The significance of the research lies in the population it centers. Sexual and gender-diverse women in Canada, including those who identify as Two Spirit, lesbian, bisexual, queer, transgender, or otherwise outside cisgender and heterosexual norms, experience documented disparities in health outcomes. These disparities are driven in large part by barriers to accessing care that is both clinically appropriate and culturally affirming. When mainstream healthcare fails these patients, whether through discrimination, lack of provider knowledge, or inflexible service models, community organizations step into the void, delivering services that range from gender-affirming care navigation to mental health support and sexual and reproductive health education. Until now, the requirements for developing and supporting this health promotion capacity among community agencies have remained largely unexamined in the health services literature.

To fill that gap, the research team conducted a qualitative descriptive study built around virtual semi-structured interviews with ten community-based staff members drawn from six Canadian provinces. Participants were purposively recruited through 2SLGBTQ+ networks, social media, and community outreach, a strategy designed to capture the perspectives of those directly embedded in service delivery rather than institutional spokespersons. The cohort reflected the diversity of roles that sustain these organizations: five health promoters, two executive directors, one therapist, one nurse practitioner, and one program coordinator, working at various career stages. Data collection took place between August and October 2024 through Zoom interviews that were audio-recorded and transcribed verbatim.

The analytical approach was methodologically rigorous. The team used NVivo 15 software to support systematic coding of the transcripts and developed themes through an iterative, consensus-driven process consistent with inductive thematic analysis. The study followed the Standards for Reporting Qualitative Research, and ethical approval was granted by the Toronto Metropolitan University Research Ethics Board under reference 2023-472, with online electronic informed consent obtained from all participants prior to participation. This level of procedural transparency matters, because qualitative findings in a politically sensitive field are only as credible as the methods behind them, and this study anchors its conclusions in a clearly documented and reproducible analytic chain.

Three overarching themes emerged from the interviews. The first concerned participants’ experiences delivering care, and it revealed the breadth of services these organizations provide. Staff emphasized the importance of delivering essential health services that include gender-affirming care, mental health support, and sexual and reproductive health education, all framed within culturally and linguistically appropriate models. In practice, this means adapting materials and encounters to the identities, languages, and lived realities of the women they serve, rather than expecting patients to conform to standardized clinical scripts. The findings underscore that cultural and linguistic appropriateness is not an optional enhancement but a core precondition for these services to work at all.

The second theme mapped the structural architecture that makes such service delivery possible. Participants identified leadership development, inter-agency partnerships, and attention to the social determinants of health as crucial components of organizational capacity. In other words, community organizations do not operate as isolated islands of care. They depend on leaders who can shepherd teams through uncertainty, on formal and informal partnerships with other agencies that extend their reach, and on programs that address the housing, income, and social conditions that shape health long before anyone walks through a clinic door. This systems-level view challenges the common caricature of community organizations as makeshift substitutes for real healthcare and reframes them as integrated nodes in a wider health promotion network.

The third theme catalogued the barriers, and it is here that the study is most sobering. Participants described inadequate and unstable funding as a chronic condition that undermines planning, retention, and service continuity. They reported shortages of trained providers, a lack of formal integration with the broader healthcare system, information gaps, language barriers, long healthcare waitlists, and persistent discrimination against the population they serve. Each of these barriers interacts with the others: unstable funding worsens workforce shortages, weak integration leaves community staff without referral pathways into hospitals and specialized care, and discrimination at the system level drives demand back onto already overstretched community services. The result is a reinforcing loop in which the organizations doing the most for a marginalized population are structurally resourced to do the least.

Against that backdrop, participants did not simply vent frustration; they proposed concrete remedies. They recommended enhancing resources, expanding staffing, strengthening education and training, intensifying advocacy efforts, deepening research engagement, and pursuing inclusive policy development to support organizational capacity. These recommendations collectively constitute a capacity-building agenda. Education and training would professionalize the workforce and improve service quality. Advocacy and policy development would address the upstream legal and institutional conditions that perpetuate inequity. Research engagement would ensure that services evolve on the basis of evidence rather than crisis response. And sustainable resourcing would give organizations the predictability they need to retain skilled staff and plan multi-year programs.

