Barriers and Enablers to Cervical Cancer Screening Among Culturally Diverse Women: A Mixed Methods Study

Barriers and Enablers to Cervical Cancer Screening Among Culturally Diverse Women: A Mixed Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Barriers and Enablers to Cervical Cancer Screening Among Culturally Diverse Women: A Mixed Methods Study Daniella Edward This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7929023/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background and Aims : Despite advances in cervical cancer prevention through HPV vaccination and self-collection screening options, participation remains disproportionately low among culturally and linguistically diverse (CALD) women in Australia. Despite national policy efforts, uptake remains low. This study aims to bridge the gap between policy and lived experience by synthesising evidence and capturing perspectives to understand why screening remains inaccessible - and how it can be transformed. Methods: A narrative review of peer-reviewed and grey literature (2015–2024) was conducted to identify structural and cultural barriers affecting cervical screening participation in CALD populations. Key themes were mapped against the socio-ecological model. In parallel, semi-structured interviews were conducted with eight multicultural health workers and cultural advisors across South Australia. Thematic analysis was used to identify recurring patterns, community insights, and practice-level solutions. Ethics approval was granted by the University of South Australia Human Research Ethics Committee. Results : Literature consistently reported language barriers, lack of culturally safe information, and limited awareness of self-collection options. Interviewees deepened this with lived insight, describing mistrust, stigma, and fear, especially among women from refugee and faith-based communities. They proposed actionable strategies: co-designed messaging, partnerships with cultural leaders, and embedding screening education into women’s community spaces. Importantly, the disconnect between national messaging and local realities was seen as a critical barrier to meaningful engagement. Conclusions and Significance/Impact: This study reveals that closing the cervical screening gap for CALD women requires more than information — it demands cultural trust, community leadership, and policy grounded in real-world experience. By combining evidence with voice, it offers a roadmap for developing inclusive, community-led screening programs. The findings advance translational public health by demonstrating how innovation begins with listening — and leads to systems that truly work for all. cancer cervical cancer public health health literacy cancer prevention preventive health Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers agreed at journal 29 Jan, 2026 Reviewers invited by journal 29 Jan, 2026 Editor invited by journal 02 Nov, 2025 Editor assigned by journal 27 Oct, 2025 Submission checks completed at journal 27 Oct, 2025 First submitted to journal 23 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7929023","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":535955769,"identity":"b58f41a5-6361-476e-bc26-7381e1855700","order_by":0,"name":"Daniella Edward","email":"data:image/png;base64,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","orcid":"","institution":"Adelaide University, Flinders University","correspondingAuthor":true,"prefix":"","firstName":"Daniella","middleName":"","lastName":"Edward","suffix":""}],"badges":[],"createdAt":"2025-10-23 06:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7929023/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7929023/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94591149,"identity":"95ffc548-fde9-422a-86b7-a8fb4a78e444","added_by":"auto","created_at":"2025-10-28 18:21:52","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":357327,"visible":true,"origin":"","legend":"","description":"","filename":"BARRIERSANDENABLERSTOCERVICALCANCERSCREENING2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7929023/v1_covered_5424b9b9-7611-4ad7-bcdc-707c4ec07a25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eBarriers and Enablers to Cervical Cancer Screening Among Culturally Diverse Women: A Mixed Methods Study\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cancer, cervical cancer, public health, health literacy, cancer prevention, preventive health","lastPublishedDoi":"10.21203/rs.3.rs-7929023/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7929023/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Aims\u003c/strong\u003e: Despite advances in cervical cancer prevention through HPV vaccination and self-collection screening options, participation remains disproportionately low among culturally and linguistically diverse (CALD) women in Australia. Despite national policy efforts, uptake remains low. This study aims to bridge the gap between policy and lived experience by synthesising evidence and capturing perspectives to understand why screening remains inaccessible - and how it can be transformed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A narrative review of peer-reviewed and grey literature (2015–2024) was conducted to identify structural and cultural barriers affecting cervical screening participation in CALD populations. Key themes were mapped against the socio-ecological model. In parallel, semi-structured interviews were conducted with eight multicultural health workers and cultural advisors across South Australia. Thematic analysis was used to identify recurring patterns, community insights, and practice-level solutions. Ethics approval was granted by the University of South Australia Human Research Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Literature consistently reported language barriers, lack of culturally safe information, and limited awareness of self-collection options. Interviewees deepened this with lived insight, describing mistrust, stigma, and fear, especially among women from refugee and faith-based communities. They proposed actionable strategies: co-designed messaging, partnerships with cultural leaders, and embedding screening education into women’s community spaces. 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The findings advance translational public health by demonstrating how innovation begins with listening — and leads to systems that truly work for all.\u003c/p\u003e","manuscriptTitle":"Barriers and Enablers to Cervical Cancer Screening Among Culturally Diverse Women: A Mixed Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-28 16:44:10","doi":"10.21203/rs.3.rs-7929023/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-15T18:56:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211233693300318621708461006419711081345","date":"2026-02-08T22:38:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29972642325359193094571174595946294008","date":"2026-02-03T17:37:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31670424233265300361874769356583656665","date":"2026-01-29T22:25:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T13:12:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-02T16:11:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-28T00:08:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-28T00:08:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-10-23T06:23:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccc068f1-3aab-4fce-9493-dbc40f44b146","owner":[],"postedDate":"October 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-29T13:23:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-28 16:44:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7929023","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7929023","identity":"rs-7929023","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}