Beliefs About the Pap Smear Among Mexican Immigrants

Few studies have examined Latinos’ beliefs about the Pap smear or what uses they attribute to the procedure. We conducted qualitative interviews with 28 Mexican immigrant women and 23 Mexican immigrant men recruited through snowball sampling. We found that individuals learned about the Pap smear from a wide variety of sources and often understood the exam to be a screening test for sexually transmitted infections in general. They also related the need for Pap smears and the development of cervical cancer to high risk sexual behaviors. Finally, participants considered men to have a significant role as vectors for disease and as barriers to screening. Our results suggest that interventions to improve cervical cancer prevention among Mexican immigrants may be most effective if they include both men and women and if they recognize and address concerns about STI spread and prevention. Furthermore, interventions must recognize that even when women know how to prevent disease, they may feel disempowered with regard to making behavioral changes that will decrease their risk for STIs or cancer.     

Family and cultural influences on cervical cancer screening among immigrant Latinas in Miami-Dade County,USA

Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA, with disparities greatest among Latino immigrants. We examined barriers and facilitators to cervical cancer screening practices among a group of immigrant Latino women in Florida, USA. Between January and May 2013, six focus group discussions, involving 35 participants, were conducted among Hispanic women in Miami to explore their knowledge, beliefs about cervical cancer and facilitators and barriers to cervical cancer screening using a theoretical framework. The data showed that family support, especially from female relatives, was an important facilitator of screening and treatment. Women, however, reported prioritising family health over their own, and some expressed fatalistic beliefs about cancer. Major obstacles to receiving a Pap smear included fear that it might result in removal of the uterus, discomfort about being seen by a male doctor and concern that testing might stigmatise them as being sexually promiscuous or having a sexually transmitted disease. Targeted education on cancer and prevention is critically needed in this population. Efforts should focus on women of all ages since younger women often turn to older female relatives for advice.     

Cervical cancer screening among Chinese immigrants in Seattle, Washington

Introduction: Chinese American women have high rates of invasive cervical cancer, compared to the general population. However, little is known about the Pap testing behavior of ethnic Chinese immigrants.Methods: We conducted a community-based survey of Chinese immigrants living in Seattle, Washington, during 1999. Two indicators of cervical cancer screening participation were examined: at least one previous Pap smear and Pap testing in the last 2 years.Results: The overall estimated response rate was 64%, and the cooperation rate was 72%. Our study sample for this analysis included 647 women. Nearly one quarter (24%) of the respondents had never had a Pap test, and only 60% had been screened recently. Factors independently associated with cervical cancer screening use included marital status, housing type, and age at immigration.Conclusion: Our findings confirm low levels of cervical cancer screening among Chinese immigrants to North America. Culturally and linguistically appropriate Pap testing intervention programs for less acculturated Chinese women should be developed, implemented, and evaluated.     

Low knowledge of cervical cancer and cervical pap smears among women in Peru, and their ideas of how this could be improved

Estimates of the percentage of women who have had Pap smears in Peru vary between 7% and 43%. This study explores what women know about cervical cancer and Pap smears, as well as their barriers to obtaining Pap smears. Focus group discussions (FGD) were conducted with a total of 177 women in four Peruvian cities. Discussions reveal that most women did not know what causes cervical cancer. Most women did not know the purpose of Pap smears, although knowledge about Pap smears was higher than knowledge about cervical cancer. Fear, embarrassment, and lack of knowledge were the main barriers identified for not getting Pap smears. Programs and policies aiming to increase Pap smear coverage must start by educating women on cervical cancer and its prevention in order to improve women's perceptions about the screening test and increase Pap smear seeking behaviors in the long term.     

A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women

ABSTRACT: BACKGROUND: The Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women. METHODS: This study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies. RESULTS: The results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting. CONCLUSIONS: Despite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity.     

Development of a theory-based (PEN-3 and Health Belief Model), culturally relevant intervention on cervical cancer prevention among Latina immigrants using intervention mapping

The development of efficacious theory-based, culturally relevant interventions to promote cervical cancer prevention among underserved populations is crucial to the elimination of cancer disparities. The purpose of this article is to describe the development of a theory-based, culturally relevant intervention focusing on primary (sexual risk reduction) and secondary (Pap smear) prevention of cervical cancer among Latina immigrants using intervention mapping (IM). The PEN-3 and Health Belief Model provided theoretical guidance for the intervention development and implementation. IM provides a logical five-step framework in intervention development: delineating proximal program objectives, selecting theory-based intervention methods and strategies, developing a program plan, planning for adoption in implementation, and creating evaluation plans and instruments. We first conducted an extensive literature review and qualitatively examined the sociocultural factors associated with primary and secondary prevention of cervical cancer. We then proceeded to quantitatively validate the qualitative findings, which led to development matrices linking the theoretical constructs with intervention objectives and strategies as well as evaluation. IM was a helpful tool in the development of a theory-based, culturally relevant intervention addressing primary and secondary prevention among Latina immigrants.     

