Knowledge, Attitude And Utilization of Cervical Cancer Screening Services Among Ethnic Minority Female Students in A UK University: A Cross-sectional Study.

doi:10.21203/rs.3.rs-4969957/v1

Background: Cervical cancer is the most frequent cancer among ethnic minority women and the most prevalent cause of cancer mortality in the UK. Furthermore, women from ethnic minority origins are more likely than British women not to carry out cervical screening due to socioeconomic issues such as lack of health insurance, language barrier and poor understanding of cervical cancer screening.

Good knowledge and a positive attitude towards receiving a cervical cancer screening are significant factors in the prevention and better outcome of cervical cancer. The study assessed the knowledge, attitude, and practice of cervical cancer screening among ethnic minority female students in the Faculty of Education, Health, and Wellbeing (FEHW), at a UK University.

Methods: From May 2023 to September 2023 a cross-sectional study was conducted on a sample of 138 ethnic minority female students in FEHW aged between 25-64 years from four departments (Public Health, Health and Social care, Health and wellbeing and Occupational psychology) using a simple random sampling technique. Data was collected using a semi-structured questionnaire and analyzed using SPSS for descriptive analysis.

Results: Of 138 participants, a mean age was 35.09 ±12.92 years and 56.7% were African, 21.0% Asia, 17.4% Bangladesh and 5.1% Caribbean. 82.6% of them have a good knowledge of cervical cancer screening. However, a substantial number (54%) of them had negative attitudes towards cervical cancer screening services which led to a low screening rate. Additionally, most of the participants 47.8% admitted embarrassment and fear as a barrier to preventing cervical cancer screening services while 78.3% of the participants have not carried out cervical cancer screening practices.

Conclusion: Ethnic minority female students in the UK had good knowledge of cervical cancer screening. However, the negative attitude and barriers encountered by the ethnic minority female students led to poor practice in the utilization of cervical cancer screening services.

Cervical cancer screening

Ethnic minority

Knowledge

Attitude

HBM

BAME.

Cervical cancer remains a threat to the human population, particularly women of reproductive age. It affects 2% of women, and it is the 14th most common disease diagnosed in the United Kingdom (Saunders et al., 2021). In support of these claims, the World Health Organization's (2022) most recent report indicated that cervical cancer is the 4th most common cancer in women globally, with 604,000 diagnoses and 342,000 deaths in 2020.

Moreover, the study of Moser, Patnick and Beral (2009) reported that white British women undergo cervical cancer screening more than ethnic minority women in the UK. This report is in agreement with one study carried out by Bang et al. (2012). According to the study, women from BAME (Black and Asian Minority Ethnic) backgrounds are less likely to go for cervical screenings and GP services with lesser CCS coverage in the UK. Despite the government plans to mitigate the number of deaths attributed to cervical cancer in the UK (Health and Social Care Information Centre, 2014) approximately 11,500 and 1,121 women still die from CC each year, while 50,000 and 3,791 additional women are identified with CC (HPV Information centre, 2021). Similarly, research has indicated a comparable prevalence percentage among women of all ages in several ethnic minority women (EMW) in Africa and Asia in the UK (Smith et al., 2007). Additionally, from the World Health Organization (2019) report, an estimated 570,000 women were diagnosed with cervical cancer in 2018, and approximately 311,000 died. However, reducing these rates primarily depends on the participation of CCS among women of ethnic minorities in the UK (Hudson et al., 2016).

Furthermore, Katito and Davies (2021) indicated that knowledge and awareness are critical in influencing health-seeking behaviours, particularly among women predisposed to one cause or another, such as Black Asian and Minority Ethnic women in the UK. However, the findings from the study of Bolarinwa and Holt (2023) highlighted that knowledge-related barriers to cervical screening practices affect the non-uptake of CCS by black Asian and minority ethnic women due to the inability to seek health services and to make informed decisions regarding the lack of knowledge about where to find adequate healthcare services. Ethnic minority populations have shown a significant disparity in the uptake of cancer screening and a relationship between poor uptake and social deprivation (Price et al., 2010). Nonetheless, in the study which included 751 males and females from colleges, fewer than half (47%) of the participants were aware of CCS transmission and prevention (Mapanga, Girdler-Brown, and Singh, 2019). The study showed that the participants lacked knowledge about the Human papillomavirus vaccine which is a crucial factor in preventing cervical cancer. This lack of knowledge, negative attitude and low utilisation of cervical cancer screening services is a concern, as it shows that more research is needed to educate the public about HPV transmission and its prevention

Study Area

The study was conducted at the University of Wolverhampton, West Midlands UK. Wolverhampton is a city in England's West Midlands area with a population of 263,700. Moreover, Wolverhampton is home to numerous notable monuments, including the Wolverhampton Art Gallery, Molineux the Wolverhampton Grand Theatre, and the Bantock House Museum. Furthermore, the University of Wolverhampton is a public research university with its main campus in Wolverhampton, England's West Midlands. There are three campuses for the institution: the City Campus, the Walsall Campus, and the Telford Innovation Campus. It offers a cutting-edge learning atmosphere that is supportive of complete libraries, computing resources, and research centres. The University of Wolverhampton is renowned for its solid industry connections and places a significant emphasis on offering practical education and job-relevant skills. It provides courses in business, the arts, health sciences, engineering, the humanities, and the social sciences (University of Wolverhampton, 2021).

Study design

The study utilised an institution-based descriptive cross-sectional research design approach to achieve its aims. As noted by Kokuro and Diji (2020) a cross-sectional descriptive survey examines how often, more widely, or highly a variable of interest appears across a certain demography. Additionally, compared to many other types of studies, cross-sectional studies take fewer resources and time to conduct, making it easier to gather data that may be used as a starting point for further research. Thus, this design approach was considered since it is much easier and cheaper to carry out compared to longitudinal study design.

Population of the study

Female students in the FEHW at the University of Wolverhampton were the study's target population of the study.

Eligibility criteria.

All regular faculty of education health and wellbeing (FEHW) postgraduate female students were included in the study.

Sample size determination

The Leslie-Kish formula was used to calculate the required sample size. The proportion of knowledge and attitude was derived from the findings of a study conducted in England, 90% (Wearn, and Shepherd, 2020) with 95% normal distribution value at a confidence level and 5% margin of error. Moreover, the Leslie Kish method of calculating the sample size technique was used because it gives an approach for predicting the proper sample size required to reach a certain level of statistical accuracy. Therefore, the following formula was used to determine the minimum sample size:

Sampling techniques.

Simple random sampling was used to recruit participants in the study population. All four departments (Master of Public Health, Occupational Psychology, Health and Social Care, health, and Well-being) in the FEHW were identified. Each department participant had an equal chance of selection for the questionnaire sent. This was done via balloting to give every department an equal chance of selection.

Data collection

The data were gathered using a modified semi-structured questionnaire. The questionnaire was generated using literature from previous studies on cervical cancer screening in a similar population in England (Tilahun, et al., 2019). Moreover, section A deals with the socio-demographic data of the participants while Section B gathered information to assess the level of knowledge on CCS, and Section C assessed the attitudes of the participants on CCS. Thus, section D elicited information on the factors influencing the low utilisation of CCS and its barriers. The participants' attitudes towards cervical cancer screening were assessed using 5 Likert scale questions. Each successful answer received a score of 1, while every incorrect response received a score of 0. For questions using a Likert scale, a score of 5 indicated the highest rank and a score of 1 indicated the lowest rank.

Data analysis

The variables were defined for each of the single-choice questions after importing the XLS-format file into SPSS (Statistical Package for Social Sciences). The data was then entered, coded, and analysed using the Statistical Package for Social Sciences (SPSS) version 29.0. Moreover, the data for socio-demographic characteristics and attitudes of female students on cervical cancer screening was presented in tables, frequencies, and percentages while the level of knowledge, barriers, and practice of female students on CCS was presented in charts. The overall female students’ attitude was classified into positive (≥50%) and (<50%) for negative attitudes while (≥50%) were categorised for good knowledge to determine the level of knowledge of cervical cancer screening among female students and (<50%) was classified for poor knowledge.

The questionnaire was sent out to 152 participants in the FEHW, only 138 participated, completed and returned the questionnaire. Therefore, the response rate was (138/152 X 100%) = 90%. Thus, the questionnaire that was completed was appropriately retrieved and analyzed accordingly.

Section A: Socio-demographic characteristics of the participants.