The authors conclude that several key factors may strengthen the health promotion capacity of community-based agencies serving sexual and gender-diverse women, including sustainable funding, workforce development, education, and research infrastructure. Crucially, they caution that future research should examine the broader applicability and effectiveness of these findings across diverse contexts, and they call for prioritizing structural change, intersectional approaches, and community-led solutions. That emphasis on intersectionality is significant, because sexual and gender-diverse women are not a homogeneous group; experiences of care vary by race, language, geography, disability, and socioeconomic status, and capacity-building strategies that ignore those intersecting identities risk reproducing the very exclusions they aim to fix.

The study was funded by the Canadian Institutes for Health Research, received on 11 November 2025, was accepted on 11 September 2026, and published open access on 22 September 2026. Its arrival could not be more timely. As health systems worldwide confront workforce shortages and rising demand for affirming care, the Canadian evidence offers a transferable insight: community-based organizations are not peripheral charities but essential health infrastructure, and the healthcare system’s treatment of sexual and gender-diverse women will depend on whether governments and institutions choose to fund, train, and formally integrate them. The ten staff members interviewed for this study described, in effect, a parallel health system running on commitment and improvisation. Converting that commitment into durable capacity, the research makes clear, is a policy choice that remains to be made.

Subject of Research: Health promotion capacity building in community-based organizations serving sexual and gender-diverse women in Canada.

Article Title: Building health promotion capacity for sexual and gender-diverse women: insights from staff at community-based organizations in Canada

Article References: Building health promotion capacity for sexual and gender-diverse women: insights from staff at community-based organizations in Canada. (n.d.). https://doi.org/10.1186/s12913-026-15624-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15624-6

Keywords: 2SLGBTQ+ health, community-based health promotion, sexual and gender-diverse women, health equity, gender-affirming care, capacity building, qualitative research, health services research, social determinants of health, workforce development, Building, health

The review, led by Nanik Setiyawati with Sri Sulistyowati and Heru Priyanto, analysed twenty-one original intervention and implementation studies spanning Argentina, Nepal, India, the United States, Kenya, Nigeria, Uganda, Tanzania, Ethiopia, Iran, Malaysia and Hong Kong. Rather than pooling effect sizes, the researchers charted who delivered each intervention, where screening access was created, how cultural barriers were addressed and whether participants were connected to follow-up care. This implementation-focused lens matters because a programme labelled a “home visit” can mean radically different things: one visit may merely encourage clinic attendance, while another offers HPV self-collection on the spot, transports the specimen and arranges follow-up for abnormal results.

From the evidence map, six recurring strategy families emerged: lay or peer workforce models, culturally tailored education, navigation and barrier reduction, HPV self-sampling, mobile health reminders and integrated community outreach. The most successful programmes combined several of these functions. In Argentina’s EMA cluster-randomised trial, community health workers offering HPV self-collection during home visits achieved an HPV testing rate of 86 percent compared with 20 percent in the control arm, a risk ratio of 4.02. In Hong Kong, a community health worker-led programme combining education, monthly phone calls and navigation for South Asian women reached 97.9 percent screening uptake at three months versus 52.6 percent among controls.

The numbers from low- and middle-income settings are equally compelling. In Nepal, female community health volunteers who provided home education, referral and follow-up raised screening uptake by 48 percent relative to control. In rural India, a nurse-led multicomponent intervention lifted Pap testing from 4.1 percent at baseline to 71.5 percent within six months. In Nigeria, women offered HPV self-collection in their community achieved 93 percent screening completion compared with 56 percent for hospital-based collection, and nearly all returned specimens were adequate for testing. In the United States, mailed HPV self-collection kits plus scheduling assistance more than doubled uptake among under-screened low-income women, reaching 72 percent versus 37 percent.

Digital tools added measurable value when they addressed concrete barriers. In Tanzania, a randomised double-blind trial found that behaviour-change text messages tripled attendance compared with a single informational message, and adding a transport eVoucher nearly doubled the effect again, pushing the odds ratio to 4.7. That combination worked because it tackled both the behavioural hesitation and the financial cost of reaching a clinic. Yet the review is careful to note that SMS strategies depend on phone access, privacy, literacy and local service capacity, which is why eligibility for the Tanzanian trial itself required mobile-phone ownership.

