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Tsegaye AT, Lin J, Cole AM, Szpiro A, Rao DW, Walson J, Winer RL. Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02038-5. [PMID: 38849693 DOI: 10.1007/s40615-024-02038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI. METHODS We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women. RESULTS CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m2 vs 18.5-24.9 kg/m2). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15-5.18). CONCLUSION CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.
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Affiliation(s)
- Adino Tesfahun Tsegaye
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA.
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA
| | - Allison M Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, USA
| | - Adam Szpiro
- Department of Biostatistics, University of Washington School of Public Health, Seattle, USA
| | - Darcy W Rao
- Gender Equality Division, Bill & Melinda Gates Foundation, Seattle, USA
| | - Judd Walson
- Departments of Global Health, Medicine (Infectious Diseases), Pediatrics and Epidemiology University of Washington, Seattle, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA
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Adebola A, Adaeze A, Adeyimika D, Lovoria WB, Gia MM. Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study. J Racial Ethn Health Disparities 2024; 11:1405-1417. [PMID: 37129785 PMCID: PMC10620103 DOI: 10.1007/s40615-023-01617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Understanding Black women's Papanicolaou (Pap) screening experiences can inform efforts to reduce cancer disparities. This study examined experiences among both US-born US Black women and Sub-Saharan African immigrant women. METHOD Using a convergent parallel mixed methods design, Black women born in the USA and in Sub-Saharan Africa age 21-65 years were recruited to participate in focus groups and complete a 25-item survey about patient-centered communication and perceived racial discrimination. Qualitative and quantitative data were integrated to provide a fuller understanding of results. RESULTS Of the 37 participants, 14 were US-born and 23 were Sub-Saharan African-born Black women. The mean age was 40.0 ± 11.0, and 83.8% had received at least one Pap test. Five themes regarding factors that impact screening uptake emerged from the focus groups: (1) positive and negative experiences with providers; (2) provider communication and interaction; (3) individual barriers to screening uptake, (4) implicit bias, discrimination, and stereotypical views among providers, and (5) language barrier. Survey and focus group findings diverged on several points. While focus group themes captured both positive and negative experiences with provider communication, survey results indicated that most of both US-born and Sub-Saharan African-born women experienced positive patient-centered communication with health care providers. Additionally, during focus group sessions many participants described experiences of discrimination in health care settings, but less than a third reported this in the survey. CONCLUSION Black women's health care experiences affect Pap screening uptake. Poor communication and perceived discrimination during health care encounters highlight areas for needed service improvement to reduce cervical cancer disparities.
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Affiliation(s)
- Adegboyega Adebola
- College of Nursing, University of Kentucky, Lexington, KY, 40536-0232, USA.
| | - Aroh Adaeze
- College of Public Health, Slippery Rock University, Slippery Rock, PA, USA
| | - Desmennu Adeyimika
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Williams B Lovoria
- College of Nursing, University of Kentucky, Lexington, KY, 40536-0232, USA
| | - Mudd-Martin Gia
- College of Nursing, University of Kentucky, Lexington, KY, 40536-0232, USA
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Rockson L, Btoush R. Cervical Cancer Screening Among Older Garifuna Women Residing in New York City. J Racial Ethn Health Disparities 2024; 11:1600-1610. [PMID: 37212964 DOI: 10.1007/s40615-023-01635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
This study examined the level of adherence to the recommended cervical cancer screening guidelines among Garifuna women residing in New York City, and screening practice association with demographic factors, access to healthcare services, perceptions/barriers to cervical cancer screening, acculturation, identity, and level of screening guideline knowledge. Four hundred Garifuna women were surveyed. The study results reveal low self-reported cervical cancer screening rates (60%), increased age, visiting a Garifuna healer in the past year, perceived benefits of receiving the screening test, and knowledge of the Pap test as having the highest predictive variability for receiving cervical cancer screening. The odds of having a Pap test were significantly lower in older women (age 65 years and above) and those visiting a traditional healer within the past year. The study findings provide several implications for developing culturally appropriate interventions aimed to increase the level of cervical cancer screening in this unique immigrant group.
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Affiliation(s)
- Lois Rockson
- Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07107, USA.
| | - Rula Btoush
- Rutgers School of Nursing, 180 University Avenue, Newark, NJ, 07102, USA
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Abraham O, Agoke A, Sanuth K, Fapohunda A, Ogunsanya M, Piper M, Trentham-Dietz A. Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States. JMIR Cancer 2024; 10:e53956. [PMID: 38447129 PMCID: PMC10955401 DOI: 10.2196/53956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/23/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Cancer prevalence data for Black Americans is monolithic and fails to consider the diverse cultures and backgrounds within that community. For instance, African immigrants constitute a meaningful proportion of the foreign-born Black immigrants in the United States (42%), but the prevalence of cancer in the African immigrant community itself is unknown. Therefore, without accurate cancer prevalence data, it is impossible to identify trends and other key factors that are needed to support the health of African immigrants and their children. Moreover, it is impossible to understand how the culture and language of subgroups influence their cancer-related health behavior. While research in this area is limited, the existing literature articulates the need for culturally responsive and culturally tailored cancer education for African immigrants and their adolescent children, which is what we advocate for in this viewpoint paper. Existing projects demonstrate the feasibility of culturally responsive programming for adults; however, few projects include or focus on adolescents or children born to African immigrants. To best meet the needs of this understudied community, researchers must use culturally competent interventions alongside familiar, usable media. For adolescents, technology is ubiquitous thus, the creation of a culturally tailored digital intervention has immense potential to improve cancer awareness and prevention for youth and their community. More research is needed to address many of the existing research gaps and develop a rich understanding of the unique experience of cancer among African immigrant families that can be used to inform intervention development. Through this viewpoint, we review the current state of cancer-related research among African immigrant families in the United States. In this paper, we acknowledge the current knowledge gaps and issues surrounding measurement and then discuss the factors relevant to designing an educational intervention targeted at African immigrants and the role of African immigrant youth.
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Affiliation(s)
- Olufunmilola Abraham
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
| | - Adeola Agoke
- African Cultural Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Kazeem Sanuth
- National African Language Resource Center, Indiana University Bloomington, Bloomington, IN, United States
| | - Abimbola Fapohunda
- Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Motolani Ogunsanya
- College of Pharmacy, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Megan Piper
- Department of Medicine and Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Amy Trentham-Dietz
- Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Ahadinezhad B, Maleki A, Amerzadeh M, Mohtashamzadeh B, Khosravizadeh O. What rate of Iranian women perform Pap smear test? Results from a meta-analysis. Prev Med 2024; 180:107871. [PMID: 38262561 DOI: 10.1016/j.ypmed.2024.107871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/30/2023] [Accepted: 01/18/2024] [Indexed: 01/25/2024]
Abstract
In this study, an attempt was made to estimate the aggregated proportion of Pap smear test uptake among women in Iran from 2012 to 2022 using meta-analysis. The data collection process involved reviewing records registered in databases between January 1, 2012, and September 11, 2022. The final data was analyzed using random effects models, and potential heterogeneity was assessed using the I2 index. To examine publication bias, Egger's test and Funnel Plot were employed. Sensitivity analysis, specifically single study exclusion Meta-analysis, was conducted to assess the influence of each individual study on the aggregated percentage of Pap smear test uptake. A total of 28,754 women were included across the 33 articles analyzed. The pooled percentage of Pap smear test uptake for both one-time and regular screenings was found to be 46.52% (95% CI: 40.91 to 52.14) and 17.80% (95% CI: 12.42 to 23.18), respectively. No significant evidence of publication bias was detected, although the influence of smaller studies was confirmed. Sensitivity analysis indicated that the overall rate of Pap smear test uptake was not highly sensitive to the results of individual studies. The findings emphasize the low rate of regular Pap smear testing among Iranian women and suggest that tailored interventions considering cultural and geographical factors specific to different provinces in Iran could help increase the utilization of this screening service.
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Affiliation(s)
- Bahman Ahadinezhad
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Aisa Maleki
- Student Research Committee, Qazvin University of Medical Sciences, Iran
| | - Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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Lee JJ, Chepkorir J, Alharthi A, Adeleye KK, Warren NE. Health Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01945-x. [PMID: 38416293 DOI: 10.1007/s40615-024-01945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.
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Affiliation(s)
- Jennifer J Lee
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | | | - Abeer Alharthi
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Khadijat K Adeleye
- University of Massachusetts Amherst College of Nursing, Amherst, MA, USA
| | - Nicole E Warren
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Savage LC, Minardi F, Miller SJ, Jandorf LH, Erblich J, Margolies LR, Konte H, Sly JR. Identifying Frequently Endorsed Benefits and Barriers to Breast Cancer Screening for African-Born Women in the NYC Metropolitan Area: a Pilot Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01865-2. [PMID: 38082068 PMCID: PMC11322984 DOI: 10.1007/s40615-023-01865-2] [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: 05/01/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 03/01/2024]
Abstract
Most cancer screening data report on Black participants without distinguishing nativity, limiting our understanding of the needs of distinct groups within the African diaspora. The purpose of this pilot study was to assess demographic characteristics and perceptions of the benefits of and barriers to mammography among African immigrant women in New York City (NYC). Forty-two women who were 40 years or older, born in Africa, and English and/or French-speaking were recruited from African immigrant communities in NYC to complete a survey. Eighty percent of our sample aged 50 to 73 was adherent to the 2016 USPSTF mammography screening guideline. The most frequently endorsed benefits were that mammography will help find breast cancer early, could help find a breast lump before it is big enough to feel, and that if found early, breast cancer could be successfully treated. The most endorsed barriers were that having a mammogram is painful and that lack of insurance or being treated rudely at the mammogram center would keep participants from having a mammogram. Chi-square analyses assessed relationships between demographic characteristics and perceptions about mammography and revealed that endorsement of barriers to screening (e.g., health issues, transportation problems, pain, and time associated with mammography) varied by educational attainment. Findings suggest that future interventions should be multi-level and (1) support patients in accessing screening via resource sharing, (2) address other commonly cited barriers such as fear of pain during the procedure, and (3) support anti-racist healthcare environments especially in terms of treatment by providers.
