Cultural Barriers Affecting Cervical Cancer Screening
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Cultural Barriers Affecting Cervical Cancer Screening
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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 Healthcare Providers Student Name Doctor of Public Health Walden University 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 Healthcare Providers Problem Statement There was a significant drop in the record of women who have cervical cancer in Canada after the introduction of a screening that helps to detect this type of cancer early and cure it before it causes adverse effects to a person (Ferdous et al., 2018). However, despite the decrease, immigrant Muslim women still record-high rates of cervical cancer. In a survey done by the National Household Survey in 2011 reported that over 600, 000 out of 1,000, 000 cases of cervical cancer is the Muslim women in Ontario (Lofters et al., 2017). The author continues to say that 60% of the 600, 000 women are foreign-born (Lofters et al., 2017). In another research by the Institute for Clinical Evaluate Sciences (ICES) between 2012 and 2015 found that 47% of the 761, 019 Muslim women in Ontario were overdue in their Pap test. Pap test is a cervical cancer screening procedure done to detect whether there are cancer cells capable of making a woman develop cervical cancer (ICES, 2017). Another study conducted by Bacal et al., (2019) focused on determining whether the immigrant status has an impact on the low cancer screening among immigrant Muslim women. Lofters et al., (2017) says that the reason why many immigrant Muslim women refuse to take the cancer screening tests is related to religious beliefs. In another study conducted by Lofters et al., (2017) shows that healthcare accessibility and lack of-up-date information regarding cervical cancer screening in Muslim majority countries has an impact on the rate of screening uptake. However, recent research has indicated that the attitude, knowledge, and access to healthcare services like cervical cancer screening can impact health accessibility decisions of individuals and healthcare practitioners (Rajah, Hassali, CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 3 & Lim, 2017). Cultural Barriers Affecting Cervical Cancer Screening
Another study conducted by Humphries et al., (2019) and Rajah, Hassali, & Lim (2017) found out that healthcare practitioners attitude, knowledge, and barriers to healthcare care services had an impact on health outcomes of patients in India. One of the critical areas that have helped overcome a high record of health-related problems is determining whether healthcare practitioners play a role in the problem because they are the ones that interact with patients directly and offer healthcare services (Tatar et al., 2019). Purpose of the Study The main objective of the study is enhancing the understanding why the low rates of cervical cancer screening among immigrant Muslim women in Ontario are because of the attitude, knowledge, and barriers to healthcare delivery among healthcare practitioners. The study will apply the mixed method design but primarily focusing on the qualitative phenomenological approach. The study will collect data through the use of questionnaires, interviews, and online database reports to provide in-depth understanding how healthcare providers can develop strategies of helping increase the rates of cervical cancer screening among the immigrant Muslim women. Significance The study will fill the gap in the low rates of cervical cancer screening among immigrant Muslim women living in Ontario, Canada. The research is unique because it focuses on an area that has not been exploited in explanation of why there is a very low record of cervical cancer screening among immigrant Muslim women (Lofters et al., 2017), especially since they make up almost 20% of Canada’s entire population (Ferdous et al., 2018). The result of the study will CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 4 provide comprehensive insight into the impact that healthcare provides have in providing a quality healthcare service. The results should provide sufficient information that will enable healthcare practitioners to develop better strategies that will improve the quality of their services, especially among immigrant Muslim women. Healthcare providers will find better ways of delivering cancer screening services to immigrant Muslim women in a way that encourages immigrant women to take screening tests. Policymakers can use the information to help improve cultural competence, flexibility, and adaptability skills among healthcare service practitioners. Policymakers can also make decisions on how to modify or develop new policies that will facilitate unbiased healthcare delivery, the continuous learning process in healthcare services, and the desire for delivering quality healthcare services. Healthcare faces many issues that forces constant changes while providing high-quality services to patients. Therefore, determining how their attitudes, knowledge, and barriers to cancer screening among immigrant Muslim women will help understand the importance of healthcare service practitioners to adapt or acquire the critical skills that will ensure continuous delivery of healthcare services to all patients. Cultural Barriers Affecting Cervical Cancer Screening
