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

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.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical Committee of University of South Autralia Human Research Ethics Committee gave ethical approval for this work.

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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