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Affiliation(s)
- Leah C Savage
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Francesca Minardi
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah J Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina H Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joel Erblich
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Hunter College, New York, NY, USA
| | - Laurie R Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jamilia R Sly
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Ghebrendrias S, Mody S, Washington S, Hussein B, Jama F, Jacobs M. A Cervical Cancer Screening Toolkit for Somali Women: A Pilot Randomized Controlled Trial. J Immigr Minor Health 2023; 25:1307-1314. [PMID: 37071376 PMCID: PMC10111298 DOI: 10.1007/s10903-023-01455-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 04/19/2023]
Abstract
This study aims to determine whether a novel cervical cancer screening toolkit will increase rates of pap test completion and HPV vaccination among Somali women living in the United States. We conducted a randomized controlled, pilot trial from June 2021 to February 2022. Somali women aged 21 to 70 were randomized to either receive a toolkit (infographic, video and an in-person health seminar) or not. Health passports confirming a completed pap test and/or HPV vaccination by clinician signature were used to measure outcomes. The primary outcome was pap test completion and the secondary outcome was HPV vaccination. We enrolled 57 participants. Patients randomized to the treatment arm were significantly more likely to have had a pap test (53.7% vs. 3.7%, p < 0.0001) and were also more likely to have received the HPV vaccine (10.7% vs. 3.7%, p = 0.6110). This toolkit increased rates of pap test completion and more participants in the intervention arm received HPV vaccination, though numbers were low. The study design may serve as a reproducible model to determine the effectiveness of patient education materials.
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Affiliation(s)
- Selemawit Ghebrendrias
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, M:9300 Campus Point Drive, MC 7433, La Jolla, San Diego, CA 92037 USA
| | - Sheila Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, M:9300 Campus Point Drive, MC 7433, La Jolla, San Diego, CA 92037 USA
| | - Sierra Washington
- Department of Obstetrics and Gynecology, Stony Brook University School of Medicine, 101 Nicolls Road, HSC T9 Room 090, Stony Brook, NY 11794-8091 USA
| | - Balquiso Hussein
- Somali Family Service, Community Health Worker, 5348 University Ave Unit 203, San Diego, CA 92105 USA
| | - Fadumo Jama
- Somali Family Service, Community Health Worker, 5348 University Ave Unit 203, San Diego, CA 92105 USA
| | - Marni Jacobs
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, M:9300 Campus Point Drive, MC 7433, La Jolla, San Diego, CA 92037 USA
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Lemmo D, Martino ML, Vallone F, Donizzetti AR, Freda MF, Palumbo F, Lorenzo E, D'Argenzio A, Caso D. Clinical and psychosocial constructs for breast, cervical, and colorectal cancer screening participation: A systematic review. Int J Clin Health Psychol 2023; 23:100354. [PMID: 36415605 PMCID: PMC9677078 DOI: 10.1016/j.ijchp.2022.100354] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Research has identified a wide range of psychosocial factors associated to choosing to engage in ongoing cancer screenings. Nevertheless, a systematic review of the theoretical frameworks and constructs underpinning studies on breast, cervical, and colorectal cancer screening participation has yet to be conducted. As part of the action-research project “Miriade,” the present study aims to identifying the main theoretical frameworks and constructs adopted in the literature over the past five years to explain cancer screening participation. According to the PRISMA guidelines, a search of the MEDLINE/PubMed and PsycINFO databases was made. Empirical studies conducted from 2017 to 2021 were included. The following keywords were used: breast OR cervical OR colorectal screening AND adhesion OR participation OR engagement AND theoretical framework OR conceptual framework OR theory. Overall, 24 articles met the inclusion criteria. Each theoretical framework highlighted clinical and psychosocial constructs of cancer screening participation, focusing on the individuals (psycho-emotional functioning and skills plan) and/or the health services perspectives. Findings from the present study acknowledge the plurality of the theoretical frameworks and constructs adopted to predict or promote breast, cervical, and colorectal cancer screening adhesion and the need for new research efforts to improve the effectiveness of cancer screening promotion interventions.
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Affiliation(s)
- Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
- Corresponding author.
| | - Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Federica Vallone
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Anna Rosa Donizzetti
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | | | - Francesco Palumbo
- Department of Political Science, University of Naples Federico II, Naples, Italy
| | - Elvira Lorenzo
- Directorate General for Health Protection and Coordination of the Regional Health System, Campania Region, Italy
| | - Angelo D'Argenzio
- Directorate General for Health Protection and Coordination of the Regional Health System, Campania Region, Italy
| | - Daniela Caso
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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La Frinere-Sandoval QNNB, Cubbin C, DiNitto DM. Racial and ethnic disparities in cervical and breast cancer screenings by nativity and length of U.S. residence. ETHNICITY & HEALTH 2023:1-17. [PMID: 36774194 DOI: 10.1080/13557858.2023.2174254] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Previous studies of disparities in breast and cervical cancer screenings have focused on broad racial/ethnic groups or nativity status without accounting for immigration histories. Recent theoretical work argues for using intersectional approaches and examining within-group inequalities. Utilizing multiple years of National Health Interview Survey (NHIS) data, we examined between- and within-group Papanicolaou (Pap) test and mammogram screening based on nativity and length of U.S. residence for Asian and Hispanic women, along with non-Hispanic Black and White women. DESIGN The study samples consist of 54,900 women ages 21-64 without a hysterectomy who responded to questions about Pap test screening and 36,300 women ages 40-64 who responded to questions about mammogram screening. Asian and Hispanic women were further stratified by nativity and, for immigrants, length of time in the United States. Logistic regression analysis was used to identify significant associations with Pap test and mammogram screenings. RESULTS Recent Asian and Hispanic immigrants had the lowest Pap test and mammogram rates among all other groups, while Black (and White women for mammograms) women had the highest rates. After accounting for age, marital status, health insurance, education, employment status, and income, both Asian groups had lower odds, and Black and all Hispanic groups had higher odds of Pap test screening compared with White women. Similar results were observed for mammogram screening, except that long-term immigrant/U.S.-born Asian and U.S.-born Hispanic women did not have significantly different odds compared with White women. In general, the strength and direction of most sociodemographic variables were similar across groups for Pap test screening but differed for mammogram screening. CONCLUSIONS The between-group differences identified emphasize the disparities in screening between racial/ethnic groups while the within-group differences suggest the need to examine whether more targeted outreach efforts and prevention messages can increase screening for specific groups.
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Affiliation(s)
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas, Austin, Austin, TX, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas, Austin, Austin, TX, USA
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Rosato I, Dalla Zuanna T, Tricarico V, Barbiellini Amidei C, Canova C. Adherence to Cervical Cancer Screening Programs in Migrant Populations: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2200. [PMID: 36767568 PMCID: PMC9915157 DOI: 10.3390/ijerph20032200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Organized cervical cancer screening programs to promote the early identification of precancerous lesions have proven to be effective in decreasing the burden associated with cervical cancer, but knowledge regarding screening adherence among migrant women compared to that of native women has not been summarized. A systematic search of the literature on PubMed, Scopus and Embase led to the identification of 772 papers that were published up to July 2022 and reported population-based data regarding adherence to cervical screening. The screening participation rates among migrant women, compared to native women, were pooled using a random-effects meta-analysis. A total of 18 papers were included in the review, with most of them being conducted in Europe (83.3%). Overall, migrants showed a significantly lower participation rate compared to native women (OR for screening adherence: 0.54, 95% CI = 0.42-0.70). This discrepancy was especially evident for migrant women from North Africa and Sub-Saharan Africa (OR = 0.47, 95% CI = 0.35-0.63, and OR = 0.35, 95% CI = 0.24-0.49, respectively). The results of this systematic review emphasize the importance of increasing cervical cancer screening adherence among migrant women. A significant heterogeneity in screening adherence was observed based on the country of origin. Interventions aimed at reducing the disparities in screening participation should specifically consider how to improve the recruitment of migrant women.
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Affiliation(s)
- Isabella Rosato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Valentina Tricarico
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Claudio Barbiellini Amidei
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padua, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
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Adegboyega A, Wiggins A, Obielodan O, Dignan M, Schoenberg N. Beliefs associated with cancer screening behaviors among African Americans and Sub-Saharan African immigrant adults: a cross-sectional study. BMC Public Health 2022; 22:2219. [PMID: 36447190 PMCID: PMC9710024 DOI: 10.1186/s12889-022-14591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Beliefs influence cancer screening. However, there are conflicting findings about how belief influence cancer screening among Black adults. The aim of this study was to evaluate the relationships between beliefs (religiosity, fatalism, temporal orientation, and acculturation) and cervical, breast, and colorectal cancer screening behaviors among African Americans and sub-Saharan African immigrants. METHODS We conducted a cross-sectional survey of 73 African American and 59 English speaking Sub-Saharan immigrant adults recruited from Lexington and surrounding cities in Kentucky. Data collected included sociodemographic variables, cancer screening behaviors, and several instruments that characterize beliefs, including religiosity, fatalism, temporal orientation, and acculturation. RESULTS Participants' mean age was 43.73 years (SD = 14.0), 83% were females, and 45% self-identified as sub-Saharan immigrants. Based on eligibility for each screening modality, 64% reported having ever had a Pap test, 82% reported ever having mammogram, and 71% reported ever having a colonoscopy. Higher education (OR = 2.62, 95% CI = 1.43-4.80) and being insured (OR = 4.09, 95% CI = 1.10 - 15.18) were associated with increased odds of cervical cancer screening (pap test), while cancer fatalism (OR = 0.24, 95% CI = 0.07 - 0.88) was associated with decreased odds. Increased age (OR = 1.57, 95% CI = 1.06 - 2.32) and reduced present orientation (OR = 0.42, 95% CI = 0.22 - 0.80) were associated with receipt of a mammogram. Nativity was the only factor associated with colonoscopy screening. Compared to African Americans, sub-Saharan African immigrants were 90% less likely to have had a colonoscopy (OR = 0.10, 95% CI = 0.02 - 0.66). CONCLUSION This study contributes to the existing literature by confirming that beliefs are important in cancer screening behaviors among African American and sub-Saharan African immigrants. These findings should inform the development of cancer control and prevention programs for Black adults. TRIAL REGISTRATION US National Library of Science identifier NCT04927494. Registered June 16, 2021, www. CLINICALTRIALS gov.