The immigrant Muslim women will also benefit by receiving quality cervical cancer screenings that do not raise a concern and development of positive attitudes towards acquiring other healthcare services. It will even encourage other immigrant Muslim women to obtain the cervical cancer screening. 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 has been a considerable problem in many societies across the CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 5 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). 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 very low 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 CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 6 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 screenings. 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 practices of immigrant women and their knowledge and attitudes towards the screenings and vaccinations of cervical cancer. Framework The theoretical framework of the study will be Wagner’s Chronic Care Model (1998) is a population-based approach that facilitates quality care for patients with chronic illnesses in primary care settings. The model has been associated with improvement on health outcomes among a target population. The model examines the relationship between the community and healthcare systems that may impact the quality of care or access to quality healthcare. The community aspects focus on the availability of resources and policies that will improve self management among patients. The healthcare systems focus on the organization of healthcare like the decision support, delivery systems designs, and clinical information systems (Wagner, 1998). Since the theoretical framework will provide substantial details of how healthcare systems CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 7 settings affect the relationship of healthcare practitioners and patients, it will provide sufficient details regarding the impact of healthcare practitioners’ attitudes, knowledge, and experience affect delivering of quality healthcare since they are part of the healthcare system. Since the model focuses on identifying elements that can help improve patient outcome finding whether the attitude, knowledge, and barriers to cervical screenings will help understand the approaches that healthcare practitioners should adapt to help change the perspectives and attitudes of the immigrant Muslim women on cervical cancer screenings and treatment. Additionally, the model provides a guideline of how to initiate the needed changes causing gaps in quality health delivery services and strategies of helping overcome the gaps. Research Question Cultural Barriers Affecting Cervical Cancer Screening
❖ For the test of health specialist competencies and skills in cervical cancer screening delivery, what are their level of understanding, their attitudes, and knowledge in the provision of the screening services to the immigrant Muslim women? ❖ Based on the low rates of cervical cancer treatments among the immigrant Muslim women as compared to the native Canadians in Ontario, determining how healthcare provider’s attitude, knowledge, and barriers to cervical cancer screening affect the decisions of acquiring the tests or treatment? Hypothesis ❖ The healthcare delivery attitude, knowledge, and barriers to cervical cancer screening among immigrant Muslim women have an impact on the high rate of cervical cancer reports among this group. CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 8 ❖ The health providers where the immigrant Muslim women are located have a negative attitude and insufficient skills in effectively administering cervical cancer screening and treatment. Nature of the Study The study will utilize mixed methods, primarily the qualitative approach. The qualitative approach will focus on examining if there is a significant relationship between low cervical cancer screening and the attitude, knowledge of the healthcare providers in Ontario, Canada, which is the primary focus of the study. The quantitative approach of the study will focus on a statistical analysis of the cervical cancer screening reports amongst immigrant Muslim women in different regions of Canada to determine if there is a significant difference in the reports based on the quality of services, health provider attitude, and knowledge. Finally, I will examine how attitude and knowledge in the quality healthcare delivery shape the perspective of the immigrant Muslim women in acquiring healthcare services. 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. Cultural Barriers Affecting Cervical Cancer Screening
