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Khoja L, Zoulfikar M, Hak L, Yousif S, Aljebori M, Stiffler M, Tariq M, Burgard S, Fleischer NL, Wallner LP, Pearce CL. Overcoming Cultural Barriers and Building Healthcare Trust: A Mixed Methods Study on Cervical Cancer Prevention Among Arab American Women Across Major U.S. Cities. Cancers (Basel) 2024; 17:5. [PMID: 39796637 PMCID: PMC11718821 DOI: 10.3390/cancers17010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 12/10/2024] [Accepted: 12/17/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Understanding why Arab American women have lower adherence to cervical cancer screening compared to other racial/ethnic groups is important. The study aimed to understand attitudes and knowledge of cervical cancer prevention and HPV vaccination among Arab American women. METHODS A mixed-method approach was employed, including nine focus groups and an online questionnaire. Demographic characteristics, medical history, screening practices, and attitudes towards HPV vaccination and HPV self-sampling for cervical cancer screening were assessed. RESULTS Focus group participants (n = 22) demonstrated varying levels of knowledge about cervical cancer and HPV, including limited awareness of the Papanicolaou (Pap) test. Participants expressed mixed feelings about HPV self-sampling. Among questionnaire respondents (n = 25), who on average had a higher socioeconomic status than focus group participants, 73.9% had undergone a Pap test, with 94% up to date on screening. While 59% preferred self-sampling at home, almost two in five cited concerns about sample accuracy. CONCLUSIONS Our study demonstrates the variability in attitudes and experiences towards cervical cancer screening among Arab American women, potentially driven by socioeconomic disparities. Our qualitative results suggest the need for targeted, culturally tailored health education in the Arab American community. Further research should explore effective strategies to engage this underserved group and enhance adherence to prevention programs.
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Affiliation(s)
- Lilah Khoja
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; (L.K.); (M.Z.); (S.Y.); (M.A.); (N.L.F.); (L.P.W.)
| | - Manar Zoulfikar
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; (L.K.); (M.Z.); (S.Y.); (M.A.); (N.L.F.); (L.P.W.)
| | - Layla Hak
- College of Human Medicine, Michigan State University, 804 Service Rd Suite A112, East Lansing, MI 48824, USA;
| | - Sabrina Yousif
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; (L.K.); (M.Z.); (S.Y.); (M.A.); (N.L.F.); (L.P.W.)
| | - Manar Aljebori
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; (L.K.); (M.Z.); (S.Y.); (M.A.); (N.L.F.); (L.P.W.)
| | - Matthew Stiffler
- Center for Arab Narratives at the Arab American National Museum, ACCESS, 6450 Maple St., Dearborn, MI 48126, USA;
| | - Madiha Tariq
- Oakland County Michigan Government, 2100 Pontiac Lake Road, Waterford Township, MI 48328, USA;
| | - Sarah Burgard
- Department of Sociology, University of Michigan, 500 S State St., Ann Arbor, MI 48109, USA;
| | - Nancy L. Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; (L.K.); (M.Z.); (S.Y.); (M.A.); (N.L.F.); (L.P.W.)
| | - Lauren P. Wallner
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; (L.K.); (M.Z.); (S.Y.); (M.A.); (N.L.F.); (L.P.W.)
- Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Celeste Leigh Pearce
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; (L.K.); (M.Z.); (S.Y.); (M.A.); (N.L.F.); (L.P.W.)
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Abstract
ABSTRACT Sexual history taking is an important part of caring for any clinical population. However, the topic is often wrapped in discomfort that makes it more challenging than it needs to be for both the provider and the individual providing the history. The act of taking an effective sexual history is more than simply asking all the right questions in the right ways; it requires an awareness of the impact of the clinical environment, the provider's own comfort with the content, and an awareness of any personal biases. In this study, we provide a framework for evaluating and addressing many of these factors as well as providing key points for consideration as a health care provider of any level. We offer several concrete strategies for including these strategies and processes in multiple clinical environments.
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