A Comparative Study of Preventive Healthcare Behaviors Among African Immigrant Women (AIW) and African American Women (AAW): Barriers and Facilitators of Cervical Cancer Prevention

Abstract

Abstract Background: Early screening, detection, and treatment of cervical pre-cancerous cells could prevent up to 80% of cervical cancers and reduce cervical cancer mortality by 52% globally. In the United States cervical cancer incidence has decreased by as much as 50% over the past 40 years due to widespread utilization of preventive health services. Yet, health disparities in cervical cancer persist among African immigrant women (AIW) and African American women (AAW) in the US. There is limited research exploring the barriers and facilitators of preventive health services for AIW and AAW. Purpose: To explore perceived barriers and facilitators, and lived experiences of AIW and AAW related to cervical cancer prevention services. Methods: A qualitative study included 14 AIW and 14 AAW, residing in the Washington, DC-Baltimore Metropolitan area. Purposive sampling technique was used to recruit participants from churches,community center, grocery stores and a radio station. A semi-structured interview guide and a demographic questionnare were used for data collection. Data were analyzed using the Intepretative Phenomenological Analysis Method. Nvivo software was used to organize and code the data. Results: The mean age of participants was 41.1(11.9), with most of the women being college educated (93%), with health insurance (96%) that paid for cervical cancer prevention (89%). Many (79%) had not received HPV vaccine and 82% had a pap smear within 1-4years. AIW and AAW data were triangulated and revealed few differences between the groups. Six broad themes emerged grounded in the Health Belief Model. Barriers identified included limited knowledge and awareness of HPV infection, risk, and vaccines; myths related to abstinence, fear, and cleanliness of healthcare facilities; lack of trust and reliance on God for healing. Facilitators included the need to feel safe and healthy; prevent and treat disease; utilize informal and formal support systems; and receive recommendation from providers and public health education related to preventive services. Conclusion: Study findings can be used to mitigate barriers and enhance facilitators to develop culturally tailored interventions for AAW and AIW. The active engagement of health providers, the community and faith based partners can be leveraged to strengthen the development of prevention research.