Barriers and Facilitators to Cervical Cancer Screening Among Iraqi Refugees Resettled in Philadelphia: A Qualitative Analysis of Patient and Provider Perceptions
Cervical cancer remains a significant public health problem globally despite being highly preventable via early screening and treatment. Middle-Eastern refugees represent a large segment of refugees resettled in the US recently. Limited research exists regarding screening in this population particularly in the post-resettlement period. The purpose of this project was to identify barriers and facilitators to cervical cancer screening among recently resettled Middle-Eastern refugee women as well as recommend potential solutions to cervical cancer screening based on provider and patient perceptions. This was a mixed methods study that included both qualitative and quantitative analysis. A retrospective chart review was conducted to determine cervical cancer screening completion in refugees resettled in Philadelphia (n = 423). To better understand and address the barriers and facilitators for cervical cancer screening, we conducted focus groups with Iraqi refugee women (n = 7) and healthcare providers (n = 9). Pap smears were conducted for 62% of Middle Eastern and 67% of non-Middle Eastern refugees, which is lower than the Healthy People 2020 goal as well as national, state, and local rates. Results indicated a similar association between country of origin and cervical cancer screening χ(1) = 0.795, p = 0.37. The women perceived the following as barriers: embarrassment, fear of the procedure and results, physician gender, lack of insurance coverage, and competing life priorities. Providers reported similar barriers but also included system based barriers such as translation services, lack of provider training, and lack of time. Facilitating factors included several community-based programs such as group education sessions in the community, and training community members to become health agents. These results suggest a need for comprehensive, culturally competent cervical cancer prevention, education programs, and interventions for Middle-Eastern refugees in Philadelphia as well as strategies to improve access to care and patient–provider relationships.
Presentation: 23:4
