Cervical Cancer Screening

Running Head: CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA Prospectus Knowledge, Attitudes, and Barriers to Cervical Cancer Screening Among Muslim Immigrant Women in Ontario Canada to Assist Policymakers and Healthcare Providers Student Name Doctor of Public Health Walden University A00000000 1 CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 2 Knowledge, Attitudes, and Barriers to Cervical Cancer Screening Among Muslim Immigrant Women in Ontario Canada to Assist Policymakers and Healthcare Providers Problem Statement One of the biggest healthcare problems in modern days is the different types of cancer despite the majority of them having a cure. One of the most problematic cancer is cervical cancer that affects women; there is a high record of deaths despite being a cure upon screening to determine the extent of damage it has inflicted on the body (Vahabi & Lofters,2016). The problem becomes more prominent when it comes to Muslim immigrant women in Ontario, Canada. The reason is that despite Canada showing a significant decline in cases of cervical cancer recently (Lofters et al., 2017), there is still a very high number among (Ferdous et al., 2018) Muslim Immigrants. The most significant contributor to the decrease in cervical cancer among Canadian women is the screening process, especially the Pap tests. Many scholarly types of researches like Lofters et al., (2017), Vahabi & Lofters (2016), and Ferdous et al., (2018), link the high rate of cervical cancer among immigrant women to their religious beliefs and practices It is a big problem, particularly in Ontario Canada where a National Household Survey conducted in 2011 found that there are over 600 000 Muslim women out of around one million and more than 60% of them are foreign-born (Lofters et al., 2017). Lofter et al., (2017) continues to say that the number is very high to ignore because the medical care of this woman is very high for individual families and the state, especially when one considers that it is something that should not be a problem. Additionally, it means that the cases of cervical cancer will continue to be high among the foreign Muslim women in Ontario, Canada if a construct solution is not found. One of the best ways to start to analyze and understand the problem before developing a CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 3 solution is to understand the knowledge of Muslim immigrants on cervical cancer and their attitudes towards it based on their religious beliefs (Ferdous et al., 2018). Purpose of the Study The purpose of the study is to achieve an in-depth understanding of the relationship between Islamic religious beliefs and the screening among immigrant Muslim women to Ontario, Canada. The first step is to determine the knowledge that Muslim women have when it comes to cervical cancer. In other words, how well do the immigrant Muslim women know about cervical cancer? Some of the areas are understanding if they know what cervical cancer is, how it starts, signs and symptoms, the effect on the body, ways to minimize chances of contradicting it, and the available treatments(Lofters et al., 2017). The second phase will be determining the attitude that Muslim women have towards cervical cancer. That is, how do they react when they know that they are experiencing signs and symptoms of cervical cancer or the types of healthcare services available for screening the disease to administer the recommended treatments? Finally, the third step shall determine whether their attitudes towards cervical cancer have a relationship with their religious beliefs and practices. That is, does religious practices and beliefs prevent women from inquiring the cervical cancer screening or does it encourage women to acquire it and how does all this impact the overall cervical cancer cases among the immigrant Muslim women in Ontario, Canada. Significance CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 4 Understanding the impact of religious beliefs towards shaping the knowledge and attitude of immigrant Muslim women in Ontario, Canada (Lofters et al., 2017), is critical for policymakers and healthcare providers. There is a big gap in cervical cancer screening among immigrant Muslim women in Ontario, Canada despite the decrease in cases of cervical cancer in Canada, especially after the introduction of the Pap test(Ferdous et al., 2018). Additionally, there is a possible gap between the knowledge and attitude of immigrant Muslim women with their religious beliefs and practices. Therefore, evaluating the relationship between the knowledge and attitude of Muslim women immigrants to their religious practices and beliefs can help determine the best policies or strategies for policymakers and healthcare providers