An Examination of Misconceptions and Their Impact on Cervical Cancer Prevention Practices among Sub-Saharan African and Middle Eastern Refugees

Abstract

Objective: The purpose of the study was to understand cervical cancer screening and prevention practices of refugee women in San Diego, California and identify desired components of a cervical cancer screening toolkit. Methods: We conducted a qualitative study utilizing semi-structured focus groups and identified common themes via grounded theory analysis. Results: There were 53 female refugee participants from Sub-Saharan Africa and the Middle East. Over half of all women surveyed expressed a fear of pelvic exams and loss of modesty as barriers to seeking gynecologic care, with nearly 34% avoiding routine pap tests. Of the 18 participants who were asked if they were aware of the Human Papilloma Virus (HPV) vaccination, only one had heard of the vaccine and none had received it for themselves or their children. Over 60% of participants were interested in educational materials surrounding HPV and pap tests. Conclusion:There is a significant lack of knowledge regarding cervical cancer screening and HPV vaccination among refugee women in San Diego, California. Refugee women in this study were interested in multi-modal educational materials as part of a cervical cancer screening toolkit.

A Cervical Cancer Screening Toolkit for Somali Women: A Pilot Randomized Controlled Trial

“…Those who declined a pap test in the intervention arm reported a fear of the pain associated with a speculum exam and loss of modesty, which is consistent with patterns of avoidance in similar studies [ 26 , 29 , 35 ]. Additionally, the frequent requests for transportation to clinic visits, aid in appointment scheduling, and support for childcare by those who did receive a pap test reflect underlying socioeconomic barriers to participation.…”

“…Prior to conducting this study, 6 semi-structured focus groups were conducted with 53 participants to examine the cervical cancer prevention practices of refugee women from the Middle East and Sub-Saharan Africa living in San Diego, California. Participants outlined patterns of pap test and HPV vaccination avoidance while detailing desired components of a culturally-centered, cervical cancer prevention toolkit [ 35 ]. Additionally, an online review of over 100 cervical cancer screening infographics, brochures and videos were reviewed to assess the currently available resources.…”

Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis

“…The included studies addressed human papillomavirus (HPV) (n = 25), 21 , 29–31 , 35 , 37 , 40 , 42 , 44 , 46–48 , 50 , 53 , 55 , 57 , 60 , 61 , 65–68 , 71 , 72 , 74 influenza (n = 14), 20 , 24–26 , 28 , 36 , 41 , 46 , 47 , 52 , 58 , 59 , 63 , 64 hepatitis B (n = 11), 22 , 27 , 34 , 39 , 42 , 43 , 46 , 49 , 51 , 56 , 75 COVID-19 (n = 9), 18 , 19 , 23 , 32 , 38 , 45 , 54 , 69 , 73 pneumococcal (n = 6), 26 , 41 , 46 , 47 , 58 , 59 tetanus, diphtheria, pertussis/tetanus diphtheria (Tdap/Td) (n = 6), 33 , 41 , 42 , 46 , 47 , 62 hepatitis A (n = 2), 42 ...…”

“…Three themes regarding interventions emerged from the seven applicable studies: receiving information from a trusted source, 32 , 50 , 53 , 63 , 68 providing culturally tailored education, 32 , 50 , 53 , 63 , 68 and facilitating access. 32 , 68 A strong physician recommendation was found to be a trusted resource in most studies, while others sought family support or support from community leaders.…”

The Newcomer Well Woman Clinic: A Cross-Sectional Evaluation of an Innovative Care Model to Support the Sexual and Reproductive Health Needs of Refugee Women

“…It has been extensively documented that refugee women are at risk for having inadequate knowledge regarding contraception and cervical cancer prevention [21,22]. Educating refugees about sexual and reproductive health has been identi ed as a means of improving utilization of preventative healthcare services and sexual and reproductive health outcomes [21].…”