Table 1: Socio-demographic characteristics of the female students.

Variable

Frequency (n = 138)

Percent (%)

Age (years)

25-35

36-46

47-57

58 and above

Mean age (years) 35.09 ±12.92

77

34

26

1

55.8

24.6

18.8

0.8

Race

Africa

Asia

Bangladesh

Caribbean

78

29

24

7

56.5

21.0

17.4

5.1

Marital Status

Single

Married

Divorced

In a relationship

26

84

7

21

18.8

60.9

5.1

15.2

Family size

Income less than family size

Income greater than family size

Income equal to family size

87

20

31

63.0

14.5

22.5

Employment status

Part time work

Unemployed

Full time

103

35

0

74.6

25.4

Table 1 shows the social demographic characteristics of the female students who participated in the study. The mean age of the participants was 35.09 ±12.92 years with 56.5% (78) of the female students majorly African, while a greater number of the participants 60.9% (84) were married. More than half of the participants 63.0% (87) have income less than their family size, while 74.6% (103) of the participants have part-time work employment status.

Section B: Knowledge of Cancer cervical screening

Figure 1 shows the knowledge of cervical cancer screening with 114 (82.6%) said they had heard about cervical cancer screening while 24 (17.4%) said they had not heard about cervical cancer screening.

Table 2: Source of Information on cervical cancer screening.

Variables	Frequency	Percent (%)
Health care professional	52	37.7
Mass media	29	21.0
Friends	25	18.1
Internet	17	12.3
Books	15	10.9
Total	138	100

Table 2 revealed the source of information on cervical cancer screening the table above shows that 52 (37.7%) of the participants mentioned healthcare professionals as their source of information on cervical cancer screening. However, less than half 29 (21.0%) of the participants claimed that mass media was their source of information on cervical cancer screening while 25 (18.1%), 17 (12.3%) and 15(10.9%) of the participants admitted that friends, internet, and books were their source of information regarding cervical cancer screening.

Figure 2 shows the method of cervical cancer prevention among female students. More than half 52.9% (73) of the participants indicated that cervical cancer can be prevented through the HPV vaccine while 22.5% (31) stated that having one partner can reduce the risk of getting cervical cancer. Moreover, 16.7% (23) stated that using birth control pills can prevent CC and less than half 7.9% (11) of the participants affirmed that cervical cancer is not preventable. Therefore, female students who participated in the study have good knowledge of the prevention of cervical cancer.

Section C: Attitude towards cervical cancer screening

Table 3: Female students’ attitude on cervical cancer screening.

Statement	Strongly Agree	Agree	Strongly Disagree	Disagree
I feel uncomfortable with male health care giver carrying out pap test.	57(41.3%)	20(14.5%)	17(12.3%)	44(31.9%)
I do not think my spouse would permit me to carry out CCS	34(24.6%)	0(0%)	73(52.9%)	31(22.5%)
To carried CCS goes against my cultural values and belief	38(27.5%)	33(23.9%)	28(20.3%)	39(28.3%)
I do not think CCS is necessary	12(8.7%)	29(21%)	51(37%)	46(33.3%)
A cancer diagnosis and test make me feel nervous	51(37%)	42(30.4%)	18(13%)	27(19.6%)
positive Attitude	64 (46%)
Negative Attitude	74 (54%)

Key: SA: Strongly Agree= 5; A: Agree= 4; D: Disagree=2; SD: Strongly Disagree=1

Table 3 indicates the attitude of female students toward cervical cancer screening with 74 (54%) of the participants showing a negative attitude towards cervical screening service while 64 (46%) indicated a positive attitude toward cervical screening. Thus, this shows that a significant number of female students who participated in the study have negative attitudes towards cervical cancer screening services.

Section D: Utilization of cervical cancer screening services

Figure 3 shows the utilization of cervical cancer screening services. 108 (78.3%) stated that they have not carried out cervical cancer screening while 30 (21.7%) admitted that they have carried out cervical screening services.