Development of cervical cancer control interventions for Chinese immigrants

The objective of the study was to develop a culturally relevant video and a pamphlet for use as a cervical cancer screening educational intervention among North-American Chinese women. The project conducted 87 qualitative interviews and nine focus groups to develop a culturally tailored intervention to improve Pap testing rates. The intervention consisted of an educational/motivational video, a pamphlet, and home visits. Less acculturated Chinese women draw on a rich tradition of herbal knowledge and folk practices historically based on Chinese medical theory, now mixed with new information from the media and popular culture. The video, the pamphlet, and the outreach workers knowledge base were designed using these results and combined with biomedical information to address potential obstacles to Pap testing. Culturally relevant information for reproductive health promotion was easily retrieved through qualitative interviews and used to create educational materials modeling the integration of Pap testing into Chinese women's health practices.     

A nurse-delivered intervention to reduce barriers to breast and cervical cancer screening in Chicago inner city clinics.

An 18-month intervention was implemented to increase breast and cervical cancer screening among poor African-American women in Chicago. Breast and cervical cancer screening programs were set up in two public clinics, one community-based and the other hospital-based. Nurse clinicians and public health workers were used in these programs to recruit women in the clinics and in targeted community institutions to receive free breast and cervical cancer screening. The following barriers were specifically addressed by the intervention: accessibility of screening, knowledge about breast and cervical cancers, access to followup screening examinations, and access to treatment. A computerized followup system was specifically designed to track patients. During the 18 months of the intervention, 10,829 visits were made by 7,654 low-income women. A total of 84 cases of breast cancer and 9 cases of cervical cancer were detected. Awareness of the program, as measured by a survey after the completion of the intervention, increased in both clinics compared with baseline results. Knowledge about breast and cervical cancers also increased, as measured by scores on tests given before and after a class on breast and cervical cancers. Followup rates were 86 percent for women attending the programs. More than 90 percent of the women referred for evaluation of breast abnormalities kept an appointment. In summary, the intervention was successful in reducing barriers to breast and cervical cancer detection and in attracting a high-risk group of women.     

Introducing HPV triage into the English cervical cancer screening program: consequences for participation

OBJECTIVE: To predict the likely impact of adding human papillomavirus (HPV) triage for minor abnormalities on participation in the English cervical cancer screening program. METHOD: Contingent valuations of the existing Pap program and a possible HPV-augmented screening program, obtained from questionnaires completed by 1141 women in east-central England. RESULTS: The value of participating in Pap screening was negatively associated with age, positively associated with educational level, and positively associated with the level of household income. Higher levels of worry about cervical cancer were associated with higher valuations of screening. Adding HPV-based triage to the Pap program lowered the value of screening participation for only two women, whereas for the sample as a whole, it increased the average valuation by about 47 percent. Supposedly-negative characteristics of HPV testing, when described, were expected to trigger psychosocial concerns in respondents and thereby give rise to significant decreases in valuations of participating in a Pap-plus-HPV program. For most women, however, such information changed their valuations of participation in screening little, if at all. CONCLUSIONS: Accepting the proposition that higher contingent valuations indicate stronger behavioural preferences, our results offer insubstantial grounds for believing that the inclusion of HPV triage would detrimentally affect participation in Pap screening for cervical cancer.     

Cancer Prevention Strategies Among California Farmworkers: Preliminary Findings

Abstract: This study was conducted to identify barriers to cancer prevention and evaluate the effectiveness of a cancer prevention project to increase screening for cervical and breast cancer among Spanish-speaking farmworkers in California's Central Valley. Bilingual health educators met with farmworker communities near Merced and Modesto, CA, to determine barriers that prevented women from seeking screening for breast and cervical cancer. Using information from focus groups and health fairs, a targeted outreach protocol was developed that will eventually enroll 2,500 farmworkers in a cancer education and screening program. Participants received a presentation in Spanish on breast and cervical cancer that included a pretest and post-test to assess increases in knowledge. Clients were encouraged to attend Golden Valley Health Centers Inc. (GVHC) to receive free breast and cervical cancer screenings. Vouchers, redeemable for modest personal hygiene gifts by clients, were tracked to assess prevention behavior when appointments were kept at GVHC.
Sixty farmworkers attended focus groups and 363 attended health fairs to provide input to the cancer prevention program. As of December 1,1995,1,732 female farmworkers were enrolled in an outreach program designed to increase knowledge and promote cancer screening. Data from pretests and post-tests indicated a statistically significant increase in knowledge about cancer and its prevention among participants. Furthermore, 317 participants redeemed vouchers for cancer screenings at GVHC.
Active community collaboration and culturally appropriate intervention strategies, employed in conjunction with clinical services, can be successful in increasing cancer prevention awareness and screenings among female farmworkers.     

