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Table 3 Details of included studies

From: Barriers and facilitators for cervical cancer screening among adolescents and young people: a systematic review

References; Country Study design; graded Risk of Bias Sample size; population details Average age (SD) Type of screening Barriers Facilitators
Abotchie and Shokar [20]; Ghana Cross-sectional survey; medium risk 157 university students NR (age range 20–35, most between 21 and 25) Pap smear Low knowledge, low awareness, concern regarding partner disapproval, cost, time constraints, embarrassment, perceived not susceptible, fear of virginity loss Knowledge of benefits of screening, perception of severity of disease
Agboeze et al. [21]; Nigeria (Abstract only) Cross-sectional survey; medium risk 234 female students 22 (SD 3) Pap smear Low awareness, low accessibility, fear of cancer diagnosis NR
Akujobi et al. [22]; Nigeria (Abstract only) Cross-sectional survey; medium risk 220 third and fourth year female science students 23.8 (SD NR) Pap smear Lack of knowledge, lack of awareness about importance of screening, lack of awareness about where services are attainable NR
Al-Naggar et al. [23]; Malaysia Cross-sectional survey; medium risk 287 female university students 20.9 (SD 1.89) Pap smear Fear of intimate nature of examination, HCP did not recommend/educate, lack of awareness of screening sites, cost, fear of virginity loss, embarrassment, fear of pain and discomfort NR
Al-Shaikh et al. [24]; Saudi Arabia Cross-sectional survey; medium risk 1400 students studying health fields 20.4 (SD 1.3) Pap smear Lack of awareness, perception of low sensitivity of test, misconception of serious complications of test NR
Albuquerque et al. [25]; Brazil Cross-sectional survey; medium risk 493 women,, young women (< 20) n = 64 35.4 (SD NR) Pap smear Low knowledge and awareness NR
Alwahaibi et al. [26]; Oman Cross-sectional survey; medium risk 494: 204 patients, 133 staff, 157 students NR (students all age 20–30) Pap smear Low knowledge, lack of awareness, physician gender, uncertainty of reliability of Pap smears Belief of test allowing successful prevention and treatment for cancer
Annan et al. [27]; Ghana Cross-sectional survey; medium risk 200 female university students 20.4 (SD 1.96) Unspecified NR Cervical cancer knowledge, perceived susceptibility, perceived deadliness, perceived benefits of screening
Ayinde et al. [28]; Nigeria Cross-sectional survey; medium risk 421 undergraduate students 23.6 (SD 3.6) Pap smear Lack of awareness Increased knowledge and awareness
Bigaard et al. [29]; Denmark (Abstract only) Qualitative focus groups (cross-sectional); medium risk Sample size not reported in abstract; HPV vaccinated women NR (age range 23–29) Pap smear Lack of knowledge, perceived not susceptible (test not relevant to them) NR
Binka et al. [30]; Ghana Cross-sectional survey; medium risk 410 female students NR (83% < 29 years; 17% > 30) Unspecified Lack of awareness NR
Black et al. [31]; Canada Cross-sectional focus groups; medium risk 80 women NR (98% between age 20 and 29) Pap smear Discontinuity of care from HCP after moving away for work/school, difficulty finding female HCP, fear of discomfort and invasiveness of test, lack of awareness, lack of time Reminders, email from HCP, linking testing to renewal appointment for oral contraceptives, assistance with finding HCP, longitudinal relationship with HCP or clinic, education, testing by female HCP, increased convenience (e.g. clinic on campus)
Blomberg et al. [32]; Sweden Cross-sectional focus groups; medium risk 138 women from Stockholm cervical cancer screening registry 30 (SD 0) Pap smear Fear of pain and discomfort Letter of invitation, flexibility in timing and location, choice of HCP, having test done with other exams, social marketing on importance of screening, cost-free testing
Blomberg et al. [33]; Sweden Cross-sectional focus groups; medium risk 38 women from Cervical Cancer Screening administrative registry 30 (SD 0) Pap smear Lack of knowledge, lack of awareness, perceived not susceptible Existing relationship with clinic
Byrd et al. [34]; United States Cross-sectional survey; medium risk 200 women 21 (SD NR) Pap smear Embarrassment, pain, embarrassment, fear of virginity loss, lack of awareness of where to be tested, fear of partner disapproval, misconception (only women who have had babies) need to be tested, fear of testing perceived as sexual activity NR
Duffet-Leger et al. [35]; Canada Cross-sectional survey; medium risk 1041 university students 20.7 (SD 1.77) Pap smear NR Beliefs/behaviours of friends and family, sense of empowerment about getting Pap test
Head and Cohen [36]; United States Cross-sectional individual and group interviews; medium risk 19 women NR (median age of 20) Pap smear Negative past experiences, limited choice in HCP, fear of parental disapproval, cost, low accessibility, lack of privacy in small community (e.g. running into someone they know at the clinic) Encouragement/support from mother