Section E: Barriers to cervical cancer screening

Table 4: Barrier preventing cervical cancer screening services

Variables	Frequency (138)	Percent (%)
Embarrassment and fear	66	47.8
Household income	20	14.5
Marital status	44	31.9
Limited access to healthcare facility	8	5.8

Ultimately, table 4 shows the barriers preventing the utilisation of cervical cancer screening with a significant number of 66 (47.8%) of the participants indicating embarrassment and fear as the major factor preventing cervical screening services, while 44 (31.9%) acknowledged marital status as a barrier. Moreover, less than half 20 (14.5%) of the participants mentioned household income and less than two-thirds 8 (5.8%) of the participants indicated limited access to healthcare facilities as a barrier to preventing cervical cancer screening.

Results from the socio-demographic characteristics of the participants show a mean age of 35.09 ±12.92 in a population of ethnic minority women aged 25-35. It is important to note that the majority of the participants (55.8%) who participated in the study were young female students. The study was done under the participants' socio-demographic characteristics such as age, race, marital status, family size and employment status. Moreover, 56.5% of the female students were African descendants while a greater number of the participants (60.9%) were married. More than half of the participants (63.0%) have income less than their family size, while 74.6% of the participants have part-time work employment status.

Findings from the study on the knowledge of cervical cancer screening among ethnic minority female students revealed that a favourable number of the participants have good knowledge of cervical cancer screening. Moreover, more than half of the participants (52.9%) indicated that cervical cancer can be prevented through HPV (Human Papilloma Virus) vaccine. The good knowledge of cervical cancer screening services among female students can be linked to the following factors a higher degree of educational qualification of the participants, and easy access to reliable and accurate information on the cervical screening programme. Another factor may be knowledge provided by medical professionals, government health agencies, and reliable media, websites, and journals. This finding is similar to the study carried out by Mengesha, Messele and Beletew (2020) in Ethiopia which showed that 65.1% had good knowledge of cervical cancer screening. The study revealed that the promotion of cervical screening services was supported by peer encouragement and advocacy groups. These organizations offered information and encouraged women to prioritize their health in the issue of cervical cancer. However, this finding is in contrast with the study carried out by Adio-Moses (2016) in Ibadan North Local Government Area Nigeria which revealed poor understanding regarding the relationship between cervical cancer screening and early sexual experience. Similar findings were reported in Nigeria in the study conducted by Yahya (2019) where 94% of the participants in the intervention group who participated in the study had extremely poor knowledge about cervical cancer screening.

The difference in research findings can be owing to the research population's differences. However, the poor knowledge of cervical cancer screening can be attributed to a lack of awareness in the study location which may have resulted in low public health campaigns, and poor health literacy rates. Additionally, some women may be discouraged from obtaining information or taking part in screening programmes by factors like societal stigma, and discussion about sexual health on cervical cancer which led to poor understanding of cervical cancer screening services.

The findings on the participant’s attitudes toward cervical cancer screening among ethnic minority female students were also assessed in the study. The findings from the study revealed that a higher proportion (54%) of the participants have a negative attitude towards cervical cancer screening while less than half of the participants (46%) only showed a positive attitude toward cervical cancer screening service. This finding is comparable to the study carried out by Tadesse, Tafa Segni, and Demissie (2022) in Ethiopia. According to the study, most of the participants (71.7%) believed that cervical cancer leads to death. This finding is also similar to the study conducted by Moss et al. (2016) in England on the attitude towards cervical cancer screening among immigrant women. The finding of the study indicated that the attitudes and behaviours of ethnic minority women show that they were not actively participating in cervical screening in England because of negative attitudes and the threat of cervical cancer screening. This belief is in line with the HBM (Health Belief Model) theory. According to the theory, factors in determining the possibility of utilizing healthcare services are perception due to the threat of the disease. Therefore, this risk posed by cervical cancer is due to the low utilization of cervical cancer screening services among women (Ahmed Esa, and Mohamed El-zayat, 2018).

Moreover, 52.9% and 22.5% of the participants reported that their spouses do not allow them to participate in cervical screening services while only 24.6% stated that they were supported by their spouses to carry out cervical cancer screening. This negative attitude can emanate from the patriarchal system in Africa where men have complete power over their families. It can be argued that this negative attitude in this study can be because of cultural and societal stigma surrounding the topics associated with cervical cancer, such as sex and birth control which may have influenced various factors other than health-related knowledge on health-seeking behaviour (Luo et al., 2020).

