Table 2.
Overview of studies reporting barriers and facilitators within micro, meso and macro level framework.
| No. | Reference—author(s) (year) [Country] underserved population | Barriers | Facilitators | ||||
|---|---|---|---|---|---|---|---|
| Macro | Meso | Micro | Macro | Meso | Micro | ||
| 1 | Gele et al. (2017) (23) [Norway] Immigrant groups—Pakistani and Somali women |
Lack of trust in health system; Inadequate access to primary care services of quality | Long waiting times; Lack of translated information provision in appropriate format; Lack of access to female clinicians | Limited cancer/screening awareness; Concern about stigma (sexual activity and FGM) Limited belief in the principle of prevention; Competing time and economic pressures |
Improved dissemination of information; Improved access to female doctors; Institution of a recall system | ||
| 2 | Azerkan et al. (2015) (24) [Sweden] Immigrant groups—Danish and Norwegian women |
Lack of trust in health system | Complex care pathway; Impersonal correspondence; Previous negative experiences of care | Limited cancer/screening awareness; Previous trauma; Migration-related routine disruption; Limited belief in principle of prevention and state intervention | |||
| 3 | Darwin and Campbell (2009) (25) [UK] Sexual minority women |
Lack of inclusivity in campaign material | Concern about sigma due to sexual identity | Improved awareness training for staff | |||
| 4 | Marlow et al. (2015) (26) [UK] Ethnic minority groups |
Lack of suitable appointments | Limited cancer/screening awareness; Fear of results; Limited belief in the principle of prevention; Embarrassment |
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| 5 | Marques et al. (2021) (27) [Portugal] Migrant groups |
Barriers registering for care services; Incorrect information held by registries | Lack of (translated) information; Complex care pathway; Lack of access to female / representative staff | Limited cancer/screening awareness; imited belief in the principle of prevention; Lack of health autonomy; Concern about stigma (FGM) | Continuity of care; Access to translation services | Access to self-sampling; Availability of time during appointments | |
| 6 | Edelman et al. (2013) (28) [UK] Women who self-identified as having a substance use problem and actively used in the past month |
Concern about stigma (hygiene, drug use, sexual history) and triggering trauma; Fear of results; Competing time pressure (related to substance dependency); Low self-regard; Low engagement with principle of screening; | Option for family co-attendance | ||||
| 7 | Salad et al. (2015) (29) [Netherlands] Ethnic minority group—Somali women |
Lack of (translated) information; Lack of access to female staff | Limited cancer/screening awareness; Concern about stigma (FGM) | ||||
| 8 | Badre-Esfahani et al. (2021) (30) [Denmark] Ethnic minority groups – women from Middle Eastern and North African countries and Pakistan |
Negative care experiences; Limited health system trust; Perception of hostility and structural racism |
Limited access to female staff | Limited cancer/screening awareness; Embarrassment’ Concern about stigma (FGM); Limited belief in the principle of prevention; Fear of results; Competing time pressures |
Provide targeted information and reminders; Increase routes of access to screening | ||
| 9 | Tatari et al. (2020) (31) [Denmark] Ethnic minority and immigrant groups – women from Turkey, Iraq, Somalia, Lebanon, Syria, Saudi Arabia, Uzbekistan, Morocco, Pakistan, and Vietnam |
Long waiting times; Mistrust of doctors | Lack of translated information | Limited cancer/screening awareness; Limited belief in the principle of prevention; Fear of results, stigma (FGM), pain and embarrassment. | |||
| 10 | Akhagba (2017) (32) [Poland] Ethnicity minority /migrant group – Egyptian, Kenyan, Nigerian and Eritrean women |
Long waiting times; Care costs | Lack of translated information; Lack of access to female staff | Limited cancer/screening awareness; Embarrassment; Lack of social network prompts | Increased social network support | ||
| 11 | Ekechi et al. (2014) (33) [UK] Ethnic minority groups – Black women predominantly from African or Caribbean backgrounds |
Complex pathway | Limited cancer/screening awareness; Competing time pressures; Fear of screening test and results; Embarrassment | Improved education | |||
| 12 | Condon et al. (2021) (34) [UK] Ethnic minority groups -Participants self-identified as Roma (from Slovakia and Romania) or as Gypsies, Travelers or Show people (described as Gypsy/Travelers) |
Inaccessible language and lack of translated information; Complex pathways | Fear of results; Embarrassment | ||||
| 13 | Todorova et al. (2009) (35) [Bulgaria and Romania] representative sample of women from Bulgaria and Romania including ethnic minorities and immigrant women from Turkey and Hungary. |
Long waiting times; Costs of care | Lack of reminders / prompts | Limited cancer/screening awareness: Lack of social network prompts; Competing time pressures | |||
| 14 | Grandahl et al. (2012) (36) [Sweden] immigrant groups from Middle East, Africa, Asia, and East Europe |
Lack of translated information; Lack of access to female staff | Deprioritisation of own health; Concern about stigma (sexual practices) and sampling process; Embarrassment; Lack of social network prompts | Increased healthcare accessibility; Improved experiences of healthcare | |||
| 15 | Nelson et al. (2021) (37) [UK] Ethnic minority groups – South Asian, East European, Chinese, Black African and Caribbean women |
Experiences of racism and discrimination; Incorrect patient contact data | Lack of translated information; Lack of access to female staff; | Limited cancer/screening awareness; Competing time pressures (work and care); Fear of pain; Concern about stigma (FGM); Embarrassment; Lack of social network prompts | Flexibility of appointments; Provision of prompts/ reminders | Increased prompts through social networks | |
| 16 | Hamdiui et al. (2020) (38) [Netherlands] Migrant groups – Turkish and Moroccan women |
