1. Title of Research Project
Researcher’s Name
Department(s), University of Kentucky, Lexington, KY
Pap Screening inAfrican Immigrants: State of the Science
Adebola Adegboyega, PhD candidate, RN & Ana-Maria Linares DNSc, RN
University of Kentucky College of Nursing
Background
Results
Results
We identified 16 studies,11 were specific for cervical cancer and 5 included other cancers. Ten studies conducted in the U.S.
One intervention study was identified.
Research is at rudimentary stage.
Cervical cancer is the second most common cancer among women worldwide, and the leading cause of cancer-related deaths among women in developing countries.¹
Routine Pap screening may reduce the burden of cervical cancer morbidity and mortality through early detection and improved treatment outcome.
Immigrant women are disproportionately affected by cervical cancer² but there is scarce literature on African immigrants [AI] compared to other migrant groups.
AI group is a rapidly rising new population in the United States.³
With a growing number of AI to the US, there is potential for many of the disease characteristics affecting them in Africa to impact their health as they live in the US.²
High % of cervical cancer risk and HPV prevalence translates to a high burden of cervical cancer in Africa as well as an increased risk in Africans who immigrate to the U.S.²
Beliefs and attitudes
Fatalistic beliefs, cancer is attributed to God’s will
Negative attitude to screening due to unfamiliarity with screening.
Testing may threaten virginity in young women.
Cancer is a curse.
Religiosity
Women who attended religious services at least once a week were more likely to be overdue for screening.
Prevention has no impact on God’s plan for one’s life.
Faith serves as a protection from cancer.
Healthcare experience
Lack of trust in healthcare system.
Communication issues.
Sampling methods
Theoretical models
Convenience (n= 7)
Behavioral model for vulnerable populations (n=1)
Randomization (n=2)
Socio-ecological framework (n=1)
Stratified (n=3)
Theory of health behavior (n=1)
Not specified (n=4)
Not specified (n= 13)
Limitations
Pap screening adherence
Screening rate is suboptimal. Rate ranges from 19.4% - 63%.
Factors associated with greater odds of Pap screening completion
Length of stay
Established immigrants were more likely to be screened compared to recent immigrants.
Refugees were at higher risks of not being screened.
Health care interactions:
Significant positive association between the duration of established care, number of visits and post-natal or obstetrics/gynecological visits and screening.
Emergency department visits were associated with an increased likelihood of screening completion.
Providers’ reminder and recommendations increase screening.
Patient-provider relationship and trained medical interpreter use encourage
screening.
Gender concordance
Patient-provider gender concordance improve screening adherence .
Barriers to Pap screening completion
Personal characteristics
Younger women (25-44) years old were less likely to be screened compared to their counterpart of years old.
Single women were less likely to be screened compared to married women.
Mixed findings for association between level of education and screening.
Low knowledge of Pap screening
African immigrants have limited knowledge related to screening benefits and cervical cancer risk factors.
A quality appraisal of the studies was not done due its heterogeneity.
Due to limitation of use of keywords and Mesh terms, some studies might have been missed.
Objectives
Implications/Future Research
To explore theoretical concepts used in studies related to Pap screening among AI.
Identify correlates of Pap screening among AI.
Identify gaps in the literature to guide future research
Research should use theoretical frameworks and rigorous methodology for further understanding and explanation of Pap screening adherence among AI.
Need for culturally targeted interventions to address knowledge gaps. Grassroots health promotions and improvements in healthcare interaction are important.
Providers should be aware of women’s values, preferences and beliefs and discuss screening in the context of the potential benefits and harms.
Research should address diversity of AI and delineate differences in subpopulations.
Methods
Electronic searches from three data base using key terms: “cervical cancer screening”, “African immigrants”, “cervical neoplasm screening”, “Pap test”, “African refugees”, “immigrants”, and “African descents.”
Inclusion and exclusion criteria
Eligible studies included African born immigrants, published in an English peer reviewed journal between 2005 and Abstracts, review papers, case studies and epidemiological studies were excluded.
Abstraction and synthesis
Abstracts and titles were screened for relevance. Articles were retrieved and evaluated to determine if they met the inclusion criteria.
References
1.Globocan (2012). Mortality, and prevalence worldwide in Retrieved from
2. Forney-Gorman A, Kozhimannil KB. (2015) . Differences in Cervical Cancer Screening Between African-American Versus African-Born Black Women in the United States. Journal of Immigrant and Minority Health.:1-7.
3. Batalova J. & Zong J. (2014) . Sub-Saharan African immigrants in the United States. Retrieved from: