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. 2025 Sep 1;52(5):371–381. doi: 10.1188/25.ONF.371-381

Cervical Cancer Screening Beliefs and Practices Among Black Immigrant Women From Africa and the Caribbean Living in Massachusetts

Kayoll G Gyan 1,✉, Hayley Dunnack Yackel 1, Deborah Effiong 1, Cherice Escobar Jones 1, Richard Wamai 1
PMCID: PMC12377865  PMID: 40849924

Abstract

OBJECTIVES

To examine the cervical cancer screening beliefs and practices of Black immigrant women from sub-Saharan African or Caribbean countries living in Massachusetts.

SAMPLE & SETTING

19 women who self-identified as being sub-Saharan African or Caribbean, spoke English, were foreign-born, were aged 25–65 years, and had been living in the United States for at least six months were included.

METHODS & VARIABLES

A qualitative descriptive design and thematic analysis were used. A semistructured interview guide was developed based on the PEN-3 cultural model.

RESULTS

Facilitators of cervical cancer screening included a sense of personal responsibility to maintain one’s health, cultivating trust within the healthcare system, and cultivating community support. Barriers included pain and fear, navigating a new identity as a Black immigrant, a lack of formal education on sexual health, and challenges accessing the healthcare system.

IMPLICATIONS FOR NURSING

Culturally tailored resources and community partnerships may be useful in promoting cervical cancer screening in Black immigrant women.

Keywords: immigrant women, Black women, cervical cancer, cervical cancer screening

Cervical cancer is the fourth most common cancer in women globally, with about 660,000 new cases and 350,000 deaths in 2022 (World Health Organization, 2024). Cervical cancer is caused by infection with the human papillomavirus (HPV). Persistent infection with high-risk strains of HPV commonly occurs after sexual activity. Other risk factors for developing cervical cancer include a lack of or infrequent screening, HPV persistence, and immunosuppression (National Cancer Institute, 2023). Despite these various risk factors, cervical cancer is highly preventable through HPV vaccination and participation in timely screening with a Papanicolaou (Pap) or HPV DNA test. According to the U.S. Preventive Services Task Force (2024), it is recommended that women aged 21–29 years should screen for cervical cancer every three years with cervical cytology alone and women aged 30–65 years should screen every five years with clinician- or patient-collected high-risk HPV primary screening.

In the United States, it is estimated that there will be about 13,360 new cases of cervical cancer and 4,320 related deaths in 2025 (American Cancer Society, 2025). Black women are disproportionately diagnosed with cervical cancer in the United States (Bray et al., 2018; Vaccarella et al., 2017). The current incidence of cervical cancer is 7.3 per 100,000 Black women compared to 6.5 per 100,000 White women (U.S. Cancer Statistics Working Group, 2023). In addition, the cervical cancer mortality rate for Black women is 54% higher than that of White women, with a larger disparity observed after correcting for women who underwent a hysterectomy (Beavis et al., 2017; Saka et al., 2025). In addition, Black women are more likely to be diagnosed with cervical cancer at later stages, contributing to this population having lower stage-specific survival rates. Although these racial comparisons are helpful, they do little to facilitate understanding of subgroup characteristics and barriers that may account for disproportionate cervical cancer risk and cervical cancer rates among Black women from different ethnic groups. Through globalization and immigration patterns, the United States has become more culturally and demographically diverse, with many Black residents immigrating from African and Caribbean countries where cervical cancer screening and early detection programs are not readily accessible. Black women in the United States are inclusive of U.S.-born (i.e., African American) and foreign-born women of African or Caribbean descent. In recognition of the diversity of Black women in the United States and the varied social and cultural barriers they may experience in cervical cancer screening, a more nuanced approach for promoting cervical cancer screening among Black immigrant women in the United States is needed.

