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Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study

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Abstract

Background

Understanding Black women’s Papanicolaou (Pap) screening experiences can inform efforts to reduce cancer disparities. This study examined experiences among both US-born US Black women and Sub-Saharan African immigrant women.

Method

Using a convergent parallel mixed methods design, Black women born in the USA and in Sub-Saharan Africa age 21–65 years were recruited to participate in focus groups and complete a 25-item survey about patient-centered communication and perceived racial discrimination. Qualitative and quantitative data were integrated to provide a fuller understanding of results.

Results

Of the 37 participants, 14 were US-born and 23 were Sub-Saharan African-born Black women. The mean age was 40.0 ± 11.0, and 83.8% had received at least one Pap test. Five themes regarding factors that impact screening uptake emerged from the focus groups: (1) positive and negative experiences with providers; (2) provider communication and interaction; (3) individual barriers to screening uptake, (4) implicit bias, discrimination, and stereotypical views among providers, and (5) language barrier. Survey and focus group findings diverged on several points. While focus group themes captured both positive and negative experiences with provider communication, survey results indicated that most of both US-born and Sub-Saharan African-born women experienced positive patient-centered communication with health care providers. Additionally, during focus group sessions many participants described experiences of discrimination in health care settings, but less than a third reported this in the survey.

Conclusion

Black women’s health care experiences affect Pap screening uptake. Poor communication and perceived discrimination during health care encounters highlight areas for needed service improvement to reduce cervical cancer disparities.

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References

  1. Giaquinto AN, Miller KD, Tossas KY, Winn RA, Jemal A, Siegel RL. Cancer statistics for African American/Black People 2022. CA Cancer J Clin. 2022;72(3):202–29. https://doi.org/10.3322/caac.21718.

    Article  PubMed  Google Scholar 

  2. Adunlin G, Cyrus JW, Asare M, Sabik LM. Barriers and facilitators to breast and cervical cancer screening among immigrants in the United States. J Immigr Minor Health. 2019;21(3):606–58. https://doi.org/10.1007/s10903-018-0794-6.

    Article  PubMed  Google Scholar 

  3. Adegboyega A, Hatcher J. Factors influencing pap screening use among African immigrant women. J Transcult Nurs. 2017;28(5):479–87. https://doi.org/10.1177/1043659616661612.

    Article  PubMed  Google Scholar 

  4. Harcourt N, Ghebre RG, Whembolua GL, Zhang Y, Warfa Osman S, Okuyemi KS. Factors associated with breast and cervical cancer screening behavior among African immigrant women in Minnesota. J Immigr Minor Health. 2014;16(3):450–6. https://doi.org/10.1007/s10903-012-9766-4.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nolan J, Renderos TB, Hynson J, Dai X, Chow W, Christie A, Mangione TW. Barriers to cervical cancer screening and follow-up care among black women in Massachusetts. J Obstet Gynecol Neonatal Nurs. 2014;43(5):580–8. https://doi.org/10.1111/1552-6909.12488.

    Article  PubMed  Google Scholar 

  6. Christy K, Kandasamy S, Majid U, Farrah K, Vanstone M. Understanding Black women’s perspectives and experiences of cervical cancer screening: a systematic review and qualitative meta-synthesis. J Health Care Poor Underserved. 2021;32(4):1675–97. https://doi.org/10.1353/hpu.2021.0159.

    Article  PubMed  Google Scholar 

  7. Wearn A, Shepherd L. Determinants of routine cervical screening participation in underserved women: a qualitative systematic review. Psychol Health. 2022:1–26. https://doi.org/10.1080/08870446.2022.2050230.

  8. Mouton CP, Carter-Nolan PL, Makambi KH, Taylor TR, Palmer JR, Rosenberg L, Adams-Campbell LL. Impact of perceived racial discrimination on health screening in black women. J Health Care Poor Underserved. 2010;21(1):287–300. https://doi.org/10.1353/hpu.0.0273.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Logan RG, Daley EM, Vamos CA, Louis-Jacques A, Marhefka SL. “When is health care actually going to be care?” The lived experience of family planning care among young Black women. Qual Health Res. 2021;31(6):1169–82. https://doi.org/10.1177/1049732321993094.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gary F, Still C, Mickels P, Hassan M, Evans E. Muddling through the health system: experiences of three groups of black women in three regions. J Natl Black Nurses Assoc: JNBNA. 2015;26(1):22–8.

