Chinese-Australian Women’s Knowledge, Facilitators and Barriers Related to Cervical Cancer Screening: A Qualitative Study

  • Cannas Kwok
  • Kate White
  • Jessica K. Roydhouse
Original Paper


Understanding the different facilitators and barriers to screening within cultural and ethnic groups is important for developing appropriate education and outreach programs to underserved groups. Qualitative methods were employed to gain a rich understanding of participant views. In-depth interviews were conducted with 18 Chinese Australian women in their native languages and analysed using content analysis. Knowledge of cervical cancer was low, and few participants understood the benefits and purpose of screening. Having a doctor’s recommendation was a strong motivator, and returning for screening was encouraged by having a female Chinese doctor perform the exam, receiving a reminder letter and the absence of cost for screening participation. However, participation was inhibited by logistical barriers, cultural beliefs and previous painful screening experiences. A range of multifaceted facilitators and barriers must be considered when developing interventions to increase the rates of cervical screening in this population.


Chinese women Cervical cancer screening Qualitative research Australia 



The authors would like to thank the participants for their time and Ms Shuk Man Wan for her assistance in conducting the interviews.


  1. 1.
    Ferlay J, Shin H, Bray F, Forman D, Mathers C, Parkin D. GLOBOCAN 2008, Cancer incidence and mortality Worldwide:. IARC CancerBase No 10 [Internet] [serial on the Internet]. 2010: Available from:
  2. 2.
    Screening and early detection of cancer. Geneva: World Health Organisation; [cited 2010 2 July]; Available from:
  3. 3.
    Mohar A, Frias-Mendivil M. Epidemiology of cervical cancer. Cancer Invest. 2000;18(6):584–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Mathew A, George PS. Trends in incidence and mortality rates of squamous cell carcinoma and adenocarcinoma of cervix–worldwide. Asian Pac J Cancer Prev. 2009;10(4):645–50.PubMedGoogle Scholar
  5. 5.
    Johnston GM, Boyd CJ, MacIsaac MA. Community-based cultural predictors of Pap smear screening in Nova Scotia. Can J Public Health. 2004;95(2):95–8.PubMedGoogle Scholar
  6. 6.
    Fontana M, Bischoff A. Uptake of breast cancer screening measures among immigrant and Swiss women in Switzerland. Swiss Med Wkly. 2008;138(49–50):752–8.Google Scholar
  7. 7.
    Woltman KJ, Newbold KB. Immigrant women and cervical cancer screening uptake: a multilevel analysis. Can J Public Health. 2007;98(6):470–5.PubMedGoogle Scholar
  8. 8.
    Siahpush M, Singh GK. Sociodemographic predictors of pap test receipt, currency and knowledge among Australian women. Prev Med. 2002;35(4):362–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Taylor RJ, Mamoon HA, Morrell SL, Wain GV. Cervical screening in migrants to Australia. Aust N Z J Public Health. 2001;25(1):55–61.PubMedCrossRefGoogle Scholar
  10. 10.
    Xiong H, Murphy M, Mathews M, Gadag V, Wang PP. Cervical cancer screening among Asian Canadian immigrant and nonimmigrant women. Am J Health Behav. 2010;34(2):131–43.PubMedGoogle Scholar
  11. 11.
    Lofters A, Glazier RH, Agha MM, Creatore MI, Moineddin R. Inadequacy of cervical cancer screening among urban recent immigrants: a population-based study of physician and laboratory claims in Toronto, Canada. Prev Med. 2007;44(6):536–42.PubMedCrossRefGoogle Scholar
  12. 12.
    Amankwah E, Ngwakongnwi E, Quan H. Why many visible minority women in Canada do not participate in cervical cancer screening. Ethn Health. 2009;14(4):337–49.PubMedCrossRefGoogle Scholar
  13. 13.
    Wu TY, West B, Chen YW, Hergert C. Health beliefs and practices related to breast cancer screening in Filipino, Chinese and Asian-Indian women. Cancer Detect Prev. 2006;30(1):58–66.PubMedCrossRefGoogle Scholar
  14. 14.
