‘Before You Teach Me, I Cannot Know’: Immigrant Women’s Barriers and Enablers With Regard to Cervical Cancer Screening Among Different Ethnolinguistic Groups in Canada

Abstract

Objective: To describe the similarities and differences among multiple groups of immigrant women and Canadian-born women of low socio-economic status regarding barriers and enablers associated with cervical cancer screening, in order to inform core elements of a strategy that would be acceptable across multiple underscreened groups.Method: Within a health behaviour framework, we used a qualitative explanatory multiple-case study approach consisting of focus group interviews (n=11) in Hamilton, Canada. Participants were newly immigrated (1-5 years) women and a group of Canadian-born women of low socio-economic status; all participants were in the age range 35-69 years and married. Language groups were Arabic, Cantonese, Somali, Dari (Afghanistan) and Spanish (Latin America). Two separate focus groups for each ethnolinguistic group were conducted; one in English and one in the native language. A template approach to analysis was used.Results: All groups indicated a strong need for information on necessity of screening and on how the procedure is done. Use of a video and a group discussion format were desired strategies. Women had positive feelings about being proactive for their health even if prevention had not been the norm in their home countries. There were differences between groups with respect to preferring a female clinician, which was a higher priority than language congruence with the provider. Only Chinese and Arabic groups discussed embarrassment and modesty as barriers. Conclusion:Addressing key knowledge gaps around cervical cancer screening through personal approaches, educational videos and invitations may be useful core strategies to remove stigma and fear around screening and improve uptake across multiple ethnic groups and in women of lower socioeconomic status.

Cervical Cancer: Barriers to Screening in the Somali Community in Minnesota

“…Cultural beliefs and religious practices are a significant part of this community and the impact of religion advocating for healthy life style as well as an emphasis on the role of god and prayer in predicting one's health were clearly identified. Our findings are consistent with other studies that have reported on these views of religion, and modesty in regards to cervical cancer screening [18, 20, 21]. At the system level, our study participants indicated that the health care providers who do not share their similar religious beliefs find it hard to understand why the women decline to screen.…”

Understanding Cancer Screening Service Utilization by Somali Men in Minnesota

“…Studies that have addressed cancer-screening barriers in Somali women indicated that some of the perceived barriers were fear of cancer, embarrassment of the screening test, and limited English ability [24–26]; these barriers are similar to those reported by Somali men in this study. In addition to these perceived barriers, Somali men in our study stressed the fear of private health information being compromised by Somali interpreters; interpreters who are also members of their community.…”

“…To our knowledge this is the first study that has discussed at length the barriers faced by Somali men in relation to use and access to cancer screening services. Several studies have addressed cancer screening barriers for Somali women [24–29]. …”

“…However, some geographic or population specific U.S. based studies have examined barriers and facilitators to cancer screening among Somali women [24–26]. Some of the barriers reported by Somali women included; reported include fear of cancer, embarrassment, lack of insurance, no transportation, and limited English proficiency [24–26].…”

“…Some of the barriers reported by Somali women included; reported include fear of cancer, embarrassment, lack of insurance, no transportation, and limited English proficiency [24–26]. One Study conducted in Minnesota, showed that Somali women are less likely to undergo Pap testing compared to other African immigrant women [27].…”