Culturally informed views on cancer screening: a qualitative research study of the differences between older and younger Somali immigrant women

"I Trust That Only God Can Protect Me, But …": The Religious Meaning Behind Mammogram Attitudes and Behaviors Among Immigrant Muslim Women

Although breast cancer is the second leading cause of death among women in the United States, women from ethnic minorities still underutilize mammogram screenings. Immigrant Muslim women (IMW) demonstrated low mammogram screening rates compared to the national target of 77.1% determined by Healthy People 2030. Although IMW comprise an understudied population in the health field, a limited number of studies have proposed that Islamic religious beliefs have an impact on their behaviors and practices in regard to mammogram use. This study aimed to understand the meanings IMW ascribe to their religious beliefs in relation to mammogram utilization. A qualitative thematic analysis study was conducted on a purposive sample. A total of 28 IMW were recruited for one-on-one interviews in either Arabic or English, and inductive thematic analysis as per Braun and Clarke (2008) informed data analysis, guided by symbolic interactionism. A total of 28 interviews (10 in English and 18 in Arabic) were conducted with IMW whose mean age was 54.7. During these interviews, three major themes emerged regarding the participants' experience with mammograms, within the context of their religious beliefs: (a) 'Your body is a trust,' (b) the notions of al-tawakkul and al-tawaakoul, and (c) religious methods for coping with mammogram use. Results from this study suggests some religious means that can be integrated into an educational program designed for IMW to enhance their mammogram screening rates.

"I'm not Alone; He will be There for Me": A Mixed-Method Approach Exploring the Impact of Spousal Support on Mammogram Utilization and Health Beliefs

Regular mammogram screenings are effective for early breast cancer (BC) detection and decreased mortality rate. However, immigrant Muslim Arab women (IMAW) are less likely to adhere to these screenings although the rate of BC among IMAW is high. Recent studies have explored low mammogram screening rates among immigrant Muslim and/or Arab women from a limited perspective, overlooking the fact that husbands have an influence in IMAW's health behaviors toward cancer screenings. Thus, this mixed-method approaches were employed to (a) explore the association between spousal support and IMAW's health beliefs toward mammograms and their utilization, (b) to understand IMAW's experiences of spousal influence related to their mammogram use and health beliefs. The quantitative portion of the study, recruitment and data collection were conducted via online surveys in Arabic and English. Logistic regressions were used to explore relationships between perceived spousal support and IMAW's mammogram utilization and health beliefs. The qualitative portion of the study was conducted on a purposive sample of IMAW. A semi-structured interview guide in Arabic and English was used during one-on-one interviews. Arabic interviews were translated into English and transcribed by professionals. Interviews were analyzed by thematic analysis according to Braun and Clarke (2008). A total of 184 IMAW completed the survey with mean age of 50.4 (SD = 5.58, range = 45-60). Results revealed low mammogram screening rate among IMAW. Only 32.6% adhered to mammograms. Spousal support was positively associated with ever having obtained a mammogram and IMAW's adherence to mammogram. The 20 qualitative interviews, 16 in Arabic and four in English, produced rich description supporting results from the survey which includes, (a) types of spousal support, (b) impact of spousal support on participants' mammogram utilization and experience, and (3) impact of spousal support on participants' health beliefs toward mammograms. Findings from surveys and interviews show that a husband's support is positively associated with IMAW's mammogram utilization and health beliefs. Suggesting a new approach to integrate husbands in culturally appropriate interventions to increase mammogram screening rates among IMAW.

Interventions to Increase Cancer Screening Adherence Among Somali Immigrants in the US and Europe: A Systematic Review

Cancer screening rates among immigrant and refugee populations in high income countries is significantly lower than native born populations. The objective of this study is to systematically review the effectiveness of interventions to improve screening adherence for breast, cervical and colorectal cancer among Somali immigrants. A literature search was conducted for the years 2000-2021 and eight studies met eligibility criteria. The following intervention components were found to increase adherence to cervical cancer screening: home HPV test, educational workshop for women and education for general practitioners. A patient navigator intervention was found to increase screening for breast cancer. Educational workshops motivated or increased knowledge regarding cancer screening for breast, cervical and colorectal cancer. However, most of the studies had limitations due to methodology with potential for introduction of bias. Therefore, future studies comparing effectiveness of specific intervention components to reduce disparities in cancer screening among Somali immigrants and refugees are encouraged.

Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States

Cancer prevalence data for Black Americans is monolithic and fails to consider the diverse cultures and backgrounds within that community. For instance, African immigrants constitute a meaningful proportion of the foreign-born Black immigrants in the United States (42%), but the prevalence of cancer in the African immigrant community itself is unknown. Therefore, without accurate cancer prevalence data, it is impossible to identify trends and other key factors that are needed to support the health of African immigrants and their children. Moreover, it is impossible to understand how the culture and language of subgroups influence their cancer-related health behavior. While research in this area is limited, the existing literature articulates the need for culturally responsive and culturally tailored cancer education for African immigrants and their adolescent children, which is what we advocate for in this viewpoint paper. Existing projects demonstrate the feasibility of culturally responsive programming for adults; however, few projects include or focus on adolescents or children born to African immigrants. To best meet the needs of this understudied community, researchers must use culturally competent interventions alongside familiar, usable media. For adolescents, technology is ubiquitous thus, the creation of a culturally tailored digital intervention has immense potential to improve cancer awareness and prevention for youth and their community. More research is needed to address many of the existing research gaps and develop a rich understanding of the unique experience of cancer among African immigrant families that can be used to inform intervention development. Through this viewpoint, we review the current state of cancer-related research among African immigrant families in the United States. In this paper, we acknowledge the current knowledge gaps and issues surrounding measurement and then discuss the factors relevant to designing an educational intervention targeted at African immigrants and the role of African immigrant youth.

Health Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review

Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.

Exploring self-care and cervical cancer prevention attitudes and practices among Moroccan and Pakistani immigrant women in Catalonia, Spain: a comparative qualitative study

BACKGROUND

Self-care and preventive health strategies may trigger health inequities when individuals' cultural values and health beliefs are not fully understood and considered. In the case of cervical cancer (CC) screening programs immigrant women have shown lower attendance compared with native women, which increases the risk of late diagnosis and, consequently, a lower probability of survival. HPV self-sampling for CC screening has been recently added to the World Health Organization's (WHO) list of self-care interventions as a promising tool to reduce this disparity and improve screening coverage. In Catalonia, Spain, the introduction of HPV self-sampling as a part of the new population-based CC screening program, is a significant step. However, there is a lack of research addressing self-care and prevention among immigrant populations in this region. This study aims to fill this gap exploring self-care and prevention attitudes and practices among Moroccan and Pakistani women.

METHODS

We conducted focus groups and individual interviews with 36 Moroccan and 37 Pakistani women in Barcelona, Spain. The topic guide of the focus groups included case vignettes to stimulate the discussion and a semi-structured questionnaire was used for the interviews.

