Provider Perspectives on Promoting Cervical Cancer Screening Among Refugee Women

Abstract

Objective Many refugees in the United States emigrated from countries where the incidence of cervical cancer is high. Refugee women are unlikely to have been screened for cervical cancer prior to resettlement in the U.S. National organizations recommend cervical cancer screening for refugee women soon after resettlement. We sought to identify health and social service providers’ perspectives on promoting cervical cancer screening in order to inform the development of effective programs to increase screening among recently resettled refugees. Methods This study consisted of 21 in-depth key informant interviews with staff from voluntary refugee resettlement agencies, community based organizations, and healthcare clinics serving refugees in King County, Washington. Interview transcripts were analyzed to identify themes. Results We identified the following themes: 1) refugee women are unfamiliar with preventive care and cancer screening; 2) providers have concerns about the timing of cervical cancer education and screening; 3) linguistic and cultural barriers impact screening uptake; 4) provider factors and clinic systems facilitate promotion of screening; and 5) strategies for educating refugee women about screening. Conclusion Our findings suggest that refugee women are in need of health education on cervical cancer screening during early resettlement. Frequent messaging about screening could help ensure that women receive screening within the early resettlement period. Health education videos may be effective for providing simple, low literacy messages in women's native languages. Appointments with female clinicians and interpreters, as well as clinic systems that remind clinicians to offer screening at each appointment could increase screening among refugee women.

Results From a Pilot Video Intervention to Increase Cervical Cancer Screening in Refugee Women

“…The model posits that the interaction of predisposing (i.e., demographics, health beliefs, and social structure), enabling (i.e., personal, family, and community resources), and need-for-care factors (i.e., perceived and evaluated health concerns) determine the use of health services (in this case, cervical cancer screening; Babitsch, Gohl, & von Lengerke, 2012; Gelberg, Andersen, & Leake, 2000). Our video was developed based on input from community advisors from Karen-Burmese and Nepali-Bhutanese refugee communities; key informant interviews with individuals from refugee resettlement organizations; focus groups with Karen-Burmese and Nepali-Bhutanese refugee women; and our previous experience producing cervical cancer screening education videos for other Asian refugee groups (Burke et al, 2004; Lor et al, 2017; Mahloch et al, 1999; Zhang et al, 2017).…”

“…Focus group participants also identified issues related to the health care system that make it difficult to get cervical cancer screening, including their limited English proficiency, concerns about health insurance and health care costs, transportation difficulties, and uneasiness about seeing male providers for women’s health exams. Based on recommendations from our community advisors as well as refugee resettlement organization personnel, we avoided clinical, technical, and complicated terminology (Zhang et al, 2017). For example, the videos include simple messages that focus on promoting regular Pap testing rather than messages addressing detailed guidelines for interval Pap testing and human papillomavirus (HPV) testing.…”

“…Refugee women face barriers to accessing health care services such as language, cost, and transportation (Lor et al, 2017). Some research also suggests that providers may be unsure about when to provide screening given the many health conditions that may need to be addressed on arrival in the United States (Zhang et al, 2017).…”

“…However, they may also have many competing priorities that cause them to delay seeking preventive health services (Morris, Popper, Rodwell, Brodine, & Brouwer, 2009). Therefore, there is a need for educational interventions that can be used throughout early resettlement to help women understand the importance of cervical cancer screening (Zhang et al, 2017). The Guide to Community Preventive Services (2017) recommends that interventions to improve cervical cancer screening include education that is culturally tailored to address the context of the communities they are targeting.…”

The Medical Evaluation of the Newly Resettled Female Refugee: A Narrative Review

“…There are several actions that providers can take in order to make cervical cancer screening more accessible and acceptable to refugee women. Education in the patient's native language about the purpose of screening and a step-by-step description of the procedure helps provide knowledge and reassurance (Anaman, Correa-Velez & King, 2016;Abdullahi, Copping, Kessel, Luck & Bonell, 2013;Zhang et al, 2016). In addition, having female-only providers and interpreters and deferring the Pap smear until the second clinic visit can also make the procedure more acceptable to the patient.…”