Muslim immigrant women’s views on cervical cancer screening and HPV self-sampling in Ontario, Canada

Abstract

BackgroundCanada has observed significant decreases in incidence and mortality of cervical cancer in recent decades, and this has been attributed to appropriate screening (i.e., the Pap test). However, certain subgroups including Muslim immigrants show higher rates of cervical cancer mortality despite their lower incidence. Low levels of screening have been attributed to such barriers as lack of a family physician, inconvenient clinic hours, having a male physician, and cultural barriers (e.g., modesty, language). HPV self –sampling helps to alleviate many of these barriers. However, little is known about the acceptability of this evidence-based strategy among Muslim women. This study explored Muslim immigrant women’s views on cervical cancer screening and the acceptability of HPV self-sampling.MethodsAn exploratory community-based mixed methods design was used. A convenience sample of 30 women was recruited over a 3-month period (June–August 2015) in the Greater Toronto Area. All were between 21 and 69 years old, foreign-born, self-identified as Muslim, and had good knowledge of English. Data were collected through focus groups.ResultsThis study provides critical insights about the importance of religious and cultural beliefs in shaping the daily and health care experiences of Muslim women and their cancer screening decisions. Our study showed the deterring impact of beliefs and health practices in home countries on Muslim immigrant women’s utilization of screening services. Limited knowledge about cervical cancer and screening guidelines and need for provision of culturally appropriate sexual health information were emphasized. The results revealed that HPV self-sampling provides a favorable alternative model of care to the traditional provider-administered Pap testing for this population.ConclusionTo enhance Muslim immigrant women screening uptake, efforts should made to increase 1) their knowledge of the Canadian health care system and preventive services at the time of entry to Canada, and 2) access to culturally sensitive education programs, female health professionals, and alternative modes of screening like HPV self-sampling. Health professionals need to take an active role in offering screening during health encounters, be educated about sexual health communication with minority women, and be aware of the detrimental impact of preconceived assumptions about sexual activity of Muslim women.

Effect of an Intervention in General Practice to Increase the Participation of Immigrants in Cervical Cancer Screening

“…The stronger effect related to women from Poland, Somalia, and Pakistan might have resulted not only from women reading the poster, but also because their GPs recommended the CCS test to them more often than to other immigrant groups. Our previous study 17 and another study from Canada 28 show that the threshold for HCPs raising the topic of CCS with immigrant women is even higher when the women's appearance or dress differs from that of the general population. This may be the case for women from Somalia and Pakistan, and our pointing it out to GPs in the intervention during the educational sessions may have contributed to changing the GPs' attitudes toward these particular groups.…”

Self-Sampling as a Plausible Alternative to Screen Cervical Cancer Precursor Lesions in a Population with Low Adherence to Screening: A Systematic Review

“…(14) Were the main potential confounders measured and statistically adjusted for their impact on the relationship between exposure and outcome? [3] moderate to high Possati-Resende [10] moderate to high Haguenoer [1] high Allende [19] moderate to high Maza [11] moderate to high Esber [9] moderate Gottschlich [23] moderate Laskow [13] moderate Mbatha [14] moderate El-Zein [8] moderate Poli [16] low to moderate Vahabi [7] moderate to high Stanczuk [17] moderate Winer [4] moderate Chatzistamatiou [12] moderate B Requirements for quality assessment of articles included in the CASP checklist systematic review for randomized controlled trials comprised: (1) Did the study address a clearly focused issue? (2) Has the designation of patients for treatment been randomized?…”

“…In addition, 36.8% of the studies focus on rural populations and 31.5% on urban populations. Information on ethnicity and religion is scarce but quite valuable, especially as evidenced by the study by Vahabi and Lofters [7], in which the authors portray immigrant Muslim women in Canada and assess the importance of religious and cultural beliefs in the way these women face sexual health, the cervical sampling by a medical doctor, and their familiarity about cervical carcinoma.…”

“…Consequently, a cheap, practical, and highly sensitive solution with high specificity is always welcomed by the health authorities. In this context, the self-collection of vaginal cells delegates the responsibility to the women themselves to minimize the negative impact that any religious and cultural constraints may cause, and indecisive women can be encouraged to participate in screening programs [5][6][7]. The methodological premise of self-sampling is simple, since the material is sent to a reference laboratory that will evaluate the presence of HPV.…”

Low level of awareness among Iranian women concerning cervical cancer and screening: the role of knowledge, risk perceptions and cues to action

“…In addition these findings will be helpful for developing effective health promoting interventions for Muslim women from Islamic countries living in the western or non-Islamic countries as well in order to provide them culturally tailored information suitable to their background. (43)(44)(45).…”