Journal of Community Health

, Volume 36, Issue 1, pp 121–131 | Cite as

Examining Barriers to Cervical Cancer Screening and Treatment in Florida through a Socio-Ecological Lens

  • Ellen Daley
  • Amina Alio
  • Erica H. Anstey
  • Rasheeta Chandler
  • Karen Dyer
  • Hannah Helmy
Original paper

Abstract

Cervical cancer incidence and mortality have declined in the U.S. over the past 50 years because of broad screening efforts; however, some states continue to bear a greater burden due to under-screened and -treated populations. The purpose of this study was to utilize the socio-ecological model to examine barriers to cervical cancer screening and treatment in Florida. A qualitative semi-structured interview guide was used to conduct telephone interviews with 21 purposively sampled health care professionals from 13 high-risk counties. Interviews were transcribed and coded using themes identified a priori based on levels of the socio-ecological model. Investigators identified barriers to cervical cancer screening and treatment in Florida across four levels: (1) regulations and funding issues at the policy level are inconsistent between federal, state and local levels; (2) community level barriers range from cultural differences and fear of deportation, to transportation issues; (3) institutional level barriers complicate the administration of screening and treatment services; and (4) individual beliefs, behaviors, and stressors due to poverty hinder women’s ability to access services. Many of our findings are consistent with previous studies that identified constraints to screening and treatment of cervical cancer, such as poverty and lack of access to care. This study adds to the literature by examining barriers from the viewpoint of service providers and program coordinators, and through the utilization of the socio-ecological model to provide a comprehensive framework for identifying and understanding these challenges.