RESULTS

Our findings show that most Moroccan and Pakistani women do not prioritize self-care and prevention. They seek care for symptom treatment rather than disease prevention. In this sense, they reported not having the habit of doing regular check-ups and their self-care and prevention attitudes and practices seemed to be conditioned by cultural values. The implementation of an effective call and recall system could enhance the engagement of these populations with CC screening services.

CONCLUSION

This study provides evidence on how universal concepts of self-care and prevention may not aligned with more collectivist societies, emphasizing the limited applicability and motivation of global self-care interventions guidelines for individuals with different cultural backgrounds and values. Therefore, the successful implementation of CC screening programs or any other self-care intervention requires the adoption of culturally appropriate strategies.

Integrating HPV self-collect into primary care to address cervical cancer screening disparities

Human papillomavirus (HPV) self-collect shows promise to increase cervical cancer screening rates in underscreened populations, such as Somali patients, but little is known about how to integrate such an approach in primary care. In this study, primary care providers and staff who provide primary care services to Somali women were asked for their views on integrating HPV self-collect into routine care to address cervical cancer screening disparities. Thirty primary care providers and staff participated in semi-structured interviews exploring their views on HPV self-collect and their anticipated needs or barriers to implementing this approach into the clinic generally and with specific patient populations, such as Somali women. A thematic analysis using the constructivist version of grounded theory was undertaken. Providers and staff anticipate positive patient reaction to the option of HPV self-collect, and were interested in using this approach both for Somali patients and for all patients in general. HPV self-collect was viewed as straightforward to integrate into existing clinic workflows. Providers largely lacked awareness of the evidence supporting primary HPV testing and HPV self-collect specifically, sharing concerns about effectiveness of self-collect and the lack of a physical exam. Providers felt clinic-wide staff education and patient education, along with strategies to address disparities, such as cultural and linguistic tailoring would be needed for successful implementation. Integrating HPV self-collect as an option in the cervical cancer screening process in a primary care clinical encounter offers considerable opportunity to address health disparities and may benefit all patients.

Barriers and facilitators of colorectal cancer screening among East African men in Minnesota: a qualitative investigation

Objective: This study aimed to explore barriers and facilitators to colorectal cancer (CRC) screening among East African men in Minnesota.Design: Six focus groups were conducted in Minneapolis and St. Paul, MN, USA. Participants were asked to describe individual and structural barriers to CRC screening, and discuss strategies that would address individual and structural barriers to screening. Audio-recorded conversations were transcribed verbatim and translated to English. The transcriptions were analyzed using a thematic analysis. Major themes that emerged on individual barriers were lack of knowledge, fear, and privacy.Results: Themes that emerged on structural barriers were distrust in the medical system, lack of health care coverage, and access to the health care system. Education, client reminders, mass media, increased clarity in communication with the provider and translator, and increased access to health care were frequently mentioned strategies to increase CRC screening in the East African community. Participants expressed favorable views toward the concept of patient navigation.Conclusion: Our findings indicate the need to develop culturally appropriate, multi-faced, intervention programs that are aimed at eliminating personal, cultural, and structural barriers.

Breast cancer screening among immigrant Muslim arab women in the United States: Analyzing relationships between beliefs, knowledge, spousal support and mammogram utilization

BACKGROUND

Regular mammogram screenings contribute to a decreased breast cancer (BC) mortality rate. Women from ethnic minorities in the United States, however, often underutilize mammogram screenings; in particular, immigrant Muslim Arab (IMAW) women have low mammogram screening rates.

OBJECTIVE

To explore the associations between mammogram utilization and (a) health and religious beliefs, (b) level of knowledge about mammograms, (c) health care provider (HCP) recommendations, and (d) spousal support.

METHODS

A cross-sectional study employed online data collection. An Arabic or English survey was completed by women who were 45 or older and married, had immigrated from Arab countries, and had no history of breast cancer. Logistic regression was conducted for data analyses.

RESULTS

Of the 184 Immigrant Muslim Arab survey participants, 86.6% reported having had at least one mammogram in their lifetime, and 32.6% adhered to mammograms. Ever having obtained a mammogram and adherence to mammograms were negatively associated with perceived mammogram barriers and positively associated with (a) spousal support, (b) level of mammogram knowledge, and (c) perceived self-confidence. Receiving (HCP) recommendation increased the likelihood of ever having obtained a mammogram. Finally, participants who reported higher levels of perceived mammogram benefits were more likely to have obtained a mammogram within the last 2 years compared to their counterparts.

CONCLUSIONS

IMAW have demonstrated low mammogram adherence rate.

IMPLICATIONS

Nursing clinicians and scholars must play a role in designing and implementing interventions to promote women adherence to mammograms. Involving husbands in these interventions may improve immigrant Muslim Arab women's mammogram adherence rates.

Association between Breast Cancer Knowledge and Mammogram Utilization among Immigrant Muslim Arab Women in California: Cross-Sectional Design

BACKGROUND

Regular mammogram screenings have contributed to early breast cancer (BC) diagnoses and lowered the mortality rate by 40% in the United States of America (USA). Nonetheless, ethnic women living in developed countries, such as immigrant Muslim Arab women (IMAW), are less likely to get mammograms.

AIM OF THE STUDY

In our study, we aimed to understand health behaviors among IMAWs as understudied populations in the USA.

METHODS

We conducted a cross-sectional study on a convenience sample of IMAW living in southern California. We used logistic regression and multivariate logistic regressions to analyze the data.

RESULTS

The total number of participants who completed the survey was 184 IMAW. Participants who had a higher level of knowledge about BC signs and symptoms and mammogram knowledge were more likely to have obtained a mammogram at some point compared with their counterparts (OR = 1.23, p = 0.03, CI: 1.07-1.42; OR = 2.23, p = 0.23, CI: 1.11-4.46, respectively).

CONCLUSIONS

Our results provide more evidence emphasizing the important influence of BC and mammogram knowledge on immigrant women's behavior regarding mammogram utilization. The average level of knowledge in all three domains (BC risk factors, BC signs and symptoms, and mammogram use) reported in this study is considered low.

System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers' perspectives

Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers' desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.

