Promoting health by empowering women, strengthening partnerships, and enhancing health care systems: one Pap test at a time.

Invasive cervical cancer, a highly preventable disease, is the thirteenth most common form of cancer among Canadian women and third amongst those women 20 to 40 years of age (Public Health Agency of Canada [PHAC], 2009). Health care providers (HCP)s know that adherence to the Canadian recommendations for regular screening, using the Pap test, reduces incidence and mortality rates (Marcus & Crane, 1998). Yet, only 30% of women in Newfoundland and Labrador consistently participate in cervical screening (Newfoundland and Labrador CHI, 2006) and mortality rates are alarming. The most recent data reveal that the incidence in 1998 was 1.5 times the national average (Health Canada, 1998) while mortality was estimated at 2.5 times the national average (NLCHI, 2006). A two-phased study conducted in Newfoundland and Labrador sought an in-depth understanding of women's perceptions, beliefs and attitudes associated with cervical cancer screening, reasons for non-participation, and personal insights to improve the screening experience. Seven main themes are identified: physical factors, emotional factors, life gets in the way, lack of education, health care providers, cultural impact, and birth control/pregnancy. Implications for nursing practice and future research are discussed.