should establish to fill this gap. Notably, for policymakers, understanding whether religious beliefs and practices have a contribution to the knowledge and attitude of Muslim women is essential (Ferdous et al., 2018). It will help determine the effective ways that they can set policies that will encourage many immigrant Muslim women to inquire about the screenings of Cervical cancer without conflicting with their religious beliefs and practices (Ferdous et al., 2018). For example, if religious beliefs and practices limit the immigrant Muslim women from learning and understanding cervical cancer, there can be a policy that requires them to pass a small lesson of understanding it (Lofters et al., 2017). In the case of healthcare givers, they can get an in-depth understanding of cultural barriers preventing or limiting the immigrant Muslim women from inquiring screening services for cervical cancer in a way that will encourage more women to investigate about the services to gain knowledge about it. CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 5 The research findings can help develop positive social changes in society like changing healthcare policies to improve accessibility and development of healthcare programs. Healthcare policies can change to increase the accessibility of healthcare services like cervical cancer screening among immigrants. Development of healthcare programs will focus on educating and creating awareness regarding healthcare issues like cervical cancer screening awareness. The two social changes can help reduce cervical cancer reports among immigrant Muslims, which is an indication of an increase in quality of life. Background Cervical cancer is a type of cancer that affects the cells of the cervix that starts as a malignant tumor but is preventable through the Pap test screening and the HPV vaccine (Ferdous et al., 2018). Cervical Cancer Screening

Cervical cancer has been a considerable problem in many societies across the world, but after the introduction of the screenings and vaccines, the cases drastically reduced (Lofters et al., 2017). Canada is one country that has benefited greatly in the introduction of screenings because of the reduction in the number of deaths of women having cervical cancer reduced (Lofters et al., 2017). According to Ferdous et al. (2018), the reason is that early screening and detection of cervical cancer while it is at stage A-1 increases the chance of survival from 74% to 93% but the rate decreases to 15% when detected in stage IV-B. Therefore, since the introduction of the screening in Canada in 1960, its popularity and knowledge among women have led to a significant drop in deaths of women due to this cancer. For instance, the mortality rate decreased by 2.8% from 1992 to 2008, and the number has been getting better by the years due to increased spread in screenings of cervical cancer (Ferdous et al., 2018). CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 6 However, the problem is that there are still reports of high cervical cancer among Muslim immigrant women in Canada, specifically Ontario(Lofters et al., 2017). The number of immigrant women screening is deficient compared to other populations, which a big problem is considering that the Canada population is made up of more than 20% of immigrants (Ferdous et al., 2018). In another study by Lofters et al., (2017) says that Ontario, Canada, has over 60% of Muslim immigrant women, that is 600, 000. Despite the high number, reports show that Muslim women receive low screenings of cervical cancer. According to Lofters et al. (2017), found out that the majority of women do not inquire about the Pap tests and HPV vaccines because they believe that they cause either infections or invasion of privacy. The study was consistent with a previously conducted research in Norway where some of the immigrant Muslim women under investigation on dangers of acquiring cancer said that disclosing information of sexual nature was a taboo according to their religious studies (Leinonen et al., 2017). According to research done by Hassan et al., (2011), the big gap is highly contributed by lack of knowledge by healthcare providers and Muslim immigrants due to cultural barriers meaning that healthcare providers lack sufficient understanding of how to deal with immigrants Muslim women which drives them away from inquiring the tests. There is a clear gap between the knowledge and attitude of immigrant Muslim women in terms of cervical cancer. That is why Vahabi & Lofters, (2016) study conclusion was that there is need of increased knowledge of the healthcare system of Canada for immigrants at the entry points, increase cultural sensitivity education for policymakers and healthcare givers, and initiating educational programs to increase knowledge of cervical cancer to the targeted population. All the studies, Vahabi & Lofters, (2016), Lofters et al., (2017), Hassan et al., (2011), and (Leinonen et al., 2017) show that there is a strong link between religious beliefs and CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 7 practices of immigrant women and their knowledge and attitudes towards the screenings and vaccinations of cervical cancer. Cervical Cancer Screening

