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Table 1 Selected quotations from focus groups and individual interviews, study on HPV and cytology among rural, indigenous women in Mexico

From: Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study

Theme Subtheme Example quotation
Beliefs and knowledge about cervical cancer Correct knowledge “If you detect it in time, you can take that sickness out so it won’t progress any more and with a treatment you are fine.” (Interview with a Nahua woman)
  Incorrect knowledge “Between these two sicknesses [HPV and cervical cancer] we’re in danger, we should go to the clinic or a doctor. If we feel pain in the womb, go to a doctor.” (Focus group with Mam women)
Perceptions of and knowledge about the Human Papillomavirus (HPV) Correct knowledge [Cervical cancer is caused] “by infections, because later they become like a tumor in the womb.” (Interview with a Mam woman)
“There is a vaccine for human papillomavirus. I heard it on the radio, that there are vaccines.” (Interview with Huichol woman)
  Combined correct and incorrect knowledge “Well, as far as I know, the virus is transmitted through sexual contact. Then this human papillomavirus, it begins without any warning. Then later it progresses, then the discomfort in our parts [genitals] begins and that’s when the discharge starts and it progresses to the cervix and when it gets to the cervix it goes into the uterus and that is when the doctor sends us for an operation.” (Interview with a Nahua woman)
Perceptions, knowledge and experiences related to cytology Combined correct and incorrect knowledge “Moderator: What is cervical cancer, what do you know about cervical cancer?
Huichol woman 1: They say you can die of cancer, if you don’t detect it early.
Moderator: And how do you detect it?
Huichol woman 1: With the Papanicolaou, doing it periodically.
Moderator: And what’s periodically?
Huichol woman 1: Every three months.
Moderator: Everyone, how often do you think you need to get a Papanicolaou?
Huichol woman 2: Once a year.
Huichol woman 3: Depends on how you feel, once a year or every two years, I get it every two years.
Moderator: What do you mean, how you feel?
Huichol woman 3: If you feel burning.” (Focus group with Huichol women)
Barriers to cervical cancer screening using cytology or the HPV self-sampled test Pain and fear of unsterile equipment as a barrier “[When they did the Papanicolaou test], maybe they did it wrong. I don’t know, but I felt something like a scrape. Then I thought maybe the equipment wasn’t disinfected. … I thought about it a lot before doing it again, because I was afraid.” (Interview with a Nahua woman)
  Not receiving test results as a barrier “A lot of us say, and we’ve talked about this before, when we get a Papanicolaou, the results don’t arrive, and we don’t know what it is that’s going on. There we are with the doctor, asking why the results don’t arrive. … Whatever it [the result] is, they should give it to me.” (Interview with a Mam woman)
  Unequal gender relations as a barrier “The first time I went to check myself, with the Papanicolaou tests, I had problems. I got beat-up. My husband hit me because he said I had gone to do things with the [male] doctor. When it wasn’t even a doctor who examined me, the [female] nurse examined me! She took the sample, but at home my husband didn’t believe that.” (Interview with a Nahua woman)
  Lack of gender-related barriers “Because with all these [health education] talks they give us, women are more secure in themselves. So, we don’t really ask men for permission anymore, because it’s something that’s good for us.” (Interview with a Huichol woman)
“I decided it [to perform the HPV test] myself, alone. I don’t ask anyone’s permission. … How am I going to ask him if he [her husband] wants it or not? It’s not for him, it’s for me.” (Interview with a Nahua woman)
Perceived advantages of the self-sampled HPV test Less embarrassment “This one [the HPV test] is good because it [cytology or the Papanicolaou test] really does embarrass you, not because your husband doesn’t want it or doesn’t let us, but because it’s embarrassing and because of embarrassment we don’t do it, and so this [self-sampled HPV test] is good for us.” (Interview with a Huichol woman)
“because you do it yourself, since always, even if there is trust, you feel a little embarrassed to undress in front of someone else” (Interview with a Nahua woman)
  More comfortable “Well, this one [the self-sampled HPV test] is better, because it is more comfortable to do it.” (Interview with a Mam woman)