Withdrawn: Hearing Women's Voices: Using Focus Groups to Plan Culturally Acceptable Primary Cervical Cancer Screening in Grenada, West Indies

Background and Purpose: Cervical cancer is a leading source of morbidity and mortality in Latin America and the Caribbean, including the small island state of Grenada, West Indies (Bahadoor et al, 2016). Persistent social inequalities including poverty, gender inequality, and the legacies of colonialism and slavery complicate Grenadian women’s access to knowledge about human papillomavirus (HPV) and cervical cancer, as well as the medical and social care needed to prevent and treat the disease. In order to plan for the most culturally appropriate and acceptable screening methodologies, we—an interdisciplinary group of Grenadian and U.S. medical and social service providers and educators—set out to understand women’s knowledge, attitudes and perceptions related to HPV, cervical screening and treatment in Grenada.

Methods: Local facilitators (co-authors on this presentation) convened 10 focus groups in 2018- 2019, including over 70 participants (women aged 19-59) and representing 5 of 6 Grenadian parishes. Participants were asked about their knowledge of pelvic exams, Pap smears, HPV, reasons for seeking (or avoiding) cervical cancer screening, and how different modalities of testing might affect their decision-making. This research was approved by the IRB at Grenada’s St. George’s Medical School, and each participant signed a written consent. Data were analyzed through a process of identifying themes and codes (Charmaz, 2006). Two researchers reviewed each transcript independently, and themes were defined and reviewed until there was agreement. Responses were then organized into common themes and coded.

Results: Four major themes emerged from the data: (1) Knowledge of screening rationale and methods; (2) Knowledge of HPV and Cervical Cancer; (3) Reasons for avoiding cervical cancer screening; and (4) Need for further information. While many respondents had heard of HPV, far fewer knew how to prevent HPV or about its causative role in cervical cancer. Women were almost universally unaware of the existence of high-risk HPV testing. Many focus group participants knew that cervical cancer screening was beneficial, but they reported experiencing barriers to obtaining that screening, including concerns about privacy and stigma, potential discomfort, cost, and inconvenience.

Conclusions and Implications: Our findings have important implications for future cervical cancer screening efforts in Grenada, and the role that social workers can play in educating women, understanding their concerns, and pushing to reduce/remove the barriers that women encounter. A focus on educating Grenadians about the role of HPV in cervical cancer and the importance of early detection through screening should be central to these efforts. In addition, addressing outstanding issues of access and stigma are key to eliminating cervical cancer in Grenada. Combating cervical and other HPV-related cancers in Grenada will go hand-in-hand with fight poverty, stigma, and inequality.