Table 2. Authors’ recommendations for health professionals and Primary Health Care Clinics based on screened Indigenous women’s views and experiences of cervical screening.

Theme	Recommendation a
Enhancing strength and control	• Frame discussions about cervical screening and general health in terms of how women can take control of their health. • Emphasise benefits of cervical screening for the women personally, but also for family and community, through living long and healthy lives • Avoid placing too much pressure on women to screen opportunistically • Emphasise the short duration of cervical screening as a positive feature • Emphasise that cervical screening is part of a holistic women’s health routine • Move conversations beyond that screening is necessary; explain why screening is beneficial. • Discuss HPV self-collection with eligible women as a means to enhance control over health
Overcoming fears, shame, and negative experiences.	• Acknowledge emotional obstacles to screening, including shame, discomfort and feelings of invasiveness • Ensure results are rapidly and clearly communicated back to women to avoid anxiety • Maternal health checks are a good opportunity to discuss screening with women, as they feel less shame about women’s health checks after the experience of pregnancy and childbirth • Acknowledge that a woman’s first experience of cervical screening can shape her attitudes to cervical screening in the future. Ensuring that the first screen is a positive experience may support women to continue screening into the future.
Talking more openly about screening	• Consider women’s differing information needs. Check with women to ensure the amount of information provided is enough to make them feel comfortable screening • Provide women with a variety of information channels including both “active” (e.g., discussion with health professional) and “passive” (e.g., brochure in waiting room) options • Use social media, where appropriate in the community and using appropriate language, to promote women’s health awareness and events in the clinic • Facilitate women’s group meetings at the PHCC to encourage women to talk with health professionals and with other women about screening and other health matters in approachable and comfortable setting • Encourage women to share knowledge gained with other women; community champions may be helpful • Explain changes to the cervical screening program, emphasising changes to terminology, longer screening intervals, and increased sensitivity of the test, as women responded positively to these aspects
Enhancing screening providers’ relationships with Indigenous women	• Ensure that all staff practice culturally safe health care delivery • Recognise the importance of building long-term, trusting relationships with women • Employ Aboriginal and Torres Strait Islander staff • Ensure there are female health professionals available to conduct cervical screening; confirm women’s preference for who conducts screening. • Recognise that cervical screening is generally viewed as Women’s Business; this means that women may not wish to discuss cervical screening with male professionals or see cervical screening information displayed in shared men’s and women’s spaces in the clinic • Ensure appropriate measures to assure women of their privacy and confidentiality when screening are put in place (e.g., separate women’s clinic or private and discrete clinical rooms) • Explain cervical screening and its benefits in a gentle and empathetic manner, using clear and simple language. Avoid medical jargon. • Acknowledge the importance of health professionals’ trusting and long-lasting relationships as a key factor in helping women to participate in screening
Overcoming logistical barriers to screening	• Implement flexible appointment scheduling in the clinic, such as extended business hours so that women may attend before or after work • Ensure there are a variety of staff available (such as nurses) to conduct screening to avoid longer waiting times for doctors • Connect women with transport options to attend the clinic • Provide space and time for women to physically prepare to cervical screening, such as the option to shower or freshen up • Warm the speculum before conducting screening • Ensure examination tables and clinical spaces meet women’s physical needs, including women of different body sizes and with disability.
Supporting women employed in PHCCs to screen	• Support female staff to attend health appointments, including cervical screening, with flexible working options • Ensure female staff’s right to privacy and confidentiality are respected in the clinic • Provide opportunities for female staff to complete cervical screening during work hours • Conduct a staff screening day. Organise for a health professional external to the PHCC to conduct the screening to enhance female staff member’s sense of privacy and anonymity.

^a Recommendations were developed by the authors based on the outcomes of the qualitative analysis and were not validated by participants.