Background: Latinas are disproportionately burdened with cervical cancer, with mortality rates 50% higher for Latinas than non-Latina whites, largely due to differences in screening rates. Particular Latino subgroups, such as those from migrant farmworker backgrounds, have less access to health services and lower education than other subgroups. In this study, we report survey findings examining knowledge, beliefs and perceptions about causes of cervical cancer and barriers related to use of the Pap test among Mexican farmworker women in South Georgia.
Methods: We employed cultural consensus analysis methods to calculate the level of shared knowledge among a convenience sample of 40 Mexican immigrant women (20 women who have been living in the U.S. >10 years; 20 women who have been living in the U.S. ≤10 years) who had not received a Pap test in over 2 years. In a previous study using free lists, we identified 15 causes of cervical cancer and 15 barriers to screening among Latino immigrant populations. We used several types of questions to assess consensus regarding understanding of 15 causes of cervical cancer and 15 barriers to completing the Pap test. For the causes, we asked participants to rank the severity of the items, sort them into no more than four piles, and label each pile. For the barriers, we asked participants to sort them into piles only and label each pile. This methodology allows for the direct measurement of inter-participant agreement regarding the structure and organization of the knowledge domain and the calculation of both individual estimates of cultural competency and the average level of competency for the group on the knowledge domain. We used UCINET to analyze the rank data and Visual Anthropac to analyze the pile sort data to assess the level of cultural model sharing and to visualize categories using multidimensional scaling and cluster analysis.
Results: There was consensus among respondents for the rank order of causes of cervical cancer (Eigenratio = 4.9). Out of the 15 culturally identified causes of cervical cancer, the top five were multiple sex partners, HPV, HIV, lack of a regular Pap test, and sexual relations before 16 years of age. When respondents completed the 15 item pile sort for causes, there was also consensus (Eigenratio = 7.4). Using cluster analysis, the items formed 5 clusters: (1) family history, destiny; (2) chemicals in food, poor diet, smoking; (3) birth control pills, abortion, multiple pregnancies; (4) not using condoms, poor hygiene; and (5) multiple sex partners, sexual relations before age 16, HPV, HIV, not getting a regular Pap test. When respondents completed the 15 item pile sort for reasons not to get the Pap test, there was very high consensus (Eigenratio = 14.2). Using cluster analysis, the 5 clusters were: (1) knowledge (do not know the purpose, do not know the cost, do not know where to get it, lack of knowledge about the test), (2) fear (fear of positive results, fear of the exam, wait for symptoms to appear), (3) social and environmental constraints (too expensive, no insurance, no transportation, do not know English); (4) do not have a regular doctor in U.S. and prefer to use services in Mexico; and (5) not convenient and my husband won't let me go.
Conclusions: There was cultural consensus for all three methods among the respondents irrespective of length of time residing in the U.S. There remains possible confusion between HIV and HPV, since these items were sorted into the same piles and ranked high for cervical cancer risk factors. The aggregate findings suggest that cultural models for causes and barriers persist throughout the immigrant's acculturation process in the U.S. According to this study, barriers to screening encountered constituted a shared cultural domain despite varying time residing in the U.S.
Citation Format: John S. Luque, Jonathan Maupin, Yelena Tarasenko, Moya Alfonso, Lisa Watson, Claudia Reyes-Garcia. Causes and barriers associated with the Pap test among Latina farmworkers in Georgia. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A53. doi:10.1158/1538-7755.DISP13-A53