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Affiliation(s)
- A. Adegboyega
- grid.266539.d0000 0004 1936 8438University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232 USA
| | - A.T. Wiggins
- grid.266539.d0000 0004 1936 8438University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232 USA
| | - O. Obielodan
- grid.266539.d0000 0004 1936 8438University of Kentucky College of Public Health, Lexington, USA
| | - M. Dignan
- grid.266539.d0000 0004 1936 8438Prevention Research Center, University of Kentucky College of Medicine, Lexington, KY USA
| | - N. Schoenberg
- grid.266539.d0000 0004 1936 8438Center for Health Equity Transformation, College of Medicine, University of Kentucky, 468 Healthy Kentucky Research Building, Lexington, KY 40536 USA ,grid.266539.d0000 0004 1936 8438Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, USA
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Adjei CA, Stutterheim SE, Bram F, Naab F, Ruiter RAC. Correlates of hepatitis B testing in Ghana: The role of knowledge, stigma endorsement and knowing someone with hepatitis B. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4564-e4573. [PMID: 35701984 PMCID: PMC10083906 DOI: 10.1111/hsc.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Hepatitis B testing is the gateway for prevention and care. However, previous studies document low hepatitis B testing uptake in sub-Saharan Africa. This study investigated knowledge, stigma endorsement and knowing someone with hepatitis B as correlates of hepatitis B testing behaviours among people in the Greater Accra and Northern regions of Ghana. A cross-sectional survey was completed by 971 participants (Greater Accra = 503, and Northern region = 468) between October 2018 and January 2019. Approximately 54% of the participants reported having been tested for hepatitis B. The logistic regression analyses showed that having greater hepatitis B knowledge was positively associated with hepatitis B testing (OR = 1.22, 95% CI: 1.14-1.30). Higher hepatitis B stigma endorsement was negatively related to hepatitis B testing (OR = 0.97, 95% CI: 0.96-0.99). Also, participants who knew someone (i.e. parent, sibling and/or friend) with hepatitis B were more likely to have tested compared to those who did not know someone with hepatitis B (OR = 7.15, 95% CI: 5.04-10.14). This study demonstrates that knowing someone with hepatitis B increases the likelihood of testing, highlighting the need to create safe and non-judgmental contexts for people with hepatitis B (PWHB) to disclose if they want to. Also, given that greater hepatitis B knowledge increases testing and hepatitis B stigma endorsement impedes testing, interventions that increase knowledge and reduce stigma should be incorporated in efforts to promote testing in Ghana.
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Affiliation(s)
| | - Sarah E. Stutterheim
- Department of Health PromotionCare and Public Health Research Institute, Maastricht UniversityMaastrichtThe Netherlands
| | - Fleuren Bram
- Department of Work and Social PsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Florence Naab
- Department of Maternal and Child HealthUniversity of GhanaAccraGhana
| | - Robert A. C. Ruiter
- Department of Work and Social PsychologyMaastricht UniversityMaastrichtThe Netherlands
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Osokpo OH, Lewis LM, Ikeaba U, Chittams J, Barg FK, Riegel BJ. Self-Care of African Immigrant Adults with Chronic Illness. Clin Nurs Res 2022; 31:413-425. [PMID: 34726102 PMCID: PMC8951348 DOI: 10.1177/10547738211056168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance (p < .0001), monitoring (p < .0001), and management (p < .0001). The perception of inadequate income was a significant determinant of poor self-care management (p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.
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Affiliation(s)
- Onome H. Osokpo
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Lisa M. Lewis
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Uchechukwu Ikeaba
- West Chester University of Pennsylvania, 25 University Avenue, West Chester, PA 19383
| | - Jesse Chittams
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Frances K. Barg
- University of Pennsylvania Perelman School of Medicine, 915 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Barbara J. Riegel
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
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Hassan SA, Mohamed F, Sheikh N, Basualdo G, Daniel NA, Schwartz R, Gebreselassie BT, Beyene YK, Gabreselassie L, Bayru K, Tadesse B, Libneh HA, Shidane M, Benalfew S, Ali A, Rao D, Patel RC, Kerani RP. "They Wait until the Disease Has Taking over You and the Doctors Cannot Do Anything about It": Qualitative Insights from Harambee! 2.0. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12706. [PMID: 34886432 PMCID: PMC8657258 DOI: 10.3390/ijerph182312706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022]
Abstract
African immigrants make up a large subgroup of Black/African-Americans in the US. However, because African immigrant groups are typically categorized as "Black," little is known about their preventative healthcare needs. Differences in culture, life and healthcare experiences between African immigrant populations and US-born people may influence preventive health care uptake. Thus, policymakers and healthcare providers lack information needed to make informed decisions around preventive care for African immigrants. This formative study was conducted among the largest East African immigrant communities in King County, WA. We recruited religious leaders, community leaders, health professionals, and lay community members to participate in thirty key informant interviews and five focus group discussions (n = 72 total), to better understand preventative healthcare attitudes in these communities. Through inductive coding and thematic analysis, we identified factors that impact preventative healthcare attitudes of the Somali, Ethiopian and Eritrean immigrant communities and deter them from accessing and utilizing healthcare. Cultural beliefs and attitudes around preventative healthcare, mistrust of westernized healthcare, religious beliefs/views, intersecting identities and shared immigrant experiences all influence how participants view preventative healthcare. Our results suggest that interventions that address these factors are needed to most effectively increase uptake of preventative healthcare in African immigrant communities.
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Affiliation(s)
- Shukri A. Hassan
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
| | - Farah Mohamed
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
- Somali Health Board, Tukwila, WA 98188, USA; (M.S.); (A.A.)
| | - Najma Sheikh
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Guiomar Basualdo
- Department of Anthropology, University of Washington, Seattle, WA 98195, USA;
| | - Nahom A. Daniel
- Department of Biology, University of Washington, Seattle, WA 98195, USA;
| | - Rahel Schwartz
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
- Ethiopian Health Board, Seattle, WA 98118, USA
| | | | - Yikealo K. Beyene
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Luwam Gabreselassie
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Kifleyesus Bayru
- Eritrean Health Board, Seattle, WA 98122, USA; (B.T.G.); (Y.K.B.); (L.G.); (K.B.)
| | - Bethel Tadesse
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | - Hirut Amsalu Libneh
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | | | - Sophia Benalfew
- Ethiopian Community Center in Seattle, Seattle, WA 98118, USA; (R.S.); (B.T.); (H.A.L.); (S.B.)
| | - Ahmed Ali
- Somali Health Board, Tukwila, WA 98188, USA; (M.S.); (A.A.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Rena C. Patel
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA; (N.S.); (D.R.)
| | - Roxanne P. Kerani
- Department of Medicine, University of Washington, Seattle, WA 98104, USA; (R.C.P.); (R.P.K.)
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Abdi HI, Hoover E, Fagan SE, Adsul P. Cervical Cancer Screening Among Immigrant and Refugee Women: Scoping-Review and Directions for Future Research. J Immigr Minor Health 2021; 22:1304-1319. [PMID: 32350683 DOI: 10.1007/s10903-020-01014-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to explore existing research on determinants of cervical cancer screening among immigrants and refugees in the U.S. A scoping review was conducted on 77 studies targeting immigrant and/or refugee women in the U.S., investigating factors related to cervical cancer screening. Sixty-three percent of studies were conducted in the past ten years, and included 122,345 women. Studies predominately explored knowledge, beliefs and barriers related to cervical cancer and screening. Common beliefs included fear of cancer, treatment and death. Participants perceived pap smears to be associated with embarrassment, pain and fear. Barriers to screening were reported in three categories: psychosocial (shame and embarrassment), communication (inability to speak in English), and barriers related to access (lack of insurance or primary care provider). Study findings indicate research focused at the individual-level and future research should focus on exploring multilevel influences on cancer screening uptake.
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Affiliation(s)
- Hamdi I Abdi
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN, 55455, USA
| | | | | | - Prajakta Adsul
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, 1 University of New Mexico, 2325 Camino de Salud, Albuquerque, NM, 87131, USA.
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Cudjoe J, Nkimbeng M, Turkson-Ocran RA, Commodore-Mensah Y, Han HR. Understanding the Pap Testing Behaviors of African Immigrant Women in Developed Countries: A Systematic Review. J Immigr Minor Health 2021; 23:840-856. [PMID: 33165711 PMCID: PMC8747177 DOI: 10.1007/s10903-020-01119-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND African immigrant (AI) women remain burdened by cervical cancer, but the prevalence and correlates of Pap testing remains unclear in this population. OBJECTIVE To review studies on the prevalence and determinants of Pap testing among AI women living in developed countries. METHODS PubMed, CINAHL, Embase, and Scopus were searched for relevant articles that included African-born immigrant participants; were published in English; addressed the prevalence of Pap testing; conducted in a developed country; and identified correlates of Pap testing behavior. The Andersen Behavioral Model guided synthesis of the key findings. RESULTS Sixteen studies met the inclusion criteria. The prevalence of Pap testing ranged from 4.6% to 73.0%. Having a female provider and access to primary care facilitated Pap testing. Barriers to Pap testing included low income, male healthcare providers, and no history of gynecological exam. CONCLUSIONS Healthcare providers and social determinants-particularly income and healthcare access, play an important role in improving Pap testing among AI women. Larger qualitative and mixed methods studies are needed to explore other important determinants of Pap testing such as disease knowledge, self-efficacy, health literacy to reduce the burden of cervical cancer among AI women.
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Affiliation(s)
- Joycelyn Cudjoe
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Inova Health System, 8110 Gatehouse Road, Falls Church, VA, 22042, USA.
| | - Manka Nkimbeng
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN, 55444, USA
| | - Ruth-Alma Turkson-Ocran
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Yvonne Commodore-Mensah
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Cardiovascular and Chronic Care, The Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Hae-Ra Han
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Cardiovascular and Chronic Care, The Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Community Innovation and Scholarship, The Johns Hopkins School of Nursing, 855 N Wolfe Street, Baltimore, MD, 21205, USA
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Jin SW, Lee J, Lee HY. Analyzing factors associated with decisional stage of adopting breast cancer screening among Korean American women using precaution adoption process model. ETHNICITY & HEALTH 2021; 26:431-447. [PMID: 30326735 PMCID: PMC6531354 DOI: 10.1080/13557858.2018.1520813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
Background: Korean American (KA) women have experienced higher prevalence and lower survival rates of breast cancer (BC) than other ethnic groups in the United States. However, BC screening rates for KA women remain significantly lower than the national target (81.1%) specified by Healthy People 2020. Few studies have explained how the decision to adopt BC screening occurs and progresses and what factors contribute to this decision among KA women. This study used Weinstein's Precaution Adoption Process Model (PAPM) as a theoretical framework to examine characteristics and factors associated with the decisional stage of mammography adoption.Methods: A cross-sectional self-report survey was administered among KA women (N = 308) ages 50-80 from the Atlanta metropolitan area. A total of 281 KA women completed the survey, answering questions about socio-demographics, health-related information, mammography history, doctor recommendation, BC screening knowledge, self-efficacy for BC screening, decisional balance scores on attitudes and beliefs pertaining to mammography, and the seven-stage PAPM.Results: KA women reported a low rate of mammography uptake with about 24% and 35% of the participants undergoing mammography within the last year and two years, respectively. KA women in stages 5 (decided yes), 6 (action), and 7 (maintenance) were likely to have increased screening-related knowledge, positive decisional balance, and regular medical check-up compared to those in stages 1 (unaware), 2 (unengaged), and 3 (deciding).Conclusion: This study highlights important factors that could potentially facilitate BC screening among KA women in Georgia. The findings also provide implications for interventions and practice for increasing mammography screening among medically underserved populations.
