Breaking Down Cultural and Ethnic Barriers in Pap Smear Compliance

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.

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