    PubMed  Google Scholar 

  11. Sutton AL, Hagiwara N, Perera RA, Sheppard VB. Assessing perceived discrimination as reported by Black and White women diagnosed with breast cancer. J Racial Ethn Health Disparities. 2021;8(3):589–95. https://doi.org/10.1007/s40615-020-00817-4.

    Article  PubMed  Google Scholar 

  12. Chinn JJ, Martin IK, Redmond N. Health equity among Black women in the United States. J Womens Health. 2021;30(2):212–9. https://doi.org/10.1089/jwh.2020.8868.

    Article  Google Scholar 

  13. Adegboyega AO, Hatcher J. Unequal access: African immigrants and American health care. Ky Nurse. 2016;64(1):10–2.

    PubMed  Google Scholar 

  14. McRoy L, Epané J, Ramamonjiarivelo Z, Zengul F, Weech-Maldonado R, Rust G. Examining the relationship between self-reported lifetime cancer diagnosis and nativity: findings from the National Health and Nutrition Examination Survey (NHANES) 2011–2018. Cancer Causes Control. 2022;33(2):321–9. https://doi.org/10.1007/s10552-021-01514-1.

    Article  PubMed  Google Scholar 

  15. Farr DE, Cofie LE, Brenner AT, Bell RA, Reuland DS. Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth. BMC Womens Health. 2022;22(1):1–9. https://doi.org/10.1186/s12905-022-01694-1.

    Article  Google Scholar 

  16. Creswell JW, Clark VLP. Designing and conducting mixed methods research. Los Angeles: Sage publications; 2017.

    Google Scholar 

  17. Leech NL, Onwuegbuzie AJ. Guidelines for conducting and reporting mixed research in the field of counseling and beyond. J Couns Dev. 2010;88(1):61–9. https://doi.org/10.1002/j.1556-6678.2010.tb00151.x.

    Article  Google Scholar 

  18. US preventive Services Task Force. Cervical Cancer Screening. 2018. https://uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening.

  19. Singhal A, Jackson JW. Perceived racial discrimination partially mediates racial-ethnic disparities in dental utilization and oral health. J Public Health Dent. 2022;82:63–72. https://doi.org/10.1111/jphd.12515.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hausmann LR, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and use of preventive health services. J Gen Intern Med. 2008;23(10):1679–84. https://doi.org/10.1007/s11606-008-0730-x.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Finney Rutten LJ, Augustson E, Wanke K. Factors associated with patients’ perceptions of health care providers’ communication behavior. J Health Commun. 2006;11(S1):135–46. https://doi.org/10.1080/10810730600639596.

    Article  Google Scholar 

  22. Otter. ai. 2019. https://otter.ai

  23. Tekeste M, Hull S, Dovidio JF, Safon CB, Blackstock O, Taggart T, et al. Differences in medical mistrust between black and white women: implications for patient–provider communication about PrEP. AIDS Behav. 2019;23(7):1737–48. https://doi.org/10.1007/s10461-018-2283-2.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Filler T, Jameel B, Gagliardi AR. Barriers and facilitators of patient centered care for immigrant and refugee women: a scoping review. BMC Public Health. 2020;20(1):1–12. https://doi.org/10.1186/s12889-020-09159-6.

    Article  Google Scholar 

  25. Cuevas AG, O'Brien K, Saha S. African American experiences in healthcare:“I always feel like I’m getting skipped over”. Health Psychol. 2016;35(9):987–95. https://doi.org/10.1037/hea0000368.

    Article  PubMed  Google Scholar 

  26. Anderson JN, Graff JC, Krukowski RA, Schwartzberg L, Vidal GA, Waters TM, et al. “Nobody will tell you. You’ve got to ask!”: an examination of patient-provider communication needs and preferences among Black and White women with early-stage breast cancer. Health Commun. 2021;36(11):1331–42. https://doi.org/10.1080/10410236.2020.1751383.

