Background: Cervical cancer is the second cause of cancer related mortality for Filipino women. Mortality rates of cervical cancer are high amongst Filipino women; however, uptake of cervical cancer screening (e.g., pap-testing) is low. In 2015, 2.34 million overseas Filipino workers (OFW) were recorded. Migration may present additional barriers to accessing pap-testing. Gaining understanding of barriers and facilitators to pap-testing for OFWs is crucial to improve uptake of pap-testing.

Methods: An explanatory sequential mixed-methods research design was adopted comprising two phases, a web-based cross-sectional survey (N=480), followed by web-based qualitative interviews (N=8). A socio-ecological conceptual framework was used to explore barriers and pap-test uptake. Bivariate and multivariate logistic regression analyses were used to assess key determinants of pap-testing. Qualitative results were analysed using thematic content analysis.

Results: The sample included 480 OFWs (59.3% domestic workers) living and working in 28 different countries (mean age 36.69, age range 23-58). The largest proportion of women who participated lived in Hong Kong (24.4%). Nearly all (96.4%) of OFWs were aware of pap-testing but less than half (43.5%) had ever engaged in pap-testing. Statistically significant predictors of pap testing were: marital status; fear of outcome of pap-test; having sufficient time; recommendation from health care provider; and collectivism values. Exploration of results through interviews, revealed additional findings and social and structural contexts not conducive to pap-testing, including poverty and the overriding need to provide financially for family.

Conclusion: This study demonstrated the complexity and multifactorial characteristics of pap-testing following the socio-ecological framework. For OFWs, individual, social-cultural, and institutional barriers to pap-testing were embedded in structural barriers, resulting in health inequalities. Recommendations targeted at multiple levels offer the potential for further understanding and the development of culturally appropriate interventions, with the ultimate aim of increasing OFWs’ uptake of pap-testing.