Historically, foreign-born women in the United States are less likely to be screened and are more likely to die from cervical cancer compared with their U.S.-born counterparts (Dominguez et al., 2015; Seeff & McKenna, 2003; Singh & Hiatt, 2006; Singh & Miller, 2004; White et al., 2017). More than half of the cervical cancer–related deaths in the United States occur in foreign-born women (Hallowell et al., 2019). Studies show that among Black individuals, African immigrants record the lowest cancer screening rates and experience the worst cancer outcomes (Hurtado-de-Mendoza et al., 2014; Sheppard et al., 2015). Data from studies that examine differences in cervical cancer screening behaviors among Black women based on place of birth and nationality have identified differential cervical cancer risks and Pap testing rates. For example, an analysis of the National Health Interview Survey 2013 and 2015 data found that foreign-born women were more than twice as likely to have never received a Pap test compared to U.S.-born women (13.4% versus 5.2%) (Centers for Disease Control and Prevention, 2017). A pooled analysis of the National Health Interview Survey found that foreign-born women aged 18 years or older were more than twice as likely to have never received a Pap test compared with U.S.-born women (18.6% versus 6.8%, respectively) (Strelow & O’Laughlin, 2022). Women from Caribbean (14.6%) and African (27.8%) countries are among those more likely to be unscreened compared to U.S.-born women (7.6%) (Cofie et al., 2024). Another analysis of the National Health Interview Survey found that immigrant women were three times less likely to have ever had a Pap test compared with U.S.-born Black women and were at higher risk for presenting with late-stage disease (Forney-Gorman & Kozhimannil, 2016).

The literature has examined differences among U.S.-born Black women and Black immigrant women that may contribute to cervical cancer risks (Amuta-Jimenez et al., 2022; Mantula et al., 2024). First, a lack of a comprehensive cervical cancer screening program contributes to cervical cancer being the most frequently diagnosed cancer among sub-Saharan African women and the leading cause of cancer death, accounting for about 25% of total annual new cancer cases and deaths among this group (Adegboyega et al., 2022; Lim & Ojo, 2017). In addition, early detection reduces the morbidity and mortality of cervical cancer; however, Black immigrant women experience social, cultural, and structural barriers that create inequities to accessing cervical cancer screening, such as a lack of health insurance, less timely contact with the healthcare system, and other sociodemographic factors (Cudjoe et al., 2019). For example, a study of U.S.-born Black individuals and sub-Saharan African immigrants found significant differences in screening behaviors based on socioeconomic indicators (Adegboyega et al., 2022). In particular, having a higher education and being insured were associated with increased odds of cervical cancer screening (Adegboyega et al., 2022).

Foreign-born women in the United States experience structural barriers to cervical cancer screening, such as a lack of knowledge about where to go for Pap testing, lack of access to health care, lack of insurance coverage, high cost of care, and lack of interpreter services (Adunlin et al., 2019). Adegboyega et al. (2022) also found disparities in cancer screening that were evident for not only cervical cancer screening but for other cancer preventive tools as well (e.g., mammography, colonoscopy). In addition, nativity (U.S.-born Black individuals versus sub-Saharan African immigrant) was the only indicator associated with having had a colonoscopy, with sub-Saharan African immigrants being 90% less likely to have undergone a colonoscopy compared to U.S.-born Black patients (Adegboyega et al., 2022). Another study on the effect of barriers on cervical cancer screening in Black women found that for every one-point increase in perceived barriers to screening, the odds of being up to date decreased by 81% (Adegboyega et al., 2024). Therefore, there is a need for studies that further explicate the barriers that Black immigrant women face to fully comprehend their experience navigating a complex healthcare system, and it is vital to develop appropriate strategies to reduce those barriers.

Purpose

The purpose of this study was to qualitatively examine the cervical cancer screening beliefs and practices of Black immigrant women in Massachusetts using the PEN-3 cultural model, a culturally oriented conceptual framework. The research questions that guided this study were as follows: (a) What are Black immigrant women’s attitudes and beliefs toward cervical cancer screening? and (b) What barriers and facilitators do Black immigrant women experience when obtaining cervical cancer screening? In this study, Black immigrant women are defined as Black women who immigrated to the United States from Africa or the Caribbean.

Conceptual Framework

Airhihenbuwa (1990) posits that culture plays a central role in an individual’s engagement or disengagement in a preventive behavior. The PEN-3 cultural model operationalizes culture within the following three domains: relationships and expectations, cultural empowerment, and cultural identity. In the current study, two of the PEN-3 model’s domains, the relationships and expectations domain and cultural empowerment domain, were used to operationalize culture as researchers examined the barriers and facilitators to cervical cancer screening among Black immigrant women (see Figure 1). Within the relationships and expectations domain, culture is operationalized as perceptions, enablers, and nurturers that influence a person’s, family’s, or community’s actions toward engaging in a health behavior. The relationships and expectations domain identifies perceptions (e.g., knowledge, attitudes, beliefs), enablers (e.g., community and environmental or structural factors), and nurturers (e.g., family, support networks) as important influencers on cervical cancer screening. Positive perceptions, enablers, and nurturers promote engagement in cervical cancer screening; existential perceptions are not harmful and do not necessarily influence cervical cancer screening; and negative perceptions are barriers to cervical cancer screening. The cultural identity domain identifies the intervention points of entry. These may occur at the level of person, extended family, or neighborhood.

