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Facilitators and Barriers to Cervical Cancer Screening Among Chinese Canadian Women

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Abstract

Background: Chinese Canadian women have higher cervical cancer incidence, and lower Pap testing, rates than the general Canadian population. Predisposing, enabling and reinforcing factors associated with ever having a Pap test, and having a recent Pap test within the last 2 years, were assessed in Chinese women in British Columbia using the PRECEDE-PROCEED model.

Method: Chinese women (n=512) between the ages of 20 and 79 years and residing in Greater Vancouver were interviewed about Pap testing, health care, traditional health beliefs, acculturation and sociodemographic characteristics. Two analyses were done, comparing women who had ever and never had a Pap test, and comparing women who had and had not received a recent Pap test. Focus groups and qualitative interviews ensured cultural sensitivity in the survey questionnaire.

Results: Seventy-six percent reported ever having a Pap test and 57% reported having a Pap test within the last 2 years. Traditional health beliefs were not associated with ever or recent Pap testing. However, belief that Pap testing prevented cancer and general knowledge about the Pap test were associated with screening. Concern about pain/discomfort with the test, availability of time, culturally sensitive health care services and recommendation for Pap testing by a physician were also associated with screening. Factors differed for ever, and recently, having a Pap test.

Interpretation: Pap testing is less common among Chinese Canadian women. Continuing education about Pap testing is recommended for physicians serving underscreened Chinese women. Culturally and linguistically appropriate educational materials are needed for the Chinese community.

Résumé

Contexte: La proportion des Canadiennes d’origine chinoise qui se soumettent au test de Papanicolaou est plus faible, et les taux d’incidence du cancer du col de l’utérus sont plus élevés que dans la population canadienne en général. Nous avons utilisé le modèle PRECEDE/PROCEED pour évaluer la relation entre les facteurs de prédisposition, d’incitation et de renforcement et le fait d’avoir ou de ne pas avoir subi un test de Papanicolaou au cours des deux dernières années, chez les Canadiennes d’origine chinoise de la Colombie-Britannique.

Méthode: Nous avons mené des entrevues auprès de femmes d’origine chinoise (n=512) âgées de 20 à 79 ans qui habitent la région métropolitaine de Vancouver. Les questions ont porté sur le test de Papanicolaou, les soins de santé, les croyances traditionnelles en matière de santé, l’acculturation et les caractéristiques socio-démographiques. Nous avons ensuite établi une première comparaison entre les femmes qui ont déjà subi un test de Papanicolaou et celles qui ne l’ont jamais subi, et une deuxième entre celles qui ont ou qui n’ont pas subi le test récemment. Des groupes échantillons et des entretiens en profondeur ont permis de s’assurer que le questionnaire d’enquête prenait en compte les réalités culturelles.

Résultats: Parmi les femmes interrogées, 76 % ont déclaré n’avoir jamais subi un test de Papanicolaou et 57 % ont affirmé avoir subi le test au cours des deux dernières années. Nous n’avons pas établi de lien entre les croyances traditionnelles en matière de santé et le fait d’avoir ou de ne pas avoir subi un test de Papanicolaou. Cependant, nous avons pu établir une relation entre le dépistage et la connaissance générale du test de Papanicolaou et le fait de croire qu’il peut prévenir le cancer. Les préoccupations concernant la douleur causée par le test ou l’inconfort, le temps disponible, les services de santé culturellement adaptés et le fait d’être incitée à se soumettre au test de Papanicolaou par un médecin ont également été associés au dépistage. Les facteurs diffèrent dans le cas des femmes qui n’ont jamais subi un test de Papanicolaou ou de celles qui l’ont subi récemment.

Interprétation: Le test de Papanicolaou est une pratique moins courante chez les Canadiennes d’origine chinoise. Les médecins qui sont en contact avec des femmes d’origine chinoise qui ne se soumettent pas au test de dépistage devraient recevoir une formation continue sur le test de Papanicolaou. La communauté chinoise devrait avoir à sa disposition des documents éducatifs adaptés sur le plan culturel et linguistique.

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Author information

Authors and Affiliations

  1. Population and Preventive Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada

    T. G. Hislop & C. Teh

  2. Cancer Control Research Program, BC Cancer Agency, Canada

    T. G. Hislop & C. Teh

  3. Direction de la Santé Publique Montréal-Centre, Québec, Canada

    M. Deschamps

  4. Department of Medicine, University of Washington, Seattle, WA, Canada

    C. Jackson & S.-P. Tu

  5. International Medicine Clinic, Harborview Medical Center, Seattle, Canada

    C. Jackson & S.-P. Tu

  6. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Canada

    S. M. Schwartz, A. Kuniyuki, Y. Yasui & V. Taylor

  7. Department of Epidemiology, University of Washington, Canada

    S. M. Schwartz

  8. Department of Health Services, University of Washington, Canada

    V. Taylor

Authors
  1. T. G. Hislop
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  2. C. Jackson
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  3. S. M. Schwartz
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  4. M. Deschamps
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  5. S.-P. Tu
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  6. A. Kuniyuki
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  7. C. Teh
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  8. Y. Yasui
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  9. V. Taylor
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Corresponding author

Correspondence to T. G. Hislop.

Additional information

Acknowledgements: This work was supported by the US National Cancer Institute (Grant #74326 and Cooperative Agreement #86322) and the British Columbia Health Research Foundation (Grant #180(96-2)).

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Hislop, T.G., Jackson, C., Schwartz, S.M. et al. Facilitators and Barriers to Cervical Cancer Screening Among Chinese Canadian Women. Can J Public Health 94, 68–73 (2003). https://doi.org/10.1007/BF03405056

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