Adekunle Toluwani, Adekunle Tiwaladeoluwa, Afolabi Esther
Public Health Department, Calvin University, 3201 Burton SE, Grand Rapids, Michigan, USA.
Department of Obstetrics and Gynecology, University of Wisconsin-Madison, McConnell Hall, 4th Floor 1010 Mound St. Madison, WI, 53715, Madison, United States.
J Immigr Minor Health. 2025 Aug 13. doi: 10.1007/s10903-025-01756-0.
Refugee women face unique challenges in accessing preventive healthcare services upon resettlement, particularly for cervical cancer screening and HPV vaccination. Despite national efforts to reduce cervical cancer incidence, uptake remains disproportionately low among newly arrived refugee populations. Emerging research suggests that trust in healthcare systems and providers plays a pivotal role in shaping engagement with these services, yet little is known about how trust is built or broken in the early resettlement period. This study explores how trust and medical mistrust shape cervical cancer prevention behaviors among newly arrived refugee women in the United States, with attention to the multilevel relational and contextual factors that influence screening and vaccination. We conducted in-depth, semi-structured interviews with 17 refugee women resettled within the past two years in a Mid-western City, recruited through a community-based organization. Interviews were conducted in participants' preferred languages and lasted approximately 60 min. Data were thematically analyzed using Braun and Clarke's six-step framework, supported by Dedoose software. A codebook was developed through double coding and refined via consensus meetings. Themes were reviewed collaboratively and verified through member checking to enhance analytical rigor. Participants (n = 17) ranged in age from 21 to 56 and represented five countries, with the majority from Rwanda and Congo. Most had less than a high school education, and nearly all reported limited or no prior knowledge of cervical cancer, Pap smears, or HPV vaccination. Some confused HPV with other illnesses, while others attributed cervical cancer to unrelated factors such as stress or diet. Four themes emerged: trust as a precondition for engagement; provider trust shaped by cultural concordance, communication, and respect; systemic mistrust shaped by health literacy, practical/access issues and social influences; and the importance of community-based relationships in rebuilding trust and supporting preventive care engagement. Refugee women's engagement with cervical cancer prevention is shaped not only by knowledge but also by cultural safety, provider concordance, and systemic trust. Interventions must prioritize community-rooted education, gender-concordant care, and culturally responsive communication to improve prevention outcomes.
难民妇女在重新安置后获得预防性医疗服务方面面临独特挑战，尤其是在宫颈癌筛查和人乳头瘤病毒（HPV）疫苗接种方面。尽管各国都在努力降低宫颈癌发病率，但新抵达的难民群体对这些服务的接受程度仍然极低。新出现的研究表明，对医疗系统和医疗服务提供者的信任在决定是否参与这些服务方面起着关键作用，但对于在重新安置初期信任是如何建立或破裂的，人们却知之甚少。本研究探讨了信任和医疗不信任如何影响美国新抵达的难民妇女的宫颈癌预防行为，并关注影响筛查和疫苗接种的多层次关系和背景因素。我们通过一个社区组织招募了17名在过去两年内重新安置在中西部一个城市的难民妇女，对她们进行了深入的半结构化访谈。访谈以参与者喜欢的语言进行，持续约60分钟。使用布劳恩和克拉克的六步框架对数据进行主题分析，并得到Dedoose软件的支持。通过双重编码开发了一个编码手册，并通过共识会议进行完善。通过共同审查主题并通过成员核对进行验证，以提高分析的严谨性。参与者（n = 17）年龄在21岁至56岁之间，来自五个国家，大多数来自卢旺达和刚果。大多数人受教育程度低于高中，几乎所有人都表示对宫颈癌、巴氏涂片检查或HPV疫苗接种的先前知识有限或一无所知。一些人将HPV与其他疾病混淆，而另一些人则将宫颈癌归因于压力或饮食等无关因素。出现了四个主题：信任是参与的前提条件；文化契合、沟通和尊重塑造了对医疗服务提供者的信任；健康素养、实际/获取问题和社会影响塑造了对系统的不信任；基于社区的关系在重建信任和支持预防性护理参与方面的重要性。难民妇女对宫颈癌预防的参与不仅受到知识的影响，还受到文化安全、医疗服务提供者的契合度和系统信任的影响。干预措施必须优先考虑以社区为基础的教育、性别契合的护理以及具有文化响应性的沟通，以改善预防效果。