FIGURE 1.

FIGURE 1

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PEN-3 Cultural Model

During the assessment phase of the PEN-3 cultural model, it is customary to use only two domains to assess for any domain interactions (Airhihenbuwa et al., 2009; Airhihenbuwa & Webster, 2004; Iwelunmor et al., 2014). In this cross-tabulation approach for which the goal was to better understand Black immigrant women’s cervical cancer screening perceptions, the relationships and expectations (with perceptions, enablers, and nurturers) domain was crossed with the cultural empowerment (positive, existential, and negative) domain.

Methods

A qualitative descriptive approach was used to examine factors influencing participants’ cervical cancer screening beliefs and behaviors. A semistructured interview guide was developed and organized based on the relationships and expectations domain and the cultural empowerment domain of the PEN-3 cultural model (see Supplemental Figure 1 online). This study was performed in accordance with the principles of the Declaration of Helsinki. Approval was granted by the ethics committee at Northeastern University in Boston, Massachusetts (21-09-19).

Participants and Setting

Participants were recruited from the following communities in Massachusetts with high numbers of sub-Saharan African and Caribbean residents: Worcester, Lowell, Waltham, and Boston. Inclusion criteria were as follows: women who (a) self-identified as being sub-Saharan African or Caribbean, (b) spoke English, (c) were foreign-born, (d) were aged 25–65 years, and (e) had lived in the United States for at least six months and as many as five years. Prior research has demonstrated that immigrants do not assimilate to their new country’s health outcome standards until after five years, with some outcomes not aligning until 15 years postimmigration (Hagos & Hamilton, 2024). The time inclusion criterion was expanded to include immigrants who had been living in the United States for longer than five years because recruitment proved to be challenging with the shorter time restriction. Exclusion criteria were women who (a) were already diagnosed with cervical cancer, (b) had a hysterectomy, (c) were aged older or younger than 25–65 years, and (d) did not communicate effectively in English.

Procedure

Academic–community partnerships with two community organizations, UHAI for Health and the African Bridge Network, and a Ugandan community liaison facilitated recruitment of study participants. UHAI for Health (n.d.) promotes education and awareness about preventable health conditions among African immigrants and connects them to medical services. The African Bridge Network (n.d.) provides support to African immigrants across Massachusetts to navigate the challenges that accompany integrating into the United States. The community partners had more than 20 years serving as a community advocate within the African immigrant and refugee communities in Massachusetts. Each community partner connected the study’s principal investigators with staff members from their partner organizations for recruitment. Staff members identified potential participants and obtained permission for them to be contacted by the principal investigators or the study research assistants. The study flyer and informational brochures were sent to the email directories of UHAI for Health and African Bridge Network, and each organization also posted the information in their respective offices and on social media accounts. The study team placed advertisements on air with a local radio station called Radio Uganda. The flyer was distributed on Radio Uganda’s WhatsApp platform, in their office, and via their social media accounts. Snowball sampling was also used to refer network members to the study (Creswell & Poth, 2017). Flyers were posted at restaurants, churches, and salons that serve Caribbean and African immigrants.

Following institutional review board approval, the study’s research assistants screened participants for eligibility via telephone and emailed participants the study information sheet after verbal consent was obtained. A time was scheduled for interviews to be conducted via telephone. Each interview lasted 45–60 minutes. At the end of each interview, participants received a $40 Walmart gift card via email or mail.