The Importance of “Easy Japanese”: Communicating Health Information to Foreigners in Japan

The number of foreign workers in Japan has been increasing in recent years. In Shimane Prefecture, people from non-English speaking countries account for most of the foreign resident population. Language barriers pose numerous challenges for this population. Their problems communicating in the medical context, in particular, contribute to their avoidance of hospitals. In addition to translation machines and English, "Easy Japanese" has been found to help Japanese healthcare workers communicate with foreign patients. “Easy Japanese" refers to easy-to-understand Japanese that involves rephrasing words and sentences. The use of Easy Japanese should be promoted among medical professionals in Japan as it is considered a communication skill that can be improved through practice. A voluntary study group was formed among medical students. During the first session, students were presented with background information, explaining why the need for Easy Japanese is increasing. In the second session, they practiced paraphrasing words. Finally, in the third session, they conducted simulated medical communication and practiced Easy Japanese with foreign residents to determine whether they were able to convey their intentions. Participants were recruited via social networking service, with five participants in the first session, five in the second, and eight in the third. Through this project, it became clear that for participants, the usual way of speaking Japanese came first in practice and that it was difficult for them to produce easy-to-understand phrases at the spur of the moment without practice. Additionally, medical students reported that the expressions they acquired through several practice sessions were helpful when talking with international students on campus. The final session involved a student-led Easy Japanese study group. Based on the students’ comments, we found that this study group was useful for them. Accordingly, Easy Japanese education should be continued and expanded to more students in the medical field and to the local community, including foreign residents, to measure its effectiveness.

Older People's Help-Seeking Behaviors in Rural Contexts: A Systematic Review

Help-seeking behavior (HSB) is vital for older people to sustain their health. As people in aging societies increasingly demand management of their multiple symptoms, communities should encourage HSBs. In rural communities, insufficient healthcare and human resources influence older people’s health. However, no related comprehensive evidence exists so far. This study investigates the present condition of older people’s HSBs in rural contexts in aging societies. We conducted a systematic review by searching six databases (PubMed, Cochrane Library, EMBASE, Medline, and Web of Science) for original studies regarding HSBs of older people in rural contexts published until January 2022. Extracted articles were analyzed based on participants, settings, HSB causes and contents, and older people’s HSB outcomes in rural contexts. Sixteen studies were included in the systematic review: seven investigated the associations between HSBs and participants’ backgrounds, and three the quality of life. Six studies investigated HSB perception, diagnosis, clarifying HSB contents, professional care trend, self-rated health, and mortality. Unlike few studies investigating the association between HSBs and health-related outcomes, this systematic review explains the current evidence regarding rural older people’s HSBs. Due to insufficient evidence from longitudinal studies in clarifying interventions for effective HSBs, future studies should use observational and interventional designs.

A Culturally Adapted Colorectal Cancer Education Video for the Somali Community in Minnesota: A Pilot Investigation

PURPOSE

This study aims to develop and test feasibility of a colorectal cancer (CRC) education video appropriate for Somali immigrants.

DESIGN

One-group pretest-posttest design.

SETTING

Minneapolis, MN.

SAMPLE

Thirty-one Somali men (mean age = 60.6; SD = 13.0).

INTERVENTION

A CRC education video was developed in the Somali language with Somali community partners. Participants were invited to a workshop and watched the video.

MEASURES

Levels of understanding about CRC and screening were assessed before vs after the video.

ANALYSIS

Binomial tests were conducted to examine changes in level of understanding.

RESULTS

Analysis on pre-post, within-person changes in understanding about cancer, and CRC screening showed that proportions with a positive change in understanding risks of cancer (80%) and benefits of CRC screening (90%) were significantly higher than expected if the video had no effect (50%; P = .012, P < .001, respectively). Ninety-three percent of participants agreed that the video contained useful information.

CONCLUSION

These results provide evidence of usefulness of culturally tailored videos to facilitate CRC screening in the Somali community. Results of this study were limited by a small sample size and lack of a control group.

"They Wait until the Disease Has Taking over You and the Doctors Cannot Do Anything about It": Qualitative Insights from Harambee! 2.0

African immigrants make up a large subgroup of Black/African-Americans in the US. However, because African immigrant groups are typically categorized as “Black,” little is known about their preventative healthcare needs. Differences in culture, life and healthcare experiences between African immigrant populations and US-born people may influence preventive health care uptake. Thus, policymakers and healthcare providers lack information needed to make informed decisions around preventive care for African immigrants. This formative study was conducted among the largest East African immigrant communities in King County, WA. We recruited religious leaders, community leaders, health professionals, and lay community members to participate in thirty key informant interviews and five focus group discussions (n = 72 total), to better understand preventative healthcare attitudes in these communities. Through inductive coding and thematic analysis, we identified factors that impact preventative healthcare attitudes of the Somali, Ethiopian and Eritrean immigrant communities and deter them from accessing and utilizing healthcare. Cultural beliefs and attitudes around preventative healthcare, mistrust of westernized healthcare, religious beliefs/views, intersecting identities and shared immigrant experiences all influence how participants view preventative healthcare. Our results suggest that interventions that address these factors are needed to most effectively increase uptake of preventative healthcare in African immigrant communities.

Psychosocial Correlates of Experience and Intention to Receive Colorectal Cancer Screening: A Cross-Sectional Study Among East African Men in the U.S

Cancer screening is an important approach to reducing disease burden. The rate of colorectal cancer (CRC) screening among immigrants in the U.S. is very low. Our study's aim was to examine correlates of experience with, and intention to, receive CRC screening among East African men who were up-to-date (UTD) with CRC screening (n = 64, mean age 65) and those who had never been screened or were overdue for one (NOD; n = 47, mean age 60), compared on demographic characteristics, attitudes toward cancer, psychosocial stress, and health behaviors. UTD men had significantly less emotional concerns about cancer screening and experienced significantly greater distress and lower resiliency than NOD men. However, these results were attenuated after controlling for demographic confounders. Perceived risk, trust in the medical system, and PTSD symptoms were significantly associated with an intention to undertake CRC screening in the next 12 months. These results should be used to guide efforts toward increasing CRC screening rates among immigrant communities.

Cervical Cancer Screening Among Immigrant and Refugee Women: Scoping-Review and Directions for Future Research

The purpose of this study is to explore existing research on determinants of cervical cancer screening among immigrants and refugees in the U.S. A scoping review was conducted on 77 studies targeting immigrant and/or refugee women in the U.S., investigating factors related to cervical cancer screening. Sixty-three percent of studies were conducted in the past ten years, and included 122,345 women. Studies predominately explored knowledge, beliefs and barriers related to cervical cancer and screening. Common beliefs included fear of cancer, treatment and death. Participants perceived pap smears to be associated with embarrassment, pain and fear. Barriers to screening were reported in three categories: psychosocial (shame and embarrassment), communication (inability to speak in English), and barriers related to access (lack of insurance or primary care provider). Study findings indicate research focused at the individual-level and future research should focus on exploring multilevel influences on cancer screening uptake.

Preventive Cancer Screening Among Resettled Refugee Women from Muslim-Majority Countries: A Systematic Review

As refugee populations continue to age in the United States, there is a need to prioritize screening for chronic illnesses, including cancer, and to characterize how social and cultural contexts influence beliefs about cancer and screening behaviors. This study examines screening rates and socio-cultural factors influencing screening among resettled refugee women from Muslim-majority countries of origin. A systematic and integrative review approach was used to examine articles published from 1980 to 2019, using PubMed, CINAHL, and PsycINFO. A total of 20 articles met the inclusion criteria. Cancer screening rates among refugee women are lower when compared to US-born counterparts. Social and cultural factors include religious beliefs about cancer, stigma, modesty and gender roles within the family context. The findings of this review, suggest that resettled refugee women underutilize preventive services, specifically mammography, Pap test and colonoscopy screening, and whose perceptions and behaviors about cancer and screening are influenced by social and cultural factors.

