Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review

Background: Cervical cancer (CC) is the second most common female cancer. In Indonesia, national CC screening coverage is low at 12, highlighting the need to investigate facilitators and barriers to screening. Objective: This review synthesises research on facilitators and barriers to the delivery and uptake of CC screening; analyses them in terms of supply- and demand-side factors and their interconnectedness; and proposes recommendations for further research. Methods: Medline Ovid, CINAHL, Global Health, Neliti, SINTA and Google Scholar were searched, applying a search string with keywords relevant to screening, CC and Indonesia. In total 34 records were included, all were publications on CC screening in Indonesia (2000-2020) in English or Indonesian. Records were analysed to identify findings relevant to the categories of barriers and facilitators, supply-and demand-side factors. Results: Demand-side facilitators identified included: husband, family or social/peer support (14 studies); information availability, knowledge and awareness (12 studies); positive attitudes and strong perception of screening benefit and the seriousness of CC (12 studies); higher education and socioeconomic status (11 studies); having health insurance; and short distance to screening services (4 studies). Evidence on supply-side was limited. Supply-side facilitators included counselling and support (6 studies), and ease of access (6 studies). Demand-side barriers identified focused on: lack of knowledge/awareness and lack of confidence in screening (14 studies); fear, fatalism and shame (10 studies); time and transportation constraints (8 studies); and lack of husband approval and support (6 studies). Supply-side barriers included: lack of skilled screening providers (3 studies); lack of advocacy and health promotion (3 studies); resource constraints (3 studies); and lack of supervision and support for health care providers (3 studies). Conclusions: Facilitators and barriers were mirrored in the supply- and demand-side findings. The geographical scope and population diversity of existing research is limited and further supply-side research is urgently needed. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.