Bayo Lapawol (Let Their Voices Be Heard): Haitian Women’s Barriers to and Facilitators of Cervical Cancer Prevention and Control

Abstract

This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women ( n = 25) who were on average 42 years ( SD = 9.8, range: 26–57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model’s dimensions of cultural identity, relationships and expectations, and cultural empowerment, women’s recommendations to overcome barriers spanned education, evaluation, and empowerment, respectively, across individual, interpersonal, and institutional systems. Study results call for more extensive examination of the diversity present in the groups of African origin to unearth transnational, multifaceted determinants of health by biology, beliefs, and behaviors including sociocultural and socioenvironmental access. Future interventions must include development of proactive policies, which deliberately pressure the government and global community to prioritize health infrastructure while simultaneously educating women about and dispelling fear of cervical cancer, thus empowering Haitian women to live their healthiest lives. Accordingly, this study may contribute to understanding global health equity advances and improving public health infrastructure in underresourced settings in low- and middle-income countries in the Caribbean.

Qualitative Research Methods in Chronic Disease: Introduction and Opportunities to Promote Health Equity

“…Photovoice is the most commonly used participatory method to provide insight into a community’s assets and people’s daily experiences, including in the context of chronic disease (e.g., 3 , 68 , 79 ). We encourage the continued application of a range of participatory methods to qualitative research to center the voices of key stakeholders (e.g., 72 , 97 ). Such participatory visual qualitative methodologies ( 45 ), including body mapping and community mapping, have been applied to better understand the complex causes of health inequities ( 55 , 83 ).…”

Sociodemographics and health-literacy as predictors of cervical cancer screening practices among Haitian women: A secondary data analysis of 2016–17 DHS surveys

“…While numerous studies provide links between the influence of broad indicators of social determinants of health on linkage to cervical cancer screening and treatment, our study is one of the first to provide preliminary insight on how linguistic preferences rooted in colonialism and classism may influence engagement in cervical cancer screening in Haiti. Moise et al (2021) [3] states that Haitian women's health should be contextualized through a syndemic approach using both a biomedical and anthropological lens; as the French language disadvantages individuals of low socioeconomic status who are primarily Creole speaking. These specific nuances are imperative to understand when working with Haitian communities, and provides significance to the importance of ensuring that research with Haitians are led by individuals who are aware of these critical contexts.…”

“…Cervical cancer, which is primarily caused by infection with human papillomavirus (HPV), is the fourth most diagnosed cancer amongst women globally [1]. Haiti reports the highest rates of cervical cancer incidence and mortality in the Caribbean, with cervical cancer being the second most diagnosed female cancer among women between 15-44 years old [2][3][4]. The mortality associated with cervical cancer in Haiti is alarming-amongst those who are diagnosed, approximately 75% will die from the disease [4].…”

“…HPV vaccination) and secondary prevention (i.e. cervical cancer screening), women in Haiti are less likely to engage in preventative measures [3,6]. To date , HPV vaccines are not included into Haiti's national immunization schedule.…”

Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: Protocol for a photovoice study of young childbearing people’s perspectives of maternal near-misses in northwest Haiti

“…This move signaled the recognition of young people having their own unique health challenges [1,2] and highlighted the potential of youth as "key drivers of change in the post-2015 era" [2]. This shift signifies an important investment in young people (by UN definitions: adolescents age 10-24, and youth age [15][16][17][18][19][20][21][22][23][24] [3]) as full participants in society [1,4]. Young people hold the opportunity to unleash the human potential of this "Sustainable Development Goals Generation" in order to transform our world [2].…”