Testing the Feasibility and Acceptability of a Religiously-Tailored Text Messaging Intervention to Reduce Smoking Among Somali Muslim Men During Ramadan

INTRODUCTION

The prevalence of smoking among Somali Muslim male immigrants residing in Minnesota is estimated at 44%, however smoking reduction is common during the month of Ramadan. This study evaluated the feasibility and impact of a religiously tailored text message intervention delivered during Ramadan to encourage smoking reduction among Somali Muslim men who smoke.

METHODS

Fifty Somali men were recruited. Participants received two text messages per day starting 1 week prior to and throughout the month of Ramadan. Approximately half were religiously tailored and half were about the risks of smoking and benefits of quitting. Smoking behavior was assessed at baseline, and at weeks 4 (end of Ramadan), 8, and 16. Outcomes included feasibility, acceptability, and preliminary impact of the text message intervention on smoking reduction and bioverified abstinence.

RESULTS

The average age was 41 years. Average time to first cigarette was 1.8 hours at baseline, and 46% of participants smoked menthol cigarettes. Eighteen of 50 participants selected English and 32 selected Somali text messages. Subjects significantly reduced self-reported cigarettes per day (CPD) from 12.4 CPD at baseline to 5.8 CPD at week 16 (p < 0.001). Seven subjects reported quitting at week 16, five completed CO testing, confirming self-reported abstinence. The majority of participants found the cultural and religious references encouraging at the end of the week 16 survey.

CONCLUSIONS

Religiously tailored text messages to decrease smoking are feasible and acceptable to Somali Muslim men who smoke during Ramadan. This intervention for addressing smoking disparities is worthy of further study.

IMPLICATIONS

Recruitment of Somali Muslim men who smoke is feasible and supports the idea that further studies targeting smoking during Ramadan are practical. Ramadan presents a window of opportunity upon which to build smoking cessation interventions for smokers who identify as Muslim. These preliminary findings suggest that text messaging is a feasible and acceptable intervention strategy, and that religious tailoring was well received. Such an approach may offer potential for addressing smoking disparities among Somali Muslim male smokers.

TRIAL REGISTRATION

ClinicalTrial.gov: NCT03379142.

Closing the Gap: Participatory Formative Evaluation to Reduce Cancer Screening Disparities among Patients with Limited English Proficiency

Patients with limited English proficiency (LEP) have disproportionately lower rates of cancer screening than English-proficient patients. Given the multifactorial nature of screening disparities, strategies to improve screening rates must address barriers within and outside of the clinic setting. The objectives of this study were to understand local barriers from multiple stakeholder perspectives, to identify potential multilevel intervention approaches, and to mobilize community-engaged intervention decision making and planning. This participatory formative evaluation approach employed needs assessment and user engagement in order to enhance intervention usefulness and relevance. The study took place in several stages and involved clinic and community partners in a small metropolitan area of the Midwest USA. Interviews were conducted with LEP patients (n = 9) who had not completed three recommended screenings (breast, cervical, and colorectal), primary care providers (n = 5), medical interpreter (n = 5), and community members (n = 3). These highlighted multilevel barriers including limited patient understanding of preventive health, time and cost constraints, and variable roles of language interpreters. The literature was also reviewed to identify interventions used with similar populations. Findings from this review suggest that interventions are largely focused on single population groups or address single screening barriers. Finally, a community-academic summit (n = 48 participants) was held to review results and develop recommendations for community and clinic interventions. Findings from this study indicate that it is possible to engage a diverse group of stakeholders in strategies that are responsive to health care providers and patients, including LEP patients from heterogeneous backgrounds.

The SWIM study: Ethnic minority women's ideas and preferences for a tailored intervention to promote national cancer screening programmes-A qualitative interview study

BACKGROUND

Ethnic minority women from non-Western countries are less likely than the native women to participate in screening programmes for cervical cancer, breast cancer and colorectal cancer. This social inequality can result in loss of possibility for prevention, delayed diagnosis and treatment and, ultimately, lower chance of survival. Developing a tailored intervention might be the solution to reduce social inequalities in cancer screening, and a key feature in intervention research is to consult the target group.

OBJECTIVE

To explore ethnic minority women's own ideas and preferences for a cancer screening intervention and identify their attitudes to different strategies.

METHODS

An interview study with five focus group interviews, two group interviews with an interpreter and three individual interviews. Thirty-seven women from 10 non-Western countries contributed to the study. The interviews were audio-recorded and transcribed verbatim followed by a thematic analysis.

RESULTS

According to the women, a tailored intervention should focus on knowledge in the form of face-to-face teaching. The women further suggested information material in their own language with a simple, positive and concrete communication strategy. They would like to be involved in an awareness strategy and share the knowledge with their network.

CONCLUSION

Ethnic minority women were interested in a tailored intervention, and they were keen to contribute with ideas and preferences. The findings emphasized the potential of a tailored intervention with specific suggestions to the content when attempting to reduce inequality in cancer screening participation.

PATIENT OR PUBLIC CONTRIBUTION

Minority women were involved in the interview study.

Exploring Health Literacy and the Correlates of Pap Testing Among African Immigrant Women: Findings from the AfroPap Study

African immigrant (AI) women have low rates of Pap testing. Health literacy plays a pivotal role in health behaviors. Sources and types of health information could shape health literacy and inform the Pap testing behaviors of AI women. However, the influences of health literacy, sources, and types of health information along with cultural and psychosocial correlates on the Pap testing behaviors of AI women are poorly understood. To examine how sources and types of health information impact health literacy, and in turn, how health literacy and cultural and psychosocial factors influence the Pap testing behaviors of AI women. An adapted Health Literacy Skills Framework guided the selection of variables for this cross-sectional study. Convenience sampling was used to recruit 167 AI women, 21-65 years. Multivariate logistic regression was used to assess correlates of Pap testing after adjusting for covariates (age, education, English proficiency, employment, income, health insurance, access to primary care, marital status, and healthcare provider recommendation). Most participants (71%) had received a Pap test in the past and used multiple (two or more) sources (65%) and types (57%) of health information. Using multiple sources of health information (aOR 0.11, p < 0.01) but not types of health information was associated with Pap testing. Having negative cultural beliefs (aOR 0.17, p = 0.01) and having high self-efficacy (aOR 9.38, p < 0.01) were significantly associated with Pap testing after adjusting for covariates. High health literacy (OR 3.23, p < 0.05) and high decisional balance (OR 5.28, p < 0.001) were associated with Pap testing in bivariate models but did not remain significant after controlling for covariates. Cultural beliefs was a significant correlate of AI women's Pap testing behaviors regardless of other known social determinants of health (education, English proficiency, age, access to primary care). Disseminating health information through various sources has the potential to promote Pap testing among AI women. Larger studies which utilize a robust sampling strategy and include a diverse group of AI women are needed in order to optimize health interventions aimed at improving Pap test screening behaviors among AI women.

