Abstract

Background: Cervical cancer is the second cause of cancer related mortality for Filipino women. Proportionally high mortality rates of cervical cancer have been found amongst Filipino women due to late presentation. Low participation rates in cervical cancer screening (pap-testing) have been found among Filipino women. Migration may present other barriers to pap-testing. Gaining understanding of barriers and facilitators to pap-testing for this group is crucial in order to improve uptake of pap-testing.
Aim: To gain insights into the knowledge, attitudes and practices concerning cervical cancer screening among female Filipino migrant workers.
Methods: The study adopted an explanatory sequential mixed-methods research design which consisted of two phases, a web-based cross sectional survey, followed by individual web-based qualitative interviews. The web-based survey, delivered via Qualtrics, was adapted from existing instruments measuring cognitive, cultural and structural factors in relation to pap-testing. Participants were recruited through the use of social media and quantitative data collection (October 2015). The survey was completed by 487 Filipino women (59.2% domestic workers), living and working in 28 different countries, with the largest proportion of women working in Hong Kong (25%) (mean age 36.37, age range 21-64). Frequencies assessing participation rates in, knowledge of and attitudes towards pap-testing as well as associations between pap-testing and potential barriers and facilitators to pap-testing were analysed using bivariate analyses followed by multivariate analyses, including factor analysis and logistic regression. These results were further explored in eight individual web-based qualitative interviews (February 2016) using a vignette approach to gain a deeper understanding of the quantitative results. Qualitative results were analysed using thematic content analysis.

Results: Despite finding that 91% of women were aware of the procedure, less than half (43%) had ever engaged in pap-testing. Factor analysis reduced the large number of variables associated with pap-testing and logistic regression found three significant overarching predictors of pap-testing: 1) Perceived barriers to action 2) Cultural and societal values, 3) Health beliefs. Making sense of the quantitative results in the qualitative exploration, revealed additional findings. Despite an apparent willingness to participate in pap-testing, many migrant women had not truly considered attending pap-testing in the host countries. The cost of pap-test Vs. saving money to provide for family back home, limited understanding of pap-testing, not knowing where to go, lack of local health care provider and no recommendation from health-care provider, were significant barriers. In the quantitative phase, ‘lack of time’ was found an important barrier, however, only when exploring this barrier in more depth qualitatively was it revealed that social, working and living circumstances underpinning this factor, presented additional challenges to engaging in pap-testing.

Conclusion: These findings indicate that a mixed-methods approach was warranted, the sum of the findings added valuable information and the use of either the quantitative or qualitative approach alone would not have answered the research question satisfactorily. Findings revealed the complexity of accessing pap-testing for this population, indicating that interventions aimed at increasing uptake of pap-testing should be targeted at multiple levels.