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Breaking Down Cultural and Ethnic Barriers in Pap Smear Compliance

Breaking Down Cultural and Ethnic Barriers in Pap Smear Compliance. Presented by: Sarah McQueen, PA-S Advisor: Gerry Gairola, Ph.D. Cervical Cancer. 12,200 cases and 4,100 deaths in the US in 2003. Latency period of 10-20 years. HPV most common cause

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Breaking Down Cultural and Ethnic Barriers in Pap Smear Compliance

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  1. Breaking Down Cultural and Ethnic Barriers in Pap Smear Compliance Presented by: Sarah McQueen, PA-S Advisor: Gerry Gairola, Ph.D

  2. Cervical Cancer • 12,200 cases and 4,100 deaths in the US in 2003. • Latency period of 10-20 years. • HPV most common cause • Survival rates decrease as disease progresses • Most women diagnosed with disease have either never had Pap Smear or did not follow-up on abnormal results • Most often asymptomatic upon discovery

  3. Cervical Cancer Risk Factors • Cigarette smoking • Multiple sexual partners • Having sex at early age • History of immunosuppressive diseases

  4. Pap Smear • Used to detect cervical cancer and diagnose some infectious diseases • Obtains cell samples from the cervix by using a speculum and either a spatula or brush • Procedure takes only a few minutes and is relatively painless • This test findsprecancerous lesions, not just invasive carcinoma

  5. Personal Experiences • Male gynecologist who shared his story of entering the profession to save women’s lives • My own horrible experience with a OB/GYN nurse practitioner.

  6. Cultural Barriers • 1 out of 10 people in America are not American-born • In 2000, an estimation of 28.4 million people in the US that were born in another country • 55% Asian American, 44% Caucasion, 43% Hispanic, 40% American Indian/Alaska Native, 37% African American women did not have pap smears.

  7. Common Barriers • Immigrants do not understand American health care system • Immigrants uncomfortable making medical decisions without family members • Unpleasant experiences in their native land • Language barrier

  8. Culturally Specific Barriers • Asian American and Pacific Islander (AAPI) • African American • Jordan (Middle East) • India • Native American • Hispanic

  9. Asian American and Pacific Islander (AAPI) • Modesty • Stigma against premarital sexual relationships. • Focus on immediate health issues • Prevention = good diet, spiritual life, and herbs • Bad luck to talk about it (Vietnamese) • Not needed after child bearing age • Reluctance toward all medical procedures • Self-giving gender roles • Overall ignorance or cancer and its treatments, risk factors, and preventability

  10. Alleviating cultural barriers to AAPI women • The National Asian Women’s Health Organization (NAWHO) found: more community partnerships, education that uses all forms of media to reach these women because many Chinese women can write their language but cannot read it, interpreters, childcare, and even transportation • Brochures • Asian Women’s Health Clinic in Canada: All staff members are fluent in either Mandarin or Cantonese, educational video in waiting room, demonstration of procedure and importance stressed • Teach prevention

  11. African American • Strong connection between God and personal health • Balance of soul, body, and mind • Less positive view of prevention • More impending issues to worry about (finances and high death rates) • Mistrust in predominately Caucasian health care force (Tuskegee/Discrimination in 60s)

  12. Alleviating cultural barriers to African American women • Teach Prevention • Culturally sensitive education videos played in waiting rooms in California • Community outreach strategies (literature distribution, community events, media, and church programs) • Free screening clinics in inner city Chicago

  13. Jordan (Middle East) • Predominance of Islam (modesty) • Overall ignorance of cancer and its treatments, risk factors, and preventability • Preference of women providers • Women sometimes treated more like property and not given much importance in society

  14. Alleviating cultural barriers to Jordanian (Middle Eastern) women • Train female providers to help women feel more comfortable exposing their body • Material to address the issue that is less sexually oriented and more physical and scholarly in nature • Start women’s clinic or meetings in communities to educate

  15. India • Bears 1/5 of the world disease burden • No national program for asymptomatic screening • No emphasis on prevention • Women’s health comes second to finances and societal responsibilities • False belief that it is caused by poor cleanliness, many births, sexual promiscuity, and using contraceptives • Also feel a diagnosis would bring shame on the family • False belief that cancer is caused by a pap smear • Sexual health not discussed even among married couples

  16. Alleviating cultural barriers to Indian women • Add programs in medical schools to teach about pap smears and cervical cancer-right now there is none • Send midwives in communities to educate the women • Information, Education, and Communication (IEC) successfully heightened awareness on prostate, oral, and breast cancers, but only recently has obtained materials about cervical cancer • Teach prevention

  17. Native American (Yakama Tribe) • More holistic outlook on life • Do not believe in focusing on only one part of the body for healing • First step towards becoming a woman but thought to prevent STI’s and pregnancy • Stigma of premarital sexual relations • Older women more concerned with their duty to give to the tribe and pass down their traditions to their children • Death is not feared • Fear that talking about it will cause it • Modesty • No focus on prevention • Focus on the present time not the future

