Journal of Community Health

, Volume 42, Issue 6, pp 1079–1089 | Cite as

Perceptions of Cervical Cancer Screening, Screening Behavior, and Post-Migration Living Difficulties Among Bhutanese–Nepali Refugee Women in the United States

Original Paper


Bhutanese–Nepali refugees are one of the largest refugee groups to be resettled in the U.S. in the past decade. Cervical cancer is a leading cause of cancer disparity in this population, yet screening rates are suboptimal. Nepali-speaking interviewers administered a community health needs questionnaire to a convenience sample of Bhutanese–Nepali refugees in a Midwestern city between July to October of 2015. Descriptive statistics were used to describe socio-demographic characteristics, Pap smear beliefs, post-migration living difficulties, and screening status. Differences in Pap test uptake between groups were tested using t test and Chi square statistics. Of the 97 female participants, 44.3% reported ever having had a Pap smear. Screening rates were lowest among women who did not know English at all. Most women had positive perceptions of Pap smears (80%) and 44.4% had received a Pap test recommendation from their healthcare provider, family, or friends. Pap testing was significantly higher among those who had positive perceptions (58.3 vs. 11.1% for women of negative perception, p = 0.01) and those who had received a recommendation (87.5 vs. 18.6% for women who had no recommendations, p < 0.001). Significant predictors of having a Pap smear were having a healthcare provider/family/friends recommendation (OR 65.3, 95% CI 11.4-373.3) and greater number of post-migration living difficulties (OR 1.18, 95% CI 1.02–1.37). The results of this study have important implications for the development of cervical cancer prevention programs targeting Bhutanese–Nepali refugees. Providing cancer prevention interventions early in the resettlement process could impact Pap test uptake in this population.


Pap test Cervical cancer Bhutanese–Nepali refugee Women Post-migration living difficulties 



We thank the Bhutanese–Nepali Community of Columbus for allowing us into their community and for their guidance throughout this project. We also thank Refugee Women in Action for their support. We want to acknowledge Jhuma Acharya, Dil Pyakurel, Sudarshan Pyakurel, and Kelly Yotebieng for their engagement in the project.


This project was supported by the Ohio State University Center for Clinical and Translational Science and Award # UL1TR001070 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to declare.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.College of NursingThe Ohio State UniversityColumbusUSA
  2. 2.Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteThe Ohio State UniversityColumbusUSA

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