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Affiliation(s)
- Seok Won Jin
- School of Social Work, The University of Memphis, 226 McCord Hall. Memphis, TN 38152. Tel: 901-678-2616, Fax:
901-678-2981. ()
| | - Jongwook Lee
- candidate and a Research Professional, Department of Applied Economics, University of Minnesota, 218G Ruttan Hall,
1994 Buford Avenue, St. Paul, MN 55108. Tel: 612-624-4218. ()
| | - Hee Yun Lee
- Associate Dean for Research, Endowed Academic Chair on Social Work (Health), School of Social Work, University of
Alabama, Tuscaloosa, 1022 Little Hall, Box 870314, Tuscaloosa, AL 35487. Tel: 205-348-6553.
()
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Rogers CR, Obidike OJ, Wallington SF, Hussein M, Mahamed ZA, Sampson J. A qualitative study of barriers and enablers associated with colorectal cancer screening among Somali men in Minnesota. ETHNICITY & HEALTH 2021; 26:168-185. [PMID: 29973057 PMCID: PMC6320306 DOI: 10.1080/13557858.2018.1493438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
The rate of cancer screening is generally increasing in the US. In Minnesota, the statewide average rate of screening for colorectal cancer (CRC) is 73%. However, screening completion is relatively low among Somali men; overall, only 27% of Somali immigrants have been screened for CRC. Factors contributing to this disparity have not been well researched. The purpose of this pilot study was to employ focus group methodology to describe and advance understanding of the barriers and enablers associated with CRC screening among Somali men ages 50-74 in Minnesota. Three focus groups were conducted among 27 Somali men in Minnesota. A 9-question, semi-structured interview guide was used. The sessions were audio recorded, transcribed verbatim, and checked for accuracy by research staff prior to data analysis. Three research team members utilized the constant comparative method and NVivo to conduct data analysis. Five barriers to CRC screening emerged from the analyses: (1) lack of knowledge, (2) emotional barriers, (3) acculturation, (4) accountability, and (5) fatalistic beliefs. In addition, two factors enabling CRC screening and prevention emerged: the need for tailored interventions and preventive lifestyle behaviors. The insights gained from this research will assist in developing health promotion and education-focused interventions that encourage Somali immigrants in Minnesota and beyond to seek early detection screening for CRC.Abbreviations: CRC: Colorectal Cancer; FIT: Fecal Immunochemical Test; FOBT: Fecal Occult Blood Test; FQHC: Federally Qualified Health Center; PA: Project Assistant; PI: Principal Investigator.
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Affiliation(s)
- Charles R. Rogers
- University of Minnesota Medical School, Dept. of Family Medicine & Community Health, 717 Delaware St. SE, Suite 166, Minneapolis, MN 55414, Tel. +1-612-626-3894, Fax +1-612-626-6782
| | | | - Sherrie F. Wallington
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
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Barriers and Facilitators to Cervical Screening among Migrant Women of African Origin: A Qualitative Study in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207473. [PMID: 33066565 PMCID: PMC7602139 DOI: 10.3390/ijerph17207473] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022]
Abstract
Globally, cervical cancer constitutes a substantial public health concern. Evidence recommends regular cervical cancer screening (CCS) for early detection of "precancerous lesions."Understanding the factors influencing screening participation among various groups is imperative for improving screening protocols and coverage. This study aimed to explore barriers and facilitators to CCS participation in women of Nigerian, Ghanaian, Cameroonian, and Kenyan origin in Finland. We utilized a qualitative design and conducted eight focus group discussions (FGDs) in English, with women aged 27-45 years (n = 30). The FGDs were tape-recorded, transcribed verbatim, and analyzed utilizing the inductive content analysis approach. The main barriers to CCS participation included limited language proficiency, lack of screening awareness, misunderstanding of screening's purpose, and miscomprehension of the CCS results. Facilitators were free-of-charge screening, reproductive health services utilization, and women's understanding of CCS's importance for early detection of cervical cancer. In conclusion, among women, the main barriers to CCS participation were language difficulties and lack of screening information. Enhancing screening participation amongst these migrant populations would benefit from appropriate information about the CCS. Those women with limited language skills and not utilizing reproductive health services need more attention from healthcare authorities about screening importance. Culturally tailored screening intervention programs might also be helpful.
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“Girl, just pray …”: Factors That Influence Breast and Cervical Cancer Screening Among Black Women in Rochester, MN. J Natl Med Assoc 2020; 112:454-467. [DOI: 10.1016/j.jnma.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/26/2019] [Indexed: 11/22/2022]
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Mahumud RA, Gow J, Keramat SA, March S, Dunn J, Alam K, Renzaho AMN. Distribution and predictors associated with the use of breast cancer screening services among women in 14 low-resource countries. BMC Public Health 2020; 20:1467. [PMID: 32993596 PMCID: PMC7526143 DOI: 10.1186/s12889-020-09557-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/17/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Breast cancer is one of the leading public health problem globally, especially in low-resource countries (LRCs). Breast cancer screening (BCS) services are an effective strategy for early determining of breast cancer. Hence, it is imperative to understand the utilisation of BCS services and their correlated predictors in LRCs. This study aims to determine the distribution of predictors that significantly influence the utilisation of BCS services among women in LRCs. METHODS The present study used data on 140,974 women aged 40 years or over from 14 LRCs. The data came from country Demographic and Health Surveys (DHS) between 2008 and 2016. Multivariate logistic regression analysis was employed to investigate the significant predictors that influence the use of BCS services. RESULTS The utilisation of BCS services was 15.41%, varying from 81.10% (95% CI: 76.85-84.73%) in one European country, to 18.61% (95% CI: 18.16 to 19.06%) in Asian countries, 14.30% (95% CI: 13.67-14.96%) in American countries, and 14.29% (95% CI: 13.87-14.74%). Factors that were significantly associated to increase the use of BCS services include a higher level of education (OR = 2.48), advanced age at first birth (> 25 years) (OR = 1.65), female-headed households (OR = 1.65), access to mass media communication (OR = 1.84), health insurance coverage (OR = 1.09), urban residence (OR = 1.20) and highest socio-economic status (OR = 2.01). However, obese women shown a significantly 11% (OR = 0.89) lower use of BSC services compared to health weight women. CONCLUSION The utilisation of BCS services is low in many LRCs. The findings of this study will assist policymakers in identifying the factors that influence the use of BCS services. To increase the national BCS rate, more attention should be essential to under-represented clusters; in particular women who have a poor socioeconomic clusters, live in a rural community, have limited access to mass media communication, and are have a low level educational background. These factors highlight the necessity for a new country-specific emphasis of promotional campaigns, health education, and policy targeting these underrepresented groups in LRCs.
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Affiliation(s)
- Rashidul Alam Mahumud
- School of Social Sciences, Western Sydney University, Penrith, New South Wales, 2751, Australia.
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia.
- Health Economics and Policy Research, School of Commerce, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia.
| | - Jeff Gow
- Health Economics and Policy Research, School of Commerce, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Syed Afroz Keramat
- Department of Economics, American International University-Bangladesh, Dhaka, 1212, Bangladesh
| | - Sonja March
- School of Psychology and Counselling, University of Southern Queensland, Toowoomba, Queensland, 4300, Australia
| | - Jeff Dunn
- Health Economics and Policy Research, School of Commerce, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Brisbane, QLD 4006, Australia
- Prostate Cancer Research Foundation of Australia, St Leonards, New South Wales, 2065, 40, Australia
| | - Khorshed Alam
- Health Economics and Policy Research, School of Commerce, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia
| | - Andre M N Renzaho
- School of Social Sciences, Western Sydney University, Penrith, New South Wales, 2751, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
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Raines Milenkov A, Felini M, Baker E, Acharya R, Longanga Diese E, Onsa S, Fernando S, Chor H. Uptake of cancer screenings among a multiethnic refugee population in North Texas, 2014-2018. PLoS One 2020; 15:e0230675. [PMID: 32226017 PMCID: PMC7105132 DOI: 10.1371/journal.pone.0230675] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/05/2020] [Indexed: 01/04/2023] Open
Abstract
Background Refugees are less likely than US born populations to receive cancer screenings. Building Bridges is a community health worker prevention program designed to increase refugee’s cancer screening uptake. The purpose of this cross sectional analysis was to assess differences in uptake of cervical, breast, liver, and colorectal screens across six cultural groups. Methods Data was abstracted in 2018 for this analysis. Participants were categorized into six cultural groups (Myanmar, Central Africa, Bhutan, Somalia, Arabic Speaking Countries, and Other) to assess differences in sociodemographic measures and screening uptake. Uptake proportions were calculated for each cancer type (cervical, breast, liver, and colon) among eligible participants, by gender and cultural group. Differences in uptake across groups were assessed using stratified analysis and logistic regression. Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were calculated for each group to assess the association between screening completion and cultural group. Findings 874 refugees were asked about cancer screening history. The majority of participants were either ‘never had been screened’ or ‘not up-to-date’ for every cancer screening. Among age eligible, 82% had no prior pap exam within the past 3 years, 81% had no prior mammogram within the past year, 69% didn’t know their Hepatitis B status and 87% never had a colon cancer screening. Overall, higher uptake of all types of cancer screenings was observed in Myanmar and Bhutanese groups, except colon cancer screening which was higher among Central African Region and Arabic Speaking participants. Conclusion Screening uptake varied by ethnic group and screening type. The program reached an under and never screened population, however, the proportion of refugees who received a cancer screening remained low compared to the US population. Diversity within refugee communities requires adaptation to specific cultural and linguistic needs to include new Americans in cancer elimination efforts.
