Attitudes, Understanding and Compliance with Cervical Cancer Screening in Eastern European Migrants to England

Introduction: The incidence of cervical cancer in England, in the 25-34 year old age group is rising but screening coverage is falling. It has been hypothesised that this might be in part due to the effect of migration of Eastern European (EE) women to England. This thesis explores the attitudes, understanding and behaviours of migrant EE women in England towards cervical cancer prevention strategies, focusing on the effect of migration. Further to assess cervical cancer prevention as an entirety the understandings and attitudes of EE adolescents and healthcare professionals in England have been investigated. Methods: Five studies, using a combination of qualitative, quantitative and systematic review research methodologies were conducted to assess the aims. The studies were conducted in England and Latvia. Results: Comparison of the English and Latvian studies revealed that both the native Latvian women and migrant EE women had lower levels of understanding of the process of cervical screening than the native English women. The largest influence on cervical screening behaviours both prior to and after migration was the women’s overall perception of the healthcare system. The migrant EE women held negative attitudes towards the healthcare system in England. Minimal changes occurred in attitudes and behaviours towards cervical screening after migration. Practice nurse smear takers in England were found to lack adequate awareness of current cervical screening protocols or HPV vaccination and not all were confident in providing HPV related patient education. Awareness of primary prevention of cervical cancer in the Latvian adolescent population was suboptimal, although they appeared to be partaking in high-risk behaviours. Conclusions: The uptake of cervical cancer prevention modalities in the migrant EE population appears to be influenced by their pre-existing knowledge of cervical screening and cervical cancer and their perception of the healthcare system and healthcare professionals in England