Exploring factors influencing the decision-making regarding cervical cancer screening participation and HPV vaccination uptake among Syrian-Dutch women: a qualitative interview study

Background In the Netherlands, a free of charge national cervical cancer (CC) screening program is available for women aged 30 to 60 years. Participation rates in the CC screening programme are lower among women with a migration background compared to the general population, as shown for the Turkish- and Moroccan-Dutch women. However, specific data on Syrian-Dutch women is lacking. It is unclear how Syrian-Dutch women make decisions regarding participating in CC screening and HPV vaccination in the Dutch context. This study aims to explore how and why Syrian-Dutch women decide to participate in the Dutch national CC screening program and whether to vaccinate their children against HPV. Methods Twelve semi-structured interviews were held with Syrian-Dutch women aged 30–60 or having a daughter between 9–26 years, between March and July 2023. The interview guide was based on the Health Belief Model, the Reasoned Action Approach, and Betancourt's Model of Culture and Behaviour. The interviews were audio recorded, transcribed verbatim and thematically analysed. Results Overall, participants had a positive attitude towards CC screening and HPV vaccination. Participants indicated barriers for participation like a lack of knowledge about HPV, misconceptions about CC, safety concerns about the HPV vaccination, shame, fear, and practical obstacles including language and procedural anxiety. However, participation of CC screening and HPV-vaccination was facilitated by advantages of early detection, self-testing, protection of health, and trust in the government. Conclusion This study provides insights into the factors that influence the decision-making to participate in CC prevention programs among Syrian-Dutch women. These factors highlight the importance of addressing awareness and cultural and social factors to overcome the barriers Syrian-Dutch women experience. Future initiatives should develop accessible and culturally relevant tailored interventions that address these barriers to improve decision-making and participation in CC prevention programs.