Pacific Women Navigating Colposcopy Services: A Concurrent Transformative Mixed Methods Approach Utilising Talanoa
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Colposcopy is the diagnostic and treatment arm in the cervical screening programme and plays an essential role in reducing the incidence and mortality of cervical cancer. Timely assessment at colposcopy clinics for Pacific women is vital to reduce the adverse consequences and negative emotional impact for women (Decker, McLachlin, & Lotocki, 2015; Priest et al., 2007). Pacific women experience considerable disparities in accessing colposcopy services in New Zealand. A quarter of Pacific women have not been seen for colposcopy following high-grade cytology at 90 days, compared to 8.2% of European/other women (M. Smith, Rumlee, & Canfell, 2017). Current Pacific health policy at Ministry of Health and District Health Board level is primarily focused on cervical screening coverage with little discussion concerning the cervical screening pathway interface between primary and secondary care in health policy. The review of the National Cervical Screening Programme Independent Monitoring Reports identified there has been an on-going disparity for Pacific women in accessing colposcopy services. Despite this being documented for many years, there is a paucity of research examining Pacific women's experiences navigating colposcopy services and the implications of these delays on clinical outcomes and service utilisation. In contrast, there is extensive research examining these factors from an international perspective, and this research highlights the complexity of colposcopy attendance, given the sensitive nature of the examination. Research among minority women highlights the importance of cultural values and beliefs when engaging minority women. The literature has identified Pacific people’s cultural values and beliefs as playing an important role in healthcare engagement. Given the complexity surrounding colposcopy attendance, a transformative mixed methods study utilising Talanoa as the theoretical perspective was undertaken to evaluate Pacific women's experiences of navigating colposcopy services in New Zealand. The quantitative component examined colposcopy clinic utilisation amongst Pacific women with delayed assessment following high-grade cytology between January 2010 and December 2015. Attendance at colposcopy clinics was found to be higher than expected at 90 days, and access to colposcopy services nationally was equitable amongst Pacific women. However, delays occurred across the cervical screening pathway with nearly a third of delays occurring between the time of cytology and referral. Socioeconomic deprivation was found to be associated with delayed colposcopy attendance, and older women were more likely to attend their colposcopy appointment compared to women under the age of 25 years. Individual Pacific ethnicity was not associated with colposcopy attendance. The qualitative component undertook individual Talanoa to explore Pacific women's experiences of navigating colposcopy services. Nine Pacific women who identified as Cook Island Māori, Samoan, and Tongan, and resided in the Auckland region participated in this study. A thematic analysis of the Talanoa revealed three main themes. These included cultural influences, making sense of the abnormality, and Pacific women's views: What needs to transform. Cultural values and beliefs played an essential part in the Pacific women's experiences of navigating colposcopy services. The experience of having a cervical abnormality caused considerable anxiety and distress for these women. The women identified several changes that could improve service delivery, including communication, cultural responsiveness, health system improvements, knowledge and education to support women. The major combined findings from this concurrent transformative mixed methods study were that colposcopy attendance among Pacific women is complex and multifactorial. While demographic factors are associated with attendance, the cultural values and beliefs of Pacific women are integral in engagement with colposcopy services. Colposcopy services need to consider the importance of providing culturally competent care when engaging with Pacific women and consideration must be given to providing individualised care.