Keywords

Cervical cancer Socio-ecological model Screening Prevention 

References

  1. 1.
    World Health Organization. (2008). Human papillomavirus infection and cervical cancer. Retrieved September 5, 2008, from http://www.who.int/vaccine_research/diseases/hpv/en/.
  2. 2.
    Ferlay, J., Bray, F., Pisani, P., & Parkin, D. M. (2004). Globocan 2002 cancer incidence, mortality and prevalence worldwide. (Vol. IARC CancerBase No. 5, Version 2.0). Lyon, France: IARC Press.Google Scholar
  3. 3.
    Pollack, A. E. (2006, December 12–13). Assuring access to vaccines that prevent cervical cancer. Paper presented at the “Stop Cervical Cancer: Accelerating Global Access to HPV Vaccines” meeting, London.Google Scholar
  4. 4.
    Steinbrook, R. (2006). The potential of human papillomavirus vaccines. New England Journal of Medicine, 354(11), 1109–1112.CrossRefPubMedGoogle Scholar
  5. 5.
    American Cancer Society. (2009). Cancer facts & figures 2009. Atlanta: American Cancer Society.Google Scholar
  6. 6.
    Akers, A. Y., Newmann, S. J., & Smith, J. S. (2007). Factors underlying disparities in cervical cancer incidence, screening, and treatment in the United States. Current Problems in Cancer, 31(3), 157–181.CrossRefPubMedGoogle Scholar
  7. 7.
    American Cancer Society. (2007). What are the key statistics about cervical cancer. Retrieved September 5, 2008, from http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_cervical_cancer_8.asp.
  8. 8.
    Katz, M. L., Wewers, M. E., Single, N., & Paskett, E. D. (2007). Key informants’ perspectives prior to beginning a cervical cancer study in Ohio Appalachia. Qualitative Health Research, 17(1), 131–141.CrossRefPubMedGoogle Scholar
  9. 9.
    Newmann, S. J., & Garner, E. O. (2005). Social inequities along the cervical cancer continuum: A structured review. Cancer Causes and Control, 16(1), 63–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Bradley, C. J., Given, C. W., & Roberts, C. (2004). Health care disparities and cervical cancer. American Journal of Public Health, 94(12), 2098–2103.CrossRefPubMedGoogle Scholar
  11. 11.
    Downs, L. S., Smith, J. S., Scarinci, I., Flowers, L., & Parham, G. (2008). The disparity of cervical cancer in diverse populations. Gynecologic Oncology, 109(2 Suppl), S22–S30.CrossRefPubMedGoogle Scholar
  12. 12.
    McDougall, J. A., Madeleine, M. M., Daling, J. R., & Li, C. I. (2007). Racial and ethnic disparities in cervical cancer incidence rates in the United States, 1992–2003. Cancer Causes and Control, 18(10), 1175–1186.CrossRefPubMedGoogle Scholar
  13. 13.
    Owusu, G. A., Eve, S. B., Cready, C. M., Koelln, K., Trevino, F., Urrutia-Rojas, X., et al. (2005). Race and ethnic disparities in cervical cancer screening in a safety-net system. Maternal and Child Health Journal, 9(3), 285–295.CrossRefPubMedGoogle Scholar
  14. 14.
    Florida Department of Health. (2009). Florida CHARTS. Retrieved October 25, 2009, from http://www.floridacharts.com.
  15. 15.
    Glanz, K., & Rimer, B. K. (1995). Theory at a glance: A guide for health promotion practice. Retrieved June 4, 2008, from http://oc.nci.nih.gov/services/Theory_at_glance/HOME.html.
  16. 16.
    McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377.PubMedGoogle Scholar
  17. 17.
    Reifsnider, E., Gallagher, M., & Forgione, B. (2005). Using ecological models in research on health disparities. Journal of Professional Nursing, 21(4), 216–222.CrossRefPubMedGoogle Scholar
  18. 18.
    Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.Google Scholar
  19. 19.
    Sword, W. (1999). A socio-ecological approach to understanding barriers to prenatal care for women of low income. Journal of Advanced Nursing;, 29(5), 25–42.CrossRefGoogle Scholar
  20. 20.
    Florida Department of Health. (2008). Program overview. Retrieved September 5, 2008, from http://www.doh.state.fl.us/Family/bcc/default.html.
  21. 21.
    Florida Association of Planned Parenthood Affiliates Inc. (2008). About us. Retrieved September 5, 2008, from http://www.floridaplannedparenthood.org/about-us/about-us.
  22. 22.
    Pope, C., Ziebland, S., & Mays, N. (2000). Qualitative research in health care: Analysing qualitative data. BMJ, 320, 114–116.CrossRefPubMedGoogle Scholar
  23. 23.
    Florida Department of Health. (2009). Program requirements: The Florida breast and cervical cancer program. Retrieved September 17, 2009, from http://www.doh.state.fl.us/Family/bcc/requirements.html.
  24. 24.
    Carrasquillo, O., & Pati, S. (2004). The role of health insurance on Pap smear and mammography utilization by immigrants living in the United States. Preventive Medicine, 39(5), 943–950.CrossRefPubMedGoogle Scholar