    McDonald JT, Kennedy S. Cervical cancer screening by immigrant and minority women in Canada. J Immigr Minor Health. 2007;9(4):323–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95(8):1410–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Kwok C, Sullivan G. The concepts of health and preventive health practices of Chinese Australian women in relation to cancer screening. J Transcult Nurs. 2007;18(2):118–26.PubMedCrossRefGoogle Scholar
  17. 17.
    Ralston JD, Taylor VM, Yasui Y, Kuniyuki A, Jackson JC, Tu SP. Knowledge of cervical cancer risk factors among Chinese immigrants in Seattle. J Community Health. 2003;28(1):41–57.PubMedCrossRefGoogle Scholar
  18. 18.
    Do HH, Taylor VM, Burke N, Yasui Y, Schwartz SM, Jackson JC. Knowledge about cervical cancer risk factors, traditional health beliefs, and Pap testing among Vietnamese American women. J Immigr Minor Health. 2007;9(2):109–14.PubMedCrossRefGoogle Scholar
  19. 19.
    Baay MF, Verhoeven V, Avonts D, Vermorken JB. Risk factors for cervical cancer development: what do women think? Sexual Health. 2004;1(3):145–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Waller J, McCaffery K, Wardle J. Beliefs about the risk factors for cervical cancer in a British population sample. Prev Med. 2004;38(6):745–53.PubMedCrossRefGoogle Scholar
  21. 21.
    Klug SJ, Hetzer M, Blettner M. Screening for breast and cervical cancer in a large German city: participation, motivation and knowledge of risk factors. Eur J Public Health 2005;15(1):70–7.Google Scholar
  22. 22.
    Tiro JA, Meissner HI, Kobrin S, Chollette V. What do women in the US know about human papillomavirus and cervical cancer? Cancer Epidemiol Biomark Prev. 2007;16(2):288–94.CrossRefGoogle Scholar
  23. 23.
    Hislop TG, Teh C, Lai A, Ralston JD, Shu J, Taylor VM. Pap screening and knowledge of risk factors for cervical cancer in Chinese women in British Columbia, Canada. Ethn Health. 2004;9(3):267–81.PubMedCrossRefGoogle Scholar
  24. 24.
    Sligo F, Jameson A, Comrie M. New Zealand Polynesian women’s access to information about cervical screening. J Manage Med. 1998;12(6):361–9, 21.Google Scholar
  25. 25.
    Woo JS, Brotto LA, Gorzalka BB. The role of sexuality in cervical cancer screening among Chinese women. Health Psychol. 2009;28(5):598–604.PubMedCrossRefGoogle Scholar
  26. 26.
    Tu SP, Yasui Y, Kuniyuki AA, Schwartz SM, Jackson JC, Hislop TG, et al. Mammography screening among Chinese-American women. Cancer. 2003;97(5):1293–302.PubMedCrossRefGoogle Scholar
  27. 27.
    Kwok C, Sullivan G. Influence of traditional Chinese beliefs on cancer screening behaviour among Chinese-Australian women. J Adv Nurs. 2006;54(6):691–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Facione NC, Giancarlo C, Chan L. Perceived risk and help-seeking behavior for breast cancer. A Chinese-American perspective. Cancer Nurs. 2000;23(4):258–67.PubMedCrossRefGoogle Scholar
  29. 29.
    Abdullahi A, Copping J, Kessel A, Luck M, Bonell C. Cervical screening: Perceptions and barriers to uptake among Somali women in Camden. Public Health. 2009;123(10):680–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Lee HY, Vang S. Barriers to cancer screening in among Americans: the influence of health care accessibility, culture, and cancer literacy. J Community Health. 2010;35(3):302–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Wong LP, Wong YL, Low WY, Khoo EM, Shuib R. Cervical cancer screening attitudes and beliefs of Malaysian women who have never had a pap smear: a qualitative study. Int J Behav Med. 2008;15(4):289–92.PubMedCrossRefGoogle Scholar
  32. 32.
    Ackerson K, Gretebeck K. Factors influencing cancer screening practices of underserved women. J Am Acad Nurse Pract. 2007;19(11):591–601.PubMedCrossRefGoogle Scholar
  33. 33.
