Provider Perspectives on Promoting Cervical Cancer Screening Among Refugee Women
- 466 Downloads
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. 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. 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. 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.
KeywordsCervical cancer Refugee Women’s health Health care providers
We would like to acknowledge the contribution of the participants in our study. This work was supported by grant number R21CA187401 from the National Cancer Institute. Dr. Zhang was supported by a National Research Service Award from the National Institutes of Health (Grant Number T32HP10002), Dr. Ornelas was supported by the Institute of Translational Health Sciences KL2 Program at the University of Washington (Grant Number ULTR0000423).
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. Journal of General Internal Medicine: Official Journal of the Society for Research and Education in Primary Care Internal Medicine, 18(12), 1028–1035.CrossRefGoogle Scholar
- 8.Refugee Health Technical Assistance Center, Refugee basics. http://refugeehealthta.org/refugee-basics/. Accessed 12 May 2016.
- 11.Nardin, R., Zallman, L., McCormick, D., Steffie, W., & Himmelstein, D. (2013). The uninsured after implementation of the Affordable Care Act: A demographic and geographic analysis. Health Affairs Blog.Google Scholar
- 12.Centers for Disease Control and Prevention, Refugee health guidelines. http://www.cdc.gov/immigrantrefugeehealth/guidelines/refugee-guidelines.html, (last revised November 12, 2013). Accessed 12 May 2016.
- 14.Raymond, N. C., Osman, W., O’Brien, J. M., et al. (2014). Culturally informed views on cancer screening: A qualitative research study of the differences between older and younger Somali immigrant women. BMC Public Health, 14, 1188. doi: 10.1186/1471-2458-14-1188.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Haworth, R. J., Margalit, R., Ross, C., & Nepal, T., & Soliman, A. S. (2014). Knowledge, attitudes, and practices for cervical cancer screening among the Bhutanese refugee community in Omaha, Nebraska. Journal of Community Health, 39(5), 872–878. doi: 10.1007/s10900-014-9906-y.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Singer, A., & Wilson J. H. (2007). Refugee resettlement in metropolitan America. Migration Information Source.Google Scholar
- 17.Centers for Disease Control and Prevention, Refugee health profiles: Burmese Refugee Health Profile. http://www.cdc.gov/immigrantrefugeehealth/profiles/burmese/index.html, (last revised June 6, 2016). Accessed 28 June 2016.
- 18.Centers for Disease Control and Prevention, Refugee health profiles: Bhutanese Refugee Health Profile. http://www.cdc.gov/immigrantrefugeehealth/profiles/bhutanese/index.html, (last revised April 7, 2014). Accessed 28 June 2016.
- 19.Levy, S. G., & Jones, J. C. (2009). Refugee resettlement in Washington; site-visit report for the United States Office of Refugee Resettlement.Google Scholar
- 22.Kepka, D. L., Coronado, G. D., Rodriguez, H. P., & Thompson, B. (2012). Development of a radionovela to promote HPV vaccine awareness and knowledge among Latino parents. Public health reports (Washington, D.C.: 1974), 127(1), 130–138.Google Scholar
- 25.Jackson, J., Haider, M., Owens, CW., et al. (2016). Healthcare recommendations for recently arrived refugees: Observations from EthnoMed. Harvard Public Health Review.Google Scholar
- 27.Johnson, C. E., Mues, K. E., Mayne, S. L., & Kiblawi, A. N. (2008). Cervical cancer screening among immigrants and ethnic minorities: A systematic review using the Health Belief Model. Journal of Lower Genital Tract Disease, 12(3), 232–241. doi: 10.1097/LGT.0b013e31815d8d88.CrossRefPubMedGoogle Scholar
- 28.Jacobs, E. A., Karavolos, K., Rathouz, P. J., Ferris, T. G., & Powell, L. H. (2005). Limited English proficiency and breast and cervical cancer screening in a multiethnic population. American Journal of Public Health, 95(8):1410–1416. doi: 10.2105/AJPH.2004.041418.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Strauss, A. L., & Corbin, J. M. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications.Google Scholar