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Affiliation(s)
- Amy Raines Milenkov
- Department of Pediatrics & Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
- * E-mail:
| | - Martha Felini
- Department of Pediatrics & Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Eva Baker
- Department of Pediatrics & Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Rushil Acharya
- Department of Pediatrics & Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Elvis Longanga Diese
- Department of Pediatrics & Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Sara Onsa
- Department of Pediatrics & Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Shane Fernando
- Department of Pediatrics & Women’s Health, University of North Texas Health Science Center, Fort Worth, TX, United States of America
| | - Holy Chor
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, United States of America
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Factors Associated with Cervical Cancer Screening Uptake: Implications for the Health of Women in Jordan. Infect Dis Obstet Gynecol 2020; 2020:9690473. [PMID: 32256030 PMCID: PMC7114762 DOI: 10.1155/2020/9690473] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/24/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose The existing factors that influence cervical cancer screening uptake worldwide do not necessarily reflect the situation in Jordan. Therefore, the aim of this study was to determine the factors associated with cervical cancer screening uptake among Jordanian women. Methods In this cross-sectional study, 500 married Jordanian women aged 21 to 65 years were recruited from eight nongovernmental organisations and community settings in Amman. Data were collected with a self-administered questionnaire regarding sociodemographic and reproductive data, a health utilisation data form, and scales on the perceived benefits of screening, perceived barriers to screening, perceived susceptibility to cervical cancer, and perceptions regarding the severity of cervical cancer. Descriptive statistics, multivariate logistic regressions, and independent t-tests were used in the data analysis. Results Among the 500 age-eligible women, only 156 (31.2%) had been screened for cervical cancer. Healthcare provider encouragement, years of marriage (odds ratio (OR) = 5.24, confidence interval (CI) = 95%, p = 0.00), and use of the private healthcare sector (OR = 2.20, CI = 95%, p = 0.012) were significant predictors of cervical cancer screening. Conclusion Cervical cancer screening uptake among Jordanian women is significantly low; determining factors for the decision to undergo screening include encouragement from the healthcare provider, the number of years of marriage, and use of the private healthcare sector. To improve uptake, structured screening programmes need to be implemented in collaboration with national partners and institutions to decrease the incidence of cervical cancer in Jordan.
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Huhmann K. Barriers and Facilitators to Breast and Cervical Cancer Screening in Somali Immigrant Women: An Integrative Review. Oncol Nurs Forum 2020; 47:177-186. [DOI: 10.1188/20.onf.177-186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Adunlin G, Cyrus JW, Asare M, Sabik LM. Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States. J Immigr Minor Health 2019; 21:606-658. [PMID: 30117005 DOI: 10.1007/s10903-018-0794-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.
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Affiliation(s)
- Georges Adunlin
- McWhorter School of Pharmacy, Samford University, 2100 Lakeshore Dr, Homewood, AL, 35229, USA.
| | - John W Cyrus
- Tompkins-McCaw Library, Virginia Commonwealth University, 509 N 12th St, Richmond, VA, 23298-0430, USA
| | - Matthew Asare
- Department of Public Health, Baylor University, One Bear Place #97313, Waco, TX, 76798-7313, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 De Soto St., Pittsburgh, PA, 15261, USA
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Rodriguez-Torres SA, McCarthy AM, He W, Ashburner JM, Percac-Lima S. Long-Term Impact of a Culturally Tailored Patient Navigation Program on Disparities in Breast Cancer Screening in Refugee Women After the Program's End. Health Equity 2019; 3:205-210. [PMID: 31106287 PMCID: PMC6524343 DOI: 10.1089/heq.2018.0104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: To examine the long-term effects of a patient navigation (PN) program for mammography screening tailored to refugee women and to assess screening utilization among these women after PN ended. Methods: We assessed the proportion of patients completing mammography screening during the prior 2 years during 2012–2016 for refugee women who had previously received PN compared with that of English-speaking women cared for at the same health center during the same period, both overall and stratifying by age. We used logistic regression to compare screening completion between refugees and English speakers, adjusting for age, race, insurance status, number of clinic visits, and clustering by primary care physician and to test trends in screening over time. Results: In 2012, the year when the funding for PN ceased, among 126 refugee women eligible for breast cancer screening, mammography screening rates were significantly higher among refugees (90.5%, 95% confidence interval [CI]: 83.5–94.7%) than among English speakers (81.9%, 95% CI: 76.2–86.5%, p=0.006). By 2016, screening rates decreased among refugee women (76.5%, 95% CI: 61.6–86.9%, p=0.023) but were not statistically significantly different from those among English-speaking women (80.5%, 95% CI: 74.4–85.3%, p=0.460). Screening prevalence for refugee women remained above the pre-PN program screening levels, and considerably so in women <50 years. Conclusion: The culturally and language-tailored PN program for refugee women appeared to have persistent effects, with refugee women maintaining similar levels of mammography screening to English-speaking patients 5 years after the PN program's end.
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Affiliation(s)
| | - Anne Marie McCarthy
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Wei He
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey M Ashburner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Adegboyega A, Aleshire M, Dignan M, Hatcher J. Spousal support and knowledge related to cervical cancer screening: Are Sub-Saharan African immigrant men interested? Health Care Women Int 2019; 40:665-681. [PMID: 31084466 DOI: 10.1080/07399332.2019.1615914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sub-Saharan African immigrant (SSAI) men have significant influence on the health-seeking behavior including cervical cancer screening uptake by their female partners/wives. We conducted a qualitative descriptive study with 21 SSAI men to explore knowledge, perceptions, and support related to cervical screening. Participants were aged 36 ± 9 years, college educated (88%), and 53% have lived in the U.S. > 5 years. Three themes emerged; inadequate cervical cancer knowledge, willingness and strategies for support, and shared versus autonomous decision making for screening. Social structure with emphasis on male leadership could be leveraged in cervical cancer screening promotion for SSAI women.
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Affiliation(s)
- Adebola Adegboyega
- a College of Nursing , University of Kentucky , Lexington , Kentucky , USA
| | - Mollie Aleshire
- a College of Nursing , University of Kentucky , Lexington , Kentucky , USA
| | - Mark Dignan
- b Prevention Research Center , University of Kentucky , Lexington , Kentucky , USA
| | - Jennifer Hatcher
- a College of Nursing , University of Kentucky , Lexington , Kentucky , USA
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Anaman JA, Correa-Velez I, King J. A survey of cervical screening among refugee and non-refugee African immigrant women in Brisbane, Australia. Health Promot J Austr 2019; 28:217-224. [PMID: 27802410 DOI: 10.1071/he16017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed To compare the level of cervical screening uptake between refugee and non-refugee African immigrant women living in Brisbane, Australia, and examine factors associated with Pap smear testing. Methods Cross-sectional survey with a convenience sample of 254 women aged 21-62 years from 22 African countries (144 refugees, 110 non-refugees). Chi-square tests were used to compare the demographic and health-related characteristics between refugee and non-refugee women. Bivariate and multiple logistic regression analyses were used to assess the relationship between the outcome variable (Pap smear testing) and the independent variables. Results Two-thirds of women had used Pap smear services in Australia. Chi-square test analysis established that non-refugee women were significantly more likely to have used Pap smear services than refugee women (73.6% vs 61.8% respectively; P=0.047). Immigration status, however, was not a significant predictor of cervical screening uptake in the multiple regression analyses. The significant predictors for screening uptake in these analyses were work arrangement, parity, healthcare visit, knowledge about Pap smear and perceived susceptibility to cervical cancer. Conclusion Most women relied on opportunistic screening after receiving invitation letters to screen or after visiting health professionals for antenatal or postnatal care. So what? The findings suggest that organised cervical screening programs are not reaching most African immigrant women living in Brisbane. It is incumbent on the public health sector, including healthcare professionals and settlement agencies working with African communities, to develop health promotion strategies that meaningfully engage African immigrant women, including those from refugee backgrounds, to enhance their knowledge about cervical cancer and screening practices.
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Affiliation(s)
- Judith A Anaman
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Ignacio Correa-Velez
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Julie King
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
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"They were just waiting to die": Somali Bantu and Karen Experiences with Cancer Screening Pre- and Post-Resettlement in Buffalo, NY. J Natl Med Assoc 2018; 111:234-245. [PMID: 30420078 DOI: 10.1016/j.jnma.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/06/2018] [Accepted: 10/05/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about how pre-resettlement experiences affect refugees' uptake of cancer screenings. The objective of this study was to characterize Somali Bantu and Karen experiences with cancer and cancer screenings prior to and subsequent to resettlement in Buffalo, NY in order to inform engagement by health providers. METHODS The study was grounded in a community-based participatory research approach, with data collection and analysis guided by the Health Belief Model and life course framework. Interviews were transcribed, independently coded by two researchers, and analyzed using an immersion-crystallization approach. We conducted 15 semi-structured interviews and six interview-focus group hybrids with Somali Bantu (n = 15) and Karen (n = 15) individuals who were predominantly female (87%). RESULTS Cancer awareness was more prevalent among Karen compared to Somali Bantu participants. Prior to resettlement, preventative health care, including cancer screening, and treatment were unavailable or inaccessible to participants and a low priority compared with survival and acute health threats. There, Somali Bantu treated cancer-like diseases with traditional medicine (heated objects, poultices), and Karen reported traditional medicine and even late-stage biomedical treatments were ineffective due to extent of progressed, late-stage ulcerated tumors when care was sought. A fatalistic view of cancer was intertwined with faith (Somali Bantu) and associated with untreated, late-stage cancer (Karen). Karen but not Somali Bantu reported individuals living with cancer were stigmatized pre-resettlement due to the unpleasant manifestations of untreated, ulcerated tumors. Now resettled in the U.S., participants reported obtaining cancer screenings was challenged by transportation and communication barriers and facilitated by having insurance and interpretation services. While Somali Bantu women strongly preferred a female provider for screenings, Karen women felt cancer severity outweighed cultural modesty concerns in terms of provider gender. SIGNIFICANCE Our findings suggest the need for culturally-relevant cancer education that incorporates the life course experiences and addresses logistical barriers in linking individuals with screening, to be complemented by trauma-informed care approaches by healthcare providers.
