Cervical screening in Canada, 2023-24

Strategies to engage equity-denied populations

Methods to identify equity-denied populations or communities include leveraging geospatial mapping, surveys, and engagement with specific communities. Engagement strategies include developing educational materials and campaigns, holding focus groups, and ongoing relationship building.

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Community engagement strategies used with equity-denied populations or communities

P/T Specific community engagement strategies each jurisdiction has used with equity-denied populations or communities
YT –
NT –
NU –
BC Focusing on building relationships with community champions and delivering targeted education/awareness campaigns
AB
  • Focus groups are used to engage colposcopy patients to develop virtual educational materials
  • Collaboration with patient advisory committee helps to understand screening needs of the LGBTQ2S+ population
SK
  • Delivering cervical screening clinics targeted towards under-screened/never screened, at-risk populations (people with low income, people without a PCP, recent immigrants and refugees, and racial or ethnic minorities). On-site support includes Indigenous Elders, clinicians with expertise in STI counselling and support, healthcare providers administering the Pap test, and gynecologists for consultation and diagnostic testing
  • Healthcare providers deliver cervical health education to all clients
  • Conducting participant surveys to gain information and feedback from these populations
MB
  • Cross-screening program (breast, colon, cervix) awareness
  • Cancer prevention messaging, education, and promotion (social media, awareness campaigns)
  • Extensive website with Pap clinic maps
  • CervixCheck partnered with community engagement liaisons in each regional health authority in the province to provide resources for group education
  • Competency training for cervical screening providers working in First Nation communities
  • Regular education sessions with federally and provincially funded healthcare providers and community-led groups
  • Partnered with various underserved communities (including First Nations, Métis, transgender, women affected by female genital cutting, and ethnic groups) in planning the HPV Self-Sample Project to:
    • Understand how they wanted to distribute kits within their community
    • Provide education session on cervical cancer screening, eligibility, kit contents, kit instructions, and frequently asked questions
    • Provide kits for the community by hand-out or by CervixCheck mail-out
    • Advise on how results were processed and educate on necessary follow-up
  • Conducted a debrief session with each group at end of the project.
ON The Ontario Cervical Screening Program (OCSP) uses mailed letters to invite, recall and remind eligible individuals who are due for cervical screening and to communicate screening test results. As part of a correspondence redesign to support HPV testing implementation, people were recruited to participate in testing of the new letters from key under-screened populations (i.e., Indigenous people, those with lower levels of achieved education) and different categories of age, immigrant status, cervical screening history, gender identity and sexual orientation. A French focus group was also conducted with five Francophone screen-eligible participants to obtain feedback on a subset of future state correspondence letters and to validate the clarity and acceptability of the translation. Focus group participants provided valuable feedback resulting in several updates that improved the overall clarity of the French letters.
QC –
NB
  • First Nations community health clinics/events focus on building relationships with community champions, and delivering targeted education (presentation or information booths) upon invitation
  • To engage with gender-diverse population, program staff are completing online training. The content of cervical program materials and guidelines is being updated to better reflect gender inclusivity
NS Collaborating with Mi’kmaq First Nations, Nova Scotians of African descent, and new immigrant populations
PE
  • The cancer screening team together with a consultant team have utilized focus groups and key stakeholder interviews to collect and analyze data. A study conducted between February and March 2023 focused on addressing questions related to cancer screening in PEI
  • To ensure that the consultant team had a diverse range of perspectives, experiences, and opinions, a consultant team reached out to community members and representatives from organizations working directly with Indigenous communities. The consultant team invited interested individuals to participate in one-on-one interviews or small-group discussion
  • The two main topics addressed were awareness and understanding of cancer screening (including cervical cancer screening), and accessibility and participation in cancer screening
NL
  • Collaboration with PCPs, regional networks, and community groups to share data, provide education and promote program participation, as well as participation in the access-to-service grant program
  • Inclusion in orientation programs province-wide for new healthcare professionals through the Better Program and provincial collaborative clinics

Strategies to improve screening participation through understanding and addressing barriers

