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

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Abstract

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.

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References

  1. Centers of Disease Control and Prevention. Centers of Disease Control and Prevention- National Breast and Cervical Cancer Early Detection Program. CDC. https://www.cdc.gov/cancer/nbccedp/about.htm. Published 2016. Accessed August 16, 2016

  2. American Cancer Society. The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer. https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html. Published 2018. Accessed August 3, 2019

  3. Beavis AL, Gravitt PE, Rositch AF (2017) Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States. Cancer.:1044–1050. https://doi.org/10.1002/cncr.30507

  4. Forney-Gorman A, Kozhimannil KB (2016) Differences in cervical cancer screening between African-American versus African-born black women in the United States. J Immigr Minor Health 18(6):1371–1377. https://doi.org/10.1007/s10903-015-0267-0

    Article  PubMed  Google Scholar 

  5. Tsui J, Saraiya M, Thompson T, Dey A, Richardson L (2007) Cervical cancer screening among foreign-born women by birthplace and duration in the United States. J Women’s Heal 16(10):1447–1457. https://doi.org/10.1089/jwh.2006.0279

    Article  Google Scholar 

  6. Institute of Medicine. Health literacy: a prescription to end confusion. Washington, D.C.: National Academies Press; 2004. doi:https://doi.org/10.17226/10883

  7. Mazor KM, Williams AE, Roblin DW, Gaglio B, Cutrona SL, Costanza ME, Han PK, Wagner JL, Fouayzi H, Field TS (2014) Health literacy and pap testing in insured women. J Cancer Educ 29(4):698–701. https://doi.org/10.1007/s13187-014-0629-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Kim K, Han H-R (2016) Potential links between health literacy and cervical cancer screening behaviors: a systematic review. Psychooncology. 25:122–130. https://doi.org/10.1002/pon.3883

    Article  PubMed  Google Scholar 

  9. Sentell T, Braun KL, Davis J, Davis T (2015) Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California. Springerplus. 4:432. https://doi.org/10.1186/s40064-015-1225-y

    Article  PubMed  PubMed Central  Google Scholar 

  10. Boom K, Lopez M, Daheri M et al (2018) Perspectives on cervical cancer screening and prevention: challenges faced by providers and patients along the Texas-Mexico border peer reView. Perspect Public Health:1–7. https://doi.org/10.1177/1757913918793443

  11. Garbers S, Chiasson MA. Inadequate functional health literacy in Spanish as a barrier to cervical cancer screening among immigrant Latinas in New York City. Prev Chronic Dis 2004;1(4):1–10. http://www.ncbi.nlm.nih.gov/pubmed/15670438%0A, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC1277947

  12. Han H-R, Huh B, Kim MT, Kim J, Nguyen T (2014) Development and validation of the assessment of health literacy in breast and cervical cancer screening. J Health Commun 19(2):267–284. https://doi.org/10.1080/10810730.2014.936569

    Article  PubMed  PubMed Central  Google Scholar 

  13. Baker DW (2006) The meaning and the measure of health literacy. J Gen Intern Med 21(8):878–883. https://doi.org/10.1111/j.1525-1497.2006.00540.x

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sistani M, Yazdani R, Virtanen J, Pakdaman A, Murtomaa H (2013) Oral health literacy and information sources among adults in Tehran, Iran. Community Dent Health 30(3):178–182. https://doi.org/10.1922/CDH

    Article  PubMed  Google Scholar 

  15. Redmond N, Baer HJ, Clark CR, Lipsitz S, Hicks LS (2010) Sources of health information related to preventive health behaviors in a national study. Am J Prev Med 38(6):620–627.e2. https://doi.org/10.1016/j.amepre.2010.03.001

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hurtado-de-Mendoza A, Song M, Kigen O, Jennings Y, Nwabukwu I, Sheppard VB (2014) Addressing cancer control needs of African-born immigrants in the US: a systematic literature review. Prev Med (Baltim) 67:89–99. https://doi.org/10.1016/j.ypmed.2014.07.006

    Article  Google Scholar 

  17. Meagley K, Schriver B, Geary RS, et al. The gender dimensions of social networks and help-seeking behaviors of young adults in Soweto, South Africa. Glob Health Action. 2016;9(0). doi:https://doi.org/10.3402/gha.v9.31138

  18. Sewali B, Okuyemi KS, Askhir A, Belinson J, Vogel RI, Joseph A, Ghebre RG (2015) Cervical cancer screening with clinic-based Pap test versus home HPV test among Somali immigrant women in Minnesota: a pilot randomized controlled trial. Cancer Med 4(4):620–631. https://doi.org/10.1002/cam4.429