Examination of Breast Cancer Screening Knowledge, Attitudes, and Beliefs among Syrian Refugee Women in a Western Canadian Province

Background

Women living in the Arab world present low breast cancer screening rates, delayed diagnosis, and higher mortality rates.

Purpose

To further explore the Muslim Syrian refugee women’s breast self-examination (BSE), utilization of clinical breast examination (CBE) and mammography.

Methods

A cross-sectional descriptive exploratory study design was used. The sample consisted of 75 refugee women. Data were collected using Champion’s Health Belief Model Scale, the Cancer Stigma Scale, and the Arab Culture-Specific Barriers to Breast Cancer Questionnaire. Descriptive, Pearson correlation and logistic regression analyses were used to analyze the data.

Results

A minority of women had BSE (32%), CBE (12%) and mammograms (6.7%) anytime during their lifetime. Women’s breast cancer screening (BCS) knowledge ranked at a medium level (M = 10.57, SD = 0.40). Low knowledge score, BSE information, policy opposition, responsibility, barriers to BSE, and seriousness were found to be statistically significant in women’s BSE practice. BSE benefits and religious beliefs significantly predict CBE Age, education, knowledge, responsibility, susceptibility, social barriers, and religious beliefs were statistically significant in women’s mammography use (p < .01).

Conclusions

Participants’ breast cancer screening practices were low. Health beliefs, Arab culture and stigma about cancer affected women’s BCS practices. Faith-based interventions may improve knowledge and practices.

The Role of Sources and Types of Health Information in Shaping Health Literacy in Cervical Cancer Screening Among African Immigrant Women: A Mixed-Methods Study

BACKGROUND

Health literacy is a strong determinant of health outcomes among immigrants. How sources and types of health information influence health literacy in the context of cervical cancer screening among African immigrant women remains unknown.

OBJECTIVE

This study was undertaken to explore how various sources and types of health information influence information sharing and health literacy in the context of cervical cancer screening among African immigrant women.

METHODS

Using a mixed-methods approach, a convenience sample of African immigrant women (N = 167) completed study surveys followed by semi-structured individual phone interviews with a purposive sub-sample (n = 20) of survey participants. The relationship between sources and types of health information and health literacy was assessed using multivariate logistic regression. Emergent themes were identified in the qualitative interviews using content analysis. Qualitative and quantitative data were merged to describe differences and similarities in African immigrant women's experiences and display of health literacy by different sources and types of health information.

KEY RESULTS

Health care providers (78%), women friends (46%), and internet (45%) were the most common sources of health information used by African immigrant women, followed by women relatives (32%), television (22%), social media (17%), and church (16%). Content analysis revealed that the health care provider was rated as the most credible source; personal experiences of family and friends made health information more relatable; and church was the least endorsed source. Health information presented verbally (adjusted odds ratio of 5.51, p = .01) was associated with higher health literacy even after controlling for covariates. Most African immigrant women had health information presented in verbal form (80%), with pictures (43%) being the least popular type of health information.

CONCLUSIONS

Study findings suggest that verbal communication is associated with health literacy in the context of cervical cancer screening among African immigrant women. Health interventions that use peer educators (women friends and family) and incorporate verbal communication may be a more effective strategy in promoting positive cervical cancer health behaviors among African immigrant women. [HLRP: Health Literacy Research and Practice. 2021;5(2):e96-e108.] Plain Language Summary: For this mixed-methods study, a convenience sample of African immigrant women (N = 167) completed study surveys followed by semi-structured individual phone interviews with a purposive sub-sample (n = 20) of the survey participants. Study findings show a strong association between verbal communication and health literacy in the context of cervical cancer screening among African immigrant women.

Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants

Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.

The Health Status of Zimbabwean Immigrants in the US: A Needs Assessment

Many Zimbabwean immigrants have settled in the US in the past 20 years. These immigrants originate from a country highly burdened with HIV and other non-communicable diseases. The health needs of these immigrants are not known. To determine the prevalence of health conditions, and healthcare utilization of Zimbabwean immigrants. A cross-sectional study of 98 Zimbabwean immigrants recruited at religious festivals, completed questionnaires and had blood pressure and weight measurements taken. Three quarters (74.4%) were overweight/obese, 34.7% had hypertension, 79.6% were health insured, 87% had regular PCPs. In the year prior 78.7% had seen a provider, and 25% had utilized the ER for care. Despite regular visits to providers participants, Zimbabwean immigrants utilized the ER more frequently than other populations and had high prevalence of preventable cardiovascular disease risk factors. Providers need to partner with this population to come up culturally appropriate prevention and management interventions.

A qualitative study of barriers and enablers associated with colorectal cancer screening among Somali men in Minnesota

The rate of cancer screening is generally increasing in the US. In Minnesota, the statewide average rate of screening for colorectal cancer (CRC) is 73%. However, screening completion is relatively low among Somali men; overall, only 27% of Somali immigrants have been screened for CRC. Factors contributing to this disparity have not been well researched. The purpose of this pilot study was to employ focus group methodology to describe and advance understanding of the barriers and enablers associated with CRC screening among Somali men ages 50-74 in Minnesota. Three focus groups were conducted among 27 Somali men in Minnesota. A 9-question, semi-structured interview guide was used. The sessions were audio recorded, transcribed verbatim, and checked for accuracy by research staff prior to data analysis. Three research team members utilized the constant comparative method and NVivo to conduct data analysis. Five barriers to CRC screening emerged from the analyses: (1) lack of knowledge, (2) emotional barriers, (3) acculturation, (4) accountability, and (5) fatalistic beliefs. In addition, two factors enabling CRC screening and prevention emerged: the need for tailored interventions and preventive lifestyle behaviors. The insights gained from this research will assist in developing health promotion and education-focused interventions that encourage Somali immigrants in Minnesota and beyond to seek early detection screening for CRC.Abbreviations: CRC: Colorectal Cancer; FIT: Fecal Immunochemical Test; FOBT: Fecal Occult Blood Test; FQHC: Federally Qualified Health Center; PA: Project Assistant; PI: Principal Investigator.

Perceptions about cancer and barriers towards cancer screening among ethnic minority women in a deprived area in Denmark - a qualitative study

BACKGROUND

Screening programmes for cervical cancer, breast cancer and colorectal cancer have been implemented in many Western countries to reduce cancer incidence and mortality. Ethnic minority women are less likely to participate in cancer screening than the majority population. In worst case this can result in higher incidence rates, later diagnosis and treatment and ultimately inferior survival. In this paper we explored the perceptions about cancer and perceived barriers towards cancer screening participation among ethnic minority women in a deprived area in Denmark.

