaabek Cervical Cancer Screening Study (ACCSS): a qualitative investigation with Canadian First Nations women

BACKGROUND

While (Pap)anicolaou screening has helped to decrease cervical cancer incidence in Canada, First Nations women continue to have a higher burden and mortality relative to mainstream populations. Many First Nations women may feel uncomfortable with the invasiveness of this test, contributing to this statistic. Implemented from 2009 to 2015 in 10 Northwest Ontario First Nations communities, the Anishinaabek Cervical Cancer Screening Study (ACCSS) uniquely addressed this Indigenous health inequity through a mixed methods approach.

OBJECTIVE

Our goal was to offer an alternative test which the women could do themselves: human papillomavirus (HPV) testing based on self-sampling. We investigated whether First Nations women preferred HPV self-sampling over healthcare provider (HCP)-administered Pap screening.

METHODS

Participatory action researchinformed by the ethical space concept has guided all stages of the ACCSS. We conducted qualitative interviews with 16 HCPs and 8 focus group discussions with 69 female community members followed by a cluster-randomised controlled trial (RCT). Here, we draw on the qualitative field data and an end-of-study community update gathering to disseminate and contextualise research findings. Informant data were evaluated using thematic analysis.

RESULTS

We discuss factors influencing participants' strong preference for HPV self-sampling over physician-conducted Pap screening. Key arguments included enhanced accessibility and more personal control, less physical and emotional discomfort and fewer concerns regarding privacy of test results. For future implementation of HPV self-sampling, study participants emphasised the need for more culturally sensitive education addressed to community members of all genders, starting at school, clarifying that HPV causes cervical cancer. Further, HPV infection should be de-stigmatised by accentuating that it affects men and women alike.

CONCLUSION

Here we show that self-sampling in conjunction with community engagement and culturally sensitive education and could be a viable option for underscreened Canadian First Nations women. These informant data echo our previous RCT results.