Perceptions of Inuit Women and Non-Inuit Healthcare Providers on the Implementation of Human Papillomavirus Self-Sampling as an Alternative Cervical Cancer Screening Method in Nunavik,Northern Quebec

Abstract

Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on CC screening services and the possible implementation of HPV self-sampling. We held 10 group discussions with 28 Inuit women and 10 semi-structured interviews with 20 HCPs. The thematic analysis extracted themes reflecting one barrier and seven facilitators to accessing CC screening and the implementation of HPV self-sampling in Nunavik. Themes included, though not limited to, language and communication in health settings, access to culturally responsive educational resources on CC, and the noninvasive nature of HPV self-sampling. This study may serve to contribute to the co-development of a strategy for implementation that is designed according to the needs and priorities of the communities.

Keywords

interventions quality of care doctor–patient nurse–patient community-based programs women’s health access to health care

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References

Abbott

Mastroianni

Sturges

, Films for the Humanities & Sciences (Firm), Kativik School Board Educational Television Levy

(2003). The history of Nunavik: In the footsteps of the Inuit. Films for the Humanities & Sciences.

Adcock

Cram

Lawton

Geller

Hibma

Sykes

Hart

(2019). Acceptability of self-taken vaginal HPV sample for cervical screening among an under-screened Indigenous population. The Australian and New Zealand Journal of Obstetrics and Gynaecology, 59(2), 301–307. https://doi.org/10.1111/ajo.12933

Ahmed

Shahid

R. K.

Episkenew

J. A.

(2015). Disparity in cancer prevention and screening in aboriginal populations: Recommendations for action. Current Oncology, 22(6), 417–426. https://doi.org/10.3747/co.22.2599

Andersson

Beauchamp

Nava-Aguilera

Paredes-Solís

Šajna

(2017). The women made it work: Fuzzy transitive closure of the results chain in a dengue prevention trial in Mexico. BMC Public Health, 17(Suppl 1), 408. https://doi.org/10.1186/s12889-017-4301-0

Andersson

Silver

(2019). Fuzzy cognitive mapping: An old tool with new uses in nursing research. Journal of Advanced Nursing, 75(12), 3823–3830. https://doi.org/10.1111/jan.14192

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Braun

Clarke

(2021). Can I use TA? should I use TA? should I not use TA? comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Counselling and Psychotherapy Research, 21(1), 37–47. https://doi.org/10.1002/capr.12360

Butler

T. L.

Anderson

Condon

J. R.

Garvey

Brotherton

J. M. L.

Cunningham

Whop

L. J.

(2020). Indigenous Australian women’s experiences of participation in cervical screening. Plos One, 15(6), e0234536. https://doi.org/10.1371/journal.pone.0234536

Canadian Cancer Statistics Advisory Committee in collaboration with the Canadian Cancer Society, Statistics Canada and the Public Health Agency of Canada (2021). Canadian cancer statistics. Canadian Cancer Society. https://cdn.cancer.ca/-/media/files/research/cancer-statistics/2021-statistics/2021-pdf-en-final.pdf?rev=2b9d2be7a2d34c1dab6a01c6b0a6a32d&hash=01DE85401DBF0217F8B64F2B7DF43986&_ga=2.266788302.1118659943.1641913693-324113583.1641913693.

10.

Canadian Cancer Society (2016). Special topic: HPV-associated cancers. https://www.cancer.ca/∼/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2016-EN.pdf?la=en.

11.

Canadian Partnership Against Cancer. Action plan for the elimination of cervical cancer in Canada 2020-2030. https://s22438.pcdn.co/wp-content/uploads/2020/11/Elimination-cervical-cancer-action-plan-EN.pdf.

12.

Cerigo

Coutlée

Franco

E. L.

Brassard

(2011). Awareness and knowledge about human papillomavirus among Inuit women in Nunavik, Quebec, Journal of Community Health, 36(1), 56–62.

13.

Cerigo

Coutlée

Franco

E. L.

Brassard

(2012). Dry self-sampling versus provider-sampling of cervicovaginal specimens for human papillomavirus detection in the Inuit population of Nunavik, Quebec. Journal of Medical Screening 19(1), 42–48. https://doi.org/10.1258/jms.2012.012011

14.