    Article  PubMed  PubMed Central  Google Scholar 

  19. Raymond NC, Osman W, O’Brien JM, Ali N, Kia F, Mohamed F, Mohamed A, Goldade KB, Pratt R, Okuyemi K (2014) Culturally informed views on cancer screening: a qualitative research study of the differences between older and younger Somali immigrant women. BMC Public Health 14(1):1188–1188. https://doi.org/10.1186/1471-2458-14-1188

    Article  PubMed  PubMed Central  Google Scholar 

  20. Feinberg I, Greenberg D, Frijters J. Understanding health information seeking behaviors of adults with low literacy, numeracy, and problem solving skills: results from the 2012 US PIAAC Study 2015

  21. Kutner, Greenberg, Jin, Paulsen. The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy 2003

  22. Diviani N, van den Putte B, Giani S, van Weert JC (2015) Low health literacy and evaluation of online health information: a systematic review of the literature. J Med Internet Res 17(5):e112. https://doi.org/10.2196/jmir.4018

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fang CY, Ma GX, Tan Y (2011) Overcoming barriers to cervical cancer screening among Asian American women. N Am J Med Sci (Boston) 4(2):77–83 http://www.ncbi.nlm.nih.gov/pubmed/21687826%0A, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3115728

  24. Gany FM, Herrera AP, Avallone M, Changrani J (2006) Attitudes, knowledge, and health-seeking behaviors of five immigrant minority communities in the prevention and screening of cancer: a focus group approach. Ethn Health 11(1):19–39. https://doi.org/10.1080/13557850500391394

    Article  PubMed  Google Scholar 

  25. Ogedegbe G, Cassells AN, Robinson CM, DuHamel K, Tobin JN, Sox CH, Dietrich AJ (2005) Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers. J Natl Med Assoc 97(2):162–169

    PubMed  PubMed Central  Google Scholar 

  26. Hui S-KA, Miller SM, Wen K-Y et al (2014) Psychosocial barriers to follow-up adherence after an abnormal cervical cytology test result among low-income, inner-city women. J Prim Care Community Health 5(4):234–241. https://doi.org/10.1177/2150131914529307

    Article  PubMed  PubMed Central  Google Scholar 

  27. Thomas KJA, Logan I (2012) African female immigration to the United States and its policy implications. Can J Afr Stud 46(1):87–107. https://doi.org/10.1080/00083968.2012.659582

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tong M, Sentell T (2017) Insights in public health: challenges investigating health outcomes in Chinese Americans using population-based survey data. Hawai’i J Med Public Heal 76(1):27–32

    Google Scholar 

  29. Zong J, Batalova J. Sub-Saharan African immigrants in the United States. Migration Policy Institute. https://www.migrationpolicy.org/article/sub-saharan-african-immigrants-united-states. Published 2017. Accessed January 25, 2019

  30. Adegboyega A, Hatcher J (2016) Unequal access: African immigrants and American health care. Ky Nurse 64(1):10–12

    PubMed  Google Scholar 

  31. Adekeye O, Kimbrough J, Obafemi B, Strack RW (2014) Health literacy from the perspective of African immigrant youth and elderly: a PhotoVoice project. J Health Care Poor Underserved 25(4):1730–1747. https://doi.org/10.1353/hpu.2014.0183

    Article  PubMed  Google Scholar 

  32. Lauderdale DS, Wen M, Jacobs EA, Kandula NR (2006) Immigrant perceptions of discrimination in health care: the California health interview survey 2003. Med Care 44(10):914–920. https://doi.org/10.1097/01.mlr.0000220829.87073.f7

    Article  PubMed  Google Scholar 

  33. English D, Lambert SF, Evans MK, Zonderman AB. Neighborhood racial composition, racial discrimination, and depressive symptoms in African Americans. Am J Community Psychol 2015;54(0):219–228. doi:https://doi.org/10.1007/s10464-014-9666-y.Neighborhood

  34. Squiers L, Peinado S, Berkman N, Boudewyns V, McCormack L (2012) The health literacy skills framework. J Health Commun 17(Suppl 3):30–54. https://doi.org/10.1080/10810730.2012.713442

    Article  PubMed  Google Scholar 

  35. Morrison TB, Flynn PM, Weaver AL, Wieland ML (2013) Cervical cancer screening adherence among Somali immigrants and refugees to the United States. Health Care Women Int 34(11):980–988. https://doi.org/10.1080/07399332.2013.770002

    Article  PubMed  Google Scholar 

  36. Perry BL, Pescosolido BA (2015) Social network activation: the role of health discussion partners in recovery from mental illness. Soc Sci Med 125:116–128. https://doi.org/10.1016/j.socscimed.2013.12.033

    Article  PubMed  Google Scholar 

  37. Han H-R, Kim K, Cudjoe J, Kim MT (2019) Familiarity, navigation, and comprehension: key dimensions of health literacy in pap test use among Korean American women. J Health Commun 24(6):585–591. https://doi.org/10.1080/10810730.2019.1607955

