Thomas-Purcell Kamilah, Sealy Diadrey-Anne, Purcell Donrie, Richards Christine, Bailey Althea, Song Gaole, Ashing Kimlin
Nova Southeastern University College of Health Care Sciences, Department of Health Science, 3200 South University Dr, Ft. Lauderdale, FL 33328, USA.
Loma Linda University, 11175 Campus St, Loma Linda, CA 92354, USA.
J Cancer Policy. 2025 Sep;45:100609. doi: 10.1016/j.jcpo.2025.100609. Epub 2025 Jun 23.
Cervical cancer remains a major public health concern in the Caribbean, where cultural beliefs, stigma, and healthcare barriers hinder prevention and early detection. While stigma has been recognized as a barrier globally, few studies have qualitatively examined how cervical cancer stigma is constructed and experienced within Caribbean cultural contexts. This study uniquely explores the intersecting social and cultural factors influencing cervical cancer-related stigma, screening behaviors, and HPV vaccination in Grenada, Jamaica, and Trinidad and Tobago, filling a critical research gap in understanding stigma beyond patient populations and across national settings.
A qualitative study was conducted using nine focus groups with 69 participants (54 women, 15 men) recruited from community organizations, health centers, and cancer support networks. Semi-structured interviews explored perceptions of cervical cancer, its causes, screening, and healthcare experiences. Thematic analysis identified key patterns in stigma and barriers to prevention.
Six major themes emerged: (1) Cancer-related stigma and fear, with fatalistic views of cancer as a death sentence; (2) Cultural beliefs, including associations between cervical cancer, promiscuity, and divine punishment; (3) Knowledge gaps and misinformation, contributing to screening and vaccine hesitancy; (4) Gender and societal expectations, reinforcing stigma and discouraging health-seeking behaviors; (5) Health system challenges, such as healthcare mistrust, confidentiality concerns, and financial constraints; and (6) Family history concerns, where secrecy surrounding cancer within families limited awareness and early detection.
Women in low-income settings faced compounded barriers due to gendered norms, limited education, and economic constraints. Healthcare confidentiality concerns further discouraged prevention. Addressing these challenges requires culturally tailored public health campaigns, stronger confidentiality protections, and expanded access to affordable screening and treatment. A regionally coordinated approach to HPV vaccination and cervical cancer prevention is needed to reduce stigma and improve equitable access to care across the Caribbean.
This study identifies key policy gaps in cervical cancer prevention and HPV vaccination. Findings highlight the need for improved confidentiality protections, enhanced healthcare system trust, and culturally relevant public health interventions to combat stigma and misinformation. Policies should also increase financial access to screening and promote family health communication to improve awareness of hereditary cancer risks. Addressing these gaps can reduce stigma, increase screening and vaccination uptake, and improve cervical cancer outcomes across the region.
宫颈癌仍是加勒比地区主要的公共卫生问题，该地区的文化信仰、耻辱感和医疗保健障碍阻碍了预防和早期检测。虽然耻辱感在全球范围内都被视为一种障碍，但很少有研究从质的角度考察在加勒比文化背景下宫颈癌耻辱感是如何形成和体验的。本研究独特地探讨了影响格林纳达、牙买加和特立尼达和多巴哥宫颈癌相关耻辱感、筛查行为和人乳头瘤病毒（HPV）疫苗接种的社会和文化因素的交叉影响，填补了在理解患者群体之外以及不同国家背景下耻辱感方面的关键研究空白。
采用定性研究方法，对从社区组织、健康中心和癌症支持网络招募的69名参与者（54名女性，15名男性）进行了9个焦点小组访谈。半结构化访谈探讨了对宫颈癌的认知、其病因、筛查和医疗保健经历。主题分析确定了耻辱感和预防障碍的关键模式。
出现了六个主要主题：（1）与癌症相关的耻辱感和恐惧，将癌症宿命论地视为死刑判决；（2）文化信仰，包括宫颈癌、滥交和神罚之间的关联；（3）知识差距和错误信息，导致筛查和疫苗接种犹豫；（4）性别和社会期望，强化耻辱感并阻碍寻求医疗行为；（5）卫生系统挑战，如对医疗保健的不信任、对保密性的担忧和经济限制；（6）家族病史担忧，家庭内部对癌症的保密限制了认知和早期检测。
低收入环境中的女性由于性别规范、教育有限和经济限制而面临多重障碍。对医疗保健保密性的担忧进一步阻碍了预防工作。应对这些挑战需要开展针对文化的公共卫生运动、加强保密性保护以及扩大获得负担得起的筛查和治疗的机会。需要采取区域协调的HPV疫苗接种和宫颈癌预防方法，以减少耻辱感并改善整个加勒比地区公平获得医疗服务的情况。
本研究确定了宫颈癌预防和HPV疫苗接种方面的关键政策差距。研究结果强调需要改进保密性保护、增强对卫生系统的信任以及开展与文化相关的公共卫生干预措施，以对抗耻辱感和错误信息。政策还应增加获得筛查的资金渠道，并促进家庭健康沟通，以提高对遗传性癌症风险的认识。解决这些差距可以减少耻辱感、提高筛查和疫苗接种率，并改善该地区的宫颈癌防治效果。