Cerigo

Coutlée

Franco

E. L.

Brassard

(2013). Factors associated with cervical cancer screening uptake among Inuit women in Nunavik, Quebec, Canada. BMC Public Health, 13(1), 438.

15.

Cerigo

Macdonald

M. E

Franco

E. L.

Brassard

(2012). HPV detection by self-sampling in Nunavik, Quebec: Inuit women’s sampling preferences. Journal of Aborig Health, 8(1), 29.

16.

Cerigo

Macdonald

M. E.

Franco

E. L.

Brassard

(2012). Inuit women’s attitudes and experiences towards cervical cancer and prevention strategies in Nunavik, Quebec. International Journal of Circumpolar Health, 71, 17996.

17.

Clarke

Braun

Hayfield

(2015). Thematic analysis. In Qualitative psychology: A practical guide to research methods (pp. 222–248). Sage Publications.

18.

Daniel

Behe

(2017). Co-production of knowledge: An inuit indigenous knowledge perspective. https://ui.adsabs.harvard.edu/abs/2017AGUFM.C13H..04D.

19.

Dickinson

J. A.

Stankiewicz

Popadiuk

Pogany

Onysko

Miller

A. B.

(2012). Reduced cervical cancer incidence and mortality in Canada: National data from 1932 to 2006. BMC Public Health, 12(1), 992. https://doi.org/10.1186/1471-2458-12-992

20.

Dodd

R. H.

Whop

L. J.

Smith

M. A.

(2021). Facilitating uptake of cervical screening among indigenous women to achieve equitable and timely elimination of cervical cancer. The Lancet Regional Health – Western Pacific, 13, 100236. https://doi.org/10.1016/j.lanwpc.2021.100236

21.

Faulkner

S. L.

Trotter

S. P.

(2017). Data saturation. The International Encyclopedia of Communication Research Methods, 1–2. https://doi.org/10.1002/9781118901731.iecrm0060

22.

Fraser

S. L.

Hordyk

S.-R.

Etok

Weetaltuk

(2019). Exploring community mobilization in Northern Quebec: Motivators, challenges, and resilience in action. American Journal of Community Psychology, 64(1-2), 159–171. https://doi.org/10.1002/ajcp.12384

23.

Fraser

S. L.

Moulin

Gaulin

Thompson

(2021). On the move: Exploring Inuit and non-Inuit health service providers’ perspectives about youth, family and community participation in care in Nunavik. BMC Health Services Research, 21(1), 94. https://doi.org/10.1186/s12913-021-06058-3

24.

Government of Canada (2018). Chapter 9: Research involving the first Nations, Inuit and Métis peoples of Canada, tri-council policy statement: Ethical conduct for research involving humans – TCPS. Government of Canada. https://ethics.gc.ca/eng/tcps2-eptc2_2018_chapter9-chapitre9.html.

25.

Gray

Chan

Clark

Jordan

(2012). Modeling the integration of stakeholder knowledge in social–ecological decision-making: Benefits and limitations to knowledge diversity. Ecological Modelling, 229, 88–96. https://doi.org/10.1016/j.ecolmodel.2011.09.011

26.

Haag

Biscardi

Smith

MacGregor

Colantonio

(2019). Traumatic brain injury and intimate partner violence: Addressing knowledge and service gaps among indigenous populations in Canada. Brain Impairment, 20(2), 197–210. https://doi.org/10.1017/BrImp.2019.16

27.

Healey

(2013). Tradition and culture: An important determinant of inuit women s health. International Journal of Indigenous Health, 4(1), 25–33. https://doi.org/10.3138/ijih.v4i1.28959

28.

Healey

Tagak

(2014). PILIRIQATIGIINNIQ ‘Working in a collaborative way for the common good’: A perspective on the space where health research methodology and Inuit epistemology come together. International Journal of Critical Indigenous Studies, 7(1), 1–7. https://doi.org/10.5204/ijcis.v7i1.117

29.

Hovey

R. B.

Delormier

McComber

A. M.

Lévesque

Martin

(2017). Enhancing indigenous health promotion research through two-eyed seeing: A hermeneutic relational process. Qualitative Health Research, 27(9), 1278–1287. https://doi.org/10.1177/1049732317697948

30.

