ABSTRACT

OBJECTIVES: Whether the lower Dutch cervical cancer (CC) screening participation of Turkish- and Moroccan-Dutch women is based on informed decision-making is unknown. Our aim was to explore how and why Turkish- and Moroccan-Dutch women decide to participate or not in the current Dutch CC screening programme as well as to learn their perceptions on self-sampling.

DESIGN: Six focus group discussions were conducted between March and April 2019 with Turkish (n = 24) and Moroccan (n = 20) women in the Netherlands, aged 30–60 years. Questions were based on an extended version of the Health Belief Model. Discussions were transcribed verbatim and thematically analysed.

RESULTS: Participants lacked knowledge about CC and its screening, and seemed to be unaware of the cons of CC screening. Perceived barriers for screening were lack of a good command of the Dutch language, having a male general practitioner, fatalism, shame and taboo, and associations of CC with lack of femininity and infertility. Other barriers were fear of the test result, cancer, suffering, death, and leaving their children behind after death. Perceived facilitators were a high perceived severity of disease, social support, and short procedure time. An additional religious facilitator included the responsibility to take care of one’s own health using medical options that God provided. Participants had low self-efficacy expectations towards performing correct self-sampling.

CONCLUSIONS: Although participants’ informed-decision making seems to be limited, this study showed that women do not only consider factual medical information, but also practical, emotional, cultural, and religious aspects prior to deciding to screen or not. Information materials should be tailored to these aspects, as well as translated to appropriate languages due to lack of a good command of the Dutch language. Self-efficacy expectations towards performing correct self-sampling should be enhanced to promote informed CC screening participation among Turkish- and Moroccan-Dutch women.

摘要

目标：土耳其-和摩洛哥-荷兰妇女参与下荷兰宫颈癌 (CC) 筛查是否基于知情决策尚不清楚。我们的目的是探索土耳其裔和摩洛哥裔荷兰妇女如何以及为何决定参加或不参加当前的荷兰 CC 筛查计划，并了解她们对自我抽样的看法。

设计：在 2019 年 3 月至 4 月期间 ，与荷兰 30-60 岁的土耳其 ( n  = 24) 和摩洛哥 ( n = 20) 女性进行了六次焦点小组讨论。问题基于健康信念模型的扩展版本。讨论被逐字转录和主题分析。

结果：参与者缺乏关于 CC 及其筛查的知识，并且似乎不知道 CC 筛查的缺点。筛查的障碍是缺乏对荷兰语的良好掌握，有一名男性全科医生，宿命论，羞耻和禁忌，以及 CC 与缺乏女性气质和不孕症的关联。其他障碍是对测试结果的恐惧、癌症、痛苦、死亡以及死后留下他们的孩子。感知到的促进者是高度感知的疾病严重性、社会支持和较短的手术时间。另一个宗教促进者包括使用上帝提供的医疗选择来照顾自己的健康的责任。参与者对执行正确的自我抽样的自我效能期望较低。

结论：尽管参与者的知情决策似乎有限，但本研究表明，女性在决定是否进行筛查之前不仅会考虑实际的医学信息，还会考虑实际、情感、文化和宗教方面的因素。由于缺乏对荷兰语的良好掌握，信息材料应针对这些方面进行定制，并翻译成适当的语言。应提高对执行正确自我抽样的自我效能期望，以促进土耳其和摩洛哥-荷兰妇女在知情的情况下参与 CC 筛查。