Data Analysis

Interviews were conducted until data saturation was achieved and no new themes were identified. Field notes were maintained for each interview. All audio recordings were transcribed, reviewed for accuracy, and deidentified prior to analysis. MAXQDA, a qualitative data analysis software, was used to analyze the transcripts. All transcripts were read in their entirety by two independent researchers to gain an understanding of the content. Data were analyzed across transcripts using Braun and Clarke’s (2006) thematic analysis method. This rigorous method identifies themes within data and provides an interpretation. Steps included (a) familiarizing oneself with the data, (b) generating initial codes, (c) searching for themes, (d) reviewing themes, (e) defining and naming themes, and (f) producing the report. To establish validity, the researchers first coded one transcript as a team to ensure consistency in coding. Then, transcripts were divided between two researchers to complete coding, with weekly team meetings to maintain trustworthiness. An additional step to ensure rigor was reviewing the field notes during data analysis as a form of reflexivity. Memos were also used within the MAXQDA program to create an audit trail for the researchers conducting the coding. After each transcript was coded, researchers created summaries of all identified codes. Themes were then identified from the codes using Braun and Clarke’s (2006) method with a focus on repetitive codes that answered the two study aims, inferring meaning across multiple participants. Themes and subthemes emerged throughout discussion during team meetings. The PEN-3 model was used in theme interpretation by comparing themes to the cultural model components to add a richer description. A third researcher served as a moderator for any coding or thematic conflicts that emerged. The Consolidated Criteria for Reporting Qualitative Research was used to enhance rigor (Tong et al., 2007).

Results

A total of 19 women were interviewed for this study. The sample’s mean age was 38.5 years (SD = 11.3, range = 20–64), and the average time spent living in the United States was 8.3 years (SD = 8.6). The sample was mostly comprised of women who had immigrated from Kenya (n = 9), had a master’s degree (n = 9), were married (n = 10), were currently working (n = 13), and had private insurance (n = 11). Participant demographics are provided in Table 1. Most had received adult vaccines (n = 11) and had a regular healthcare provider (n = 15).

TABLE 1.

Participant Demographics (N = 19)

Characteristic X̄ SD
Age (years) 38.5 11.3
Time in the United States (years) 8.3 8.6
Characteristic n
Nationality
 Kenyan 9
 Ghanaian 5
 Ugandan 3
 Dominican 1
 Jamaican 1
Language spoken at home a
 English 16
 Swahili 6
 Kikuyu 3
 Twi 2
 Akan 1
 Kikamba 1
 Kiswahili 1
 Luganda 1
 Ugandan 1
 Native language 1
 Did not answer 1
Education
 Primary school 1
 High school 3
 Bachelor’s 4
 Master’s 9
 Doctorate 2
Marital status
 Married 10
 Single 8
 Engaged 1
Type of insurance
 Private 11
 MassHealth 3
 Did not answer 5
Currently working
 Yes 13
 No 4
 Did not answer 2
Received adult vaccines
 Yes 11
 No 3
 Did not answer 5
Has a regular healthcare provider
 Yes 15
 No 3
 Did not answer 1
Avoids seeing the doctor
 Yes 4
 No 14
 Did not answer 1
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a

Some participants spoke more than 1 language at home.

Perceptions

The specific cultural factors reported among Black immigrant women that influenced their cervical cancer screening tendencies and beliefs are presented in this article. Each factor discussed corresponds with perceptions, enablers, and nurturers from the relationships and expectations domain, and is discussed as a barrier or facilitator to engaging in cervical cancer screening. The themes that described facilitators of cervical cancer screening were as follows: (a) a sense of personal responsibility to maintain one’s health, (b) cultivating trust within the healthcare system, and (c) cultivating community support for cervical cancer screening. The themes that described barriers to cervical cancer screening were as follows: (a) pain and fear, (b) navigating a new identity as a Black immigrant, (c) lack of formal education on sexual health, and (d) challenges accessing the healthcare system.

Positive Perceptions

A sense of personal responsibility to maintain one’s health

A few participants stated that everyone should undergo cancer screening because it is important to know one’s health status and obtain preventive care. The notion of an individual responsibility to maintain one’s health and seek out education was repeated throughout the interviews. A woman from Ghana aged 31 years, who had lived in the United States for two years, shared her perceptions on how she values health when asked how her religion affects her beliefs and attitudes toward cervical cancer screening, saying, “I think your health . . . every aspect of your health is a priority. We can’t compromise when it comes to one’s health, so for me personally, I don’t have anything against screenings and vaccines and all this and that.” A woman from Kenya aged 43 years, who had lived in the United States for 22 years, discussed how the importance of health maintenance motivated her to start seeing a doctor regularly for mammograms and Pap tests, saying, “I think it’s just being aware of the importance of screening and seeing a doctor, not because I’m sick, but for [preventive] measures.”