Israel

B. A.

Schulz

A. J.

Parker

E. A.

Becker

A. B.

(1998). Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173–202. https://doi.org/10.1146/annurev.publhealth.19.1.173

31.

Jagosh

Bush

P. L.

Salsberg

Macaulay

A. C.

Greenhalgh

Wong

Pluye

(2015). A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health, 15(1), 725. https://doi.org/10.1186/s12889-015-1949-1

32.

Kanatami

I. T.

(2014). Social determinants of inuit health in Canada. https://www.itk.ca/wp-content/uploads/2016/07/ITK_Social_Determinants_Report.pdf.

33.

King

Smith

Gracey

(2009). Indigenous health part 2: The underlying causes of the health gap. Lancet, 374(9683), 76–85. https://doi.org/10.1016/s0140-6736(09)60827-8

34.

Kolahdooz

Jang

S. L.

Corriveau

Gotay

Johnston

Sharma

(2014). Knowledge, attitudes, and behaviours towards cancer screening in indigenous populations: A systematic review. The Lancet Oncology, 15(11), e504–516. https://doi.org/10.1016/s1470-2045(14)70508-x

35.

Lincoln

Y. S.

Guba

E. G.

Pilotta

J. J.

(1985). Naturalistic inquiry. International Journal of Intercultural Relations, 9(4), 438–439. https://doi.org/10.1016/0147-1767(85)90062-8

36.

Louchini

Beaupré

(2008). Cancer incidence and mortality among aboriginal people living on reserves and northern villages in Quebec, 1988-2004. International Journal of Circumpolar Health, 67(5), 445–451. https://doi.org/10.3402/ijch.v67i5.18355

37.

Maar

Burchell

Little

Ogilvie

Severini

Yang

J. M.

Zehbe

(2013). A qualitative study of provider perspectives of structural barriers to cervical cancer screening among first nations women. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 23(5), e319–e325. https://doi.org/10.1016/j.whi.2013.06.005

38.

Maar

Wakewich

Wood

Severini

Little

Burchell

A. N.

Zehbe

(2016). Strategies for increasing cervical cancer screening amongst first nations communities in Northwest Ontario, Canada. Health Care Women Int, 37(4), 478–495. https://doi.org/10.1080/07399332.2014.959168

39.

Manderson

Hoban

(2006). Cervical cancer services for indigenous women: Advocacy, community-based research and policy change in Australia. Women & Health, 43(4), 69–88. https://doi.org/10.1300/J013v43n04_05

40.

Melnikow

Henderson

J. T.

Burda

B. U.

Senger

C. A.

Durbin

Weyrich

M. S.

(2018). Screening for cervical cancer with high-risk human papillomavirus testing: Updated evidence report and systematic review for the US preventive services task force. JAMA, 320(7), 687–705. https://doi.org/10.1001/jama.2018.10400

41.

Nowell

L. S.

Norris

J. M.

White

D. E.

Moules

N. J.

(2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1609406917733847. https://doi.org/10.1177/1609406917733847

42.

Nugus

Désalliers

Morales

Graves

Evans

Macaulay

A. C.

(2018). Localizing global medicine: Challenges and opportunities in cervical cancer screening in an indigenous community in ecuador. Qualitative Health Research, 28(5), 800–812. https://doi.org/10.1177/1049732317742129

43.

Nunavik Regional Board of Health and Social Services (2022). Communities: The region of Nunavik. NRBHSS. https://nrbhss.ca/en/communities.

44.

Pauktuutit Inuit Women of Canada (2006). The inuit way: A guide to inuit culture. Pauktuutit Inuit Women of Canada. https://www.relations-inuit.chaire.ulaval.ca/sites/relations-inuit.chaire.ulaval.ca/files/InuitWay_e.pdf.

45.

Pauktuutit Inuit Women of Canada (2017). Tavva: National inuit sexual health strategy. Pauktuutit Inuit Women of Canada. https://www.pauktuutit.ca/wp-content/uploads/Tavva_SexualHealth_English.pdf.

46.

Rivet

(2020). Nunavik. The Canadian Encyclopedia. https://thecanadianencyclopedia.ca/en/article/nunavik.

