Health system responsiveness in cervical screening: experiences of Muslim immigrant women in Australia

Immigrant women from Muslim backgrounds experience substantial barriers to cervical screening in Australia. Guided by the health system responsiveness framework, this study explored cervical screening experiences among South Asian immigrant women from Muslim backgrounds within institutional, sociocultural and religious contexts.

Twenty-two women from India, Pakistan and Bangladesh were recruited through online chat groups and social networks. Interviews were conducted in Urdu, Hindi, Punjabi and English, and analysed thematically using an interpretive approach informed by Braun and Clarke. The responsiveness framework guided the interpretation.

Participants commonly preferred bulk-billed clinics and South Asian female GPs. Fifteen underwent cervical screening, but many had limited understanding of its purpose or recommended screening interval, and did not receive or recall receiving results. Several described consultations as rushed and procedure-focused, with limited communication and informed participation. Some participants were not offered a choice of collection method. Self-collection reduced embarrassment for some, but limited guidance created uncertainty about completing it correctly. For others, self-insertion raised modesty concerns. Perceived low HPV risk within marriage, sometimes reinforced during clinical encounters, and concerns about blame and stigma associated with sexual transmission shaped screening perception. Entrenched gendered norms and family responsibilities contributed to deprioritising screening.

Screening completion did not necessarily represent informed participation. Primary care clinicians should clearly explain screening purpose, procedure, intervals and results; provide procedural guidance and choice of collection methods; and communicate HPV risk without reinforcing stigma. These measures could strengthen health system responsiveness by supporting clear communication, autonomy, dignity and provider choice.