Negative Perceptions

Pain and fear as barriers to cervical cancer screening

Most participants had previously undergone cervical cancer screening and described mixed personal experiences with the procedure, including pain, discomfort, and disliking the invasiveness. Participants expressed fearing their results and others reported viewing cervical cancer screening as necessary for health maintenance. A woman from Kenya aged 26 years, who had lived in the United States for one year, discussed her difficult experience with Pap testing, saying, “But for me, it felt weird and painful and uncomfortable. It’s a bit scary. I mean, the next time would be like, ‘Do I really want to [do this]?’ No.”

Navigating a new identity as a Black immigrant

Participants had been living in the United States for 8.3 years on average. However, many of their formative years and much of their adulthood was spent in sub-Saharan African or Caribbean countries. Because of this, participants described identity being grounded in their native countries and from the cultural practices that shaped their worldview. Participants discussed their living in the United States and the challenges that posed, from navigating a new identity as a Black immigrant to experiencing racism and discrimination. A woman from Kenya aged 28 years, who had lived in the United States for four years, spoke about her interactions with a doctor, saying,

I actually was just closed-mouthed to not be mocked because she was [a] White lady and I’m not really close to White people like that. Due to what I’ve heard about racism and discrimination by White people . . . I don’t really relate to my doctors very well. . . . Due to what I have heard about White [nurses] treating Black people, I feel I don’t really have to go [to the hospital], because I don’t want to be treated bad because of my skin color.

Lack of formal education on sexual health

Participants discussed an overall trend of being uncomfortable discussing their sexual health in their home country but stated that there has been some change in cultural perceptions over the years. Discussing sexual health was viewed as inappropriate, particularly among younger teenagers, in their home country, which did not allow for preventive medicine for HPV and safe sexual education. Some mentioned having their family or community provide sexual health education to women, and that new generations are influencing perceptions to be more positive and open-minded in many places. Religious beliefs were not a hindrance to screening for many participants, but others thought it could prevent Black immigrant women from seeking cervical cancer screening. A woman from Ghana aged 29 years, who had lived in the United States for three years, described the lack of sexual health education in her home country and how cultural views have shifted in recent years, saying,

A lot has changed now, because I think there’s been some improvement, but growing up, you don’t talk about sex. . . . There’s not really much education on sexual health, from home in our schools, very little. . . . Sexual health, especially women’s sexual health, is a no-go area. Nobody really talks about it. But I think that a lot has changed now. Because we have a lot more younger people that just want to talk about it.

Positive Enablers

Cultivating trust within the healthcare system

Overall, participants discussed the need for trust and comfort with their clinician as a prerequisite for cervical cancer screening. Some participants mentioned that having a female or Black clinician allowed them to feel more comfortable during cervical cancer screening. The lack of laws, such as the Health Insurance Portability and Accountability Act, and privacy protections made participants reluctant to discuss their medical concerns in their home countries. Participants described their interactions with clinicians in their home country as, at times, being uncomfortable, rude, or discriminatory. Cultural differences and racism were cited as reasons for being uncomfortable, and those who were comfortable said that they were responsible for advocating for the care that they need. A woman from Ghana aged 34 years, who had lived in the United States for four years, explained that seeing a healthcare provider who looks like her and with whom she identifies would make her feel more comfortable with using the U.S. healthcare system, saying,

I could see people of color, more people of color. [If I] see a provider is a person of color and that will put me at ease, make me more comfortable. But like always, seeing these White people, think that it can be a little bit intimidating.

A woman from Kenya aged 59 years, who had lived in the United States for 14 years, described being more comfortable discussing her health with her U.S. healthcare provider compared to her healthcare provider in Kenya because of information protections, saying,

Oh yes, because now we’ve been in this country, I’ve learned a lot. I know there is [the Health Insurance Portability and Accountability Act], and I know she cannot disclose my information without my consent. We do not have anything like that in Africa. In Kenya, we don’t have anything like that consent. So, for that one lesson I feel comfortable sharing with the doctors. Yeah, I do feel comfortable.