Additionally, more than 50% of the participants agreed that they feel uncomfortable with male healthcare practitioners performing screening tests. This is consistent with Tavafian's (2012) study, in which a favourable number of the participants (45.2%) felt that carrying out cervical screening by male healthcare professionals is a factor that contributed to not participating in the screening service. This negative attitude may be due to religious reasons. However, the study's finding is in contrast with that of Tapera et al. (2019) in Zimbabwe. The study's findings reported that the participants had a positive attitude about cervical cancer screening and treatment, and most women believed that prompt intervention for cervical cancer screening helps in preventing the transmission of the disease. Although, numerous factors may have contributed to the positive attitude on cervical screening in the study population such as an increase in knowledge on awareness of cervical screening programmes, addressing barriers like cultural barriers, and screening-related anxiety which may have promoted a positive attitude towards cervical cancer screening.

Findings on the practice of cervical cancer screening on ethnic minority female students found that the majority of the participants (78.3%) have not carried out the screening service despite having a good knowledge of cervical cancer screening. Only less than half of the participants (21.7%) indicated that they have carried out the utilization of cervical screening practice. It can be argued that since the majority of the participants who participated in the study were females of ethnic minority groups, the low participation rates among the participants may be attributed to socioeconomic issues such as lack of health insurance, and financial challenges. Moreover, ethnic minority female students in the UK could have faced further challenges in having full-time employment and poverty which may have made them less likely to seek out screening practice.

Nevertheless, it is worthy of note that the low uptake of cervical cancer screening practised by ethnic minority female students in the UK is in line with the HBM belief theory. As alluded to by Glanz, Rimer and Viswanath (2008) the assumption made by the health belief model theory may be viewed that women will be more likely to have a cervical cancer screening if they believe they have a high chance of developing the disease and if the risk is high. The finding in this study agrees with the study conducted by Marlow, Waller, and Wardle (2015) in England. According to the study, 53% of the women from BAME (Black and Asian Minority Ethnic) backgrounds significantly do not carry out cervical cancer screening compared to 47% of the white British women who participated in the screening services. The reasons for low cervical cancer screening uptake were due to limited English proficiency among some ethnic minority women which made them difficult to understand the purpose of the screening, thus resulting in low participation. Besides, one study carried out in America by Do, et al (2011) showed that unmarried Chinese immigrant women were found to be less likely to carry out cervical cancer screening. The finding has been attributed to the idea that because single Chinese women do not engage in more sexual activity, they may not be at risk of experiencing gynaecological issues which had made Chinese immigrant women unable to participate in cervical cancer screenings in the UK. However, the report released by Cancer Research UK (2015) disagreed with this finding. According to the report, the increase in the utilization of cervical cancer screening practices in the UK has resulted in a considerable decline in the incidence and death in countries with good screening methods. This can be because of the availability of healthcare professionals to carry out cervical cancer screening in Western countries, the access to healthcare facilities, and the understanding of cervical cancer services in the UK.

Regarding the barriers to cervical cancer screening among ethnic minority female students. The study showed that a favourable number of 66 (47.8%) of the participants indicated embarrassment and fear as the major barriers preventing cervical screening services. This finding is in agreement as reported by Abdullahi's (2009) study where it was found that embarrassment, fear of the screening process, and past negative experiences of cervical cancer screening were the major barriers to cervical screening tests among Somali women in London. Moreover, these findings support those of Miller and Roussi (2010) in Lederberg, which claimed that women of ethnic minorities reported Pap smear examination to be extremely painful. Additionally, in Canada, the study conducted by Ferdous et al. (2018); Gele et al. (2017), and Abboud et al. (2017) affirmed that one of the challenges preventing immigrant women from attending cervical cancer screenings is their fear of cervical screening discomfort and pain. This finding was further highlighted in the study by Ncube et al. (2015). According to the study, the challenges of the screening process are the reasons why women may feel nervousness and pain during a cervical cancer screening. However, using a strategy where women who have been screened share their personal experiences with unscreened women to dispel these myths and misconceptions will help in reducing this barrier. Although it can be disputed that these fear and embarrassment can be a result of body image concerns, feelings of shame, and anxiety among ethnic minority women when it comes to discussing sensitive topics such as cervical cancer screening which may have led to an increased sense of body dissatisfaction, consequently, impede their willingness to engage in the screening services. Consequently, these barriers show the need for tailored services such as implementing patient care programmes that can give emotional support, counselling, and encouragement to reduce screening-related fear and shame to meet the specific needs of ethnic minority groups.

