Access to health services: A qualitative study on women's access to breast and cervical cancer screening services

Breast cancer is the leading cause of cancer-related fatalities in women, followed by cervical cancer. Breast cancer is the second leading cause of cancer-related deaths globally, and cervical cancer is the seventh. As a crucial public health measure, several nations have cancer screening programs to lower the mortality and morbidity linked to certain cancer forms. The keen interest of women to have screening, however, has a significant impact on the success of screening programs. In this setting, researchers' attention has recently turned to access to breast and cervical cancer screening programs as one of the key challenges. This qualitative thesis seeks to examine how women perceive the barriers to and facilitators of access to services for breast and cervical cancer screening. The study was conducted using a basic qualitative research design. Individual interviews were conducted with 19 women attending a primary healthcare center and six women attending a Cancer Early Detection, Screening, and Education Center in Trabzon province. A semi-structured interview form was developed based on the conceptual framework and literature and used for the interviews. After obtaining the participant's consent, the interviews were recorded using an audio recording device and transcribed verbatim. The obtained texts were analyzed using NVivo 12 qualitative analysis software, applying content analysis to identify themes, categories, and codes. Within the scope of the study, the resulting model was categorized into six themes and 24 subcategories. The themes included "individual characteristics," "service delivery system," "psychological characteristics," "environmental and sociocultural factors," "geographical characteristics," and "health policy," representing women's perspectives on factors that either hinder or facilitate their access to breast and uterine cancer screening services. Under the theme of individual characteristics, women generally expressed not feeling the need for screening due to the absence of perceived risks. Within the service delivery system theme, women shared their views on factors such as waiting times and behaviors of healthcare providers which generally hindered their access to screening. Under the theme of psychological characteristics, most women expressed their fears and anxieties before, during, and after the screening process. Regarding environmental and sociocultural factors, women commonly mentioned the gender of service providers; geographic characteristics encompassed the aspects of distance and transportation, while health policy referred to issues of funding and health education hindering and facilitating access to screening services. In conclusion, the findings of this study demonstrated similarities and differences compared to existing research in the literature. Some of the significant findings specific to this study included women's misconceptions about cancer and screening services, gynecological table fear arising from negative childbirth experiences, and the difficulty in accessing screening services for women, especially in rural areas, due to seasonal migration during the summer and increased agricultural activities. Therefore, it is recommended that researchers conduct further studies in different contexts, and policymakers make improvements concerning funding, education, workforce, supply, and personnel training.