Attitudes to and use of contraception and cervical cytology services amongst Asian women.

Four inter-related studies are described which examine a sensitive and little-researched area - contraceptive and cervical cytology services for Asian women. The first is a questionnaire study of 501 women assessing their contraceptive knowledge, attitudes and usage, and their views on several related topics, including contraceptive and cervical cytology services. The second involves a national survey of 138 Health Education Units seeking information on the provision and uptake of contraceptive and cervical cytology services for Asian women, and on the availability of relevant health education materials. The third compares the effects of different health education interventions with specially developed Asian language materials upon the uptake of cervical cytology amongst 737 women who have never had cervical smears, and also looks at the women's reasons for non-attendance and their health concerns. The final study attempts to assess the relative risks of cervical dysplasia and neoplasia amongst Leicestershire's Asians and non-Asians and compares 73 Asians who have undergone colposcopy with age-matched non-Asians. There is strong approval for (83%) and high usage of (70%) contraception, especially the intra-uterine contraceptive device (33% of users). In general there is satisfaction with the available contraceptive services (73%), but the uptake of cervical cytology (32%) is only half that of the indigenous population. Nationally little is known about uptake of such services by Asians and only a limited amount of health education materials are provided. Personal intervention with a video or leaflet is effective (42% of respondents subsequently had cervical smears) but written, translated materials by post are not (11%). Home-viewed videos may be particularly effective in hard-to-reach groups. The mains reasons for non-attendance are lack of knowledge or information (41%) and fears (36%). The commonest health concern is racial harassment (66%). Abnormal results of cervical smears are less common amongst Asians than non-Asians but the annual incidence is increasing in both groups. Older Asian women are more likely to present with suspicious symptoms and have invasive cancer on biopsy than non-Asians. The studies provide a model to demonstrate how services can be developed on the basis of findings from locally-organised research and have resulted in national distribution of study materials. Recommendations made include the need to attract female general practitioners to inner city areas, the need for further research in other centres to provide comparative data, and the introduction of programmes to assess local needs and consequent provision of services.