Health beliefs and Pap smears among Thai women in Brisbane,Australia

Although a number of studies have assessed the use of Pap smear among Thai women in Thailand, little is known about factors influencing the use of this cervical cancer screening among potentially high risk Thai migrant women. We related health belief model (HBM) factors and sociodemographic variables to the use of Pap smears among migrant Thai women in Brisbane, Australia. A cross-sectional study was conducted in Brisbane, Queensland, Australia. A snowball sampling method was used to recruit 145 women. Thirty-nine percent reported regular Pap smears. Summary HBM index and self-efficacy index were positively associated with Pap smears. Barriers to screening were negatively associated. The HBM appears to be a useful framework for planning cervical cancer prevention. Strategies that reduce barriers to the screening and increase the confidence of women and their self-efficacy are likely to increase their participation.     

Breast, cervical, and colorectal cancer screening rates amongst female Cambodian, Somali, and Vietnamese immigrants in the USA

Introduction

Minority women, particularly immigrants, have lower cancer screening rates than Caucasian women, but little else is known about cancer screening among immigrant women. Our objective was to assess breast, cervical, and colorectal cancer screening rates among immigrant women from Cambodia, Somalia, and Vietnam and explore screening barriers.

Methods

We measured screening rates by systematic chart review (N = 100) and qualitatively explored screening barriers via face-to-face questionnaire (N = 15) of women aged 50–75 from Cambodia, Somalia, and Vietnam attending a general medicine clinic (Portland, Maine, USA).

Results

Chart Review – Somali women were at higher risk of being unscreened for breast, cervical, and colorectal cancer compared with Cambodian and Vietnamese women. A longer period of US residency was associated with being screened for colorectal cancer. We observed a 7% (OR 1.07, 95% CI 1.01–1.13, p = 0.01) increase in the odds that a woman would undergo a fecal occult blood test for each additional year in the US, and a 39% increase in the odds of a woman being screened by colonoscopy or flexible sigmoidoscopy for every five years of additional US residence (OR 1.39, 95% CI 1.21–1.61, p = 0.02). We did not observe statistically significant relationships between odds of being screened by mammography, clinical breast exam or papanicolaou test according to years in the US. Questionnaire – We identified several barriers to breast, cervical, and colorectal cancer screening, including discomfort with exams conducted by male physicians.

Discussion

Somali women were less likely to be screened for breast, cervical, and colorectal cancer than Cambodian and Vietnamese women in this population, and uptake of colorectal cancer screening is associated with years of residency in this country. Future efforts to improve equity in cancer screening among immigrants may require both provider and community education.     

Bolivian health providers' attitudes toward alternative technologies for cervical cancer prevention: a focus on visual inspection with acetic Acid and cryotherapy

Abstract Background: Little is known about health providers' attitudes toward visual inspection with acetic acid (VIA) and cryotherapy in the prevention of cervical cancer, as most research in Latin America and the Caribbean (LAC) has examined attitudes of the general population. This study describes attitudes of Bolivian health professionals toward new technologies for cervical cancer prevention, focusing on VIA and cryotherapy. Methods: Between February 2011 and March 2012, we surveyed 7 nurses and 35 physicians who participated in 5-day workshops on VIA and cryotherapy conducted in Bolivia. Multiple choice and open-ended questions were used to assess participants' acceptability of these procedures and the feasibility of their implementation in the context of perceived barriers for the early detection of cervical cancer in this country. Results: Most believed that cultural factors represent the main barrier for the early detection of cervical cancer (70%), although all stated that VIA and cryotherapy would be accepted by women, citing the advantages of VIA over cytology for this belief. Most also believed their colleagues would accept VIA and cryotherapy (71%) and that VIA should replace Pap testing (61%), reiterating the advantages of VIA for these beliefs. Those who believed the contrary expressed a general resistance to change associated with an already existing cytology program and national norms prioritizing Pap testing. Conclusions: Most participants had favorable attitudes toward VIA and cryotherapy; however, a sizable minority cited challenges to their adoption by colleagues and believed VIA should not replace cytology. This report can inform the development of strategies to expand the use of alternative cervical cancer screening methods in LAC and Bolivia.     