The different articles and projects should focus on the target population, the Muslim immigrant women and healthcare providers, CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 9 who report cases of cervical cancer and their responses to it without limiting the area of interest. 3. The next step 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. 4. Researching and analyzing how the theoretical framework aligns with the study and how their outcome will impact the quality of healthcare delivery among the targeted population. Limitations and Challenges 1. 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 the attitude and knowledge of cervical cancer screening of healthcare providers like religious, economic capability, and health choice behaviors of individuals among many others. CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 10 References Bacal, V., Blinder, H., Momoli, F., Wu, K. Y., & McFaul, S. (2019). Is Immigrant Status Associated With Cervical Cancer Screening Among Women in Canada? Results From a Cross-Sectional Study. Journal of Obstetrics and Gynaecology Canada, 41(6), 824-831. Ferdous, M., Lee, S., Goopy, S., Yang, H., Rumana, N., Abedin, T., & Turin, T. C. (2018). Cultural Barriers Affecting Cervical Cancer Screening
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), 7383. Humphries, C., Jaganathan, S., Panniyammakal, J., Singh, S. K., Goenka, S., Dorairaj, P., … & Manaseki-Holland, S. (2019). Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study. BMJ Open, 9(11). Institute for Clinical Evaluative Sciences (ICES). (2017). Researchers examine whether religion influences the rates of cervical cancer screening. Retrieved from https://www.ices.on.ca/Newsroom/News-Releases/2017/Researchers-examine-whetherreligion-influences-rates-of-cervical-cancer-screening CERVICAL CANCER SCREENING AMONG MUSLIM WOMEN IN CANADA 11 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. 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. Rajah, R., Hassali, M. A., & Lim, C. J. (2017). Health literacy-related knowledge, attitude, and perceived barriers: a cross-sectional study among physicians, pharmacists, and nurses in public hospitals of Penang, Malaysia. Frontiers in public health, 5, 281. Tatar, O., Wade, K., McBride, E., Thompson, E., Head, K. J., Perez, S., … & Rosberger, Z. (2019). Are Health Care Professionals Prepared to Implement Human Papillomavirus Testing? A Review of Psychosocial Determinants of Human Papillomavirus Test Acceptability in Primary Cervical Cancer Screening. Journal of Women’s Health. 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. Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1(1):2-4. Running head: PAP TESTING AMONG MUSLIM WOMEN IN CANADA Dissertation Prospectus Knowledge, Attitudes, and System Barriers that Influence Pap Testing Among Muslim Immigrant Women in Ontario, Canada Layal Mansour Doctor of Public Health Walden University 1 PAP TESTING AMONG MUSLIM WOMEN IN CANADA 2 Knowledge, Attitudes, and Barriers that Influence Pap Testing Among Muslim Immigrant Women in Ontario, Canada Problem Statement Cervical cancer (CC) is a high-burden international health issue with an approximated incidence of 528,000 and mortality of 266,000 globally in 2012 (Johnson, Armstrong, Joyce, Teitelman, & Buttenheim, 2018). Cultural Barriers Affecting Cervical Cancer Screening
Padela, Peek, Johnson-Agbakwu, Hosseinian, and Curlin (2014) presume that immigration status, racial and ethnic affiliation influence the patterns of pap testing. While developed worlds like Canada have achieved a significant decrease in the burden of the disease following Pap smear programs (Ferdous et al., 2018), immigrant Muslim women still record-high rates of the disease. Lofters et al. (2017) presume that the probability of screening CC among immigrant women is minimal, part of which is influenced by religion. A survey done by the “National Household Survey” in 2011 reported that over 600, 000 out of 1,000, 000 cases of CC is the Muslim women in Ontario (Lofters et al., 2017). The author continues to say that 60% of the 600, 000 women are foreign-born (Lofters et al., 2017). Another investigation by the “Institute for Clinical Evaluate Sciences” (ICES) between 2012 and 2015 found that 47 percent of the 761, 019 Muslim women in Ontario were overdue in their Pap test. Pap test is a CC screening procedure done to detect whether there are cancer cells capable of making a woman develop CC (ICES, 2017). Cultural Barriers Affecting Cervical Cancer Screening
Another study conducted by Bacal et al., (2019) focused on determining whether the immigrant status has an impact on the low CC screening among immigrant Muslim women. Lofters et al., (2017) says that the reason why many immigrant Muslim women refuse to take the cancer screening tests is related to religious outlooks. PAP TESTING AMONG MUSLIM WOMEN IN CANADA 2 According to Lofters et al. (2017), healthcare accessibility and insufficient up-to-date information regarding CC screening in Muslim majority countries have an impact on the rate of screening uptake. In an investigation carried out in the US, Padela, Peek, Johnson-Agbakwu, Hosseinian, and Curlin, … Cultural Barriers Affecting Cervical Cancer Screening