Facilitators and Barriers to Cervical Cancer Screening Among Chinese Canadian Women

Abstract

Background: Chinese Canadian women have higher cervical cancer incidence, and lower Pap testing, rates than the general Canadian population. Predisposing, enabling and reinforcing factors associated with ever having a Pap test, and having a recent Pap test within the last 2 years, were assessed in Chinese women in British Columbia using the PRECEDE-PROCEED model. Method: Chinese women (n=512) between the ages of 20 and 79 years and residing in Greater Vancouver were interviewed about Pap testing, health care, traditional health beliefs, acculturation and sociodemographic characteristics. Two analyses were done, comparing women who had ever and never had a Pap test, and comparing women who had and had not received a recent Pap test. Focus groups and qualitative interviews ensured cultural sensitivity in the survey questionnaire. Results: Seventy-six percent reported ever having a Pap test and 57% reported having a Pap test within the last 2 years. Traditional health beliefs were not associated with ever or recent Pap testing. However, belief that Pap testing prevented cancer and general knowledge about the Pap test were associated with screening. Concern about pain/discomfort with the test, availability of time, culturally sensitive health care services and recommendation for Pap testing by a physician were also associated with screening. Factors differed for ever, and recently, having a Pap test. Interpretation: Pap testing is less common among Chinese Canadian women. Continuing education about Pap testing is recommended for physicians serving underscreened Chinese women. Culturally and linguistically appropriate educational materials are needed for the Chinese community. La traduction du résumé se trouve à la fin de l'article.

Correlates of women's cancer screening and contraceptive knowledge among female emergency department patients

“…Patients who had governmental (Medicare, Medicaid, or both) medical insurance and patients who did not have any type of insurance demonstrated lesser cancer screening and contraceptive knowledge compared to those with private medical insurance. Our findings are supported by results from other studies [14,17-23,27,29]. For example, in Takakuwa et al's study, having private medical insurance was positively associated with greater knowledge of preventive behaviors regarding breast cancer [29], and in Han et al's study, women who had never received a clinical breast exam exhibited significantly lower knowledge of clinical breast exams [18].…”

“…Of the patients interviewed, 81.5% believed that they knew the purpose of a Pap smear; however, only 26% of those correctly indicated a Pap smear is for cervical cancer. In several studies, a lack of utilization of women's cancer screening or contraceptive methods is associated with knowledge deficits about these methods, and vice versa [14,17-24]. For example, in a 2000 study of Korean-American women by Han et al, those with less knowledge about the purpose of clinical breast exams were significantly less likely to have had one [18].…”

Overcoming Barriers to Cervical Cancer Screening Among Asian American Women

“…50 Cultural beliefs about modesty are often negatively associated with screening, whereas women who reported less concern about embarrassment were more likely to obtain screening. 42, 55 Empirical evidence supporting this association was also reported in a study of 206 Asian American college students in which openness about sexuality was a significant and positive predictor of having obtained a Pap test. 56 …”

“…50 In addition, women who held the belief that a Pap test was not necessary for sexually inactive women were less likely to be screened. 42, 55 These findings suggest that Asian American women may be uncertain or unaware of the benefits of screening and early detection.…”

“…59 Non-English speakers and immigrants are less likely to obtain screening tests than the general US population due to language and access barriers. 40, 55, 60-61 Despite the formidable challenges posed by language barriers, key services (such as providing medical translators) may help reduce or eliminate such obstacles. Indeed, among Asian American women with limited English proficiency, those who regularly used a medical interpreter were more likely to have received a Pap test compared to their counterparts who did not use an interpreter.…”