Cervical cancer among Hispanic women: assessing the impact on farmworkers

The purpose of this paper was to review the literature on Hispanic populations to outline: 1) demographics; 2) general health status; 3) cervical cancer incidence and mortality; 4) Pap smear screening rates; and 5) barriers to preventive care services. The methods: MEDLINE, Med66, Med75, and Med85 files, from 1966 to 1999, were searched for key words Hispanic health, cervical cancer and Hispanics, cervical cancer and Mexico, migrants and health, agricultural occupational health, farmworkers and cancer, and farmworker health. AGRICOLA (1982–98) was searched for key words farmworker health, agricultural workers and health, and agriculture and cancer. The results show that Hispanic immigrant women may have cervical cancer incidence rates ranging between the California rates for 1991–93 (19.8/100,000) and for Mexico in 1990 (115–220 per 100,000). Mortality rates for the same periods were 3.9/100,000 and 16.11/100,000 respectively. While survey results report Hispanic Pap smear rates above 70%, these surveys count urban women who do not share the barriers to care experienced by poor rural Hispanics. Since validated self-reports of survey responses are 20–50% lower than reported lower rates and Pap smear screening persist in Hispanic Pap evaluations and are reflected in higher morbidity and mortality from cervical cancer. That targeted community interventions have been successful in raising Pap smear rates among poor Spanish-speaking women. Such interventions should be a priority for preventive health care policy and practice.     

Individual and Community Effectiveness of a Cervical Cancer Screening Program for Semi-Urban Mexican Women

The effectiveness at the individual and community level of an educational intervention to increase cervical cancer screening self-efficacy among semi-urban Mexican women was evaluated and changes in reported community barriers were measured after the intervention was implemented. The educational intervention was evaluated with a quasi-experimental pre-test/post-test design and a control group, based on the Integrative Model of Behavior Prediction and AMIGAS project materials. For the intervention group, increased self-efficacy increased requests to obtain a Pap (p < 0.05). Barriers to obtaining a Pap were embarrassment and lack of time at the individual level, and lack of time, test conditions and fear of social rejection in the community’s cultural domain. At both the individual and community levels, having more information about the test and knowing it would be performed by a woman were primary facilitators. Few women used medically precise information when referring to the Pap and cervical uterine cancer. Although the level of self-efficacy of the participants increased, barriers in the health system affect the women’s perceived ability to get a Pap. Better care for users is needed to increase consistent use of the test. The study shows the importance of using culturally adapted, multilevel, comprehensive interventions to achieve successful results in target populations.     

Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.

Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.     

An examination of sociocultural factors associated with cervical cancer screening among low-income Latina immigrants of reproductive age

The purpose of this study was threefold: 1) to examine whether low-income Latina immigrants were less likely to receive a Pap smear than low-income non-Latinas; 2) to examine ethnic differences regarding cervical cancer knowledge; and 3) to examine the sociocultural factors associated with cervical cancer screening among low-income Latina immigrants. Participants included 225 low-income women of reproductive age attending a WIC (Women, Infants, and Children) clinic (50% Latina immigrants and 50% non-Latinas). Latina immigrants were less educated, less likely to have health insurance, and more likely to be married or living with a partner than non-Latinas (ps < 0.05). All non-Latinas had a Pap smear in the past compared to 81.3% of Latina immigrants (p < 0.001). Latina immigrants displayed significantly less knowledge regarding cervical cancer than non-Latinas (ps < 0.01). Latina immigrants tended to display culturally based knowledge and beliefs regarding cervical cancer and screening that may influence getting a Pap smear.     

Cervical cancer screening among Latinas recently immigrated to the United States

BACKGROUND: Little is known about the cancer screening practices of women whose behavior may place them at a high risk for cervical cancer. We explored factors that influence repeated Pap smear screening among recently immigrated Latinas working in bars also called cantinas. METHODS: Face-to-face interview were administered to 360 women working in 60 cantinas. Participants provided information about their cancer screening practices including the number of Pap smears completed in the 5 years before the interview. A theory-based model proposing that demographic characteristics, cancer screening barriers and facilitators, and psychosocial factors influence repeated Pap smear screening was tested with a hierarchical linear regression. RESULTS: Facilitators of cancer screening (recent visit to a physician and receiving a Pap smear in a clinic) and psychosocial variables (Pap smear beliefs, cancer screening intentions and lack of encouragement) were significantly associated with the total number reported Pap smears (adjusted R2 = 0.31, P < 0.0001). Cervical cancer risk behaviors were not significantly associated with repeated screening. CONCLUSIONS: While risk behaviors did not act as barriers, access to health care measures facilitated repeated Pap smear screening. Psychosocial factors hypothesized to function as antecedents of Pap smear screening appear instead to follow from repeated experience with the examination.     

Cancer Control Research among Cambodian Americans in Washington

PURPOSE: We summarized previous and ongoing cancer control research among Cambodian immigrants in Washington. METHODS: A literature review of articles and published abstracts was conducted. FINDINGS: Cambodian Americans have a limited understanding of Western biomedical concepts and low levels of cancer screening participation. CONCLUSIONS: Culturally appropriate cancer control interventions for Cambodian Americans should be developed, implemented, and evaluated.