Table 3.
Details of included studies
| References; Country | Study design; graded Risk of Bias | Sample size; population details | Average age (SD) | Type of screening | Barriers | Facilitators |
|---|---|---|---|---|---|---|
| Abotchie and Shokar [20]; Ghana | Cross-sectional survey; medium risk | 157 university students | NR (age range 20–35, most between 21 and 25) | Pap smear | Low knowledge, low awareness, concern regarding partner disapproval, cost, time constraints, embarrassment, perceived not susceptible, fear of virginity loss | Knowledge of benefits of screening, perception of severity of disease |
| Agboeze et al. [21]; Nigeria (Abstract only) | Cross-sectional survey; medium risk | 234 female students | 22 (SD 3) | Pap smear | Low awareness, low accessibility, fear of cancer diagnosis | NR |
| Akujobi et al. [22]; Nigeria (Abstract only) | Cross-sectional survey; medium risk | 220 third and fourth year female science students | 23.8 (SD NR) | Pap smear | Lack of knowledge, lack of awareness about importance of screening, lack of awareness about where services are attainable | NR |
| Al-Naggar et al. [23]; Malaysia | Cross-sectional survey; medium risk | 287 female university students | 20.9 (SD 1.89) | Pap smear | Fear of intimate nature of examination, HCP did not recommend/educate, lack of awareness of screening sites, cost, fear of virginity loss, embarrassment, fear of pain and discomfort | NR |
| Al-Shaikh et al. [24]; Saudi Arabia | Cross-sectional survey; medium risk | 1400 students studying health fields | 20.4 (SD 1.3) | Pap smear | Lack of awareness, perception of low sensitivity of test, misconception of serious complications of test | NR |
| Albuquerque et al. [25]; Brazil | Cross-sectional survey; medium risk | 493 women,, young women (< 20) n = 64 | 35.4 (SD NR) | Pap smear | Low knowledge and awareness | NR |
| Alwahaibi et al. [26]; Oman | Cross-sectional survey; medium risk | 494: 204 patients, 133 staff, 157 students | NR (students all age 20–30) | Pap smear | Low knowledge, lack of awareness, physician gender, uncertainty of reliability of Pap smears | Belief of test allowing successful prevention and treatment for cancer |
| Annan et al. [27]; Ghana | Cross-sectional survey; medium risk | 200 female university students | 20.4 (SD 1.96) | Unspecified | NR | Cervical cancer knowledge, perceived susceptibility, perceived deadliness, perceived benefits of screening |
| Ayinde et al. [28]; Nigeria | Cross-sectional survey; medium risk | 421 undergraduate students | 23.6 (SD 3.6) | Pap smear | Lack of awareness | Increased knowledge and awareness |
| Bigaard et al. [29]; Denmark (Abstract only) | Qualitative focus groups (cross-sectional); medium risk | Sample size not reported in abstract; HPV vaccinated women | NR (age range 23–29) | Pap smear | Lack of knowledge, perceived not susceptible (test not relevant to them) | NR |
| Binka et al. [30]; Ghana | Cross-sectional survey; medium risk | 410 female students | NR (83% < 29 years; 17% > 30) | Unspecified | Lack of awareness | NR |
| Black et al. [31]; Canada | Cross-sectional focus groups; medium risk | 80 women | NR (98% between age 20 and 29) | Pap smear | Discontinuity of care from HCP after moving away for work/school, difficulty finding female HCP, fear of discomfort and invasiveness of test, lack of awareness, lack of time | Reminders, email from HCP, linking testing to renewal appointment for oral contraceptives, assistance with finding HCP, longitudinal relationship with HCP or clinic, education, testing by female HCP, increased convenience (e.g. clinic on campus) |
| Blomberg et al. [32]; Sweden | Cross-sectional focus groups; medium risk | 138 women from Stockholm cervical cancer screening registry | 30 (SD 0) | Pap smear | Fear of pain and discomfort | Letter of invitation, flexibility in timing and location, choice of HCP, having test done with other exams, social marketing on importance of screening, cost-free testing |
| Blomberg et al. [33]; Sweden | Cross-sectional focus groups; medium risk | 38 women from Cervical Cancer Screening administrative registry | 30 (SD 0) | Pap smear | Lack of knowledge, lack of awareness, perceived not susceptible | Existing relationship with clinic |
| Byrd et al. [34]; United States | Cross-sectional survey; medium risk | 200 women | 21 (SD NR) | Pap smear | Embarrassment, pain, embarrassment, fear of virginity loss, lack of awareness of where to be tested, fear of partner disapproval, misconception (only women who have had babies) need to be tested, fear of testing perceived as sexual activity | NR |
| Duffet-Leger et al. [35]; Canada | Cross-sectional survey; medium risk | 1041 university students | 20.7 (SD 1.77) | Pap smear | NR | Beliefs/behaviours of friends and family, sense of empowerment about getting Pap test |
| Head and Cohen [36]; United States | Cross-sectional individual and group interviews; medium risk | 19 women | NR (median age of 20) | Pap smear | Negative past experiences, limited choice in HCP, fear of parental disapproval, cost, low accessibility, lack of privacy in small community (e.g. running into someone they know at the clinic) | Encouragement/support from mother |