    Article  PubMed  Google Scholar 

  27. Chawla N, Blanch-Hartigan D, Virgo KS, Ekwueme DU, Han X, Forsythe L, et al. Quality of patient-provider communication among cancer survivors: findings from a nationally representative sample. J Oncol Pract. 2016;12(12):e964–73.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jain N. Survey versus interviews: comparing data collection tools for exploratory research. Qual Rep. 2021;26(2):541–54. https://doi.org/10.46743/2160-3715/2021.4492.

    Article  Google Scholar 

  29. Oei TI, Zwart FM. The assessment of life events: self-administered questionnaire versus interview. J Affect Disord. 1986;10(3):185–90. https://doi.org/10.1016/0165-0327(86)90003-0.

    Article  CAS  PubMed  Google Scholar 

  30. Glackin EB, Forbes D, Heberle AE, Carter AS, Gray SA. Caregiver self-reports and reporting of their preschoolers’ trauma exposure: discordance across assessment methods. Traumatology. 2019;25(3):172–80. https://doi.org/10.1037/trm0000179.

    Article  PubMed  Google Scholar 

  31. Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, et al. Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med. 2013;11(1):43–52. https://doi.org/10.1370/afm.1442.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cooper LA, Roter DL, Carson KA, Beach MC, Sabin JA, Greenwald AG, Inui TS. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979–87. https://doi.org/10.2105/AJPH.2011.300558.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Beach MC, Saha S, Korthuis PT, Sharp V, Cohn J, Wilson IB, et al. Patient–provider communication differs for black compared to white HIV-infected patients. AIDS Behav. 2011;15(4):805–11. https://doi.org/10.1007/s10461-009-9664-5.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90. https://doi.org/10.2105/AJPH.94.12.2084.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Shen MJ, Peterson EB, Costas-Muñiz R, Hernandez MH, Jewell ST, Matsoukas K, Bylund CL. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2018;5(1):117–40. https://doi.org/10.1007/s40615-017-0350-4.

    Article  PubMed  Google Scholar 

  36. Benjamins MR, Middleton M. Perceived discrimination in medical settings and perceived quality of care: a population-based study in Chicago. PloS One. 2019;14(4):e0215976. https://doi.org/10.1371/journal.pone.0215976.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Borrell LN, Kiefe CI, Williams DR, Diez-Roux AV, Gordon-Larsen P. Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study. Soc Sci Med. 2006;63(6):1415–27. https://doi.org/10.1016/j.socscimed.2006.04.008.

    Article  PubMed  Google Scholar 

  38. Van Houtven CH, Voils CI, Oddone EZ, Weinfurt KP, Friedman JY, Schulman KA, Bosworth HB. Perceived discrimination and reported delay of pharmacy prescriptions and medical tests. J Gen Intern Med. 2005;20(7):578–83. https://doi.org/10.1007/s11606-005-0104-6.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ben J, Cormack D, Harris R, Paradies Y. Racism and health service utilisation: a systematic review and meta-analysis. PloS One. 2017;12(12):e0189900. https://doi.org/10.1371/journal.pone.0189900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Arif SA, Schlotfeldt J. Gaps in measuring and mitigating implicit bias in healthcare. Front Pharmacol. 2021;12:633565. https://doi.org/10.3389/fphar.2021.633565.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Fuzzell LN, Perkins RB, Christy SM, Lake PW, Vadaparampil ST. Cervical cancer screening in the United States: challenges and potential solutions for underscreened groups. Prev Med. 2021;144:106400. https://doi.org/10.1016/j.ypmed.2020.106400.

    Article  PubMed  Google Scholar 

  42. Genoff MC, Zaballa A, Gany F, Gonzalez J, Ramirez J, Jewell ST, Diamond LC. Navigating language barriers: a systematic review of patient navigators’ impact on cancer screening for limited English proficient patients. J Gen Intern Med. 2016;31(4):426–34. https://doi.org/10.1007/s11606-015-3572-3.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–54. https://doi.org/10.1111/j.1475-6773.2006.00629.x.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Cudjoe J, Nkimbeng M, Turkson-Ocran RA, Commodore-Mensah Y, Han HR. Understanding the Pap testing behaviors of African immigrant women in developed countries: a systematic review. J Immigr Minor Health. 2021;23(4):840–56. https://doi.org/10.1007/s10903-020-01119-x.

    Article  PubMed  Google Scholar 

  45. Vu N. Essential and exposed: a novel solution to improve healthcare access for undocumented Mexican immigrants in the United States. Houston J Health Law Policy. 2023:1–37.

