Culturally informed views on cancer screening: a qualitative research study of the differences between older and younger Somali immigrant women

Abstract

BackgroundSomali women are infrequently screened for breast or cervical cancer, and there is a paucity of evidence-based interventions to increase cancer screening in this community. In order to create a culturally relevant intervention for Somali women living in Minnesota, we sought to understand what Somali immigrant women know about breast and cervical cancer, what are the attitudes toward screening and what cultural barriers are there to screen as well as cultural factors that would facilitate screening.MethodsIn partnership with a community-based organization, New American Community Services (NACS), focus groups were conducted to explore the issues described above. Two focus groups were held with younger women age 20 to 35 and two were held with women age 36 to 65.ResultsTwenty-nine women participated in the four focus groups. The women identified 1) differences in health care seeking behavior in Somalia verses the United States; 2) cultural understanding of cancer and disease; 3) barriers to mammogram or Pap screening; 4) facilitators to seeking preventive cancer screening; and 5) risk factors for developing cancer.ConclusionsCultural misperceptions and attitudes need to be addressed in developing culturally-appropriate interventions to improve screening uptake for Somali women. A nuanced response is required to address barriers specific to younger and older groups. Culturally informed beliefs can be integrated into intervention development, preventive care and screening promotion.

Barriers to cervical cancer screening: A qualitative study among Somali women in Oslo Norway

“…The study findings reveal a lack of familiarity with cervical cancer and screening among the participants, who explained that they had not heard about cervical cancer until immigrating to Norway and receiving the screening invitation letter. This finding is consistent with results from previous studies [13][14][15]. The study findings also suggest that this, together with a general lack of familiarity with preventative health and tendency to seek health services only when ill, contributed to a perception of cervical cancer screening as unimportant and of little Quotes 1 "There are many things that can cause doubt, for example, you can't tell whether the person examining you is helping you or deceiving you.…”

“…The finding that the research participants did not fully trust the doctors who might examine them is consistent with the findings of a previous study in which mistrust of the health system was based on reports from friends or relatives regarding problems that they had encountered [20,22]. Furthermore, the study findings also revealed a poor doctor-patient relationship, in which the participants perceived themselves as poorly received and their doctors as predominantly and problematically concerned about the number of children they chose to have, as a barrier to screening.…”

“…The study findings that the Pap smear test was perceived as potentially conflicting with cultural and religious values about sexuality and modesty, considered invasive, and understood as potentially compromising the virginity of young and unmarried women are consistent with a previous study among Somali women [18], as well as with a recent study among Pakistani and Somali women in Oslo that found that unmarried women are not expected to undergo screening due to cultural and religious expectations that they remain sexually inactive until married [9]The study findings that the research participants prefered female practitioners and avoided screening due to concern that they might be met by a male practitioner are also similar to the findings of previous studies conducted among Somali women [13,15]. Also consistent with other studies was that the participants believed that the presence or absence of disease was a matter of God's will, which also then coincided with fatalistic attitudes about not only the development of cervical cancer, but also its outcome [13,20,21]. That most of the participants stated that they did not believe in getting cervical cancer and therefore did not need to be screened suggests that religious beliefs have an important influence on health decisions and health seeking behaviour.…”

“…As reported in previous studies, embarrasment, fear of the outcome of the test, lack of time, and language difficulties have been identified as barriers by this study [13,14,17,18]. A finding unique to this study is the fear of child protection services.…”

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

“…The messages were developed collaboratively, based on existing data [18] and the Imam’s expertise. We then convened focus groups of Somali men and women to test the messages, delivered by the Imam via videos, as a potential asset in engaging women in screening.…”