  18. Alleviating cultural barriers to Native American women • Education of the community that these women must take care of themselves by having a Pap Smear and preventing a deadly illness which will enable them to better serve their tribe and fulfill their roles • Emphasis on maintaining health rather than focusing on the consequences of the illness • Older women have great influence on the younger women, education should start with the older women • Moving the Pap Smear testing out of the family planning practice and putting it into a general health clinic • Sensitivity of the holistic nature and tribal healing ceremonies • Teach Prevention

  19. Hispanic • No focus on prevention • Fatalistic world view • Modesty • Feel that once diagnosed, you will certainly die • Fear/embarrassment of talking about it

  20. Alleviating cultural barriers to Hispanic women • Teach Prevention • Culturally sensitive education videos played in waiting rooms in California • Health care provider fluent in Spanish • Female providers

  21. Summary • Cultural beliefs must be understood by all health care professionals. • Great need for culturally sensitive health education materials. • Health care providers with some background in a foreign language. • Women of all nationalities and races should not have to die needlessly.

  22. Sources • American Cancer Society. Prevention and early detection: pap test. American Cancer Society available at www. Cancer.org/docroot/ PED/content/PED_2_3X_Pap_Test.asp?sitearea=PED. Accessed November 2, 2006. • Austin LT, McNally MJ, Stewart, DE. Breast and cervical cancer screening in Hispanic women: A literature review using the health belief model. Women’s Health Issues. 2002;12:122-128 • Blake DR, Weber BM, Fletcher K. Adolescent and young adult women’s misunderstanding of the term pap smear. Arch Pediatrics Adolescent Medicine. 2004;158:966-970 • Eaker S, Adomi HO, Sparen P. Attitudes to screening for cervical cancer: A population-based study in Sweden. Cancer Causes and Control. 2001;12:519-528 • Goel MS, Wee CC, McCarthy EP, Davis RB, Ngo-Metzger Q, Phillips RS. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. Journal of General Internal Medicine. 2993;18:1038-1035. • Gupta JK, Clark TJ, More S, Pattison H. Patient anxiety and experiences associated with an outpatient “one-stop” “see and treat” hysteroscopy clinic. Surg Endoscopy. 2004;18:1099-1104. • Hilden M, Sidenius K, Lanhoff-Roos J, Wijma B, Shei B. Women’s experiences of the gynecologic examination: factors associated with discomfort. Acta Obstetricia et Gynecologica Scandinavica. 2003;82:1030-1036. • Idestrom M, Milsom I, Andersson-Ellstrom A. Knowledge and attitudes about the Pap-smear screening program: a population-based study of women aged 20-59 years. Acta Obstetrica et Gynecologica Scandinavica. 2002;81:962-967. • Lanier AB, Kelly JJ. Pap prevalence and cervical cancer prevention among Alaska Native women. Health Care for Women International. 1999;20:471-486. • Maaite M, Barakat M. Jordanian women’s attitudes towards cervical screening and cervical cancer. Journal of Obstetrics and Gynecology. 2002;22:421-422. • Mays RM, Zimet GD, Winston Y, Kee R, Dickes J, Su L. Human Papillomavirus, genital warts, Pap Smears, and cervical cancer: Knowledge and beliefs of adolescent and adult women. Health Care for Women International. 2000;21:361-374. • National Asian Women’s Health Organization. A profile: Cervical cancer and Asian American women. NAWHO 2000 • Sent, L, MB, ChB, Ballem, P, MSc, MD, Paluck E, BSP, MSc, Yelland, MHSc, MD, Vogel, AM, MD, CM, MHSc. The Asian Women’s Health Clinic: addressing cultural barriers to preventive health care. Canadian Medical Association Journal. 1998;159:350-354. • Seow, A MBBS, Wong, ML MBBS, MPH, Smith WCS, MD, PhD, MPH, FFPHM, Lee, HP, MBBS, FAMS, FFPHM. Beliefs and attitudes as determinants of cervical cancer screening: A community-based study in Singapore. Preventive Medicine. 1995;24:134-141. • Strickland, JC PhD, RN; Chrisman, NJ. PhD, MPH; Yallup, M PhD; Powell, K BS, RN; Dick Squeoch, M MPH. Walking the journey of womanhood: Yakama Indian women and papanicolaou (Pap) test screening. Public Health Nursing. 1996;13:121-150. • Tang TS, Solomon LJ, Yeh J, Worden JK. The role of cultural variables in breast self-examination and cervical cancer screening behavior in young asian women living in the United States. Journal of Behavioral Medicine. 1999;22:419-436. • Twinn S, Cheng F, Twinn S. Increasing uptake rates of cervical cancer screening amongst Hong Kong Chinese women: the role of the practitioner. Journal of Advanced Nursing. 2000;32:335-342. • Umer, KB. Breaking cultural barriers: cervical cancer in Asian American and Pacific Islander women. Closing the Gap, Maternal Health. January/February 2004. • Yancey AK MD, MPH, Park Tanjasiri, S MPH, Klein, M, RN, MSPH, Tunder J, MPH. Increased cancer screening behavior in women of color by culturally sensitive video exposure. Preventive Medicine. 1885;24:142-148.

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