A survey of cervical screening among refugee and non-refugee African immigrant women in Brisbane, Australia
Judith A. Anaman A B , Ignacio Correa-Velez A and Julie King A
+ Author Affiliations
- Author Affiliations
A School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia.
B Corresponding author. Email: judith.anaman@yahoo.com
Health Promotion Journal of Australia 28(3) 217-224 https://doi.org/10.1071/HE16017
Submitted: 10 March 2016 Accepted: 31 August 2016 Published: 31 October 2016
Abstract
Issue addressed: To compare the level of cervical screening uptake between refugee and non-refugee African immigrant women living in Brisbane, Australia, and examine factors associated with Pap smear testing.
Methods: Cross-sectional survey with a convenience sample of 254 women aged 21–62 years from 22 African countries (144 refugees, 110 non-refugees). Chi-square tests were used to compare the demographic and health-related characteristics between refugee and non-refugee women. Bivariate and multiple logistic regression analyses were used to assess the relationship between the outcome variable (Pap smear testing) and the independent variables.
Results: Two-thirds of women had used Pap smear services in Australia. Chi-square test analysis established that non-refugee women were significantly more likely to have used Pap smear services than refugee women (73.6% vs 61.8% respectively; P = 0.047). Immigration status, however, was not a significant predictor of cervical screening uptake in the multiple regression analyses. The significant predictors for screening uptake in these analyses were work arrangement, parity, healthcare visit, knowledge about Pap smear and perceived susceptibility to cervical cancer.
Conclusion: Most women relied on opportunistic screening after receiving invitation letters to screen or after visiting health professionals for antenatal or postnatal care.
So what?: The findings suggest that organised cervical screening programs are not reaching most African immigrant women living in Brisbane. It is incumbent on the public health sector, including healthcare professionals and settlement agencies working with African communities, to develop health promotion strategies that meaningfully engage African immigrant women, including those from refugee backgrounds, to enhance their knowledge about cervical cancer and screening practices.
Key words: cancer, sexually transmitted infections, women’s health.
References
[1] Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in the world. Summary Report 24 March 2015. Barcelona, Spain: ICO HPV Information Centre, Institut Català d’Oncologia, 2015.[2] Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v. 1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer, 2013. Available from: http://globocan.iarc.fr [Verified 27 March 2015].
[3] Bruni L, Barrionuevo-Rosas L, Albero G, Aldea M, Serrano B, Valencia S, et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human papillomavirus and related diseases in Africa. Summary Report 24 March 2015. Barcelona, Spain: ICO HPV Information Centre, Institut Català d’Oncologia, 2015.
[4] World Health Organization (WHO). Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy. A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia. Geneva: WHO; 2012.
[5] Australian Institute of Health and Welfare (AIHW). Cervical screening in Australia 2001–2002 Canberra: Australian Institute of Health and Welfare; 2004.
[6] Cancer Research UK. Cervical cancer statistics. In Dunleavey R. Cervical cancer: a guide for nurses. Chichester, UK: John Wiley & Sons; 2009.
[7] Best Practice Advocacy Centre New Zealand (BPACNZ) (2013) How to increase the uptake of cervical screening: a profile of success. Best Pract J 55, 42–9.
[8] Health and Social Care Information Centre (HSCIC). Cervical screening programme, England – Statistics for 2014–2015. London: HSCIC; 2015.
[9] Australian Institute of Health and Welfare (AIHW). Cervical screening in Australia 2013–2014. Canberra: AIHW; 2016.
[10] Williams JH, Carter SM, Rychetnik L (2014) Organised cervical screening 45 years on: how consistent are organised screening practices? Eur J Cancer 50, 3029–38.
| Organised cervical screening 45 years on: how consistent are organised screening practices?Crossref | GoogleScholarGoogle Scholar | 25282406PubMed |
[11] Denny L, Quinn M, Sankaranarayanan R. Chapter 8: Screening for cervical cancer in developing countries. Vaccine 2006; 24 (Suppl 3): S3/71–S3/77.