Moving forward, 31.9% of the participants acknowledged marital status as a barrier to cervical cancer screening. As noted in the study carried out in Canada by Lofters et al. (2011) which revealed that being at age 36 to 49 prevented immigrant women from going to cervical cancer screenings. Besides, the rates of cervical cancer screening among ethnic minority women residing in economically developed countries were shown to be significantly influenced by age, location of birth, marital status, and educational level. However, the study of Meyer et al. (2016) has shown the relationship between marital status and health-seeking behaviours. The study shows that married women are more likely than unmarried women to engage in simple and fundamental preventive health-seeking behaviours like practising cervical cancer screening, eating better balanced meals, and exercising. This can be attributed to the fact that these unmarried women may feel that they have a lower possibility of developing cervical cancer than their married peers. This perception may be based on the belief that they are not sexually active or only have a few sexual partners, which would reduce the perceived need for cervical screening. Nevertheless, to address this barrier, there is a need to emphasize the significance of regular screenings and advocating for unmarried women’s needs brought on by fear and embarrassment and make them take control of their healthcare. In addition, expanding access to affordable healthcare services, such as cervical cancer screening, can be important, especially for encouraging unmarried women to have frequent screening tests. This may entail providing cervical screening services for free or at a reduced cost, expanding insurance coverage alternatives, and implementing outreach programmes that are especially geared towards these women.

Furthermore, 14.5% of the total participants in the study identified household income as a barrier to cervical cancer screening practice. This finding is consistent with the study conducted by Judah et al. (2022) in London. According to the study barriers to the low utilisation of cervical screening were significantly influenced by the household income level, which was a significant factor. Additionally, this finding supports one study carried out in England which showed that there is a relationship between the household income of ethnic minority women and the utilisation of cervical screening services (Murfin et al., 2020). This is because ethnic minority women may face challenges with access to healthcare services, particularly cervical cancer screening, due to low household income. For women with low financial means, screening tests may be sometimes expensive and may necessitate extra fees, such as travel expenses to go to the screening facility consequently serving as a barrier to cervical screening attendance. Although, this finding disagrees with the study by Marlow, Wardle, and Waller (2017). The study affirmed that lack of household income is not only considered as a substantial barrier to the utilization of cervical screening. There are other socioeconomic factors such as cultural beliefs, language barriers, and perception of healthcare facilities which might still have an impact on screening behaviours. Moreover, family income may not only constitute a substantial barrier to cervical cancer screening among ethnic minority women in the UK. Therefore, to increase screening rates and decrease inequalities in cervical cancer outcomes among ethnic minority communities, it is imperative to keep addressing these factors holistically.

It is important to note that 5.8% of the participants indicated limited access to healthcare facilities as a barrier preventing cervical cancer screening. This is comparable to one study conducted by Niyonsenga, et al. (2021) in Rwanda where 58.7% of the participants claimed that they had to travel a great distance to visit cervical cancer screening centres due to limited access to healthcare facilities. Moreover, Alem, Tegene, and Belachew (2021) study stated that 52.4% and 28.3% of the participants who took part in the study reported that they had never had the disease and lacked knowledge of the screening location. From the study, only 1.2% of the total women received the vaccinations due to lack of access to the screening location. These factors may be the result that ethnic minority students lack cultural sensitivity and awareness of special healthcare needs because of the uncertainty about their immigration status or lack of the appropriate healthcare documents, making them afraid to access the screening centre for fear of fees. Also, the shortage of healthcare staff who are from ethnic minority groups in NHS (National Health Service) and other hospitals who do not understand the student’s healthcare needs based on their peculiarity may pose a barrier to these students since the students may not be able to express their health condition to the British healthcare provider. Therefore, this highlights the need for greater inclusivity of health care professionals in NHS and awareness of cervical cancer and its available screening locations. Additionally, more accessible, affordable healthcare services for women in this region will help reduce the death rate. Nonetheless, having diverse inclusive healthcare staff from different ethnic groups will help to address this barrier.