Framework The above research shows that there is a strong relationship between the knowledge and attitude of immigrant Muslim women and their religious beliefs and practices, which may be the main factor causing a high number of cervical cancer among immigrant Muslim women in Ontario, Canada. Many Muslim immigrants refuse to get screenings and the HPV vaccine because they believe that it is the invention of their privacy, it will cause infection, or it is a taboo. The reason is that they have to share some sexual information in the Pap screenings that allow the detection of cervical cancer and administering appropriate vaccines(Leinonen et al., 2017). Therefore, the focus on the main conclusion to draw is that the main reason why there are many incidents of cervical cancer in immigrant Muslims in Ontario Canada is a lack of knowledge and a negative attitude towards vaccination and screening caused by religious belief. The most effective theoretical framework of this issue is the Health Belief Model (HBM). The HBM has been used extensively in previous researches in cases where people’s belief of HPV and Pep screening is tested. According to the model, a person’s health belief can be explained by how it influences their health actions Champion & Skinner, 2008). Therefore, in the research of immigrant women, their actions of refusing to get vaccinations or getting to understanding the importance of cervical cancer are because of their religious beliefs. The framework will help one get an in-depth understanding of determining whether the immigrant Muslim women’s attitude and knowledge towards cervical cancer vaccinations and screening has a direct relationship with their religious beliefs (Herrmann, Hall, & Proietto, 2018). Cervical Cancer Screening

The HBM CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 8 comprises an essential aspect of this research like a perceived benefit, perceived severity, perceived susceptibility, perceived barriers, and also cues to action which considers sociodemographic variables like religion, sex, age, and ethnicity as well as the income levels and education level as modifying factors for the individual behavior (Herrmann, Hall, & Proietto, 2018). However, the main limitation to consider with this framework is that it does not consider the emotional aspects of a person, which influences their decision concerning their health behaviors (Champion & Skinner, 2008). Problem ❖ Attitudes, knowledge, and barriers to healthcare access associated with cervical cancer screening Research Question ❖ What is the relationship between attitudes, knowledge, and barriers to healthcare among the immigrant women in Ontario, Canada and cervical cancer screenings? Hypothesis ❖ There is a significant relationship between the attitude and knowledge of cervical cancer among immigrant Muslim women in Ontario, Canada. ❖ There is no significance relationship between healthcare accessibility and knowledge with cervical cancer screening among immigrant Muslim women in Ontario, Canada. Nature of the Study CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 9 The study will mix the qualitative and quantitative design but mainly focus on a qualitative casual perspective. The qualitative casual view will focus on explaining whether religious beliefs have effects on the attitude and knowledge of the immigrant Muslim women on cervical cancer to develop the problem statement. For the quantitative aspect of the study, the study will focus on how consistent the cases of cervical cancer are consistent with religious beliefs indicated by variables like taboo, and sexually offensiveness to disclose this information that allows screenings and vaccinations. Together, one will get an in-depth understanding of how and why there are many cases of cervical cancer among immigrant Muslim women. Understanding this concept will make it easy for policymakers and healthcare providers to develop strategies and solutions to overcome this problem in Ontario, Canada. Secondary Data Types and Sources of Information 1. The first stage will be the development of the problem statement of understanding why there are high cases of cervical cancer among immigrant Muslim women in Ontario, Canada. 