[12] Adageba RK, Danso KA, Ankobea FK, Kolbilla DZ, Opoku P (2011) Knowledge of cervical cancer and patronage of cervical cancer screening services among female health workers in Kumasi, Ghana. Afr J Haematol Oncol 2, 157–61.
[13] Adanu RMK, Seffah JD, Duda R, Darko R, Hill A, Anarfi J (2010) Clinic visits and cervical cancer screening in Accra. Ghana Med J 44, 59–63.
[14] Perkins RB, Langrish S, Stern LJ, Simon CJ (2007) A community-based education program about cervical cancer improves knowledge and screening behavior in Honduran women. Rev Panam Salud Publica 22, 187–93.
| A community-based education program about cervical cancer improves knowledge and screening behavior in Honduran women.Crossref | GoogleScholarGoogle Scholar | 18062853PubMed |
[15] Espinas JA, Aliste L, Fernandez E, Argimon JM, Tresserras R, Borras JM (2011) Narrowing the equity gap: the impact of organized versus opportunistic cancer screening in Catalonia (Spain). J Med Screen 18, 87–90.
| Narrowing the equity gap: the impact of organized versus opportunistic cancer screening in Catalonia (Spain).Crossref | GoogleScholarGoogle Scholar | 21852701PubMed |
[16] Akinyemiju TF (2012) Socio-economic and health access determinants of breast and cervical cancer screening in low-income countries: analysis of the World Health Survey. PLoS One 7, e48834
| Socio-economic and health access determinants of breast and cervical cancer screening in low-income countries: analysis of the World Health Survey.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhslOhsr7I&md5=cac2fdc3b312bc9390484a8f81105395CAS | 23155413PubMed |
[17] Ibekwe CM, Hoque ME, Ntuli-Ngcobo B, Hoque ME (2011) Perceived barriers of cervical cancer screening among women attending Mahalapye district hospital, Botswana. Arch Clin Microb 2, 4
| Perceived barriers of cervical cancer screening among women attending Mahalapye district hospital, Botswana.Crossref | GoogleScholarGoogle Scholar |
[18] Were E, Nyaberi Z, Buziba N (2011) Perceptions of risk and barriers to cervical cancer screening at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Afr Health Sci 11, 58–64.
[19] Department of Immigration & Border Protection (DIBP). Migration to Australia’s states and territories 2012–13. 2014. Available from: https://www.border.gov.au/ReportsandPublications/Documents/statistics/migration-australia-state-territories-2012-13.pdf [Verified 5 September 2016]
[20] Department of Social Services (DoSS). Settlement reporting: providing statistical data on permanent arrivals to Australia. Australian Government. 2015. Available from: http://www.immi.gov.au/settlement_external/SettlementServlet?ACTION=GETREPORT&REPORTID=wRIUE8U1oG8TXdDSRuK2k1fByGU6qMQt4fmUgihI. [Verified 18 April 2015].
[21] Barnes DM, Harrison CL (2004) Refugee women’s reproductive health in early resettlement. J Obstet Gynecol Neonatal Nurs 33, 723–8.
| Refugee women’s reproductive health in early resettlement.Crossref | GoogleScholarGoogle Scholar | 15561660PubMed |
[22] Gorstein J, Sullivan KM, Parvanta I, Begin F. Indicators and methods for cross-sectional surveys of vitamin and mineral status of populations. Micronutrient Initiative and Centers for Disease Control and Prevention. Ottawa and Atlanta: The Micronutrient Initiative (Ottawa) and the Centers for Disease Control and Prevention (Atlanta), 2007.
[23] Data Analysis Australia (DAA). Response rates. 2014. Available from: http://www.daa.com.au/analytical-ideas/response-rates/ [Verified 25 November 2014].
