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.