Looking Beyond Knowledge and Accessibility-Exploring Barriers and Facilitators for Cervical Cancer Screening Services among Tribal Women in Tea Gardens of Darjeeling, West Bengal

Introduction: Despite efforts to motivate all reproductive age women to avail cervical cancer screening services, many still do not utilise them. Most researchers have universally identified barriers like the lack of knowledge and lack of accessibility as the reason for not availing services. However, additional barriers also prevent women from making use of these screening services. Aim: To explore the barriers to and facilitating factors for cervical cancer screening beyond the lack of knowledge and accessibility of services. Materials and Methods: This qualitative research was conducted among tribal women residing in the Kiranchandra Tea Estate and Atal Tea Estate (two tea gardens in the rural Naxalbari Block) West Bengal, India, from July 2018 to February 2019. Women aged 30-59 years, living in the garden for at least the last 5 years, not suffering from obstetrics/gynaecological disease during last two years and willing to participate in the study were included, based on a purposive sampling method. Information Education Campaign (IEC) on cervical cancer and screening were undertaken and screening services arranged in the gardens on garden holidays for two consecutive weeks. Four (4) Focus Group Discussion (FGDs) in each garden were conducted, with each FGD consisting of 5 to 6 participants (N=49). Data obtained was recorded and logged with the participants' permission and consent. A manifest content analysis was used to explore the perceived barriers and facilitators of cervical screening. Results: The major barriers identified were lack of support, burden of responsibility and the lack of felt need. The facilitators found most frequently were provision of information, social motivation, easy accessibility and affordability of screening services. Conclusion: This study revealed that there are various actual and perceived barriers to cervical cancer screening among tribal women in tea garden areas. Even after imparting knowledge and increasing availably and accessibility of a free program, familial support, burden of responsibility and lack of felt needs hinder increased uptake of the services.