    Article  PubMed  PubMed Central  Google Scholar 

  38. Waller J, Ostini R, Marlow, LAV, Mccaffery K, Zimet G. Validation of a measure of knowledge about human papillomavirus (HPV) using item response theory and classical test theory 2013. doi:https://doi.org/10.1016/j.ypmed.2012.10.028

  39. Chen G, Gully SM, Eden D (2001) Validation of a new general self-efficacy scale. Organ Res Methods 4(1):62–83. https://doi.org/10.1177/109442810141004

    Article  CAS  Google Scholar 

  40. Tang TS, Solomon LJ, McCracken LM (2000) Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older. Prev Med (Baltim). 31(5):575–583. https://doi.org/10.1006/pmed.2000.0753

    Article  CAS  Google Scholar 

  41. Park SM, Chang SB, Chung CW (2005) Effects of a cognition-emotion focused program to increase public participation in papanicolaou smear screening. Public Health Nurs 22(4):289–298. https://doi.org/10.1111/j.0737-1209.2005.220404.x

    Article  PubMed  Google Scholar 

  42. Allen JD, Mohllajee AP, Shelton RC, Othus MKD, Fontenot HB, Hanna R (2009) Stage of adoption of the human papillomavirus vaccine among college women. Prev Med (Baltim). 48(5):420–425. https://doi.org/10.1016/j.ypmed.2008.12.005

    Article  Google Scholar 

  43. Hogenmiller JR, Atwood JR, Lindsey AM, Johnson DR, Hertzog M, Scott JC (2007) Self-efficacy scale for pap smear screening participation in sheltered women. Nurs Res 56(6):369–377. https://doi.org/10.1097/01.NNR.0000299848.21935.8d

    Article  PubMed  Google Scholar 

  44. Strong C, Liang W (2009) Relationships between decisional balance and stage of adopting mammography and Pap testing among Chinese American women. Cancer Epidemiol 33(5):374–380. https://doi.org/10.1016/j.canep.2009.10.002

    Article  PubMed  PubMed Central  Google Scholar 

  45. Samuel PS, Pringle JP, James NW, Fielding SJ, Fairfield KM (2009) Breast, cervical, and colorectal cancer screening rates amongst female Cambodian, Somali, and Vietnamese immigrants in the USA. Int J Equity Health 8:30. https://doi.org/10.1186/1475-9276-8-30

    Article  PubMed  PubMed Central  Google Scholar 

  46. Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182. https://doi.org/10.1037/0022-3514.51.6.1173

    Article  CAS  PubMed  Google Scholar 

  47. Gallo F, Caprioglio A, Castagno R, Ronco G, Segnan N, Giordano L (2017) Inequalities in cervical cancer screening utilisation and results: a comparison between Italian natives and immigrants from disadvantaged countries. Health Policy (New York) 121(10):1072–1078. https://doi.org/10.1016/j.healthpol.2017.08.005

    Article  Google Scholar 

  48. Sanz-Barbero B, Regidor E, Galindo S (2011) Impact of geographic origin on gynecological cancer screening in Spain. Rev Saude Publica 45(6):1019–1026. https://doi.org/10.1590/S0034-89102011000600003

    Article  PubMed  Google Scholar 

  49. Bianco A, Larosa E, Pileggi C, Nobile CGA, Pavia M (2017) Cervical and breast cancer screening participation and utilisation of maternal health services: a cross-sectional study among immigrant women in Southern Italy. BMJ Open 7(10):e016306. https://doi.org/10.1136/bmjopen-2017-016306

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sheppard VB, Hurtado-de-Mendoza A, Song M, Hirpa F, Nwabukwu I (2015) The role of knowledge, language, and insurance in endorsement of cancer screening in women of African origin. Prev Med reports 2:517–523. https://doi.org/10.1016/j.pmedr.2015.05.012

    Article  Google Scholar 

  51. Caplan LS, McQueen DV, Qualters JR, Leff M, Garrett C, Calonge N (2003) Validity of women’s self-reports of cancer screening test utilization in a managed care population. Cancer Epidemiol Biomark Prev 12(11):1182–1187

    Google Scholar 

  52. Dutta-Bergman M (2004) Health attitudes, health cognitions, and health behaviors among internet information seekers: population-based survey. J Med Internet Res 6(2):515. https://doi.org/10.2196/jmir.6.2.e15

    Article  Google Scholar 

  53. Ndikum-Moffor FM, Faseru B, Filippi MK, Wei H, Engelman KK (2015) Health status among black African-born women in Kansas City: a preliminary assessment. BMC Res Notes 8:540. https://doi.org/10.1186/s13104-015-1469-1