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Endeshaw M, Clarke T, Senkomago V, Saraiya M. Cervical Cancer Screening Among Women by Birthplace and Percent of Lifetime Living in the United States. J Low Genit Tract Dis 2018; 22:280-287. [PMID: 30063576 PMCID: PMC6664302 DOI: 10.1097/lgt.0000000000000422] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of the study was to provide national estimates of Pap test receipt, by birthplace, and percent of lifetime in the United States (US). MATERIALS AND METHODS Pooled nationally representative data (2005, 2008, 2013, 2015) from the National Health Interview Survey were used to examine differences in Pap test receipt among adult US women by birthplace and percent of lifetime in the US. Descriptive estimates were age-adjusted. Regression models were adjusted for selected sociodemographic and healthcare access and utilization factors and presented as predicted margins. RESULTS Foreign-born women 18 years and older were more than twice as likely to have never received a Pap test compared with US-born women (18.6% vs 6.8%). Regression models showed that foreign-born women from Mexico (9.8%), South America (12.6%), Caribbean (14.6%), Southeast Asia (13.7%), Central Asia (20.4%), South Asia (22.9%), Middle East (25.0%), Africa (27.8%), Europe (16.4%), and Former Soviet Union (28.2%) were more likely to be unscreened compared with US-born women (7.6%). Foreign-born women who spent less than 25% of their life in the US had higher prevalence of never having a Pap test (20%) compared with foreign-born who spent more than 25% of their life in the US (12.7%). CONCLUSIONS Using national survey, we found that where a woman is born and the percent of her lifetime spent residing in the US do impact whether she gets screened at least once in her lifetime. IMPACT These findings may inform cervical cancer screening efforts targeting foreign-born women.
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Affiliation(s)
- Meheret Endeshaw
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | - Tainya Clarke
- Division of Health Interview Statistics, Centers for Disease Control and Prevention, National Center for Health Statistics, Atlanta, GA
| | - Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
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Allen EM, Lee HY, Pratt R, Vang H, Desai JR, Dube A, Lightfoot E. Facilitators and Barriers of Cervical Cancer Screening and Human Papilloma Virus Vaccination Among Somali Refugee Women in the United States: A Qualitative Analysis. J Transcult Nurs 2018; 30:55-63. [PMID: 30170512 DOI: 10.1177/1043659618796909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Eastern Africa has the highest rates of cervical cancer incidence (42.7 per 100,000) and mortality (27.6 per 100,000), substantially higher than worldwide incidence (14.0 per 100,000) and mortality (6.8 per 100,000). The purpose of this study was to explore facilitators and barriers to cervical cancer screening and human papilloma virus (HPV) vaccination among Somali refugee women and their children. METHOD Focus group discussions were conducted in August of 2016. Investigators performed systematic, comparative, and thematic data analyses. RESULTS The 31 Somali refugee participants ranged from 23 to 64 years old. Four major themes emerged: (1) knowledge, (2) facilitators, (3) decision making, and (4) views on intervention strategies. Doctor recommendation and family support were important facilitators. Community education was the most popular strategy in promoting screening and vaccine uptake. DISCUSSION Multilevel targeted interventions should increase knowledge and include family members to increase cervical cancer screening and HPV vaccination uptake in the Somali community.
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Affiliation(s)
| | - Hee Yun Lee
- 2 University of Alabama, Tuscaloosa, AL, USA
| | | | - Houa Vang
- 4 University of Minnesota, St. Paul, MN, USA
| | - Jay R Desai
- 5 HealthPartners Institute, Bloomington, MN, USA
| | - Amano Dube
- 6 Brian Coyle Center, Minneapolis, MN, USA
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Leinonen MK, Campbell S, Ursin G, Tropé A, Nygård M. Barriers to cervical cancer screening faced by immigrants: a registry-based study of 1.4 million women in Norway. Eur J Public Health 2018; 27:873-879. [PMID: 28957477 PMCID: PMC5881680 DOI: 10.1093/eurpub/ckx093] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Immigrants from certain low- and middle-income countries are more prone to cancers attributed to viral infections in early life. Cervical cancer is caused by human papillomavirus but is highly preventable by regular screening. We assessed participation among immigrants in a population-based cervical screening programme and identified factors that predicted non-adherence within different immigrant groups. Methods We used data from several nationwide registries. The study population consisted of 208 626 (15%) immigrants and 1 157 223 (85%) native Norwegians. Non-adherence was defined as no eligible screening test in 2008–12. We estimated prevalence ratios with 95% confidence intervals (CIs) for factors associated with non-adherence by modified Poisson regression. Results In total, 52% of immigrants were not screened. All immigrants showed 1.72 times higher non-adherence rates (95% CI 1.71–1.73) compared with native Norwegian women when adjusted for age and parity. The proportion of non-adherent immigrants varied substantially by region of origin and country of origin. Being unemployed or not in the workforce, being unmarried, having low income and having a male general practitioner was associated with non-adherence regardless of region of origin. Living <10 years in Norway was an evident determinant of non-adherence among most but not all immigrant groups. Conclusions An increasing proportion of immigrants and low screening participation among them pose new public health challenges in Europe. Immigrants are diverse in terms of their sociodemographic attributes and screening participation. Tailored information and service delivery may be necessary to increase cancer screening among immigrants.
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Affiliation(s)
| | | | - Giske Ursin
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ameli Tropé
- Department of Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Differences in cervical cancer screening between immigrants and nonimmigrants in Norway: a primary healthcare register-based study. Eur J Cancer Prev 2018; 26:521-527. [PMID: 27749381 PMCID: PMC5627531 DOI: 10.1097/cej.0000000000000311] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Supplemental Digital Content is available in the text. The prevalence of cervical cancer is high among some groups of immigrants. Although there is evidence of low participation in cervical cancer screening programs among immigrants, studies have been subject to selection bias and accounted for few immigrant groups. The aim of this study was to compare the proportion of several groups of immigrants versus nonimmigrants attending the cervical cancer-screening program in Norway. In addition, we aimed to study predictors for attendance to the screening program. Register-based study using merged data from four national registries. All Norwegian-born women (1 168 832) and immigrant women (152 800) of screening age for cervical cancer (25–69 years) registered in Norway in 2008 were included. We grouped the immigrants by world’s geographic region and carried out descriptive analyses and constructed several logistic regression models. The main outcome variable was whether the woman was registered with a Pap smear in 2008 or not. Immigrants had lower rates of participation compared with Norwegian-born women; Western Europe [adjusted odds ratio (OR), 95% confidence interval (CI): 0.84, 0.81–0.88], Eastern Europe (OR 0.64, 95% CI: 0.60–0.67), Asia (OR 0.74, 95% CI: 0.71–0.77), Africa (OR 0.61, 95% CI: 0.56–0.67) and South America (OR 0.87, 95% CI: 0.79–0.96). Younger age, higher income, residence in rural areas, and having a female general practitioner (GP) were associated with Pap smear. Longer residential time in Norway and having a nonimmigrant GP were associated with screening for some immigrant groups. Appropriate interventions targeting both immigrants and GPs need to be developed and evaluated.
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Watanabe-Galloway S, Alnaji N, Grimm B, Leypoldt M. Cancer Community Education in Somali Refugees in Nebraska. J Community Health 2018; 43:929-936. [DOI: 10.1007/s10900-018-0507-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lor B, Ornelas IJ, Magarati M, Do HH, Zhang Y, Jackson JC, Taylor VM. We Should Know Ourselves: Burmese and Bhutanese Refugee Women's Perspectives on Cervical Cancer Screening. J Health Care Poor Underserved 2018; 29:881-897. [PMID: 30122670 PMCID: PMC9731145 DOI: 10.1353/hpu.2018.0066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Refugee women are at increased risk for cervical cancer and have low rates of cervical cancer screening both in their countries of origin and in the U.S. Using the Behavioral Model for Vulnerable Populations as a conceptual framework, we conducted eight focus groups with Burmese and Bhutanese refugee women to gather information about factors influencing cervical cancer screening (31 Burmese and 27 Bhutanese participants). Less than one-third (28%) reported being screened for cervical cancer before coming to the U.S. and only 45% reported being screened after resettling in the U.S. Participants had limited knowledge about cervical cancer and the need for screening, and faced multiple barriers including competing priorities and cost. However, trusted providers and interpreters were seen as means of facilitating screening. Cervical cancer screening among Bhutanese and Burmese refugee women could be improved with culturally tailored health education and increased access to female providers and trained interpreters.
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Ornelas IJ, Ho K, Jackson JC, Moo-Young J, Le A, Do HH, Lor B, Magarati M, Zhang Y, Taylor VM. Results From a Pilot Video Intervention to Increase Cervical Cancer Screening in Refugee Women. HEALTH EDUCATION & BEHAVIOR 2017; 45:559-568. [PMID: 29202606 DOI: 10.1177/1090198117742153] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many refugee women emigrate from countries with high cervical cancer incidence rates and have low rates of cervical cancer screening both before and after resettlement. Refugee women face many barriers to cervical cancer screening, including limited knowledge of cervical cancer and screening recommendations and cultural and linguistic barriers to being screened. Our pilot study aimed to develop and evaluate educational videos to promote cervical cancer screening among Karen-Burmese and Nepali-Bhutanese refugees, two of the largest groups of refugees arriving to the United States in recent years. We developed culturally tailored narrative videos for each ethnic group. Karen-Burmese and Nepali-Bhutanese women ( N = 40) were recruited through community health educators to participate in a pre- and posttest study. We assessed changes in cervical cancer knowledge and intentions to be screened, and satisfaction with the videos. We found that women were significantly more likely to report having heard of a test for cervical cancer and indicated significantly greater intentions to be screened after watching the video. Their knowledge about cervical cancer and screening also improved significantly, and they reported high levels of acceptability with the video. Our results suggest that culturally tailored narrative educational videos were acceptable to the target audiences and may be effective in increasing cervical cancer screening among refugee women. Further research should assess how health care and social service providers could implement video-based interventions to encourage women to be screened for cervical cancer during early resettlement.