Negative Enablers

Challenges accessing the healthcare system

Health care in participants’ home countries was described as unorganized, difficult to access, and costly, with long wait times. Within the U.S. healthcare system, issues with wait times and confusion with insurance and cost discussions were cited as barriers to cervical cancer screening. Challenges with access to care and inadequate education from clinicians were also listed as barriers to cervical cancer screening. When asked whether it was difficult to find a doctor in the United States, a woman from Jamaica aged 28 years, who had lived in the United States for 10 years, described it being an individual’s responsibility to get connected with a provider, saying,

I feel like in the [United States], it’s up to you to figure out which doctor is going to be most suited for you. And fight to make sure you get in to see them and build a relationship with them. I don’t think I’ve faced any hurdles with guys [male healthcare providers]. All the doctors were open to see me and hear me.

A woman from Kenya aged 38 years, who had lived in the United States for one year, described barriers to cervical cancer screening that existed in her home country, including nonprivate clinical spaces, saying,

It has to be in a convenient place that I can easily access. And it also has to be private. Because, like I mentioned, in my country sometimes they do it in the clinical setup, so it’s not private at all.

Positive Nurturers

Cultivating community support for cervical cancer screening

Participants mentioned the positive effects of community, in the form of sisterhoods and churches, on cervical cancer screening within the Black immigrant community. Participants discussed various enablers to obtaining screening, including clinician recommendations, adequate transportation, and discussion and support from family and friends. A woman from Kenya aged 33 years, who had lived in the United States for four years, discussed the importance of friendship and sisterhood to help women within the Black immigrant community navigate medical care and the U.S. healthcare system, saying, “I think sisterhood mostly. If a friend of mine were to say, ‘You know what, I went for a cervical cancer screening.’ ‘What is it?’ Like they will first trust a friend talking about it.”

Discussion

In this study, participants’ attitudes and beliefs toward cervical cancer screening were influenced by personal experiences with screening, the importance of preventive care and education, and the negative impact of sexual health perceptions. Participants described trust in the system, community support, and ease of healthcare access as facilitators of cervical cancer screening.

Prior literature has examined barriers and facilitators to cancer screening among immigrants in the United States. Barriers included a lack of knowledge about screening, healthcare access, interpretation services, and insurance coverage, as well as high cost of care and discomfort with screening procedures (Adunlin et al., 2019; Cudjoe et al., 2019). The current study’s findings on the importance of preventive care and education, ease of healthcare access, trust in the healthcare system, and personal experiences with cervical cancer screening corroborate these prior findings. The current study expands on existing literature by identifying the positive value of community support and the negative impact of sexual health perceptions on cancer screening in this population.

Participants discussed the positive impact of sisterhood, friendship, and churches on their ability to navigate the U.S. healthcare system to obtain cervical cancer screening. Community-based participatory research methodologies have incorporated faith communities in their objective to understand and affect health outcomes for African immigrants in the United States (Cudjoe et al., 2021; Oppenheim et al., 2019). Health centers dedicated to the care of immigrant women have emerged to meet the unique challenges of this population. The African Women’s Health Center at Brigham and Women’s Hospital (n.d.) in Boston, Massachusetts, seeks to improve the health of refugee and immigrant women, particularly those who have undergone female genital mutilation. Centers like the African Women’s Health Center that provide culturally and linguistically congruent care have the potential to support the ongoing efforts to increase cervical cancer screening within the Black immigrant community. Prior research has demonstrated the success of partnering with community support networks, such as churches, family members, and friends, to enhance recruitment for studies examining cancer screening practices among African immigrants (Cudjoe et al., 2019). The effects of community-based interventions to promote cancer screening among Black immigrant women should be examined in future research.

The negative effects of sexual health perceptions on cervical cancer screening was a novel finding in this study. Discomfort with discussing sexual health, related to a lack of education on the topic in their home countries, drove this theme. Participants described how this is an evolving trend because perceptions and conversations around sexual health are becoming more progressive in their home countries. A study examining a group of African immigrant mothers’ perceptions of reproductive health education found an abundance of cultural myths and taboos through qualitative interviews (Agbemenu et al., 2018). In addition, the group studied comprised highly educated participants, like in the current study. A scoping review described the presence of stigmas and taboos surrounding preventive care when it involved sexual health (Omenka et al., 2020). It is important for clinicians to consider cultural stigma that may be present for immigrant women when discussing cervical cancer screening.