METHODS

Interview study with ethnic minority women in a deprived area in Denmark. The interviews were transcribed verbatim followed by an inductive content analysis.

RESULTS

Cancer was perceived as a deadly disease that could not be treated. Cancer screening was perceived as only relevant if the women had symptoms. Knowledge about cancer screening was fragmented, often due to inadequate Danish language skills and there was a general mistrust in the Danish healthcare system due to perceived low medical competences in Danish doctors. There was, however, a very positive and curious attitude regarding information about the Danish cancer screening programmes and a want for more information.

CONCLUSION

Ethnic minority women did not have sufficient knowledge about cancer and the purpose of cancer screening. Perceptions about cancer screening were characterised by openness and the study showed positive and curious attitudes towards screening participation. The findings emphasise the importance of culturally adapted interventions for ethnic minority women in attempts to reduce inequality in screening participation.

Interventions to Reduce Healthcare Disparities in Cancer Screening Among Minority Adults: a Systematic Review

BACKGROUND

Racial minority populations face an increased burden relative to cancer interventions. Compared with Caucasians, the cancer screening rate is substantially lower among African American, Asian American, Latinx American, and American Indian/Alaska Native populations. Barriers such as low health literacy, lack of health insurance, and miscommunication between patients and providers have been identified as important factors that result in low screening rates among minority adults. This study was designed to identify interventions targeting racial minority adults 40 years of age or older that were effective in increasing cancer screening uptake rates.

METHODS

A systematic review of articles published in and after January 2009 was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Twenty-six published studies of cancer screening intervention tested with minority adults were identified through the searches of CINAHL, Global Health, PsycINFO, PubMed, and Scopus databases.

RESULTS

Thirteen (50%) of the studies utilized lay community health workers to increase cancer awareness and knowledge and to encourage screening. These methods took place over the telephone, at community education sessions, or within the context of personalized patient navigation support. The intervention programs utilized culturally relevant materials as well as spoken and written information in the targeted population's native language. Various intervention designs resulted in statistically significant increases in cancer screening adherence. However, we found no intervention that consistently elevated cancer screening rates across all racial/ethnic minority adults.

CONCLUSIONS

The finding suggests that highly segmented interventions are needed in order to improve cancer screening among various racial/ethnic minority adults.

Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review

BACKGROUND

Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the "black" category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps.

METHODS

Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format.

RESULTS

Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers.

CONCLUSION

Knowledge about African immigrant health in the U.S. is scarce, with available literature mainly focusing on databases, which make it difficult to identify African immigrants. To our knowledge, this is the first Scoping Review pertaining to the healthcare experiences and needs of African immigrants in the U.S.

Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States

To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.

Text Message Support for Smoking Cessation During Ramadan: A Focus Group Study With Somali Immigrant Muslim Men

Introduction

Somali Muslim male immigrants in Minnesota have a high prevalence of smoking, estimated at 44%, compared with the average smoking rate for adults in the United States (14%). However, the literature has reported spontaneous reductions of smoking during Ramadan. This study sought to gather the views of Somali Muslim men on how faith impacts their smoking, and determine what messaging to incorporate into a tailored text messages intervention that draws on the Muslim faith beliefs and practices during Ramadan to promote smoking cessation.

Methods

Thirty-seven Somali adult male smokers were recruited from community settings to participate in one of five focus groups in Minneapolis and Saint Paul, Minnesota. The research study team developed a semi-structured focus group guide that explored: (1) the experience of Muslim immigrants quitting smoking during Ramadan, (2) views on text messaging interventions to reduce smoking focusing on health and faith, and (3) views on the relationship between faith and smoking. A thematic analysis was conducted.

Results

Participants reported reductions in smoking during Ramadan, which was mostly achieved without formal treatment (ie, willpower). There was interest in text messaging interventions that incorporated faith and health-related messages, and that would be delivered around the time of Ramadan. Participants described concerns about the adverse health effects of smoking, including the risk of chronic health issues, cancer, and death.

Conclusion

Combining faith and health-related text-based messaging, and tailoring interventions around and beyond Ramadan, maybe a valuable approach to help address smoking disparities in the Somali immigrant community.

Implications

Ramadan offers a unique window of opportunity to intervene upon smoking for Somali Muslim immigrant men, for whom rates of smoking are high. Combining faith and health-related text-based messaging, and tailoring interventions around and beyond Ramadan, maybe a valuable approach to help address these serious smoking disparities.

Barriers to mammography screening among racial and ethnic minority women

RATIONALE

Breast cancer is the second leading cause of cancer death among women. Disparities in breast cancer mortality rates adversely affect racial/ethnic minority women. Mammography screening is the most effective early detection method and means of reducing mortality rates. Yet, barriers prevent racial/ethnic minority women from participating in regular screening.

OBJECTIVE

This review aimed to summarize self-reported barriers to mammography screening in racial/ethnic minority women in studies using open-ended assessments and closed-ended assessments.

METHOD

Literature searches were conducted in two databases, PsycINFO and PubMed. Barriers were detailed in full by barrier type (psychological/knowledge-related, logistical, cultural/immigration-related, and social/interpersonal) and summarized briefly by race/ethnicity (African American/Black, Asian/Pacific Islander, Hispanic, American Indian/Native American, and Middle Eastern).

RESULTS

Twenty-two open-ended and six closed-ended studies were identified as eligible for this review. Overall, racial/ethnic minority women identified common logistical and psychological/knowledge-related barriers. Additionally, women reported cultural/immigration-related and social/interpersonal barriers that were closely tied to their racial/ethnic identities.

CONCLUSIONS

It was concluded that cultural/immigration-related barriers may be the only barrier type that is unique to racial/ethnic minority women. Thus, designing studies of barriers around race and ethnicity is not always appropriate, and other demographic factors are sometimes a more important focus. The variability in 'barrier' definitions, how data were collected and reported, and the appropriateness of closed-ended measures were also examined. This literature may benefit from detailed and strategically designed studies that allow more clear-cut conclusions and better comparison across studies as well as improving closed-ended measures by incorporating insights from investigations using open-ended inquiry.

Spousal support and knowledge related to cervical cancer screening: Are Sub-Saharan African immigrant men interested?

Sub-Saharan African immigrant (SSAI) men have significant influence on the health-seeking behavior including cervical cancer screening uptake by their female partners/wives. We conducted a qualitative descriptive study with 21 SSAI men to explore knowledge, perceptions, and support related to cervical screening. Participants were aged 36 ± 9 years, college educated (88%), and 53% have lived in the U.S. > 5 years. Three themes emerged; inadequate cervical cancer knowledge, willingness and strategies for support, and shared versus autonomous decision making for screening. Social structure with emphasis on male leadership could be leveraged in cervical cancer screening promotion for SSAI women.