47.

Schiffman

Kinney

W. K.

Cheung

L. C.

Gage

J. C.

Fetterman

Poitras

N. E.

Lorey

T. S.

Wentzensen

Befano

Schussler

Katki

H. A.

Castle

P. E.

(2018). Relative performance of HPV and cytology components of cotesting in cervical screening. Journal of the National Cancer Institute, 110(5), 501–508. https://doi.org/10.1093/jnci/djx225

48.

Smith

L. T.

(2012). Decolonizing methodologies (2nd ed.). Zed Books.

49.

Statistics Canada (2016). Census of population. Statistics Canada. https://www.statcan.gc.ca/eng/start.

50.

Statistics Canada (2016). Inuit: Fact sheet for Nunavik. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/89-656-x/89-656-x2016016-eng.htm.

51.

Styffe

Tratt

Macdonald

M. E.

Brassard

(2020). HPV Self-sampling in Indigenous Communities: A Scoping Review. Journal of Immigrant and Minority Health, 22(4), 852–859.

52.

Tagalik

(2010). Inuit Qaujimajatuqangit: The role of indigenous knowledge in supporting wellness in Inuit communities in nunavut. Child & Youth Health; National Collaborating Centre for Aboriginal Health.

53.

Thomsen

L. T.

Kjær

S. K.

Munk

Frederiksen

Ørnskov

Waldstrøm

(2020). Clinical performance of human papillomavirus (HPV) testing versus cytology for cervical cancer screening: Results of a large danish implementation study. Clinical Epidemiology, 12, 203–213. https://doi.org/10.2147/CLEP.S243546

54.

Tranberg

Jensen

J. S.

Bech

B. H.

Blaakær

Svanholm

Andersen

(2018). Good concordance of HPV detection between cervico-vaginal self-samples and general practitioner-collected samples using the Cobas 4800 HPV DNA test. BMC Infectious Diseases, 18(1), 348. https://doi.org/10.1186/s12879-018-3254-y

55.

Tratt

Sarmiento

Gamelin

Nayoumealuk

Andersson

Brassard

(2020). Fuzzy cognitive mapping with Inuit women: what needs to change to improve cervical cancer screening in Nunavik, northern Quebec? BMC Health Services Research, 20(1), 529.

56.

Vasileiou

Barnett

Thorpe

Young

(2018). Characterising and justifying sample size sufficiency in interview-based studies: Systematic analysis of qualitative health research over a 15-year period. BMC Medical Research Methodology, 18(1), 148. https://doi.org/10.1186/s12874-018-0594-7

57.

Wakewich

Wood

Davey

Laframboise

Zehbe

(2016). Colonial legacy and the experience of First Nations women in cervical cancer screening: a Canadian multi-community study. Critical Public Health, 26(4), 368–380. https://doi.org/10.1080/09581596.2015.1067671

58.

Walboomers

J. M.

Jacobs

M. V.

Manos

M. M.

Bosch

F. X.

Kummer

J. A.

Shah

K. V.

Snijders

P. J.

Peto

Meijer

C. J.

Muñoz

(1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology, 189(1), 12–19. https://doi.org/10.1002/(sici)1096-9896(199909)189:1<12::Aid-path431>3.0.Co;2-f

59.

Whop

L. J.

Smith

M. A.

Butler

T. L.

Adcock

Bartholomew

Goodman

M. T.

Winer

R. L.

Milosevic

Lawton

(2021). Achieving cervical cancer elimination among indigenous women. Preventive Medicine, 144(2), 106314. https://doi.org/10.1016/j.ypmed.2020.106314

60.

Witham

Carr

Badea

Ryan

Stringer

Barreno

Groot

(2021). Sâkipakâwin: Assessing indigenous cancer supports in saskatchewan using a strength-based approach. Current Oncology, 29(1), 132–143. https://doi.org/10.3390/curroncol29010012

61.

Yeh

P. T.

Kennedy

C. E.

de Vuyst

Narasimhan

(2019). Self-sampling for human papillomavirus (HPV) testing: A systematic review and meta-analysis. BMJ Global Health, 4(3), e001351. https://doi.org/10.1136/bmjgh-2018-001351