[24] Mupepi SC, Sampselle MC, Johnson TRB (2011) Knowledge, attitudes, and demographic factors influencing cervical cancer screening behavior of Zimbabwean women. J Womens Health (Larchmt) 20, 943–52.
| Knowledge, attitudes, and demographic factors influencing cervical cancer screening behavior of Zimbabwean women.Crossref | GoogleScholarGoogle Scholar |
[25] Byrd TL, Peterson SK, Chavez R, Heckert A (2004) Cervical cancer screening beliefs among young Hispanic women. Prev Med 38, 192–7.
| Cervical cancer screening beliefs among young Hispanic women.Crossref | GoogleScholarGoogle Scholar | 14715211PubMed |
[26] Gamarra CJ, Paz EPA, Griep RH (2005) Conhecimentos, atitudes e prática do exame de Papanicolaou entre mulheres argentinas. Rev Saude Publica 39, 270–6.
| Conhecimentos, atitudes e prática do exame de Papanicolaou entre mulheres argentinas.Crossref | GoogleScholarGoogle Scholar | 15895148PubMed |
[27] Owoeye IOG, Ibrahim IA (2013) Knowledge and attitude towards cervical cancer screening among female students and staff in a tertiary institution in the Niger Delta. Int J Med Biomed Res 2, 48–56.
| Knowledge and attitude towards cervical cancer screening among female students and staff in a tertiary institution in the Niger Delta.Crossref | GoogleScholarGoogle Scholar |
[28] Nwankwo KC, Aniebue UU, Aguwa EN, Anarado AN, Agunwah E (2011) Knowledge attitudes and practices of cervical cancer screening among urban and rural Nigerian women: a call for education and mass screening. Eur J Cancer Care (Engl) 20, 362–7.
| Knowledge attitudes and practices of cervical cancer screening among urban and rural Nigerian women: a call for education and mass screening.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3M3nsF2quw%3D%3D&md5=46847f418daa6546c2b81a9a59088a7bCAS |
[29] Watts L, Joseph N, Velazquez A, Gonzalez M, Munro E, Muzikansky A, et al (2009) Understanding barriers to cervical cancer screening among Hispanic women. Am J Obstet Gynecol 201, 199.e1–.e8.
| Understanding barriers to cervical cancer screening among Hispanic women.Crossref | GoogleScholarGoogle Scholar |
[30] World Health Organization (WHO). Comprehensive cervical cancer control: a guide to essential practice. Integrating health care for sexual and reproductive health and chronic diseases. Geneva: WHO; 2006.
[31] Twycross A, Shields L (2004) Validity and reliability – what’s it all about? Part 1 Validity in quantitative studies. Paediatr Nurs 16, 28–34.
| Validity and reliability – what’s it all about? Part 1 Validity in quantitative studies.Crossref | GoogleScholarGoogle Scholar | 15633276PubMed |
[32] Roberts P, Priest H (2006) Reliability and validity in research. Nurs Stand 20, 41–5.
| Reliability and validity in research.Crossref | GoogleScholarGoogle Scholar | 16872117PubMed |
[33] Tengland PA (2010) Health promotion or disease prevention: a real difference for public health practice? Health Care Anal 18, 203–21.
| Health promotion or disease prevention: a real difference for public health practice?Crossref | GoogleScholarGoogle Scholar | 19771522PubMed |
[34] Airhihenbuwa CO (1994) Health promotion and the discourse on culture: implications for empowerment. Health Educ Q 21, 345–53.
| Health promotion and the discourse on culture: implications for empowerment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M%2FpsFKlsQ%3D%3D&md5=1cbd1bf7515e5be5399de46709899754CAS | 8002358PubMed |
[35] Jirojwong S, Maclennan R, Manderson L (2001) Health beliefs and Pap smears among Thai women in Brisbane. Asia Pac J Public Health 13, 20–3.
| Health beliefs and Pap smears among Thai women in Brisbane.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38zmt1Gmsg%3D%3D&md5=56a2b31a75aa798146f5c21b40e02a31CAS | 12109255PubMed |
[36] Lesjak M, Hua M, Ward J (1999) Cervical screening among immigrant Vietnamese women seen in general practice: current rates, predictors and potential recruitment strategies. Aust NZ J Publ Health 23, 168–73.