    McMullin JM, De Alba I, Chavez LR, Hubbell FA. Influence of beliefs about cervical cancer etiology on Pap smear use among Latina immigrants. Ethn Health. 2005;10(1):3–18.PubMedCrossRefGoogle Scholar
  34. 34.
    Donnelly TT. The health-care practices of Vietnamese-Canadian women: cultural influences on breast and cervical cancer screening. Can J Nurs Res. 2006;38(1):82–101.PubMedGoogle Scholar
  35. 35.
    Blomberg K, Ternestedt BM, Tornberg S, Tishelman C. How do women who choose not to participate in population-based cervical cancer screening reason about their decision? Psychonosology. 2008;17(6):561–9.CrossRefGoogle Scholar
  36. 36.
    Oscarsson MG, Wijma BE, Benzein EG. ‘I do not need to. I do not want to. I do not give it priority’.–why women choose not to attend cervical cancer screening. Health Expect. 2008;11(1):26–34.PubMedCrossRefGoogle Scholar
  37. 37.
    Jackson JC, Do H, Chitnarong K, Tu SP, Marchand A, Hislop G, et al. Development of cervical cancer control interventions for Chinese immigrants. J Immigr Health. 2002;4(3):147–57.PubMedCrossRefGoogle Scholar
  38. 38.
    Ma GX, Toubbeh JI, Wang MQ, Shive SE, Cooper L, Pham A. Factors associated with cervical cancer screening compliance and noncompliance among Chinese, Korean, Vietnamese, and Cambodian women. J Natl Med Assoc. 2009;101(6):541–51.PubMedGoogle Scholar
  39. 39.
    Taylor VM, Jackson JC, Tu SP, Yasui Y, Schwartz SM, Kuniyuki A, et al. Cervical cancer screening among Chinese Americans. Cancer Detect Prev. 2002;26(2):139–45.PubMedCrossRefGoogle Scholar
  40. 40.
    Pourat N, Kagawa-Singer M, Breen N, Sripipatana A. Access versus acculturation: identifying modifiable factors to promote cancer screening among Asian American women. Med Care. 2010;48(12):1088–96.PubMedGoogle Scholar
  41. 41.
    Gu C, Chan CW, Twinn S. How sexual history and knowledge of cervical cancer and screening influence Chinese women’s screening behaviour in mainland China. Cancer Nurs. 2010;33(6):445–53.PubMedCrossRefGoogle Scholar
  42. 42.
    Gao W, Desouza R, Paterson J, Lu T. Factors affecting uptake of cervical cancer screening among Chinese women in New Zealand. Int J Gynaecol Obstet. 2008;103(1):76–82.PubMedCrossRefGoogle Scholar
  43. 43.
    Seow A, Huang J, Straughan PT. Effects of social support, regular physician and health-related attitudes on cervical cancer screening in an Asian population. Cancer Causes Control. 2000;11(3):223–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Hislop TG, Deschamps M, Teh C, Jackson C, Tu SP, Yasui Y, et al. Facilitators and barriers to cervical cancer screening among Chinese Canadian women. Can J Public Health. 2003;94(1):68–73.PubMedGoogle Scholar
  45. 45.
    Ji CS, Chen MY, Sun J, Liang W. Cultural views, English proficiency and regular cervical cancer screening among older Chinese American women. Womens Health Issues. 2010;20(4):272–8.PubMedCrossRefGoogle Scholar
  46. 46.
    ABS Year Book Australia, 2009–10. Canberra: Australian Bureau of Statistics 2010.Google Scholar
  47. 47.
    Behling O, Law K. Translating questionnaires and other research instruments: problem and solutions. Thousand Oaks, CA: Sage; 2000.Google Scholar
  48. 48.
    Miles MB, Huberman AM. An expanded sourcebook: qualitative data analysis. 2nd ed. London: SAGE Publications; 1994.Google Scholar
  49. 49.
    Stemler S. An overview of content analysis. Practical assessment, research & evaluation [serial on the Internet]. 2001; 7(17): Available from:
  50. 50.
    Cervical cancer screening. Cancer Council Australia; 2010 [cited 2011 5 January]; Available from:
  51. 51.