Furthermore, school campuses should provide cervical cancer screening facilities so that students may easily have access to them. Additionally, to sensitize students about the availability of screening facilities and the services offered, information on cervical cancer should be promoted on university campuses. This will help to increase students' capacity to actively participate in cancer prevention and screening programmes. Moreover, the NHS should collaborate with non-governmental organizations and student groups to ensure a high uptake of cervical screening rates to reduce cervical cancer screening barriers.

Implications For Policy, Practice in Health and Social Care

The findings from this study will help policymakers on how best to allocate resources and direct the creation of culturally appropriate programmes to boost cervical cancer screening utilization. Additionally, the study will serve as a baseline for proper health planning by the UK government, NHS, and non-governmental organizations.

The findings on knowledge of cervical cancer screening will provide data on ethnic minority women on HPV vaccination and cervical cancer screening. This will help the healthcare staff to improve policies for enhancing understanding on awareness of cervical cancer screening among women of ethnic minority groups in Wolverhampton.

Furthermore, the findings of the utilization of cervical cancer screening services will be adopted to plan training manuals and proposals and develop purposeful strategies for training nurses, doctors, and other healthcare professionals participating in the campaign against cervical cancer.

The findings will assist policymakers in ensuring that information and services for ethnic minority populations are culturally and linguistically suitable. The study will help to increase knowledge and involvement in cervical cancer screening. This may be done by translating educational materials into several languages, providing qualified translators, and enlisting the help of local leaders. Furthermore, it will make it possible for decision-makers to concentrate on tackling factors like socioeconomic status, education, and housing that may restrict access to healthcare and affect health outcomes in communities of ethnic minorities.

Ultimately, the result obtained from the study findings will positively affect women's behaviour and practice towards cervical cancer screening, which will also serve as a foundation for future research on cervical cancer screening uptake.

Limitation

The study did not employ a qualitative approach, limiting participants' ability to express their thoughts and opinions deeply. Moreover, the study's findings on knowledge, attitude, and practice regarding cervical cancer screening were based on self-reported data, potentially influenced by social desirability. Another limitation of this study is that not all university campus students were included in the study. Also, the study is only descriptive and some comparisons with different populations were performed since there were not enough literature materials.

The findings in the study emphasize that despite good knowledge of cervical cancer screening service, there was a significant negative attitude which led to poor utilization of cancer screening among ethnic minority female students. Cervical cancer screening knowledge before migration played a significant role in the attitude of ethnic minority female students. Moreover, embarrassment, household income and marital status were a major barrier to cervical cancer screening leading to a low screening uptake rate. Moreso, students from ethnic minority backgrounds were ‘underserved` for utilization of cervical cancer screening. This demonstrates the need to increase cervical cancer screening awareness among ethnic minority women to emphasize the benefits and negate the wrong misconceptions of the screening service.

Furthermore, there is a need for more awareness programmes for female students about cervical cancer and its screening, as well as to advocate for the utilization of healthcare services for cervical cancer screening uptake. To conduct the national cervical cancer screening programme, health institutions must make cervical cancer screening available, accessible, and cost-effective for ethnic minority countries, especially ethnic minority women.

SD: Standard Deviation

SPSS: Statistical Package for Social Science

HPV: Human Papilloma Virus

KAP: Knowledge Attitude and Practice

Ethics approval and consent to participate

This research was conducted in accordance with the declaration of Helsinki. The study obtained ethics approval from the University of Wolverhampton Research Ethics Committee (UOWREC). All the participants gave their informed consent to participate in the study and the use of anonymous data collection methods ensured confidentiality, and the data analysis did not involve any identification of the research participants. It was confirmed that all methods conformed with the suitability of research ethical standards.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Availability of Data and material

Upon a reasonable request, the corresponding author will provide the datasets used/ analysed in the current study.

Funding.

There is no funding for this study.

Contributions

CCK participated in the preparation of the manuscript as well as the data collection, analysis, and interpretation. Writing proposals, analysing data, and interpreting findings were all done by AUK. The final manuscript has been reviewed and approved by all authors.

Acknowledgements

The authors express gratitude to the University of Wolverhampton, Faculty of Education Health and Wellbeing, for their logistical and material support, and to the study participants and facilitators for data collection.

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No competing interests reported.

Knowledge, Attitude And Utilization of Cervical Cancer Screening Services Among Ethnic Minority Female Students in A UK University: A Cross-sectional Study.

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