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Affiliation(s)
- India J Ornelas
- 1 University of Washington, Seattle, WA, USA.,2 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Khanh Ho
- 1 University of Washington, Seattle, WA, USA
| | | | | | - Anh Le
- 1 University of Washington, Seattle, WA, USA
| | - H Hoai Do
- 2 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ying Zhang
- 1 University of Washington, Seattle, WA, USA
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Bianco A, Larosa E, Pileggi C, Nobile CGA, Pavia M. Cervical and breast cancer screening participation and utilisation of maternal health services: a cross-sectional study among immigrant women in Southern Italy. BMJ Open 2017; 7:e016306. [PMID: 29038177 PMCID: PMC5652469 DOI: 10.1136/bmjopen-2017-016306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Women make up approximately half of the world's one billion migrants. Immigrant women tend to be one of the most vulnerable population groups with respect to healthcare. Cancer screening (CS) and maternal and reproductive health have been included among the 10 main issues pertinent to women's health. The aim of this study is to explore breast and cervical CS participation and to acquire information regarding access to healthcare services during pregnancy, childbirth and the postpartum period among age eligible immigrant women in Southern Italy. METHODS A structured questionnaire was used to collect data from each participant. Women aged 25-64 years who had not had a hysterectomy and women aged 50-69 years without history of breast cancer were considered eligible for the evaluation of cervical and breast CS participation, respectively. Moreover, women who had delivered at least once in Italy were enrolled to describe antenatal and postpartum care services use. All women were recruited through the third sector and non-profit organisations (NPOs). RESULTS Rate of cervical CS among the 419 eligible women was low (39.1%), and about one-third had had a Pap test for screening purposes within a 3-year period from interview (32.8%). Regarding breast CS practices, of the 125 eligible women 45.6% had had a mammography for control purposes and less than a quarter (26, 20.8%) had their mammography within the recommended time interval of 2 years. About 80% of the respondents did not report difficulties of access and use of antenatal and postpartum services. CONCLUSION This study provides currently unavailable information about adherence to CS and maternal and child health that could encourage future research to develop and test culturally appropriate, women-centred strategies for promoting timely and regular CS among immigrant women in Italy.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
| | - Elisabetta Larosa
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
| | - Carmelo G A Nobile
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Campus of Germaneto, Catanzaro, Italy
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Ogunsiji OO, Kwok C, Fan LC. Breast cancer screening practices of African migrant women in Australia: a descriptive cross-sectional study. BMC Womens Health 2017; 17:32. [PMID: 28412942 PMCID: PMC5392914 DOI: 10.1186/s12905-017-0384-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 03/30/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Breast cancer is the most diagnosed cancer among women and a leading cause of mortality and morbidity, globally. Breast cancer mortality can be improved through routine cancer screening, yet migrant populations have lower participation rates. While African migrants are among the fastest growing migrant population in Australia, their breast cancer screening behaviour is under-studied. The aims of this study were to report breast cancer screening status of African migrant women and factors associated with their breast cancer screening behaviour in Australia. METHODS A descriptive, cross-sectional approach was utilised for this study. Two hundred and sixty four African migrant women aged 18-69 years and recruited from a number of organisations responded to a self-reported African version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Main research variables are breast cancer screening practices and demographic characteristics and total scores on each of the BCSBQ subscales. Multivariable logistic regression analyses were performed to investigate the impact of the demographic variables on the likelihood of women in the target age range 50-74 years having screening practices as recommended. RESULTS While most of the participants heard of breast awareness (76.1%) and mammogram (85.2%), only 11.4% practised monthly breast awareness, whereas 65.9% had ever had a mammogram as frequently as recommended. Age and employment were determining factors for participating in mammogram. Significant different scores were found in the "Practical barriers" between women at the target age who had and had not performed breast awareness (80.4 versus 77.5, p-value = 0.002) and mammogram (77.1 versus 70.3, p-value = 0.009) regularly as recommended. Moreover, attitudes towards general health check-ups subscale scores were significantly higher in women who had performed clinical breast examination as frequently as recommended than those who had not. CONCLUSIONS The research reveals that practical barriers and attitudes towards general health check-ups are important factors to take into account in determining African migrant women's participation in breast cancer screening. Progress in reducing breast cancer deaths through early detection needs to focus on attitudinal change among African migrants.
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Affiliation(s)
| | - Cannas Kwok
- Western Sydney University, Penrith, NSW, Australia
| | - Lee Chun Fan
- Singapore Clinical Research Institute School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Hong Kong, China
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Pratt R, Mohamed S, Dirie W, Ahmed N, VanKeulen M, Ahmed H, Raymond N, Okuyemi K. Views of Somali women and men on the use of faith-based messages promoting breast and cervical cancer screening for Somali women: a focus-group study. BMC Public Health 2017; 17:270. [PMID: 28320350 PMCID: PMC5359974 DOI: 10.1186/s12889-017-4182-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening rates for breast and cervical cancer for Muslim women in the United States are low, particularly for first-generation immigrants. Interpretations of the Muslim faith represent some of the barriers for breast and cervical cancer screening. Working to understand how faith influences breast and cervical screening for Somali women, and working with the community to identify and utilize faith-based assets for promoting screening, may lead to life-saving changes in screening behaviors. METHODS We partnered with an Imam to develop faith-based messages addressing the concerns of modesty and predetermination and promoting cancer testing and screening. A total of five focus groups were convened, with 34 Somali women (three groups) and 20 Somali men (two groups). Each focus group first discussed participant views of breast and cervical cancer screening in general and then viewed and discussed video clips of the Imam delivering the faith-based messages. RESULTS Both Somali women and men had an overwhelmingly positive response to the faith-based messages promoting breast and cervical cancer screening. The faith-based messages appeared to reinforce the views of those who were already inclined to see screening positively, with participants describing increased confidence to engage in screening. For those who had reservations about screening, there was feedback that the faith-based messages had meaningfully influenced their views. CONCLUSIONS Somali immigrant women and men found faith-based messages addressing topics of predestination and modesty and encouraging the use of screening and treatment to be both acceptable and influential. Faith can play an important role as an asset to promote breast and cervical cancer screening, and there may be substantial benefits to adding faith-based messaging to other interventions that focus on improving screening uptake. This may help to address health disparities for Somali women in this area.
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Affiliation(s)
- Rebekah Pratt
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA.
| | | | - Wali Dirie
- Islamic Civil Society of America, Minneapolis, USA
| | - Nimo Ahmed
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | | | - Huda Ahmed
- Program in Health Disparities Research, University of Minnesota, Minneapolis, USA
| | - Nancy Raymond
- Powell Center for Women's Health, Department of Psychiatry, University of Minnesota, Minneapolis, USA
| | - Kola Okuyemi
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
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Idehen EE, Korhonen T, Castaneda A, Juntunen T, Kangasniemi M, Pietilä AM, Koponen P. Factors associated with cervical cancer screening participation among immigrants of Russian, Somali and Kurdish origin: a population-based study in Finland. BMC WOMENS HEALTH 2017; 17:19. [PMID: 28284203 PMCID: PMC5346186 DOI: 10.1186/s12905-017-0375-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 03/04/2017] [Indexed: 11/21/2022]
Abstract
Background Previous studies revealed low participation in cervical cancer screening among immigrants compared with non-immigrants. Only a few studies about factors associated with immigrants’ lower participation rates have been conducted in European countries that have universal access for all eligible women. Our study aimed to explore factors associated with cervical screening participation among women of Russian, Somali, and Kurdish origin in Finland. Methods We used data from the Migrant Health and Well-being Survey, 2010-2012. Structured face-to-face interviews of groups of immigrants aged 25-60 yielded 620 responses concerning screening participation in the previous five years. Statistical analysis employed logistic regression. Results The age-adjusted participation rates were as follows: among women of Russian origin 73.9% (95% CI 68.1-79.7), for Somalis 34.7% (95% CI 26.4-43.0), and for Kurds 61.3% (95% CI 55.0-67.7). Multiple logistic regressions showed that the most significant factor increasing the likelihood of screening participation among all groups was having had at least one gynecological check-up in the previous five years (Odds ratio [OR] = 6.54-26.2; p < 0.001). Other factors were higher education (OR = 2.63; p = 0.014), being employed (OR = 4.31; p = 0.007), and having given birth (OR = 9.34; p = 0.014), among Kurds; and literacy in Finnish/Swedish (OR = 3.63; p = 0.003) among Russians. Conclusions Our results demonstrate that women who refrain from using reproductive health services, those who are unemployed and less educated, as well as those with poor language proficiency, might need more information on the importance of screening participation. Primary and occupational healthcare services may have a significant role in informing immigrant women about this importance.
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Affiliation(s)
- Esther E Idehen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 7021, Kuopio, Finland. .,Department of Public Health, University of Helsinki, Helsinki, Finland.
| | - Tellervo Korhonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 7021, Kuopio, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anu Castaneda
- Department of Welfare, Equality and Inclusion Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Teppo Juntunen
- Department of Welfare, Equality and Inclusion Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
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Ghebre RG, Sewali B, Osman S, Adawe A, Nguyen HT, Okuyemi KS, Joseph A. Cervical cancer: barriers to screening in the Somali community in Minnesota. J Immigr Minor Health 2016; 17:722-8. [PMID: 25073605 DOI: 10.1007/s10903-014-0080-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined barriers to and facilitators of cervical cancer screening among Somali immigrant women in Minnesota. We adopted the socioecological framework to illustrate screening barriers at multiple levels. We conducted 23 semi-structured key informant interviews and used a thematic exploratory approach to analyze the data. Barriers were classified into individual, community or health systems levels. Obstacles included lack of knowledge, religious beliefs, fatalism, fear, embarrassment, and lack of trust in the interpreters. Participants described a need for training of healthcare providers on issues surrounding Somali women's cultural practices and sexual health. Identifying individual, community, or health system barriers and addressing them concurrently may increase use of cancer screening services among Somali women. Future interventions need to address multilevel barriers with multilevel approaches to improve utilization of cervical cancer screening services in underserved immigrant populations in the United States.