    Jameson A, Sligo F, Comrie M. Barriers to Pacific women’s use of cervical screening services. Aust N Z J Public Health. 1999;23(1):89–92.PubMedCrossRefGoogle Scholar
  52. 52.
    Abotchie PN, Shokar NK. Cervical cancer screening among college students in Ghana: knowledge and health beliefs. Int J Gynecol Cancer. 2009;19(3):412–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Taylor VM, Yasui Y, Burke N, Nguyen T, Acorda E, Thai H, et al. Pap testing adherence among Vietnamese American women. Cancer Epidemiol Biomark Prev. 2004;13(4):613–9.Google Scholar
  54. 54.
    Jirojwong S, Manderson L. Physical health and preventive health behaviors among Thai women in Brisbane, Australia. Health Care Women Int. 2002;23(2):197–206.PubMedCrossRefGoogle Scholar
  55. 55.
    Cheek J, Fuller J, Gilchrist S, Maddock A, Ballantyne A. Vietnamese women and Pap smears: issues in promotion. Aust N Z J Public Health. 1999;23(1):72–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Holroyd E, Twinn S, Adab P. Socio-cultural influences on Chinese women’s attendance for cervical screening. J Adv Nurs. 2004;46(1):42–52.PubMedCrossRefGoogle Scholar
  57. 57.
    Holroyd E, Twinn SF, Shia AT. Chinese women’s experiences and images of the Pap smear examination. Cancer Nurs. 2001;24(1):68–75.PubMedCrossRefGoogle Scholar
  58. 58.
    Ahmad F, Gupta H, Rawlins J, Stewart DE. Preferences for gender of family physician among Canadian European-descent and South-Asian immigrant women. Fam Pract. 2002;19(2):146–53.PubMedCrossRefGoogle Scholar
  59. 59.
    Reath J, Carey M. Breast and cervical cancer in indigenous women-overcoming barriers to early detection. Aust Fam Physician. 2008;37(3):178–82.PubMedGoogle Scholar
  60. 60.
    Kelaher M, Gillespie AG, Allotey P, Manderson L, Potts H, Sheldrake M, et al. The transtheoretical model and cervical screening: its application among culturally diverse communities in Queensland, Australia. Ethn Health. 1999;4(4):259–76.PubMedCrossRefGoogle Scholar
  61. 61.
    Twinn S, Cheng F. Increasing uptake rates of cervical cancer screening amongst Hong Kong Chinese women: the role of the practitioner. J Adv Nurs. 2000;32(2):335–42.PubMedCrossRefGoogle Scholar
  62. 62.
    Brunton MA. The role of effective communication to enhance participation in screening mammography: a New Zealand case. Int J Environ Res Public Health. 2009;6(2):844–61.PubMedCrossRefGoogle Scholar
  63. 63.
    Koo JH, Arasaratnam MM, Liu K, Redmond DM, Connor SJ, Sung JJ, et al. Knowledge, perception and practices of colorectal cancer screening in an ethnically diverse population. Cancer Epidemiol. 2010.Google Scholar
  64. 64.
    Janda M, Stanton WR, Hughes K, Del Mar C, Clavarino A, Aitken JF, et al. Knowledge, attitude and intentions related to colorectal cancer screening using faecal occult blood tests in a rural Australian population. Asia Pac J Public Health. 2003;15(1):50–6.PubMedCrossRefGoogle Scholar
  65. 65.
    Jo AM, Maxwell AE, Rick AJ, Cha J, Bastani R. Why are Korean American physicians reluctant to recommend colorectal cancer screening to Korean American patients? Exploratory interview findings. J Immigr Minor Health. 2009;11(4):302–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Cannas Kwok
    • 1
  • Kate White
    • 1
    • 2
    • 3
  • Jessica K. Roydhouse
    • 1
    • 2
  1. 1.Cancer Nursing Research Unit, Sydney Nursing SchoolUniversity of SydneySydneyAustralia
  2. 2.Sydney Cancer CentreRoyal Prince Alfred HospitalSydneyAustralia
  3. 3.School of Nursing, Midwifery and Postgraduate MedicineEdith Cowan UniversityJoondalupAustralia

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