2. The second process will be determining the different websites and sources of information to help get a better understanding of the problem statement to get a better view of the gap to be filled by the research and its significance. The different articles and projects should focus on the target population, the Muslim immigrant women, who report cases of cervical cancer and their responses to it without limiting the area of interest. 3. The other will be the selection of the target population and putting them under interviews, questionnaires, and survey that focus on determining the relationship between different variables of the research. CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 10 4. Determining how well the information from the two processes aligns with the theoretical framework of the research, Health Belief Model (HBM) and whether it evidence is sufficient to continue developing the research. Limitations and Challenges 1. Cervical Cancer Screening

Ethical challenges- since the case involves religious aspects in healthcare, there is a need to be very sensitive in cases of ethical issues that can make the study invalid or participant to provide critical information. 2. Many factors may influence decision making on the health behaviors of individuals rather than religious factors to consider all of them in one research. CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 11 References Champion, V. L., & Skinner, C. S. (2008). The health belief model. Health behavior and health education: Theory, research, and practice, 4, 45-65. Ferdous, M., Lee, S., Goopy, S., Yang, H., Rumana, N., Abedin, T., & Turin, T. C. (2018). Barriers to cervical cancer screening faced by immigrant women in Canada: a systematic scoping review. BMC women’s health, 18(1), 165. doi:10.1186/s12905-018-0654-5 Hasnain, M., Connell, K. J., Menon, U., & Tranmer, P. A. (2011). Patient-centered care for Muslim women: provider and patient perspectives. Journal of Women’s Health, 20(1), 73-83. Herrmann, A., Hall, A., & Proietto, A. (2018). Using the Health Belief Model to explore why women decide for or against the removal of their ovaries to reduce their risk of developing cancer. BMC women’s health, 18(1), 184. Leinonen, M. K., Campbell, S., Ursin, G., Tropé, A., & Nygård, M. (2017). Barriers to cervical cancer screening faced by immigrants: a registry-based study of 1.4 million women in Norway. The European Journal of Public Health, 27(5), 873-879. Lofters, A. K., Vahabi, M., Kim, E., Ellison, L., Graves, E., & Glazier, R. H. (2017). Cervical Cancer Screening among Women from Muslim-Majority Countries in Ontario, Canada. Cancer Epidemiology and Prevention Biomarkers, 26(10), 1493-1499. CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 12 Lofters, A. K., Vahabi, M., Fardad, M., & Raza, A. (2017). Exploring the acceptability of human papillomavirus self-sampling among Muslim immigrant women. Cancer management and research, 9, 323. Vahabi, M., & Lofters, A. (2016). Muslim immigrant women’s views on cervical cancer screening and HPV self-sampling in Ontario, Canada. BMC Public Health, 16(1), 868. Walden University Doctoral Study Prospectus Guide Doctor of Healthcare Administration Doctor of Public Health What’s New in 2018 The 2018 edition of the Doctor of Healthcare Administration (DHA) / Doctor of Public Health (DrPH) Doctoral Study Prospectus Guide contains additional material to support prospectus development. What has not changed are the basic expectations for the content of the prospectus and how it will be evaluated and approved. Specific new items in this guide include • discussion about research design alignment, • added clarity in the outline annotations, and • updated sample prospectus documents captured in the Historical Alignment Tool (HAT). For internal use only. Walden University Academic Offices 100 Washington Avenue South, Suite 900 Minneapolis, MN 55401 1-800-WALDENU (1-800-925-3368) Walden University is accredited by The Higher Learning Commission, https://www.hlcommission.org. Cervical Cancer Screening

© 2018 Walden University, LLC DHA/DrPH Doctoral Study Prospectus Guide Page i Contents What’s New in 2018 ………………………………………………………………………………………………………… i The Prospectus ……………………………………………………………………………………………………………….. 1 Completing the Prospectus ……………………………………………………………………………………………. 1 Submitting the Prospectus …………………………………………………………………………………………….. 3 My Doctoral Research (MyDR) …………………………………………………………………………………….. 3 An Annotated Outline ……………………………………………………………………………………………………… 4 Quality Indicators……………………………………………………………………………………………………………. 7 Sample Prospectus ………………………………………………………………………………………………………….. 9 Ten Tips for Writing a Quality Prospectus ……………………………………………………………………….. 19 Sample Prospectus in the HAT ……………………………………………………………………………………….. 21 DHA/DrPH Doctoral Study Prospectus Guide Page ii The Prospectus The Do Cervical Cancer Screening