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

ABSTRACT

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.

KEYWORDS:

• Cervical cancer screening
• Indigenous health
• systematic review
• qualitative research

Acknowledgement

We acknowledge the contract from CADTH for the larger systematic review which made this secondary analysis possible. We appreciate the important contributions made by the CADTH HPV Screening team in furthering our understanding of the challenge of offering cervical cancer screening in a way that is acceptable to women. We acknowledge the research assistance selecting articles and conducting critical appraisal of articles in the larger study from Muzammil Syed, Jacqueline Wilcox, Arjun Patel and Eamon Colvin. We also like to acknowledge Caitlyn Ford for her peer-review of the search strategy and help with the search updates.

Disclosure statement

No potential conflict of interest was reported by the author(s).