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 causeSurvival rates decrease as disease progressesMost women diagnosed with disease have either never had Pap Smear or did not follow-up on abnormal resultsMost often asymptomatic upon discovery

Cervical Cancer Risk Factors

Cigarette smoking

Multiple sexual partners

Having sex at early age

History of immunosuppressive diseases

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 finds precancerous lesions, not just invasive carcinoma

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.

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.

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

Culturally Specific Barriers

Asian American and Pacific Islander (AAPI)

African American

Jordan (Middle East)

India

Native American

Hispanic

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

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 BrochuresAsian 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

African American

Strong connection between God and personal healthBalance of soul, body, and mindLess positive view of preventionMore impending issues to worry about (finances and high death rates)Mistrust in predominately Caucasian health care force (Tuskegee/Discrimination in 60s)

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

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

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

IndiaBears 1/5 of the world disease burdenNo national program for asymptomatic screeningNo emphasis on preventionWomen’s health comes second to finances and societal responsibilitiesFalse belief that it is caused by poor cleanliness, many births, sexual promiscuity, and using contraceptivesAlso feel a diagnosis would bring shame on the familyFalse belief that cancer is caused by a pap smearSexual health not discussed even among married couples

Alleviating cultural barriers to Indian women

Add programs in medical schools to teach about pap smears and cervical cancer-right now there is noneSend midwives in communities to educate the womenInformation, Education, and Communication (IEC) successfully heightened awareness on prostate, oral, and breast cancers, but only recently has obtained materials about cervical cancer Teach prevention

Native American (Yakama Tribe)

More holistic outlook on lifeDo not believe in focusing on only one part of the body for healingFirst step towards becoming a woman but thought to prevent STI’s and pregnancy Stigma of premarital sexual relationsOlder women more concerned with their duty to give to the tribe and pass down their traditions to their childrenDeath is not fearedFear that talking about it will cause itModestyNo focus on preventionFocus on the present time not the future

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 womenMoving 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 ceremoniesTeach Prevention

Hispanic

No focus on prevention

Fatalistic world view

Modesty

Feel that once diagnosed, you will certainly die

Fear/embarrassment of talking about it

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

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.

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