Developing culturally informed genetic services for the Somali immigrants in Minnesota

Misinformation and distrust often prevent individuals from minority communities to seek adequate healthcare, including genetic services. Immigrants appear to be further burdened by factors that negatively impact their health outcomes and little is known about their experience with genetic services. We sought to identify attitudes and perception of genetic services in one immigrant group, the Somali community of Minnesota and to establish a culturally informed framework for caring for members. A qualitative study comprised of 11 semi-structured key informant interviews was conducted and analyzed using a thematic approach. Main themes emerged from the analysis fell within one of four major topics: (a) Somali views and perspective on genetics and healthcare, (b) barriers to uptake of genetic services, (c) facilitators to uptake of genetic services, and (d) perspective on genetic service delivery subtypes. Somali views and perspective on genetics are often framed by religious and cultural values. These values, at times, conflicted with those common in the American healthcare system. Supports for different genetic service delivery subtypes also varied, ranging from little to no support in prenatal screening to generally positive support for pharmacogenetic testing. Future studies should prioritize topics with support and ways to better provide genetic counseling services within the Somali community.

"We are Muslims and these diseases don't happen to us": A qualitative study of the views of young Somali men and women concerning HPV immunization

BACKGROUND

Minnesota is home to the largest Somali immigrant population in the United States. Despite high rates of cervical cancer in this population, immunization rates for the human papillomavirus (HPV) are among the lowest in the nation. Targeting Somali young adults for catch-up vaccinations may be an important strategy for addressing these low rates. This study sought to understand the views of Somali young adults regarding HPV immunization.

METHODS

Four focus groups (N = 34; 21 women) were conducted at an urban clinic in Minnesota. Two groups were all female, one all male, and one mixed gender. Participants in each group discussed their views on immunization in general, and then their views on HPV immunization.

FINDINGS

Most participants had prior negative experiences with immunization and were skeptical concerning its value. In general, participants had low knowledge about HPV, though they expressed interest in knowing more. Views about HPV were influenced by culture, with risk perceived as low due to interpretations of religious beliefs and expectations around sexual behavior. Low levels of trust in doctors and other healthcare providers influenced participants' perceptions of the benefits of immunization. Participants also valued autonomy highly and resented having received required vaccinations without much choice, such as through their immigration experience or by school authorities. Participants suggested making more opportunities available for learning about HPV and how to prevent it, including via web-based platforms.

CONCLUSION

An important opportunity exists to address low HPV immunization rates in the Somali American population by offering vaccination to young adults, who are interested in learning more about HPV. However, key barriers around HPV needs to be addressed in ways that respect the need for autonomy in this age group and that build trust with providers, which may mean avoiding authoritative approaches.

Understanding and awareness of autism among Somali parents living in the United Kingdom

Using vignettes and interviews, this study examined understanding and awareness of autism, and (a)typical development more broadly, among 32 Somali parents living in the United Kingdom. Results demonstrated that parents of both autistic (n = 16) and non-autistic (n = 16) children were just as likely to identify vignettes of typically developing children, yet parents of autistic children appeared more astute to signs of atypical development. Across the whole sample, parents commonly identified and labelled vignettes of autistic children, but experienced more difficulty labelling vignettes that described children with other forms of atypical development, sometimes mislabeling these children as autistic. This suggests that there is a need for greater support in recognising and identifying different types of atypical development in the Somali community (to mitigate the risk that the term 'autism' may take on its own meaning within the Somali community, becoming a euphemism for a range of developmental conditions). Analysis of interview data identified key sociocultural factors that either helped or hindered the inclusion of families with autistic children within the community, including the Somali community's: (1) perceptions of disability, (2) beliefs about the causes of autism in the Western world and (3) strong reliance on religious beliefs in understanding and accepting an autism diagnosis.

"They were just waiting to die": Somali Bantu and Karen Experiences with Cancer Screening Pre- and Post-Resettlement in Buffalo, NY

BACKGROUND

Little is known about how pre-resettlement experiences affect refugees' uptake of cancer screenings. The objective of this study was to characterize Somali Bantu and Karen experiences with cancer and cancer screenings prior to and subsequent to resettlement in Buffalo, NY in order to inform engagement by health providers.

METHODS

The study was grounded in a community-based participatory research approach, with data collection and analysis guided by the Health Belief Model and life course framework. Interviews were transcribed, independently coded by two researchers, and analyzed using an immersion-crystallization approach. We conducted 15 semi-structured interviews and six interview-focus group hybrids with Somali Bantu (n = 15) and Karen (n = 15) individuals who were predominantly female (87%).

RESULTS

Cancer awareness was more prevalent among Karen compared to Somali Bantu participants. Prior to resettlement, preventative health care, including cancer screening, and treatment were unavailable or inaccessible to participants and a low priority compared with survival and acute health threats. There, Somali Bantu treated cancer-like diseases with traditional medicine (heated objects, poultices), and Karen reported traditional medicine and even late-stage biomedical treatments were ineffective due to extent of progressed, late-stage ulcerated tumors when care was sought. A fatalistic view of cancer was intertwined with faith (Somali Bantu) and associated with untreated, late-stage cancer (Karen). Karen but not Somali Bantu reported individuals living with cancer were stigmatized pre-resettlement due to the unpleasant manifestations of untreated, ulcerated tumors. Now resettled in the U.S., participants reported obtaining cancer screenings was challenged by transportation and communication barriers and facilitated by having insurance and interpretation services. While Somali Bantu women strongly preferred a female provider for screenings, Karen women felt cancer severity outweighed cultural modesty concerns in terms of provider gender.

SIGNIFICANCE

Our findings suggest the need for culturally-relevant cancer education that incorporates the life course experiences and addresses logistical barriers in linking individuals with screening, to be complemented by trauma-informed care approaches by healthcare providers.

The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review

Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field.

Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly).

Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination.

Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.

Facilitators and Barriers of Cervical Cancer Screening and Human Papilloma Virus Vaccination Among Somali Refugee Women in the United States: A Qualitative Analysis

INTRODUCTION

Eastern Africa has the highest rates of cervical cancer incidence (42.7 per 100,000) and mortality (27.6 per 100,000), substantially higher than worldwide incidence (14.0 per 100,000) and mortality (6.8 per 100,000). The purpose of this study was to explore facilitators and barriers to cervical cancer screening and human papilloma virus (HPV) vaccination among Somali refugee women and their children.

METHOD

Focus group discussions were conducted in August of 2016. Investigators performed systematic, comparative, and thematic data analyses.

RESULTS

The 31 Somali refugee participants ranged from 23 to 64 years old. Four major themes emerged: (1) knowledge, (2) facilitators, (3) decision making, and (4) views on intervention strategies. Doctor recommendation and family support were important facilitators. Community education was the most popular strategy in promoting screening and vaccine uptake.

