How do asylum seeking and refugee women perceive and respond to preventive health care? Cervical Screening as a case study.
Asylum seekers/refugees in Scotland are entitled to free primary and secondary healthcare at all stages of the asylum process. This includes primary prevention programmes, such as cervical screening, which are provided by Primary Care. However, there are known inequalities in accessing primary healthcare for asylum seekers and refugees, particularly women. Using cervical screening as a case study, this project explored the facilitators and barriers for the uptake of preventive medical care by asylum seeking and refugee women in Glasgow.
A qualitative research project, involving multiple semi-structured interviews and focus groups. Participants included ASR women(n=16), community workers(n=2) and ongoing interviews with primary care healthcare professionals. Thematic analysis was led by AM, with support from NB, FM and KOD in regular coding clinics. Identified themes were then mapped to the theoretical framework of candidacy. The three perspectives allowed a fuller exploration of the negotiation of candidacy, from the viewpoint of the patient, doctor and community workers, who often provide signposting for healthcare. Data on cervical screening was obtained from practices caring for ASR women.
Practice data suggests a lower uptake of cervical screening in the asylum seeking (30%)/refugee (46%) population compared to the overall practice uptake (95.99%) and the national 3 year uptake(70.5%) (ISD 2015). Emerging barriers include previous female genital mutilation (FGM), sexual assault, cultural differences and lack of knowledge about cervical screening. It was felt by participants that inequalities in cervical screening uptake could be lessened through increased education regarding cervical screening, preferably before receipt of an invitation letter, and could be undertaken within trusted community groups. Women interviewed within an established community women’s group had a higher uptake of cervical screening than women who were not. Policies surrounding entitlement were often found to be confusing and difficult to access by healthcare providers and community workers, with guidance often confusing the entitlements in England to that in Scotland. Many primary healthcare workers had never seen the Scottish Government policy document pertaining to the entitlement of asylum seekers and refugees to healthcare in Scotland.
A clear outcome of this study was the importance of giving clear, language appropriate information to asylum seeking/refugee women about cervical screening. Training regarding FGM, sexual assault and caring for ASR is also required for healthcare workers to enable them to provide sensitive and appropriate delivery of cervical screening to this population. The results from this work are being fed into training for GPs now caring for newly arrived Syrian refugees in Scotland.