| Hobbs [37]; United States (Abstract only) | Qualitative focus groups; medium risk | 15 sexually active adolescents | 18.7 (SD NR) | Pap smear | Lack of knowledge, fear of pain, embarrassment, fear of result, fear of unknown, perceived invincibility, HCP characteristics, fear of parents finding out, cost, lack of time, transportation | Education, trusting relationship with HCP, HCPs able to communicate well and put patients at ease, assured confidentiality, school programs, shorter wait times, telephone/email reminders, provision of babysitting or transportation, expanded clinic hours, having someone answer the phone when patients book appointments |
| Hoque [38], South Africa | Questionnaire; medium risk | 169 full-time undergraduate students | 20.81 (SD 1.7) | Pap smear | Low knowledge, fear of procedure, not currently experiencing symptoms | NR |
| Hoque [39], South Africa (Abstract only) | Questionnaire; medium risk | 440 university students | 20.39 (SD 1.71) | Pap smear | Low knowledge | High self-efficacy |
| Jayasinghe [40], Australia | Online survey; medium risk | 149 women | 23.2 (SD 2.1) | HPV DNA testing | Repetitive screening frequency | Public perceptions, national guidelines, gynecologist beliefs |
| Jubelirer [41]; United States | Questionnaire; medium risk | 279 tenth-grade girls | 15.3 (SD NR) | Pap smear | Embarrassment, pain, fear of cancer, confidentiality, cost | NR |
| Kahn [42], United States | Semi-structured interview; medium risk | 15 adolescents | 18.7 (SD 1.9) | Pap smear | Pain, embarrassment, fear of cancer, denial, poor HCP relationship, low knowledge, misinformation | Education, better HCP relationships, telephone and written reminders |
| Kahn [28], United States | Questionnaire; medium risk | 490 adolescents and young girls at pap smear follow-up clinics | 18.2 (SD NR) | Pap smear | Pain, inconsistent HCP, embarrassment, lack of HFP communication, lack of time, lack of transportation | Reminders, perceived control, perceived susceptibility |
| Kaneko [43], Japan | Online survey; medium risk | 700 unmarried women | 26.0 (SD NR) | Pap smear | Male physician | Free coupon for screening, perceived susceptibility |
| Kim [44], Korea (Abstract only) | Questionnaire; medium risk | 303 unmarried female university students | 22.4 (SD 2.0) | Pap smear | Low knowledge/awareness | NR |
| Kim [45], Korea (Abstract only) | Online questionnaire; medium risk | 124 unmarried university students | NR | Pap smear | Unsure of effectiveness, low awareness | Subjective norm |
| Langille [46], Canada | Questionnaire; medium risk | 1090 high school adolescents | 16.6 (SD 0.1) | Pap smear | Lack of discussion with HCP, no physician, rural area | Education from HCP |
| Lee [47], United States | Focus group; medium risk | 16 young Korean immigrant women | 26 (SD NR) | Pap smear | Low knowledge, culture-specific barriers, low accessibility to healthcare, embarrassment, fear of virginity loss, stigma around visiting gynecologist clinic, language barriers, low health literacy | NR |
| Lorenzi [39],Brazil | Survey; medium risk | 33 women with abnormal pap smears | NR (aged < 29) | Self-sampling | Embarrassment, pain | Easy to use, easy to understand, practicality |
| Najem [48], United States | Survey; medium risk | 3343 inner city high school girls | NR (aged 13 and up) | Pap smear | HCP did not recommend, lack of awareness, cost, unaware of location, perceived not susceptible, time constraints, believed test was not accurate, embarrassment, time constraint | Family role models |
| Ogbonna [49], United Kingdom | Survey; medium risk | 186 UK university students from Sub-Saharan Africa | NR (majority between age 18 and 24) | Pap smear | Low knowledge, misconceptions (such as around circumcision), cultural barriers, stigma | Perception of deadliness |
| Okoeki [50], United Kingdom | Semi-structured interviews, focus group; medium risk | 24 young women | NR (age range 25–34) | Pap smear | Low awareness, embarassment, anxiety, association with sex, intimate, cultural barriers, fear of cancer, invasiveness | Education on sensitivity, education, alternative screening methods (self-sampling) |
| Oshima [51], Japan | Focus group; medium risk | 15 university students | NR (age 20–22) | Pap smear | Lack of knowledge,misconceptions, lack of motivation, reluctance to visit gynecologist (embarrassment, stigma, invasiveness) | Media information, norms of family and friends, diagnosis within their family, education |
| Pan [52], China | Survey; medium risk | 1878 medical students | 20.8 (SD 1.3) | Unspecified | Side effects, inadequate information, low knowledge, stigma around premarital sex | High knowledge |
| Waller [53], United Kingdom | Interview, focus group; medium risk | 27 young women | NR (age range between 25 and 34 for young women) | Unspecified | Lack of access to HCP (mobility, lack of consistency), fewer reminders, time constraints, lack of peer pressure, low perceived low perceptibility, menstrual cycle timing, low knowledge, pain, uncomfortable comments, apathy | Awareness, media coverage |