"Barriers beneath the surface": healthcare access and cultural beliefs affecting cervical cancer screening among egyptian women: a qualitative study.

BACKGROUND

Cervical cancer remains the fourth most common cancer among women globally, with disproportionate burden concentrated in low- and middle-income countries. In Egypt, participation in cervical cancer screening remains critically low, shaped by intersecting layers of socio-cultural belief, limited health literacy, and structural barriers in healthcare access. Despite growing quantitative evidence, the lived experiences of Egyptian women navigating these barriers remain poorly understood. This study explored the healthcare access factors and cultural beliefs affecting cervical cancer screening among Egyptian women attending a gynaecology outpatient clinic.

METHODS

A qualitative study using reflexive thematic analysis (RTA) was conducted at the gynaecology outpatient clinic of Kafrelsheikh University Hospital, Kafrelsheikh, Egypt, between October 2025 and February 2026. Purposive sampling was used to recruit 22 adult Egyptian women. Data were collected through in-depth semi-structured interviews conducted in Arabic, audio-recorded, and transcribed verbatim. Analysis followed Braun and Clarke's six-phase reflexive thematic analysis framework.

RESULTS

Four overarching themes were identified: (1) "Silenced by Stigma and Shame" - the role of taboo, modesty norms, and social censure in suppressing women's willingness to seek screening; (2) "The Body as a Site of Cultural Negotiation" - how religious beliefs, fatalistic attitudes, and patriarchal permission structures governed bodily access and health-seeking; (3) "When the System Stands in the Way" - structural healthcare barriers including cost, unavailability of female providers, and limited facility infrastructure; and (4) "Navigating Between Fear and Faith" - the psychological tension between fear of cancer diagnosis and religious reliance on divine will.

CONCLUSIONS

Cervical cancer screening avoidance among Egyptian women is rooted in a complex convergence of cultural norms, patriarchal structures, religious fatalism, and systemic healthcare inadequacies. Culturally sensitive interventions, nurse-led outreach, and expanded access to female healthcare providers are urgently needed. Community health nurses are positioned as a critical bridge between women's health needs and culturally acceptable care.