    Article  PubMed  PubMed Central  Google Scholar 

  54. Lubetkin EI, Zabor EC, Isaac K, Brennessel D, Kemeny MM, Hay JL (2015) Health literacy, information seeking, and trust in information inHaitians. AM J Health Behav 39(3):441–445. https://doi.org/10.5993/AJHB.39.3.16

    Article  PubMed  PubMed Central  Google Scholar 

  55. Wang J, Moehring J, Stuhr S, Krug M (2013) Barriers to colorectal cancer screening in Hispanics in the United States: an integrative review. Appl Nurs Res 26(4):218–224. https://doi.org/10.1016/j.apnr.2013.08.005

    Article  PubMed  Google Scholar 

  56. Gele AA, Pettersen KS, Torheim LE, Kumar B (2016) Health literacy : the missing link in improving the health of Somali immigrant women in Oslo. BMC Public Health 16(1134):1–9. https://doi.org/10.1186/s12889-016-3790-6

    Article  Google Scholar 

  57. Kristiansen M, Lue-Kessing L, Mygind A, Razum O, Norredam M (2014) Migration from low- to high-risk countries: a qualitative study of perceived risk of breast cancer and the influence on participation in mammography screening among migrant women in Denmark. Eur J Cancer Care (Engl) 23(2):206–213. https://doi.org/10.1111/ecc.12100

    Article  CAS  Google Scholar 

  58. Commodore-Mensah Y, Ukonu N, Cooper LA, Agyemang C, Himmelfarb CD (2018) The association between acculturation and cardiovascular disease risk in Ghanaian and Nigerian-born African immigrants in the United States: the Afro-Cardiac Study. J Immigr Minor Health 20:1137–1146. https://doi.org/10.1007/s10903-017-0644-y

    Article  PubMed  Google Scholar 

  59. Lee S, Chen L, Miller M, Juon H-S (2014) A cluster analytic examinatin of acculturation and health status among Asian Americans in the Washington DC metropolitan area, United States. Soc Sci Med 96:17–23. https://doi.org/10.1016/j.socscimed.2013.07.007.A

    Article  Google Scholar 

  60. Kerani R, Narita M, Lipira L, Endeshaw M, Holmes KK, Golden MR (2019) Challenges in recruiting African-born, US-based participants for HIV and tuberculosis research. J Immigr Minor Health 21(3):533–539. https://doi.org/10.1007/s10903-018-0776-8

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pirie A, Gute DM (2013) Crossing the chasm of mistrust : collaborating with immigrant populations through community organizations and academic partners. Am J Public Health 103(12):2126–2130. https://doi.org/10.1002/hast.161/pdf

    Article  PubMed  PubMed Central  Google Scholar 

  62. Scharff DP, Matthews KJ, Jackson P, Hoffsuemmer J, Martin E, Edwards D (2010) More than Tuskegee: Undertanding mistrust about research participation. J Health Care Poor Underserved 21(3):879–897. https://doi.org/10.1353/hpu.0.0323.More

    Article  PubMed  PubMed Central  Google Scholar 

  63. Cudjoe J, Turkson-Ocran RA, Ezeigwe AK, Commodore-Mensah Y, Nkimbeng M, Han H-R (2019) Recruiting African immigrant women for community-based cancer prevention studies: lessons learned from the AfroPap study. J Community Health 44:1019–1026.  https://doi.org/10.1007/s10900-019-00677-y

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hunsaker A, Hargittai E (2018) A review of internet use among older adults. New Media Soc 20(10):3937–3954. https://doi.org/10.1177/1461444818787348

    Article  Google Scholar 

  65. Selsky C, Luta G, Mandelblatt JS, Huerta EE, Mandelbatt JS (2013) Internet access and online cancer information seeking among Latino immigrants from safety net clinic. J Health Commun 18(1):58–70. https://doi.org/10.1080/10810730.2012.688248

    Article  PubMed  Google Scholar 

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Funding

This study is sponsored by a National Cancer Institute (NCI) predoctoral grant (F31CA221096), Johns Hopkins School of Nursing Dissertation Award, and scholarship from Sigma Theta Tau International-Nu Beta Chapter. The content of this study is solely the responsibility of the authors.

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Authors and Affiliations

  1. Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA

    Joycelyn Cudjoe, Chakra Budhathoki, Phyllis Sharps & Hae-Ra Han

  2. Inova Health System, 8110 Gatehouse Road Suite 200W, Falls Church, VA, 22042, USA

    Joycelyn Cudjoe

  3. Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA

    Debra Roter & Joseph J. Gallo

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  1. Joycelyn Cudjoe
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Cudjoe, J., Budhathoki, C., Roter, D. et al. Exploring Health Literacy and the Correlates of Pap Testing Among African Immigrant Women: Findings from the AfroPap Study. J Canc Educ 36, 441–451 (2021). https://doi.org/10.1007/s13187-020-01755-9

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