CERVICAL CYTOLOGY SCREENING - HOW CAN WE IMPROVE RATES AMONG FIRST NATIONS WOMEN IN URBAN BRITISH-COLUMBIA

OBJECTIVE To determine Pap smear screening rates among urban First Nat ions women in British Columbia; to identify facilitators and barriers; and to develop, implement, and evaluate specific interventions to imp rove Pap smear screening in Vancouver. DESIGN Computer records of band membership lists and the Cervical Cytology Screening Program registry were compared to determine screening rates; personal interviews and c ommunity meetings identified facilitators and barriers to urban screen ing programs. A community advisory committee and the project team coll aborated on developing specific interventions. SETTING AND PARTICIPANT S Purposive sample of British Columbia First Nations women, focusing o n women Living in Vancouver. INTERVENTIONS Poster, art card, and follo w-up pamphlet campaign; articles in First Nations community papers com munity meetings; and Pap smear screening clinics for First Nations wom en. MAIN OUTCOME MEASURES Pap smear screening rates among BC First Nat ions women according to residence and reasons for not receiving Pap sm ears. RESULTS Pap smear screening rates were substantially lower among First Nations women than among other British Columbia women; older wo men had even lower rates. No clear differences were found among First Nations women residing on reserves, residing in Vancouver, or residing off reserves elsewhere in British Columbia. Facilitators and barriers to screening were similar among women residing on reserves and in Van couver. Many First Nations women are greatly affected by health care p roviders' attitudes, abilities to provide clear information, and abili ties to establish trusting relationships. CONCLUSIONS Family physician s are an important source of information and motivation for Pap smear screening among First Nations women.