  25. 25.
    Chilton, J. A., Gor, B. J., Hajek, R. A., & Jones, L. A. (2005). Cervical cancer among Vietnamese women: Efforts to define the problem among Houston’s population. Gynecologic Oncology, 99(3 Suppl 1), S203–S206.Google Scholar
  26. 26.
    Nguyen, T. T., McPhee, S. J., Nguyen, T., Lam, T., & Mock, J. (2002). Predictors of cervical Pap smear screening awareness, intention, and receipt among Vietnamese-American women. American Journal of Preventive Medicine, 23(3), 207–214.CrossRefPubMedGoogle Scholar
  27. 27.
    Somkin, C. P., McPhee, S. J., Nguyen, T., Stewart, S., Shema, S. J., Nguyen, B., et al. (2004). The effect of access and satisfaction on regular mammogram and Papanicolaou test screening in a multiethnic population. Medical Care, 42(9), 914–926.CrossRefPubMedGoogle Scholar
  28. 28.
    Taylor, V. M., Schwartz, S. M., Yasui, Y., Burke, N., Shu, J., Lam, D. H., et al. (2004). Pap testing among Vietnamese women: Health care system and physician factors. Journal of Community Health, 29(6), 437–450.CrossRefPubMedGoogle Scholar
  29. 29.
    Taylor, V. M., Yasui, Y., Burke, N., Nguyen, T., Acorda, E., Thai, H., et al. (2004). Pap testing adherence among Vietnamese American women. Cancer Epidemiology, Biomarkers and Prevention, 13(4), 613–619.PubMedGoogle Scholar
  30. 30.
    Tung, W. C., Nguyen, D. H., & Tran, D. N. (2008). Applying the transtheoretical model to cervical cancer screening in Vietnamese-American women. International Nursing Review, 55(1), 73–80.CrossRefPubMedGoogle Scholar
  31. 31.
    Yi, J. K. (1994). Factors associated with cervical cancer screening behavior among Vietnamese women. Journal of Community Health, 19(3), 189–200.CrossRefPubMedGoogle Scholar
  32. 32.
    Rodriguez, M. A., Ward, L. M., & Perez-Stable, E. J. (2005). Breast and cervical cancer screening: impact of health insurance status, ethnicity, and nativity of Latinas. Annals of Family Medicine, 3(3), 235–241.CrossRefPubMedGoogle Scholar
  33. 33.
    Andrasik, M. P., Rose, R., Pereira, D., & Antoni, M. (2008). Barriers to cervical cancer screening among low-income HIV-positive African American women. Journal of Health Care for the Poor and Underserved, 19(3), 912–925.CrossRefPubMedGoogle Scholar
  34. 34.
    Politi, M. C., Clark, M. A., Rogers, M. L., McGarry, K., & Sciamanna, C. N. (2008). Patient-provider communication and cancer screening among unmarried women. Patient Education and Counseling, 73(2), 251–255.CrossRefPubMedGoogle Scholar
  35. 35.
    Martinez, R. G., Chavez, L. R., & Hubbell, F. A. (1997). Purity and passion: Risk and morality in Latina immigrants’ and physicians’ beliefs about cervical cancer. Medical Anthropology, 17(4), 337–362.CrossRefPubMedGoogle Scholar
  36. 36.
    Watts, L., Joseph, N., Velazquez, A., Gonzolez, M., Munro, E., & Muzikansky, A., et al. (2009). Understanding barriers to cervical cancer screening among Hispanic women. American Journal of Obstetrics and Gynecology, 201:199.e1–8.Google Scholar
  37. 37.
    Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18, 1028–1035.CrossRefPubMedGoogle Scholar
  38. 38.
    Dignan, M., Michielutte, R., Blinson, K., Wells, H. B., Case, L. D., Sharp, P., et al. (1996). Effectiveness of health education to increase screening for cervical cancer among eastern-band Cherokee Indian women in North Carolina. Journal of the National Cancer Institute, 88(22), 1670–1676.CrossRefPubMedGoogle Scholar
  39. 39.
    McMullin, J. M., De Alba, I., Chavez, L. R., & Hubbell, F. A. (2005). Influence of beliefs about cervical cancer etiology on Pap smear use among Latina immigrants. Ethnicity and Health, 10(1), 3–18.CrossRefPubMedGoogle Scholar
  40. 40.
    Patel, N. R., Rollison, D. E., Barnholtz-Sloan, J., MacKinnon, J., Green, L., & Giuliano, A. R. (2009). Racial and ethnic disparities in incidence of invasive cervical cancer in Florida. Cancer, 115, 3991–4000.CrossRefPubMedGoogle Scholar
  41. 41.
    Florida Department of Health. (2008). Florida CHARTS. Retrieved September 5, 2008, from http://www.floridacharts.com.
  42. 42.
    Digital-Topo-Maps.com. (2005). Florida County Map. Retrieved September 5, 2008, from http://county-map.digital-topo-maps.com/florida-county-map.gif.

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ellen Daley
    • 1
  • Amina Alio
    • 1
  • Erica H. Anstey
    • 1
  • Rasheeta Chandler
    • 1
  • Karen Dyer
    • 1
    • 2
  • Hannah Helmy
    • 1
    • 2
  1. 1.Department of Community and Family HealthUniversity of South Florida College of Public HealthTampaUSA
  2. 2.Department of AnthropologyUniversity of South FloridaTampaUSA

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