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Affiliation(s)
- Rahel G Ghebre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
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Nagler RH, Lueck JA, Gray LS. Awareness of and reactions to mammography controversy among immigrant women. Health Expect 2016; 20:638-647. [PMID: 27561593 PMCID: PMC5513003 DOI: 10.1111/hex.12494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/27/2022] Open
Abstract
Background There is substantial expert disagreement about the use of mammography to screen for breast cancer, and this disagreement routinely plays out in the media. Evidence suggests that some women are aware of the controversy over mammography, but less is known about whether immigrant and other underserved women have heard about it and, if so, how they react to it. Objective To explore immigrant women's awareness of and reactions to mammography controversy. Design Community‐engaged qualitative study: we conducted six focus groups with 53 women aged 35–55 from three immigrant communities (Somali, Latina and Hmong) in a major US metropolitan area. A grounded theory approach was used to identify themes; NVivo 10 was used to enhance analyses. Results Several themes emerged: (i) low awareness of mammography controversy across groups, despite self‐reported attention to health information; (ii) high intentions to be screened, even after being told about the controversy; (iii) few reported discussions of mammography's risks and benefits with clinicians; (iv) substantial interest in learning more about mammography and breast cancer, but some low self‐efficacy to obtain such information; and (v) questions about whether health recommendations matter and what qualifies as evidence. Conclusion Given on‐going expert disagreement about mammography screening, it is important for clinicians to help women understand mammography's risks and benefits so they can make an informed choice. This is particularly critical for immigrant and other underserved women, who may be less able to access, attend to, process, retain and act on health information (a phenomenon known as communication inequality).
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Affiliation(s)
- Rebekah H Nagler
- School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA.,School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer A Lueck
- Department of Communication, Texas A&M University, College Station, TX, USA
| | - Lauren S Gray
- School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA
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Swan JH, Severance JJ, Turner K. Senior Centers and Nutritional Outcomes: A Texas Example. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:439-452. [PMID: 27191952 DOI: 10.1080/19371918.2015.1137506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Healthy diet and weight control are important for elders and senior centers (SCs). The authors consider effects of SCs on attendee nutrition and health and efforts to improve diets and weight. Data derive from surveys in 2006 (N = 798) and 2007 (N = 742) at 21 multipurpose SCs in Tarrant County, Texas, supplemented with data from 2012 (N = 1,402). Measures included attendee agreement that SC meals improved nutrition, improved health, attempts to improve diets, and success in controlling weight. Cumulative and binary logistic regression methods were employed. SC attendance and social engagement explained agreement that SC meals improved nutrition and health but were not shown to predict changes in diet or weight control. Findings suggest success of SC programs, as well as physician recommendations, in influencing attendee nutritional behavior and perceptions of nutrition and health effects. Practice recommendations include SC collaborations with local health providers to promote attendee nutritional health.
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Affiliation(s)
- James H Swan
- a Programs in Applied Gerontology, University of North Texas , Denton , Texas , USA
| | - Jennifer J Severance
- b Senior Citizen Services of Greater Tarrant County, Inc. , Fort Worth , Texas , USA
| | - Keith Turner
- a Programs in Applied Gerontology, University of North Texas , Denton , Texas , USA
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Adegboyega A, Hatcher J. Factors Influencing Pap Screening Use Among African Immigrant Women. J Transcult Nurs 2016; 28:479-487. [PMID: 27470266 DOI: 10.1177/1043659616661612] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Papanicolau (Pap) screenings disparities exist for immigrant women in the United States. This study sought to have an understanding of factors influencing Pap screening among sub-Saharan African immigrant women. METHOD This is a qualitative descriptive study. Women were recruited from the community and by word of mouth following institutional review board approval. Data were gathered through in-depth focus group and demographic questionnaires. Interview sessions were digitally recorded and transcribed verbatim. Transcripts were analyzed for themes. FINDINGS Twenty-two women aged 24 to 65 years were interviewed. Barriers to screening included low knowledge of screening, cost, cultural beliefs, fear and communication issues. Motivators to improve Pap use include provider's recommendations, enlightenment, and family support. DISCUSSION Interventions addressing the barriers peculiar to this population may alleviate these barriers and improve Pap screening use in this population. Providers have the opportunity to influence screening attitudes of African-born women by providing awareness and patient-targeted interventions.
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Pinder LF, Nelson BD, Eckardt M, Goodman A. A Public Health Priority: Disparities in Gynecologic Cancer Research for African-Born Women in the United States. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:21-6. [PMID: 27499654 PMCID: PMC4965016 DOI: 10.4137/cmwh.s39867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 01/23/2023]
Abstract
African-born immigrants comprise one of the fastest growing populations in the U.S., nearly doubling its population size in recent years. However, it is also one of the most underrepresented groups in health-care research, especially research focused on gynecologic and breast malignancies. While the opportunity exists for access to an advanced health-care system, as immigrants migrate to the U.S., they encounter the same health-care inequalities that are faced by the native-born population based on ethnicity and social class, potentiated by limitations of health literacy and lack of familiarity with U.S. health systems. Given the continued influx of African-born immigrants in the U.S., we sought to understand the representation of this population in cervical and breast cancer research, recognizing the population’s high risk for these diseases at baseline while residing in their native countries. We determined that there is limited research in these diseases that disproportionately affect them; yet, there are identifiable and potentially modifiable factors that contribute to this paucity of evidence. This clinical commentary seeks to underscore the clear lack of research available involving African-born immigrants with respect to gynecologic and breast malignancies in the existing literature, demonstrate the need for more robust research in this population, and provide fundamental insights into barriers and solutions critical to the continued health of this growing population.
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Affiliation(s)
- Leeya F Pinder
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Brett D Nelson
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA
| | - Melody Eckardt
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA
| | - Annekathryn Goodman
- Harvard Medical School, Boston, MA, USA.; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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Goergen AF, Ashida S, Skapinsky K, de Heer HD, Wilkinson AV, Koehly LM. What You Don't Know: Improving Family Health History Knowledge among Multigenerational Families of Mexican Origin. Public Health Genomics 2016; 19:93-101. [PMID: 26854931 PMCID: PMC5007856 DOI: 10.1159/000443473] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study investigated diabetes and heart disease family health history (FHH) knowledge and changes after providing personalized disease risk feedback. METHODS A total of 497 adults from 162 families of Mexican origin were randomized by household to conditions based on feedback recipient and content. Each provided personal and relatives' diabetes and heart disease diagnoses and received feedback materials following baseline assessment. Multivariate models were fitted to identify factors associated with the rate of 'don't know' FHH responses. RESULTS At baseline, US nativity was associated with a higher 'don't know' response rate (p = 0.002). Though confounded by country of birth, younger age showed a trend toward higher 'don't know' response rates. Overall, average 'don't know' response rates dropped from 20 to 15% following receipt of feedback (p < 0.001). An intervention effect was noted, as 'don't know' response rates decreased more in households where one family member (vs. all) received supplementary risk assessments (without behavioral recommendations; p = 0.011). CONCLUSIONS Limited FHH knowledge was noted among those born in the US and younger participants, representing a key population to reach with intervention efforts. The intervention effect suggests that 'less is more', indicating the potential for too much information to limit health education program effectiveness.
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Affiliation(s)
- Andrea F Goergen
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md., USA
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Sheppard VB, Hurtado-de-Mendoza A, Song M, Hirpa F, Nwabukwu I. The role of knowledge, language, and insurance in endorsement of cancer screening in women of African origin. Prev Med Rep 2016; 2:517-23. [PMID: 26844112 PMCID: PMC4721490 DOI: 10.1016/j.pmedr.2015.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND African women have lower use of cancer screening services compared to women born in the United States yet empirical data are limited about their cancer screening attitudes. OBJECTIVE To examine factors that are associated with higher endorsement of screening. METHOD We conducted a cross-sectional study of 200 women of African origin recruited via community-based outreach activities in Washington, DC. Endorsement of screening was assessed via self-report. The primary independent variables were cancer knowledge and English-language proficiency. Information was also collected about access, cancer-related beliefs, and prior breast screening behaviors. RESULTS Most participants (60%) were ≥ 40 years of age, 54% were married, and 77% were insured. Participants more likely to endorse breast cancer screening were insured (vs. uninsured) (odds ratio = 3.37; 95% confidence interval: 1.24, 9.17) and married (odds ratio = 3.23; 95% confidence interval: 1.14, 9.10) controlling for other factors. The likelihood of endorsing screening was higher among participants with English as a primary language (odds ratio = 3.83; 95% confidence interval: 1.24, 11.87) and those with greater breast cancer knowledge (odds ratio = 1.04; 95% confidence interval: 1.01, 1.08, per 1 point increase). CONCLUSIONS Average cancer knowledge in the sample was low as were non-conventional causes of cancer. Study results highlight the importance of improving cancer knowledge and reducing barriers related to language and insurance. Future studies are needed to consider nuances among diverse women of African origin.
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Affiliation(s)
- Vanessa B Sheppard
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
| | - Alejandra Hurtado-de-Mendoza
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
| | - Minna Song
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
| | - Fikru Hirpa
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
| | - Ify Nwabukwu
- African Women's Cancer Awareness Association, Silver Spring, MD, United States
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Saadi A, Bond BE, Percac-Lima S. Bosnian, Iraqi, and Somali Refugee Women Speak: A Comparative Qualitative Study of Refugee Health Beliefs on Preventive Health and Breast Cancer Screening. Womens Health Issues 2015. [DOI: 10.1016/j.whi.2015.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sewali B, Pratt R, Abdiwahab E, Fahia S, Call KT, Okuyemi KS. Understanding cancer screening service utilization by Somali men in Minnesota. J Immigr Minor Health 2015; 17:773-80. [PMID: 24817627 PMCID: PMC4227966 DOI: 10.1007/s10903-014-0032-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined factors that influence use of cancer screening by Somali men residing in Minnesota, USA. To better understand why recent immigrants are disproportionately less likely to use screening services, we used the health belief model to explore knowledge, beliefs, and attitudes surrounding cancer screening. We conducted a qualitative study comprised of 20 key informant interviews with Somali community leaders and 8 focus groups with Somali men (n = 44). Somali men commonly believe they are protected from cancer by religious beliefs. This belief, along with a lack of knowledge about screening, increased the likelihood to refrain from screening. Identifying the association between religion and health behaviors may lead to more targeted interventions to address existing disparities in cancer screening in the growing US immigrant population.
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Affiliation(s)
- Barrett Sewali
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Rebekah Pratt
- Corresponding author: Barrett Sewali, Department of Family Medicine and Community Health, 717 Delaware St. SE. Ste. 166, Minneapolis, MN 55414, Phone: 612-625-4912, Fax: 612-626-6782,
| | - Ekland Abdiwahab
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Saeed Fahia
- Confederation of Somali Community in Minnesota, Minneapolis, MN
| | - Kathleen Thiede Call
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
- Center for Health Equity, University of Minnesota, Minneapolis, MN
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kolawole S. Okuyemi
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
- Center for Health Equity, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
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