Perhaps the review’s most important contribution is its insistence on framing screening promotion as a prevention cascade: engagement, communication, access, screening completion, result delivery, triage and treatment linkage. When the authors traced participants beyond the first test, troubling gaps appeared. In rural Kenya, community health campaigns raised population-level screening uptake to 60 percent versus 37 percent for facility-based delivery, but treatment acquisition among HPV-positive women remained low in both arms, at roughly 39 percent and 31 percent with no statistically significant difference. In Uganda, a community self-sampling programme achieved 82 percent participation, yet only 35 percent of women who tested positive for high-risk HPV and received SMS instructions actually attended follow-up, with transport costs, disbelief, childcare burdens and the absence of symptoms all cited as barriers.

These downstream failures carry a hard lesson for policymakers: a first screening test is an intermediate milestone, not the finish line. The review argues that programmes should begin with the least-screened population and specify a complete pathway from trust to treatment linkage, identifying who delivers the message, how cultural and language barriers are addressed, which screening route is offered, how results are communicated and how positive findings are followed up. Education alone, the evidence shows, is often insufficient. Two included trials, one in Hong Kong and one in Kenya, improved knowledge or beliefs without producing a clear screening uptake advantage, underscoring the distinction between changing minds and changing access.

The review also exposes persistent reporting deficiencies that limit how transferable these models are. Uptake was commonly reported, but fidelity to the intervention design, cost, workforce training, equity reach, participant burden, result notification, triage and long-term sustainability were inconsistently documented. Although many studies intentionally recruited rural, low-income, ethnic-minority or safety-net populations, few reported stratified data on who actually completed screening, received results or reached follow-up care across intersecting barriers. A Ugandan cost-effectiveness analysis built on the ASPIRE trial suggested that HPV screen-and-treat could reduce lifetime cervical cancer risk from 4.2 percent to as low as 2.4 percent with repeated screening, at incremental costs of roughly US$130 to US$470 per year of life saved, but those estimates hinge on test costs, treatment linkage and modelled assumptions.

The practical prescription that emerges is to match the intervention to the documented barrier profile of a community. Where mistrust or language barriers dominate, culturally concordant messengers such as community health workers, promotoras and lay health advisors supply relational trust and local legitimacy. Where access barriers dominate, self-sampling, local campaigns, worksite programmes and navigation can physically move the screening opportunity closer to the people who need it. Where downstream retention is weak, result-delivery systems and treatment navigation become the priority investment. The authors acknowledge limitations, including reliance on open bibliographic records, incomplete exclusion-reason logging and heterogeneous study designs that preclude meta-analysis, but the pattern across twenty-one studies is consistent enough to guide programme design today.

As the world pursues the World Health Organization’s cervical cancer elimination targets, this evidence map reframes what success looks like. Getting a woman to complete a screening test matters enormously, but the true measure of a community-based programme is whether she then receives her result, attends follow-up if the test is abnormal and obtains treatment when needed. Programmes that connect trusted community interfaces with feasible screening routes and reliable aftercare, the review concludes, are the ones positioned to convert screening activity into genuine cancer prevention, and future evaluations should report cascade completion and implementation conditions rather than celebrating uptake numbers alone.

Subject of Research: Community-based health promotion strategies to increase uptake of cervical cancer screening

Article Title: Mapping community-based health promotion strategies for cervical cancer screening uptake: A scoping review of intervention components, delivery models and implementation gaps

Article References: Setiyawati, N., Sulistyowati, S., & Priyanto, H. (2026). Mapping community-based health promotion strategies for cervical cancer screening uptake: A scoping review of intervention components, delivery models and implementation gaps. Public Health in Practice, 12, Article 100857. https://doi.org/10.1016/j.puhip.2026.100857

Image Credits: AI Generated

DOI: 10.1016/j.puhip.2026.100857

Keywords: cervical cancer screening, HPV self-sampling, community health workers, health promotion, prevention cascade, patient navigation, SMS reminders, scoping review, global health equity, cancer elimination, public health in practice, screening uptake