Barriers and Facilitators to Breast and Cervical Cancer Screening in Somali Immigrant Women: An Integrative Review

Knowledge, Age, and Perceived Social Barriers Regarding Mammography Screening Among Immigrant Arab Women in the United States: A Predictive and Associative Analysis

Background: Ethnic minority women in the United States continue to experience racial disparities. Immigrant Arab women (IAW) underutilize mammography screening (MS) even compared with other ethnic minorities. This population still has gaps in knowledge regarding breast cancer (BC) and screening methods and encounters social barriers, highlighting the imperative role of the male figure and the family, which hinders screening. Materials and Methods: A cross-sectional design with an exploratory and predictive approach was employed to examine knowledge gaps and perceived social barriers associated with MS and to identify predictive factors of MS among IAW in California. The analysis included 316 women that met the eligibility criteria. Results: Familiarity with MS and awareness of screening recommendations were the specific areas of knowledge significantly associated with mammography uptake (odds ratio [OR] 15.4, 95% confidence interval [CI]: 5.6-40.8, p < 0.001) and (OR 12.07, 95% CI: 7-21, p < 0.001), respectively. Logistic regression revealed three MS predictors, the two knowledge areas and age. Perceived social barriers were significantly associated with age [F (3,312) = 4.684, p = 0.003]. There was a significant difference in social barriers between women in their 40s and those in their 60s (p = 0.002) and between women in their 50s and those in their 60s (p = 0.003), suggesting lower barriers among women in their 60s (M = 14.3). Living status was significantly associated with perceived social barriers [F (1,314) = 8.83, p = 0.003]. Conclusions: This study offered valuable insights for health care professionals, policymakers, and community organizations working to improve BC early detection in immigrant and ethnic women to reduce social disparities and reinforce social justice. Knowledge-deficit areas and social barriers must be analyzed and incorporated in awareness programs to improve screening practices of IAW.

Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State

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.

Interventions to Increase Cancer Screening Adherence Among Somali Immigrants in the US and Europe: A Systematic Review

Cancer screening rates among immigrant and refugee populations in high income countries is significantly lower than native born populations. The objective of this study is to systematically review the effectiveness of interventions to improve screening adherence for breast, cervical and colorectal cancer among Somali immigrants. A literature search was conducted for the years 2000-2021 and eight studies met eligibility criteria. The following intervention components were found to increase adherence to cervical cancer screening: home HPV test, educational workshop for women and education for general practitioners. A patient navigator intervention was found to increase screening for breast cancer. Educational workshops motivated or increased knowledge regarding cancer screening for breast, cervical and colorectal cancer. However, most of the studies had limitations due to methodology with potential for introduction of bias. Therefore, future studies comparing effectiveness of specific intervention components to reduce disparities in cancer screening among Somali immigrants and refugees are encouraged.

Cervical Cancer Screening Uptake and Experiences of Black African Immigrant Women in Canada

Cervical cancer is one of the leading causes of cancer-related death among African women. Unfortunately, in most sub-Saharan African nations, women are vulnerable if they are unaware that cervical cancer is preventable with frequent screening and early treatment. The aim of this study was to examine Black African immigrant women's perceptions and experiences of cervical screening in British Columbia, Canada. Twenty Black African immigrant women were interviewed using the qualitative research method Interpretive Description. Data collection approaches included indepth interviews and analytic memos. Data were analyzed using a constant comparative technique guided by a socioecologic framework to capture subjective experiences and perceptions. Four key themes were identified, including confusing conceptualizations about cancer and cancer screening, competing priorities, concerns for modesty, and commitment to culture. The study findings point to the need for more active approaches to promoting cervical screening for this population.

A qualitative exploration of the spiritual wellbeing of women with advanced cervical cancer in Ghana

BACKGROUND

Spiritual wellbeing is one of the most important aspects of human health, alongside physical, psychological and social factors. Religiosity/spirituality can play a critical role in the lives of people experiencing life-threatening illnesses, such as cervical cancer. Most women with cervical cancer in Africa, including Ghana, are diagnosed at the advanced stage. These women lean on their spiritual connections for strength during their illness. Despite the fact that numerous studies have been conducted on the relevance of religiosity/spirituality in the experience of cancer in other jurisdictions, the same cannot be said about Ghana. The study aims to fill this gap in the literature.

AIM

To explore the spiritual wellbeing of women diagnosed with advanced cervical cancer in Ghana.

METHOD

A qualitative explorative design was employed, with purposive sampling used to recruit 15 women with advanced cervical cancer from a cancer treatment centre of a teaching hospital in Ghana. Individual face-to-face interviews, lasting between 45-90 minutes, were used to gather information. Interviews were audio taped with participants' consent. Data were analysed using thematic content analysis.

FINDINGS

The following sub-themes were identified within one overarching theme of the spiritual wellbeing of women with advanced cervical cancer: the meaning of illness and acceptance; a sense of hope and religiosity; uncertainty; and the will to live.

