Table 2.

Barriers to utilization of breast and cervical cancer preventative and treatment services in African-born immigrants.^a

CLASSIFICATION	PROBLEM	POTENTIAL SOLUTION(S)
Socioeconomic
Poverty/lack of resources	Legal status is a major determinant of immigrants’ access to social services and jobs with benefits Difficulty coordinating travel to appointments	Gateway programs upon entering the U.S. to navigate legal system Increase resources/social programming available to immigrants
Lack of insurance/economic support	Immigrants have lower rates of health insurance coverage than U.S.-born populations; some differences based on immigration status, time in the U.S., and country of origin	Increase awareness of health programming and free screening/healthcare opportunities in communities
Access to healthcare and treatment bias	Lack of knowledge about navigating the health system	Community liaisons within healthcare system
Cultural
Practices/beliefs (religious, spiritual or other)	Limited number of providers who were familiar with their cultural beliefs and/or practices; lack of open communication about cancer in communities	Cultural competency training in public facilities; CME programs for clinical staff; provider pairing or immigrant-health designated providers; Social workers available; support groups and community-based education programs
Gender-based concerns	Issues of modesty Social standing in households; beliefs of husbands/males about cancer/women’s health issues	Female practitioner provision Education of male community leaders; male community health workers providing education to other males
Education/health literacy
Differences in health knowledge and practice	Only visit healthcare provider when symptoms are present; cancer as a curse	Community health educators from communities; support groups
Language barriers	Limited materials in their native language; interpreters unavailable or with limited medical knowledge	Increase resources that are culturally and linguistically sensitive; increase pool of certified interpreters and ensure medical interpretive skills
Level of education	Overall, immigrants are less likely than U.S.-born populations to have graduated from high school; although variations exist	Offer educational services through community and use easy-to-understand language and educational materials
Psychosocial
Migration and immigration experiences including acculturative stress	Competing priorities (work, school, family)	Social work and other support programs; evening/weekend medical services
Mistrust and other attitudes	Issues of privacy Issues related to trauma or assault	Mental health services available with specific competencies in immigrant health concerns
Perceived discrimination	Distrust of physicians and government facilities	Community liaisons for healthcare system

Note:

^aBased on extrapolated themes from studies utilized within this commentary.