To the Editor: We describe our experience of using community consultative strategies at a family planning clinic in Dubbo, central-west New South Wales, to increase recruitment of Indigenous women to a human papillomavirus (HPV) prevalence study — WHINURS (Women, Human papillomavirus, Indigenous, Non-Indigenous, Urban, Rural Study).1 The strategies also resulted in a sustained increase in the number of Indigenous women attending the clinic for cervical screening.
The Family Planning NSW research team committed to recruit 50 Indigenous and 100 non-Indigenous women from January 2006 to WHINURS. The researchers worked collaboratively with, among others, the National Indigenous Immunisation Coordinator of the National Centre for Immunisation Research and Surveillance and the Dubbo Aboriginal Women’s Advisory Group. The study was approved by the Aboriginal Health and Medical Research Council of NSW Ethics Committee. Non-Indigenous women were recruited within a few months but, despite the clinic team’s efforts, only one Indigenous woman was recruited over 12 months.
Strategies to increase recruitment were then developed with input from one of us (C J O, a Wiradjuri Health Promotion Officer). Key strategies included street walks with a family planning nurse in Dubbo’s main street, attendance at community forums (including mothers’ groups and playgroups), and provision of drop-in clinics and transport assistance. As a result, an additional 42 Indigenous women aged 18–40 years were recruited between January and April 2007 for HPV and Pap tests.
There are many barriers to Indigenous women participating in cervical screening programs.2,3 An added benefit of our recruitment approach was that the number of Indigenous women attending the clinic for Pap tests increased from 29 in 2006 to 81 in 2007, suggesting that the strategies had a sustained effect on cervical screening rates.
The involvement of a respected and trusted Wiradjuri woman (C J O), known in the region as an advocate for Indigenous women’s health, appeared critical to the success of the recruitment intervention. The street walks and community visits with family planning nurses were a strategy to ensure that Indigenous women who are “very skilled at observing people and reading the unspoken word” felt safe and comfortable about undergoing the sensitive examination (C J O). The women were able to discuss their fear of finding an abnormality and balance this against their desire to do the right thing by their children by having a health check.
Given that the age-standardised mortality rate for cervical cancer from 2001 to 2004 was 4.7 times higher for Indigenous women than for non-Indigenous women,4 we suggest that lessons learned from our study could help facilitate continued participation of Indigenous women in the national cervical screening program.
- 1. Garland SM, Brotherton J, Condon J, et al. Human papillomavirus genotype prevalence in Australian women (Indigenous, non-Indigenous, urban, rural populations). International Papillomavirus Conference; 2007 Nov 3-9; Beijing, China.
- 2. Carey M. The RACGP Aboriginal and Torres Strait Islander women’s project: evaluation report, January 2003. Melbourne: Royal Australian College of General Practitioners, 2003. http://www.racgp.org.au/Content/NavigationMenu/Advocacy/AboriginalandTorresStraitIslanderHealth/Projectreports/20030514womensproject.pdf (accessed Feb 2008).
- 3. Hunt JM, Geia LK. Can we better meet the healthcare needs of Aboriginal and Torres Strait Islander women [editorial]? Med J Aust 2002; 177: 533-534. <MJA full text>
- 4. Australian Institute of Health and Welfare. Cervical screening in Australia 2004–2005. Canberra: AIHW, 2007: 28-33. (Cancer Series No. 38, AIHW Cat. No. CAN 33.) http://www.aihw.gov.au/publications/can/csa04-05/csa04-05.pdf (accessed Dec 2007).
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