In addition, a recurring notion of an individual’s responsibility to manage their health was found throughout themes in the current study. This was particularly prevalent in the themes about the importance of preventive care, education, and ease of healthcare access, with participants stating that they were responsible for managing their own health and navigating the healthcare system. Health as a personal responsibility consisted of individual choices is a sentiment rooted in the American idea of free choice (Hook & Rose Markus, 2020). For an individual to successfully manage the healthcare system, health literacy is essential (Liu et al., 2020). In the current study, the need for trust in providers and ease of access to the healthcare system were important elements in obtaining cervical cancer screening. Although immigrants in the United States may feel they have an individual responsibility to manage their health, this study suggests that additional factors, such as culturally congruent education and community support, are important elements in obtaining cancer screening. The emergence of the notion of individual responsibility for health among immigrants in the United States should be explored in future research.

Limitations

This study had some limitations. First, the study included Black immigrant women from five countries, Ghana, Kenya, Uganda, Jamaica, and Dominica, which may limit the generalizability of findings to immigrants from other countries and regions. A second limitation was that the sample included in this study was highly educated, with 15 participants having a bachelor’s degree or higher. The barriers and facilitators described may not be generalizable to those with lower levels of education. In addition, the initial inclusion criteria limited participation to those who had resided in the United States for at least six months and as many as five years. The maximum time limit (as many as five years) criterion restricted the inclusion of other Black immigrant women who were interested in participating; because of slow recruitment, this criterion was eliminated. Although the rationale for this time criterion was to obtain the perspectives of recently arrived immigrants, the authors realized that obtaining the perspectives of those who had been in the United States longer may have added to the richness of study findings. The findings reported here identify important factors for consideration in increasing access to cervical cancer screening among Black immigrant women in the United States.

Implications for Nursing Practice

The study’s findings have important implications for research and nursing practice. For Black immigrant women, cervical cancer screening is closely linked to perceptions of sexual health. Stigmas surrounding exposure of vaginal areas and genitals associated with sexuality and childbirth deeply shape Black immigrant women’s comfort with Pap testing and, in some cases, may act as a deterrent to screening. Nurses must be aware of these perceptions and take steps to communicate in culturally and socially appropriate ways with their patients to promote the acceptance of and participation in cervical cancer screening. These steps can include additional time for clinical appointments to address concerns prior to procedures, strategic draping of sensitive areas, and availability of Black female clinicians. Efforts to diversify the staff at clinical sites in immigrant communities should be made through recruitment and training practices. Additional research should examine the use and acceptance of HPV self-sampling screening techniques in this population as well as community healthcare workers acting as partners in increasing access among Black immigrants and other racial and ethnic minority populations.

Additional implications for patient education include the need for culturally tailored materials to address these factors, including acknowledgment of stigma and deterrents for this population. Future research should include community-based participatory research designs to partner community organizations and Black immigrant women to best address their needs.

Conclusion

This study points to several attitudes and beliefs that influence Black immigrant women’s experience of obtaining cervical cancer screening. Clinical sites must acknowledge and mitigate the deterrents that exist for Black immigrant women to ensure access to screening for this vulnerable population. Partnering with community organizations to support the ease of healthcare access is a useful strategy to address barriers that Black immigrant women face in obtaining cervical cancer screening.

KNOWLEDGE TRANSLATION.

  • ■ Nurses must communicate with patients in culturally and socially appropriate ways to promote acceptance of and participation in cervical cancer screening.

  • ■ Patient education materials should be culturally tailored to address the deterrents identified in this article, including the negative impact of sexual health perceptions and lack of trust in healthcare providers.

  • ■ Clinical sites should partner with community organizations to promote trust and access to care for Black immigrant women.

Supplementary Information

forum-525-371-suppl.pdf (65.1KB, pdf)

Funding Statement

This research was funded, in part, by a Northeastern University Tier 1 Seed Grant (351242; principal investigator: Gyan).

Footnotes

The authors gratefully acknowledge the community partners who facilitated this study: Jane Kimani, MEd, CHES, LADC1; Emmanuel Owusu, MA; and Rosette Serwanga, MS.

SUPPLEMENTARY MATERIAL AVAILABLE ONLINE: Visit https://bit.ly/45mSNRh to access supplementary material for this article.

This research was funded, in part, by a Northeastern University Tier 1 Seed Grant (351242; principal investigator: Gyan).

Gyan and Wamai contributed to the conceptualization and design. Gyan, Effiong, and Escobar Jones completed the data collection. Gyan and Effiong provided statistical support. Gyan, Dunnack Yackel, and Effiong provided the analysis. All authors contributed to the manuscript preparation.

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