Lack of (translated) information about screening and services; Lack of access to female staff | Limited cancer/screening awareness; Low engagement with principle of screening; Embarrassment; Limited social-network prompts; Fear of test, results and stigma (sexual activity); Competing pressures (work and care) | Reduced appointment length; Provision of information leaflets and reminders | Improved awareness of screening and cervical cancer; Improved social network support around screening | ||
| 17 | Andreassen et al. (2017) (39) [Romania] Ethnic minority group – Roma women |
Costs of care; Perception of hostility and structural racism; Long waiting times | Lack of invitation from medical staff | Limited cancer/screening awareness; Unclear options for follow-up; Low engagement with principle of screening; | Increasing awareness of cervical cancer and screening | ||
| 18 | Goutard et al. (2009) (40) [France] Women with physical disabilities |
Physical access barriers to care settings | Screening enabled in multi-disciplinary settings | ||||
| 19 | Abdullahi et al. (2009) (41) [UK] Migrant groups – Somali women |
Lack of translated information; Lack of access to female staff and convenient appointment times | Limited cancer/screening awareness; Embarrassment; Competing time pressures (care); Concern about stigma (FGM); Low engagement with principle of screening; Fear of screening test | Cultural sensitivity training for staff; Provision of prompts and translated information; Option for community co-attendance | |||
| 20 | Jackowska et al. (2012) (42) [UK] Central and Eastern migrant groups – Polish, Slovak, and Romanian women |
Health system distrust | Lack of translated information | Limited cancer/screening awareness; Migration-related time pressures/ routine disruption | Free access to care | Convenient appointment options with prompts / reminders; | |
| 21 | Møen et al. (2019) (43) [Norway] Immigrant groups |
Complex care pathway; Lack of translated and culturally sensitive information provision; Lack of access to female staff | Limited cancer/screening awareness | Improved access to female staff | |||
| 22 | Thomas et al. (2005) (44) [UK] Ethnic minority groups – African, Caribbean, Gujarati, Pakistani, Greek, and Arabic women |
Adverse prior care experiences; Long waiting times; Health system distrust; Perception of hostility and structural racism | Lack of translated information and invitations to screening; Lack of cultural competence among staff | Limited cancer/screening awareness; Concerns about stigma | Provision of community education and mobile clinics; Improving access to female staff; Improved cultural awareness and access to translation services | ||
| 23 | Cadman et al. (2012) (45) [UK] Women who have experienced sexual abuse |
Lack of access to female staff; Limited trauma competence among staff | Challenges trusting healthcare staff; Concern about pain and emotional trauma; | Continuity of care and option for chaperone; Enabling autonomy over sample collection | |||
| 24 | Marlow et al. (2015) (46) [UK] Older women (aged 50–65 years) from ethnic minority and lower socioeconomic groups |
Challenge booking suitable appointment times | Limited cancer/screening awareness; Low engagement with principle of screening; Embarrassment | ||||
| 25 | Marlow et al. (2019) (47) [UK] Ethnic minority groups – women from Indian, Pakistani, Bangladeshi, Caribbean, African, Black British, Black Other, and White Other backgrounds |
Unsuitable appointment times; Lack of invitations and reminders; Negative previous care experiences | Limited cancer/screening awareness; Low engagement with principle of screening; Lack of social network prompts; Fear of screening environment and process (hygiene, pain, issues related to FGM, and perceived risk of contracting cancer); Embarrassment; Competing time pressures | ||||
| 26 | Idehen et al. (2020) (48) [Finland] Migrant group - African women |
Perception of hostility and structural racism | Negative previous experiences of screening; Lack of translated information | Limited cancer/screening awareness | Free access to care | Increased routes to access screening; Cultural competence among staff and in screening promotion; Provision of translated information/ reminder letters | |
| 27 | Patel et al. (2020) (49) [UK] Migrant group—Eastern European women |
Health system distrust; Limited access to primary care services | Lack of translated information | Limited cancer/screening awareness | Improved awareness of cervical cancer | ||
| 28 | Berner et al. (2021) (50) [UK] Transgender men and non-binary people |
Experience of stigma based on gender status | Lack of inclusive and targeted information | Concern about stigma (gender status), gender dysphoria, identity disclosure and procedural pain; Embarrassment; Competing time pressures | Access to specialist trans services; Provision of inclusive and targeted information; Access to self-sampling; Delivery of a call-recall system | ||
| 29 | Andreassen et al. (2018) (51) [Romania] Ethnic minority group – Roma women |
Costs of care | Distance to services | Limited cancer/screening awareness; Fear of results; Competing time pressures | |||
| 30 | Conway et al. (2014) (52) [UK] Ethnic minority / migrant group—Chinese women |
Health system distrust; Low levels of care registration | Lack of invitation to screening | Limited cancer/screening awareness | |||
| 31 | Anderson et al. (2013) (53) [Estonia] Migrant women, those not speaking native language (Estonian) and women with low income. |
Limited cancer/screening awareness | |||||
| 32 | Forrest et al. (2004) (54) [UK] Ethnic minority / Migrant groups—Indian, Pakistani, African-Caribbean and white British |
Provision of Self-testing option | |||||
| 33 | Catarino et al. (2016) (55) [Switzerland]* Women from migrant communities as well as women who were unemployed, and uninsured. |
Cost barriers | Limited cancer/screening awareness; Time barriers (work); Fear of test process, results and clinic attendance; | ||||