Cervical cancer screening among ethnically diverse black women: knowledge, attitudes, beliefs, and practices

This is a descriptive study of cervical cancer screening knowledge, attitudes, beliefs, and practices among ethnically diverse black women. We conducted 6 focus groups with Haitian, African, English-speaking Caribbean, and African American women recruited from a federally qualified health center. Overall, there was limited knowledge and confusion across ethnic groups about cervical cancer and its risk factors, the Pap test, and the human papilloma virus (HPV) and its association with cervical cancer. At the same time, there were distinct differences between ethnic groups in knowledge, practices, and cultural beliefs about cervical cancer. African women knew the least among all the groups, while African American participants had the greatest knowledge of HPV. However, their knowledge was still limited. Patient-doctor relationship was the single most important facilitator for cervical cancer screening. Barriers to cervical cancer screening included cost, busy work schedule, fear of the unknown, lack of insurance or being unemployed, and fear of disclosing immigration status. Interventions with ethnically diverse black women would benefit from recognizing cultural barriers and misconceptions that vary by ethnic group. Culturally based strategies suggested by the focus groups include the use of existing social networks, the use of indigenous community-based health workers, and the inclusion of women of all ages in cervical cancer education because of the roles they have in extended families.