DISCUSSION

Multilevel targeted interventions should increase knowledge and include family members to increase cervical cancer screening and HPV vaccination uptake in the Somali community.

Provider Perspectives on Promoting Cervical Cancer Screening Among Refugee Women

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.

We Should Know Ourselves: Burmese and Bhutanese Refugee Women's Perspectives on Cervical Cancer Screening

Refugee women are at increased risk for cervical cancer and have low rates of cervical cancer screening both in their countries of origin and in the U.S. Using the Behavioral Model for Vulnerable Populations as a conceptual framework, we conducted eight focus groups with Burmese and Bhutanese refugee women to gather information about factors influencing cervical cancer screening (31 Burmese and 27 Bhutanese participants). Less than one-third (28%) reported being screened for cervical cancer before coming to the U.S. and only 45% reported being screened after resettling in the U.S. Participants had limited knowledge about cervical cancer and the need for screening, and faced multiple barriers including competing priorities and cost. However, trusted providers and interpreters were seen as means of facilitating screening. Cervical cancer screening among Bhutanese and Burmese refugee women could be improved with culturally tailored health education and increased access to female providers and trained interpreters.

Self-administered versus provider-directed sampling in the Anishinaabek Cervical Cancer Screening Study (ACCSS): a qualitative investigation with Canadian First Nations women

BACKGROUND

While (Pap)anicolaou screening has helped to decrease cervical cancer incidence in Canada, First Nations women continue to have a higher burden and mortality relative to mainstream populations. Many First Nations women may feel uncomfortable with the invasiveness of this test, contributing to this statistic. Implemented from 2009 to 2015 in 10 Northwest Ontario First Nations communities, the Anishinaabek Cervical Cancer Screening Study (ACCSS) uniquely addressed this Indigenous health inequity through a mixed methods approach.

OBJECTIVE

Our goal was to offer an alternative test which the women could do themselves: human papillomavirus (HPV) testing based on self-sampling. We investigated whether First Nations women preferred HPV self-sampling over healthcare provider (HCP)-administered Pap screening.

METHODS

Participatory action researchinformed by the ethical space concept has guided all stages of the ACCSS. We conducted qualitative interviews with 16 HCPs and 8 focus group discussions with 69 female community members followed by a cluster-randomised controlled trial (RCT). Here, we draw on the qualitative field data and an end-of-study community update gathering to disseminate and contextualise research findings. Informant data were evaluated using thematic analysis.

RESULTS

We discuss factors influencing participants' strong preference for HPV self-sampling over physician-conducted Pap screening. Key arguments included enhanced accessibility and more personal control, less physical and emotional discomfort and fewer concerns regarding privacy of test results. For future implementation of HPV self-sampling, study participants emphasised the need for more culturally sensitive education addressed to community members of all genders, starting at school, clarifying that HPV causes cervical cancer. Further, HPV infection should be de-stigmatised by accentuating that it affects men and women alike.

CONCLUSION

Here we show that self-sampling in conjunction with community engagement and culturally sensitive education and could be a viable option for underscreened Canadian First Nations women. These informant data echo our previous RCT results.

Views of Somali women and men on the use of faith-based messages promoting breast and cervical cancer screening for Somali women: a focus-group study

BACKGROUND

Screening rates for breast and cervical cancer for Muslim women in the United States are low, particularly for first-generation immigrants. Interpretations of the Muslim faith represent some of the barriers for breast and cervical cancer screening. Working to understand how faith influences breast and cervical screening for Somali women, and working with the community to identify and utilize faith-based assets for promoting screening, may lead to life-saving changes in screening behaviors.

METHODS

We partnered with an Imam to develop faith-based messages addressing the concerns of modesty and predetermination and promoting cancer testing and screening. A total of five focus groups were convened, with 34 Somali women (three groups) and 20 Somali men (two groups). Each focus group first discussed participant views of breast and cervical cancer screening in general and then viewed and discussed video clips of the Imam delivering the faith-based messages.

RESULTS

Both Somali women and men had an overwhelmingly positive response to the faith-based messages promoting breast and cervical cancer screening. The faith-based messages appeared to reinforce the views of those who were already inclined to see screening positively, with participants describing increased confidence to engage in screening. For those who had reservations about screening, there was feedback that the faith-based messages had meaningfully influenced their views.

CONCLUSIONS

Somali immigrant women and men found faith-based messages addressing topics of predestination and modesty and encouraging the use of screening and treatment to be both acceptable and influential. Faith can play an important role as an asset to promote breast and cervical cancer screening, and there may be substantial benefits to adding faith-based messaging to other interventions that focus on improving screening uptake. This may help to address health disparities for Somali women in this area.

Awareness of and reactions to mammography controversy among immigrant women

Background

There is substantial expert disagreement about the use of mammography to screen for breast cancer, and this disagreement routinely plays out in the media. Evidence suggests that some women are aware of the controversy over mammography, but less is known about whether immigrant and other underserved women have heard about it and, if so, how they react to it.

Objective

To explore immigrant women's awareness of and reactions to mammography controversy.

Design

Community‐engaged qualitative study: we conducted six focus groups with 53 women aged 35–55 from three immigrant communities (Somali, Latina and Hmong) in a major US metropolitan area. A grounded theory approach was used to identify themes; NVivo 10 was used to enhance analyses.

Results

Several themes emerged: (i) low awareness of mammography controversy across groups, despite self‐reported attention to health information; (ii) high intentions to be screened, even after being told about the controversy; (iii) few reported discussions of mammography's risks and benefits with clinicians; (iv) substantial interest in learning more about mammography and breast cancer, but some low self‐efficacy to obtain such information; and (v) questions about whether health recommendations matter and what qualifies as evidence.

Conclusion

Given on‐going expert disagreement about mammography screening, it is important for clinicians to help women understand mammography's risks and benefits so they can make an informed choice. This is particularly critical for immigrant and other underserved women, who may be less able to access, attend to, process, retain and act on health information (a phenomenon known as communication inequality).

Factors Influencing Pap Screening Use Among African Immigrant Women

PURPOSE

Papanicolau (Pap) screenings disparities exist for immigrant women in the United States. This study sought to have an understanding of factors influencing Pap screening among sub-Saharan African immigrant women.

METHOD

This is a qualitative descriptive study. Women were recruited from the community and by word of mouth following institutional review board approval. Data were gathered through in-depth focus group and demographic questionnaires. Interview sessions were digitally recorded and transcribed verbatim. Transcripts were analyzed for themes.

FINDINGS

Twenty-two women aged 24 to 65 years were interviewed. Barriers to screening included low knowledge of screening, cost, cultural beliefs, fear and communication issues. Motivators to improve Pap use include provider's recommendations, enlightenment, and family support.

DISCUSSION

Interventions addressing the barriers peculiar to this population may alleviate these barriers and improve Pap screening use in this population. Providers have the opportunity to influence screening attitudes of African-born women by providing awareness and patient-targeted interventions.