{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:42:30Z","timestamp":1792255350296,"version":"4.4.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical cancer remains the fourth most common cancer among women globally, with disproportionate burden concentrated in low- and middle-income countries. In Egypt, participation in cervical cancer screening remains critically low, shaped by intersecting layers of socio-cultural belief, limited health literacy, and structural barriers in healthcare access. Despite growing quantitative evidence, the lived experiences of Egyptian women navigating these barriers remain poorly understood. This study explored the healthcare access factors and cultural beliefs affecting cervical cancer screening among Egyptian women attending a gynaecology outpatient clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative study using reflexive thematic analysis (RTA) was conducted at the gynaecology outpatient clinic of Kafrelsheikh University Hospital, Kafrelsheikh, Egypt, between October 2025 and February 2026. Purposive sampling was used to recruit 22 adult Egyptian women. Data were collected through in-depth semi-structured interviews conducted in Arabic, audio-recorded, and transcribed verbatim. Analysis followed Braun and Clarke\u2019s six-phase reflexive thematic analysis framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four overarching themes were identified: (1) \u201cSilenced by Stigma and Shame\u201d \u2014 the role of taboo, modesty norms, and social censure in suppressing women\u2019s willingness to seek screening; (2) \u201cThe Body as a Site of Cultural Negotiation\u201d \u2014 how religious beliefs, fatalistic attitudes, and patriarchal permission structures governed bodily access and health-seeking; (3) \u201cWhen the System Stands in the Way\u201d \u2014 structural healthcare barriers including cost, unavailability of female providers, and limited facility infrastructure; and (4) \u201cNavigating Between Fear and Faith\u201d \u2014 the psychological tension between fear of cancer diagnosis and religious reliance on divine will.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cervical cancer screening avoidance among Egyptian women is rooted in a complex convergence of cultural norms, patriarchal structures, religious fatalism, and systemic healthcare inadequacies. Culturally sensitive interventions, nurse-led outreach, and expanded access to female healthcare providers are urgently needed. Community health nurses are positioned as a critical bridge between women\u2019s health needs and culturally acceptable care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12905-026-04911-3","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:05:14Z","timestamp":1792224314000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cBarriers beneath the surface\u201d: healthcare access and cultural beliefs affecting cervical cancer screening among egyptian women: a qualitative study"],"prefix":"10.1186","volume":"26","author":[{"given":"Marwa Mamdouh","family":"Shaban","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nermen Abdelfatah","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Shaban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"issue":"3","key":"4911_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229\u201363. https:\/\/doi.org\/10.3322\/caac.21834.","journal-title":"CA Cancer J Clin"},{"key":"4911_CR2","unstructured":"World Health Organization. Cervical Cancer: Fact Sheet. Geneva: WHO. 2024. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cervical-cancer."},{"issue":"1","key":"4911_CR3","doi-asserted-by":"publisher","first-page":"2432","DOI":"10.1186\/s12889-025-23532-3","volume":"25","author":"S Mohammadi","year":"2025","unstructured":"Mohammadi S, Lotfi Z, Ardakani SMY, Salehnia N, Rafiei S. Barriers and facilitators to cervical cancer screening in the Eastern Mediterranean Region: a systematic review. BMC Public Health. 2025;25(1):2432. https:\/\/doi.org\/10.1186\/s12889-025-23532-3.","journal-title":"BMC Public Health"},{"issue":"1","key":"4911_CR4","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1186\/s12885-025-13530-4","volume":"25","author":"MB Behery","year":"2025","unstructured":"Behery MB, Bahbah AA, Shawqi MM, El-Said YM, Sherif LN, Ataallah HA, et al. Knowledge, attitude, and practice towards uterine cervical cancer screening in Egyptian females: a nationwide cross-sectional study. BMC Cancer. 2025;25(1):273. https:\/\/doi.org\/10.1186\/s12885-025-13530-4.","journal-title":"BMC Cancer"},{"key":"4911_CR5","volume-title":"Cancer Today. Egypt fact sheet: GLOBOCAN 2022","author":"International Agency for Research on Cancer. Global Cancer Observatory","year":"2024","unstructured":"International Agency for Research on Cancer. Global Cancer Observatory. Cancer Today. Egypt fact sheet: GLOBOCAN 2022. Lyon, France: International Agency for Research on Cancer; 2024."},{"issue":"5","key":"4911_CR6","doi-asserted-by":"publisher","first-page":"100224","DOI":"10.1016\/j.apjon.2023.100224","volume":"10","author":"WKW So","year":"2023","unstructured":"So WKW, Cummings GG, Ayala de Calvo LE, Cheng KKF, Devi MK, Fernandez RS, et al. Roles and activities of nurses in cancer prevention and early detection in low- and middle-income countries: a scoping review. Asia Pac J Oncol Nurs. 2023;10(5):100224. https:\/\/doi.org\/10.1016\/j.apjon.2023.100224.","journal-title":"Asia Pac J Oncol Nurs"},{"issue":"1","key":"4911_CR7","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1186\/s12889-025-24004-4","volume":"25","author":"MM Abu-Elenin","year":"2025","unstructured":"Abu-Elenin MM, Shahin MA, Abdeldaim DE. Preventive insights and practices of female health professionals regarding cervical cell dysplasia: a cross-sectional study in Egypt. BMC Public Health. 2025;25(1):1647. https:\/\/doi.org\/10.1186\/s12889-025-24004-4.","journal-title":"BMC Public Health"},{"key":"4911_CR8","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12905-015-0252-8","volume":"15","author":"S Khan","year":"2015","unstructured":"Khan S, Woolhead G. Perspectives on cervical cancer screening among educated Muslim women in Dubai (the UAE): a qualitative study. BMC Womens Health. 2015;15:90. https:\/\/doi.org\/10.1186\/s12905-015-0252-8.","journal-title":"BMC Womens Health"},{"issue":"5","key":"4911_CR9","doi-asserted-by":"publisher","first-page":"3453","DOI":"10.1007\/s10943-023-01886-5","volume":"62","author":"A Namoos","year":"2023","unstructured":"Namoos A, Sheppard V, Abdelkarim M, Abosamak N, Ramadan R, Albayati A, et al. Exploring factors influencing cervical cancer prevention behaviors: unveiling perspectives of conservative Muslim American women in Virginia. 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Qual Health Res. 2016;26(13):1753\u201360. https:\/\/doi.org\/10.1177\/1049732315617444.","journal-title":"Qual Health Res"},{"issue":"20","key":"4911_CR14","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","volume":"310","author":"World Medical Association","year":"2013","unstructured":"World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u20134. https:\/\/doi.org\/10.1001\/jama.2013.281053.","journal-title":"JAMA"},{"issue":"5","key":"4911_CR15","doi-asserted-by":"publisher","first-page":"e058739","DOI":"10.1136\/bmjopen-2021-058739","volume":"12","author":"F Christie-de Jong","year":"2022","unstructured":"Christie-de Jong F, Kotzur M, Amiri R, Ling J, Mooney JD, Robb KA. Qualitative evaluation of a co-designed faith-based intervention for Muslim women in Scotland to encourage uptake of breast, colorectal and cervical cancer screening. 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The study was conducted in accordance with the Declaration of Helsinki [\n                      \n                      ]. Written informed consent was obtained from all participants.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"531"}}