P/T Strategies used with equity-denied populations or communities to identify and reduce barriers to screening participation
YT –
NT –
NU –
BC –
AB Committees and focus groups are used to identify barriers to screening on a regular basis. Strategies to reduce barriers are issue dependent (e.g., animated video series in different languages to promote and educate about cancer screening). Due to human resource constraints, access to healthcare providers continues to be an issue, not just for equity-deserving populations, but also for cancer screening as a whole.
SK Pap clinics targeted (but not exclusively) towards high-risk populations address the following barriers: lack of healthcare provider, fear of cancer, lack of culturally appropriate screening, and difficulty accessing the healthcare system.
MB
  • Screening programs actively promote access to interpreter services for most public-facing communications. Cancer screening education module was created with and for educators with low literacy. All resources are translated into English and French and are focus-tested with PCPs and public advisory groups before distribution.
  • Pap clinic promotion for people without a PCP. Pap test clinics report four accessibility features: Hoyer lift, attendants on site, height-adjustable exam table, and wheelchair accessibility.
ON
  • The Ontario Cervical Screening Program (OCSP) has recruited people to participate in testing of new correspondence letters from key under-screened populations (i.e., Indigenous people, those with lower levels of achieved education) and different categories of age, immigrant status, cervical screening history, gender identity and sexual orientation. Several program resources, such as our public-facing web pages, have been updated to use inclusive and gender-neutral language. Correspondence letters will be updated to use inclusive and gender-neutral language (e.g., referring to “people with a cervix” as opposed to “women”) when the OCSP implements HPV testing.
  • Mobile coaches in two Regional Cancer Programs, North West and Hamilton Niagara Haldimand Brant, provide screening services to people who do not have a primary care provider or face barriers accessing existing screening services (due to transportation or other barriers).
  • Many regions have done work to train community ambassadors to address awareness and knowledge, as well as language and cultural barriers. Some regions offer Pap clinics for people without a primary care provider.
  • In addition to English and French, cervical screening awareness materials are now available in 23 languages.
  • The Screening Activity Report (SAR) is an online report, which provides screening data to help family doctors improve their cancer screening rates and appropriate follow-up. The report allows family doctors to quickly find specific cancer screening information for each patient, including those who are overdue or have never been screened.
QC Currently working on implementing a Quebec-wide medical directive and collective prescription for participants with no family physician via primary care access points.
NB
  • Individuals without a regular healthcare provider can call the Cancer Screening Line or visit the website to find available local clinics offering Pap screening services. In cases where no clinics are available, participants can register with NB Health Link or they can escalate their concerns with regional health authorities (RHAs).
  • The program has on-the-phone interpreter services available for those with language barriers. Staff is fluent in both French and English.
  • The cervical program has clinical practice guidelines for those without a screening recommendation from a healthcare provider. The program regularly communicates with health providers on program updates to activities and recommendations, and sends program letters to providers in cases where screening is overdue.
  • For those experiencing difficulty accessing the healthcare system, NB Cancer Screening Line receives and handles inquiries regarding access to screening services. In cases where no clinics are available, participants can register with NB Health Link or they can escalate their concerns with the RHAs.
  • NB Cancer Screening Line is available to respond to calls from individuals, including those with low health literacy.
  • Recent immigrants and refugees with federally issued health cards are invited to participate in program.
  • To address barriers to screening for gender-diverse people, program staff are completing online training and screening program content is being updated. Program materials and guidelines will better reflect gender inclusivity.
NS Nova Scotia is offering education sessions to reduce barriers to screening.
PE To reduce barriers to screening, PE is holding focus groups and interviewing key stakeholders.
NL The Cervical Cancer Screening Initiatives Program seeks to work with community groups and organizations to reduce barriers to all cancer screening. The program seeks opportunities to collaborate on the importance of and access to all cancer screening services in the province. Specific strategies include access to service grants, healthcare education and orientation sessions, social media ads, and public presentations. Cancer screening programs are also proposing that a nurse practitioner can help in service delivery for clients who do not have a primary healthcare provider.

-No information was provided at the time data were collected.

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