Vahabi Mandana, Lofters Aisha
Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.
Centre Global Health and Health Equity, Ryerson University, Toronto, ON, Canada.
BMC Public Health. 2016 Aug 24;16(1):868. doi: 10.1186/s12889-016-3564-1.
Canada has observed significant decreases in incidence and mortality of cervical cancer in recent decades, and this has been attributed to appropriate screening (i.e., the Pap test). However, certain subgroups including Muslim immigrants show higher rates of cervical cancer mortality despite their lower incidence. Low levels of screening have been attributed to such barriers as lack of a family physician, inconvenient clinic hours, having a male physician, and cultural barriers (e.g., modesty, language). HPV self -sampling helps to alleviate many of these barriers. However, little is known about the acceptability of this evidence-based strategy among Muslim women. This study explored Muslim immigrant women's views on cervical cancer screening and the acceptability of HPV self-sampling.
An exploratory community-based mixed methods design was used. A convenience sample of 30 women was recruited over a 3-month period (June-August 2015) in the Greater Toronto Area. All were between 21 and 69 years old, foreign-born, self-identified as Muslim, and had good knowledge of English. Data were collected through focus groups.
This study provides critical insights about the importance of religious and cultural beliefs in shaping the daily and health care experiences of Muslim women and their cancer screening decisions. Our study showed the deterring impact of beliefs and health practices in home countries on Muslim immigrant women's utilization of screening services. Limited knowledge about cervical cancer and screening guidelines and need for provision of culturally appropriate sexual health information were emphasized. The results revealed that HPV self-sampling provides a favorable alternative model of care to the traditional provider-administered Pap testing for this population.
To enhance Muslim immigrant women screening uptake, efforts should made to increase 1) their knowledge of the Canadian health care system and preventive services at the time of entry to Canada, and 2) access to culturally sensitive education programs, female health professionals, and alternative modes of screening like HPV self-sampling. Health professionals need to take an active role in offering screening during health encounters, be educated about sexual health communication with minority women, and be aware of the detrimental impact of preconceived assumptions about sexual activity of Muslim women.
近几十年来，加拿大宫颈癌的发病率和死亡率显著下降，这归因于适当的筛查（即巴氏试验）。然而，包括穆斯林移民在内的某些亚群体尽管发病率较低，但宫颈癌死亡率却较高。筛查水平低归因于诸如缺乏家庭医生、诊所营业时间不便、医生为男性以及文化障碍（如羞怯、语言）等因素。人乳头瘤病毒（HPV）自我采样有助于缓解其中许多障碍。然而，对于这一基于证据的策略在穆斯林女性中的可接受性知之甚少。本研究探讨了穆斯林移民女性对宫颈癌筛查的看法以及HPV自我采样的可接受性。
采用基于社区的探索性混合方法设计。2015年6月至8月的3个月期间，在大多伦多地区招募了30名女性作为便利样本。所有参与者年龄在21至69岁之间，出生在国外，自我认定为穆斯林，且英语水平良好。通过焦点小组收集数据。
本研究提供了关于宗教和文化信仰在塑造穆斯林女性日常和医疗保健经历及其癌症筛查决策方面重要性的关键见解。我们的研究表明，母国的信仰和健康习惯对穆斯林移民女性利用筛查服务具有阻碍作用。强调了对宫颈癌和筛查指南的了解有限，以及需要提供符合文化背景的性健康信息。结果显示，对于这一人群，HPV自我采样为传统的由医护人员进行的巴氏检测提供了一种更有利的替代护理模式。
为提高穆斯林移民女性的筛查接受率，应努力：1）在她们进入加拿大时增加其对加拿大医疗保健系统和预防服务的了解；2）提供获得符合文化敏感的教育项目、女性健康专业人员以及HPV自我采样等替代筛查方式的机会。医疗专业人员需要在健康问诊期间积极提供筛查服务，接受与少数族裔女性进行性健康沟通的教育，并意识到对穆斯林女性性活动的先入为主观念的不利影响。
