Table 2.

Health care provider's perspectives on factors influencing cervical cancer screening in Singapore.

Patient factors	Health care provider factors	Health system factors	Health promotion factors
Awareness, perception, belief, and motivation toward screening • Poor awareness of disease and screening • Disease perception • Beliefs and motivation to screen Preference and acceptance for screening • Preference for female HCPs in primary care • Preference for specialist care • Lower acceptance to screening in primary care due to mental fatigue from other comorbidities • Differing health priorities with increasing age • Higher acceptance to screening in tertiary care when seen for other gynecological conditions • Discomfort • Privacy • Embarrassment • Fear of results • Shyness Others • Low education level and health literacy • Social support • Lack of time for screening	Time and priority • Lack of time to discuss screening • Lower disease priority compared to other chronic diseases Practice of screening • Providers may not strictly follow national screening guidelines • Financial incentives available for GPs to conduct screening • GPs not offering screening • Inadequate counseling for patients • Female chaperone required for male HCPs • Heavy reliance on HCPs to initiate screening conversation, without the support of systematic reminders • Relationship with patients facilitates screening discussion Post-screening procedures • Manual process of tracing and disseminating test results • Administrative burden of subsidy claims among solo-practice GPs • Challenge in discharging patients from tertiary care to primary care for subsequent screening	National disease priority and organized screening program supported by legislation • Lower national priority for cervical cancer • Ununified health system with multiple information technology systems to obtain patient information • Lack of national call and recall system • Limited visibility of screening practices, coverage, and outcomes • Limited involvement of private laboratories to report screening results • Lack of legislation to mandate reporting of screening outcomes • Slow national implementation of new screening technologies Resource allocation in primary and tertiary care setting • High accessibility of screening services that are helmed at primary care level • Higher efficiency with nurse-led services in polyclinics • Limited availability of appointment slots for screening in polyclinics • Strict screening criterion with number of days post-menstruation in polyclinics • Inefficient resource allocation for screening in tertiary care compared to primary care Subsidies for cost of screening • Restriction of screening subsidies • Effectiveness of subsidies in influencing screening uptake	Effectiveness and delivery of health promotion • Limited effectiveness in raising awareness compared to other diseases • Lack of age differentiated health promotion • Limitations in delivery of existing health promotion materials

GP, general practitioner; HCP, Health care provider.