| Cervical screening among immigrant Vietnamese women seen in general practice: current rates, predictors and potential recruitment strategies.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3mtV2qsw%3D%3D&md5=720780543207c49a80045a47447c8b3cCAS |
[37] Aminisani N, Armstrong BK, Canfell K (2012) Cervical cancer screening in Middle Eastern and Asian migrants to Australia: a record linkage study. Cancer Epidemiol 36, e394–400.
| Cervical cancer screening in Middle Eastern and Asian migrants to Australia: a record linkage study.Crossref | GoogleScholarGoogle Scholar | 23017217PubMed |
[38] Ogunsiji O, Wilkes L, Peters K, Jackson D (2013) Knowledge, attitudes and usage of cancer screening among West African migrant women. J Clin Nurs 22, 1026–33.
| Knowledge, attitudes and usage of cancer screening among West African migrant women.Crossref | GoogleScholarGoogle Scholar | 23336438PubMed |
[39] Harcourt N, Ghebre R, Whembolua G-L, Zhang Y, Warfa Osman S, Okuyemi K (2014) Factors associated with breast and cervical cancer screening behavior among African immigrant women in Minnesota. J Immigr Minor Health 16, 450–6.
| Factors associated with breast and cervical cancer screening behavior among African immigrant women in Minnesota.Crossref | GoogleScholarGoogle Scholar | 23334709PubMed |
[40] Juon H-S, Seung-Lee C, Klassen AC (2003) Predictors of regular Pap smears among Korean-American women. Prev Med 37, 585–92.
| Predictors of regular Pap smears among Korean-American women.Crossref | GoogleScholarGoogle Scholar | 14636792PubMed |
[41] Morema EN, Atieli HE, Onyango RO, Omondi JH, Ouma C (2014) Determinants of cervical screening services uptake among 18–49 year old women seeking services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. BMC Health Serv Res 14,
| Determinants of cervical screening services uptake among 18–49 year old women seeking services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya.Crossref | GoogleScholarGoogle Scholar | 25100298PubMed |
[42] Soneji S, Fukui N (2013) Socioeconomic determinants of cervical cancer screening in Latin America. Rev Panam Salud Publica 33, 174–82.
| Socioeconomic determinants of cervical cancer screening in Latin America.Crossref | GoogleScholarGoogle Scholar | 23698136PubMed |
[43] Brown DR, Wilson RM, Boothe MA, Harris CE (2011) Cervical cancer screening among ethnically diverse black women: knowledge, attitudes, beliefs, and practices. J Natl Med Assoc 103, 719–28.
| Cervical cancer screening among ethnically diverse black women: knowledge, attitudes, beliefs, and practices.Crossref | GoogleScholarGoogle Scholar | 22046849PubMed |
[44] Jameson A, Sligo F, Comrie M (1999) Barriers to Pacific women’s use of cervical screening services. Aust NZ J Publ Health 23, 89–92.
| Barriers to Pacific women’s use of cervical screening services.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M7otlaltw%3D%3D&md5=c13129cc6183e4b2a461b5daa8e4893cCAS |
[45] Bethune GR, Lewis HJ (2009) Let’s talk about smear tests: social marketing for the National Cervical Screening Programme. Public Health 123, e17–22.
| Let’s talk about smear tests: social marketing for the National Cervical Screening Programme.Crossref | GoogleScholarGoogle Scholar | 19740498PubMed |
[46] Gardner DG, Cummings LL, Dunham RB, Pierce JL (1998) Single-item versus multiple-item measurement scales: an empirical comparison. Educ Psychol Meas 58, 898–915.
| Single-item versus multiple-item measurement scales: an empirical comparison.Crossref | GoogleScholarGoogle Scholar |
[47] Airhihenbuwa CO (2010) Culture matters in global health. Euro Health Psychol 12, 52–4.