Hobbs [37]; United States (Abstract only) Qualitative focus groups; medium risk 15 sexually active adolescents 18.7 (SD NR) Pap smear Lack of knowledge, fear of pain, embarrassment, fear of result, fear of unknown, perceived invincibility, HCP characteristics, fear of parents finding out, cost, lack of time, transportation Education, trusting relationship with HCP, HCPs able to communicate well and put patients at ease, assured confidentiality, school programs, shorter wait times, telephone/email reminders, provision of babysitting or transportation, expanded clinic hours, having someone answer the phone when patients book appointments
Hoque [38], South Africa Questionnaire; medium risk 169 full-time undergraduate students 20.81 (SD 1.7) Pap smear Low knowledge, fear of procedure, not currently experiencing symptoms NR
Hoque [39], South Africa (Abstract only) Questionnaire; medium risk 440 university students 20.39 (SD 1.71) Pap smear Low knowledge High self-efficacy
Jayasinghe [40], Australia Online survey; medium risk 149 women 23.2 (SD 2.1) HPV DNA testing Repetitive screening frequency Public perceptions, national guidelines, gynecologist beliefs
Jubelirer [41]; United States Questionnaire; medium risk 279 tenth-grade girls 15.3 (SD NR) Pap smear Embarrassment, pain, fear of cancer, confidentiality, cost NR
Kahn [42], United States Semi-structured interview; medium risk 15 adolescents 18.7 (SD 1.9) Pap smear Pain, embarrassment, fear of cancer, denial, poor HCP relationship, low knowledge, misinformation Education, better HCP relationships, telephone and written reminders
Kahn [28], United States Questionnaire; medium risk 490 adolescents and young girls at pap smear follow-up clinics 18.2 (SD NR) Pap smear Pain, inconsistent HCP, embarrassment, lack of HFP communication, lack of time, lack of transportation Reminders, perceived control, perceived susceptibility
Kaneko [43], Japan Online survey; medium risk 700 unmarried women 26.0 (SD NR) Pap smear Male physician Free coupon for screening, perceived susceptibility
Kim [44], Korea (Abstract only) Questionnaire; medium risk 303 unmarried female university students 22.4 (SD 2.0) Pap smear Low knowledge/awareness NR
Kim [45], Korea (Abstract only) Online questionnaire; medium risk 124 unmarried university students NR Pap smear Unsure of effectiveness, low awareness Subjective norm
Langille [46], Canada Questionnaire; medium risk 1090 high school adolescents 16.6 (SD 0.1) Pap smear Lack of discussion with HCP, no physician, rural area Education from HCP
Lee [47], United States Focus group; medium risk 16 young Korean immigrant women 26 (SD NR) Pap smear Low knowledge, culture-specific barriers, low accessibility to healthcare, embarrassment, fear of virginity loss, stigma around visiting gynecologist clinic, language barriers, low health literacy NR
Lorenzi [39],Brazil Survey; medium risk 33 women with abnormal pap smears NR (aged < 29) Self-sampling Embarrassment, pain Easy to use, easy to understand, practicality
Najem [48], United States Survey; medium risk 3343 inner city high school girls NR (aged 13 and up) Pap smear HCP did not recommend, lack of awareness, cost, unaware of location, perceived not susceptible, time constraints, believed test was not accurate, embarrassment, time constraint Family role models
Ogbonna [49], United Kingdom Survey; medium risk 186 UK university students from Sub-Saharan Africa NR (majority between age 18 and 24) Pap smear Low knowledge, misconceptions (such as around circumcision), cultural barriers, stigma Perception of deadliness
Okoeki [50], United Kingdom Semi-structured interviews, focus group; medium risk 24 young women NR (age range 25–34) Pap smear Low awareness, embarassment, anxiety, association with sex, intimate, cultural barriers, fear of cancer, invasiveness Education on sensitivity, education, alternative screening methods (self-sampling)
Oshima [51], Japan Focus group; medium risk 15 university students NR (age 20–22) Pap smear Lack of knowledge,misconceptions, lack of motivation, reluctance to visit gynecologist (embarrassment, stigma, invasiveness) Media information, norms of family and friends, diagnosis within their family, education
Pan [52], China Survey; medium risk 1878 medical students 20.8 (SD 1.3) Unspecified Side effects, inadequate information, low knowledge, stigma around premarital sex High knowledge
Waller [53], United Kingdom Interview, focus group; medium risk 27 young women NR (age range between 25 and 34 for young women) Unspecified Lack of access to HCP (mobility, lack of consistency), fewer reminders, time constraints, lack of peer pressure, low perceived low perceptibility, menstrual cycle timing, low knowledge, pain, uncomfortable comments, apathy Awareness, media coverage