The role of knowledge, language, and insurance in endorsement of cancer screening in women of African origin

October 28, 2015

African immigrants are among the fastest-growing immigrant populations in the US (US Census Bureau, 2010) but cancer research has been scarce in this population (Venters and Gany, 2011). Breast cancer is the leading cause of cancer death in this group (American Cancer Society, 2014). African immigrants and African Americans are similar in the prevalence of certain risk and protective factors (Borrell et al., 2006). However, African immigrants tend to be underrepresented in studies (Borrell et al., 2006Creque et al., 2010Morrison et al., 2012Perkins et al., 2010 and Tsui et al., 2007) and/or lumped together with other populations (Goel et al., 2003Seeff and McKenna, 2003 and Zhao, 2010). Thus, few studies report information specific to this group. The scarce research with African immigrants has shown cancer-related disparities across the cancer control continuum (Creque et al., 2010Goel et al., 2003Morrison et al., 2012Seeff and McKenna, 2003Tsui et al., 2007 and Zhao, 2010). For instance, like African American women, West African women are more likely than Whites to be diagnosed at later stages, with larger tumor sizes, and with triple negative breast cancer (Jemal and Fedewa, 2012 and Stark et al., 2010). Moreover, African immigrants have lower screening rates compared to Non-Hispanic Whites (Morrison et al., 2012) and other immigrant groups (Samuel et al., 2009 and Tsui et al., 2007). Some barriers to screening include access factors (e.g. health insurance), pragmatic constraints (e.g. language difficulties), limited knowledge and awareness, and other psychosocial aspects (e.g. stigma, attributing cancer to fate) (Abdullahi et al., 2009Al-Amoudi et al., 2013Carroll et al., 2007Ehiwe et al., 2013Harcourt et al., 2013Morrison et al., 2012Morrison et al., 2013Ndukwe et al., 2013Odedina et al., 2009Samuel et al., 2009Sheppard et al., 2010 and Wallace et al., 2013).

A few small qualitative studies have highlighted the need for a better understanding of cancer attitudes in African-born women (Al-Amoudi et al., 2013Carroll et al., 2007,Ndukwe et al., 2013 and Sheppard et al., 2010). To date, only small pilots (e.g.,Piwowarczyk et al., 2013 and Samuel et al., 2009) and/or qualitative reports that focus on African immigrant women have been published (Al-Amoudi et al., 2013Carroll et al., 2007Ndukwe et al., 2013 and Sheppard et al., 2010). With the exception of the study byHarcourt et al. (2014), most quantitative studies have been based on chart reviews (Morrison et al., 2012 and Morrison et al., 2013) or survey data (Tsui et al., 2007) that did not include self-reported psychosocial variables. Furthermore, to our knowledge, none of the prior quantitative studies focused on breast cancer knowledge or screening attitudes among African immigrant women; only one intervention has been published to improve breast cancer screening in this population (Piwowarczyk et al., 2013). Thus, there is a need for increased research specifically centered on African immigrants in order to inform intervention approaches. The present report is part of a larger community and academic joint effort to systematically address the cancer control needs of women of African origin in the Washington, DC metro area. The aims of this study were to examine the factors associated with endorsement of cancer screening practices in order to provide community-based organizations with suggestions for intervention strategies and service provision, and to identify areas for more in-depth study.


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