CONCLUSION

Many participants believed they were bewitched, and the devil was responsible for their cervical cancer. Healthcare providers should adopt a multi-disciplinary approach and widen their care strategies to include spirituality, to enhance the treatment outcomes of women living with advanced cervical cancer.

Sexual Modesty in Sexual Expression and Experience: A Scoping Review, 2000 - 2021

Sexual modesty is the social, cultural, interpersonal, and psychological systems - defined by the tenets of Script Theory - that regulate individuals' sexual expression and experience at the social, legal, and interpersonal boundaries of acceptable/not-acceptable, private/public, and personal/social. Almost all aspects of sexual expression and experience are touched by the pervasive modesty standards for sexual communication, sexual display, sexual relations, and sexual behaviors. Sexual modesty influences an array of sexual and reproductive health outcomes. Many aspects of sexual modesty are enforced by legal as well as social, cultural, and religious proscriptions, including social shaming and ostracism as well as corporal and capital punishments. The purpose of this paper is to summarize a diverse literature related to sexual modesty from the years 2000 to 2021 in order to clarify its role in sexual health and sexual wellbeing and to identify directions for new research.

'We can bear it!' Unpacking barriers to hepatocellular carcinoma screening among patients with hepatitis B: A qualitative study

AIMS AND OBJECTIVES

To explore barriers to hepatocellular carcinoma screening among patients with hepatitis B.

BACKGROUND

Hepatitis B-related hepatocellular carcinoma is a major cause of cancer-related mortality globally. A preventive strategy for screening is needed to improve early tumour detection and overall survival. However, utilisation remains suboptimal and barriers are understudied and largely focused on clinical factors.

DESIGN

A qualitative study based on the preventive health model using phenomenological hermeneutical approach.

METHODS

Face-to-face semi-structured interviews were conducted with 23 hepatitis B patients from November 2020 to February 2021. Interpretative phenomenological analysis was used. The COREQ checklist was followed.

RESULTS

Four themes were identified: (i) miscognition, (ii) cultural stigma and taboo, (iii) social norms of enduring hardship and (iv) social barriers at the community, health system and policy levels. Patients had misconceptions about inactive carriers, asymptomatic nature of chronic hepatitis B, hepatocellular carcinoma risks and screening recommendations. Influenced by the taboo of hepatocellular carcinoma, stigma against hepatitis B and enduring hardship norms, they perceived screening as divination, avoided utilisation to hide disease status and endured symptoms until they were intolerable. Insufficient community support, a lack of shared decision-making in health systems, and inadequate rural reimbursement policy and hepatocellular carcinoma detection capacity further precluded utilisation.

CONCLUSIONS

Cognitive and sociocultural barriers precluded individuals' intention, utilisation and persistence of hepatocellular carcinoma screening. The results highlight intervention targets for miscognition, stigma, taboo and social norms; propose family-focused, community-based education programs; suggest health systems to introduce decision aids; and inform policymaking and upskilling of physicians in rural areas.

RELEVANCE TO CLINICAL PRACTICE

Collaborative efforts are needed to improve real-world hepatocellular carcinoma screening, including education to address knowledge deficiencies, psychological counselling to reduce stigma and taboo beliefs, support for shared decision-making and reimbursement policies.

The SWIM study: Ethnic minority women's ideas and preferences for a tailored intervention to promote national cancer screening programmes-A qualitative interview study

BACKGROUND

Ethnic minority women from non-Western countries are less likely than the native women to participate in screening programmes for cervical cancer, breast cancer and colorectal cancer. This social inequality can result in loss of possibility for prevention, delayed diagnosis and treatment and, ultimately, lower chance of survival. Developing a tailored intervention might be the solution to reduce social inequalities in cancer screening, and a key feature in intervention research is to consult the target group.

OBJECTIVE

To explore ethnic minority women's own ideas and preferences for a cancer screening intervention and identify their attitudes to different strategies.

METHODS

An interview study with five focus group interviews, two group interviews with an interpreter and three individual interviews. Thirty-seven women from 10 non-Western countries contributed to the study. The interviews were audio-recorded and transcribed verbatim followed by a thematic analysis.

RESULTS

According to the women, a tailored intervention should focus on knowledge in the form of face-to-face teaching. The women further suggested information material in their own language with a simple, positive and concrete communication strategy. They would like to be involved in an awareness strategy and share the knowledge with their network.

CONCLUSION

Ethnic minority women were interested in a tailored intervention, and they were keen to contribute with ideas and preferences. The findings emphasized the potential of a tailored intervention with specific suggestions to the content when attempting to reduce inequality in cancer screening participation.

PATIENT OR PUBLIC CONTRIBUTION

Minority women were involved in the interview study.

2020: A Time for Contemplation and Action

Depending on which interpretation of the Gregorian and other calendars that you may believe to be the most accurate, the new decade either began on January 1, 2020, or will begin January 1, 2021. In any case, the contemplation of decades and time passing offers a time for appraisal and reflection, a chance to step outside of the day-to-day routines to consider less urgent, and perhaps more important issues that we will face in the near future.