  46. Van Der Heide I, Uiters E, Jantine Schuit A, Rademakers J, Fransen M. Health literacy and informed decision making regarding colorectal cancer screening: a systematic review. Eur J Public Health. 2015;25(4):575–82. https://doi.org/10.1093/eurpub/ckv005.

    Article  PubMed  Google Scholar 

  47. Peterson EB, Ostroff JS, DuHamel KN, D’Agostino TA, Hernández M, Canzona MR, Bylund CL. Impact of provider-patient communication on cancer screening adherence: a systematic review. Prev Med. 2016;93:96–105. https://doi.org/10.1016/j.ypmed.2016.09.034.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Friedman AM, Hemler JR, Rossetti E, Clemow LP, Ferrante JM. Obese women’s barriers to mammography and pap smear: the possible role of personality. Obesity. 2012;20(8):1611–7. https://doi.org/10.1038/oby.2012.50.

    Article  PubMed  Google Scholar 

  49. Poorolajal J, Jenabi E. The association between BMI and cervical cancer risk: a meta-analysis. Eur J Cancer Prev. 2016;25(3):232–8. https://doi.org/10.1097/CEJ.0000000000000164.

    Article  CAS  PubMed  Google Scholar 

  50. Clarke MA, Fetterman B, Cheung LC, Wentzensen N, Gage JC, Katki HA, Schiffman M. Epidemiologic evidence that excess body weight increases risk of cervical cancer by decreased detection of precancer. J Clin Oncol. 2018;36(12):1184. 1184–1191. https://doi.org/10.1200/JCO.2017.75.3442.

    Article  PubMed  Google Scholar 

  51. Gnade CM, Hill EK, Botkin HE, Hefel AR, Hansen HE, Sheets KA, et al. Effect of obesity on cervical cancer screening and outcomes. J Low Genit Tract Dis. 2020;24(4):358–62. https://doi.org/10.1097/LGT.0000000000000570.

    Article  PubMed  Google Scholar 

  52. Aleshire ME, Adegboyega A, Escontrías OA, Edward J, Hatcher J. Access to care as a barrier to mammography for Black women. Policy Polit Nurs Pract. 2021;22(1):28–40. https://doi.org/10.1177/1527154420965537.

    Article  PubMed  Google Scholar 

  53. Fang CY, Ragin CC. Addressing disparities in cancer screening among US immigrants: progress and opportunities. Cancer Prev Res. 2020;13(3):253–60. https://doi.org/10.1158/1940-6207.CAPR-19-0249.

  54. Zhang X, Li P, Zhang C, Guo P, Wang J, Liu N, et al. Breast cancer screening practices and satisfaction with healthcare providers in Chinese women: a cross-sectional study. Cancer Nurs. 2022;45(2):E573–81. https://doi.org/10.1097/NCC.0000000000000942.

    Article  PubMed  Google Scholar 

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Funding

Research reported was supported by a National Institutes of Health National Cancer Institute grant (K01CA251487: Adegboyega). Support for the use of REDCap was provided by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

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Authors and Affiliations

  1. College of Nursing, University of Kentucky, Lexington, KY, 40536-0232, USA

    Adegboyega Adebola, Williams B. Lovoria & Mudd-Martin Gia

  2. College of Public Health, Slippery Rock University, Slippery Rock, PA, USA

    Aroh Adaeze

  3. Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria

    Desmennu Adeyimika

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  1. Adegboyega Adebola
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  2. Aroh Adaeze
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  4. Williams B. Lovoria
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  5. Mudd-Martin Gia
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Contributions

AA and GMM conceptualized the paper. Material preparation, data collection, and analysis were performed by AA, AA, AD, and GMM. AA and LW were responsible for interpreting the results. The first draft of the manuscript was written by AA and AA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Adegboyega Adebola.

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Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from the Office of Research Integrity at the University of Kentucky (Jan 10/2021/protocol#: 60704).

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All participants provided written informed consented prior to participation in the study.

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Adebola, A., Adaeze, A., Adeyimika, D. et al. Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study. J. Racial and Ethnic Health Disparities 11, 1405–1417 (2024). https://doi.org/10.1007/s40615-023-01617-2

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