In sub-Saharan Africa, cervical cancer is the leading cause of cancer related death, with 68,000 new cases detected each year, and a high percentage remaining undiagnosed. In the United States (U.S), an introduction of the Papanicolaou (Pap) test, a low-cost early detection procedure, has resulted in a significant decrease in the incidence of cervical cancer. However, African immigrant women (AIW), a fast-growing immigrant population in the US, face a disproportionate burden of disease, and their worse cancer outcomes have been attributed to low Pap testing. Studies of other immigrant groups such as Asians and Hispanics, have shown that limited health literacy, the degree to which individuals have the capacity to obtain, process and understand basic health information and services to make appropriate health decisions, is associated with poor cancer screening. However, there is a dearth of research on how this phenomenon presents among AIW, and the pathways by which health literacy impacts Pap testing are unclear. Within the African cultural context, informal communication methods are used to disseminate women?s health information, and may play a crucial role in influencing health literacy. Therefore, sources (family/relatives, friends, ethnic church, TV/Radio, internet, social media, physician) and types (verbal, written text, pictures) of health information exchange are suggested as possible mechanism by which health literacy is influenced and health behavior such as Pap testing are adopted. The purpose of this mixed methods study is to understand how sources and types of health information impact health literacy and ultimately, Pap testing behaviors among AIW in the US. The study will address these specific aims: (1) Examine the relationships of the number of sources and types of health information with the level of health literacy among AIW; (2) Examine the mechanism through which sources and types of health information and health literacy impact Pap testing behaviors among AIW; (3) Explore how sources of health information influence AIW Pap testing behaviors and how they seek health information using open-ended interviews; (4) Describe how sources/types of health information impact health literacy and information sharing to guide Pap testing. The project is guided by an adapted Health Literacy Skills framework, a conceptual model which addresses the determinants of health literacy, and the relationship between health literacy and Pap testing. A comprehensive and disease specific instrument validated in immigrant populations will be the primary measure of health literacy. This study is aligned with the NCI strategic mission to improve health outcomes among minority populations. This training plan will begin a program of research to understand the complex interaction among health literacy, culture, and psychosocial determinants of Pap testing. This study will inform the development of culturally tailored interventions to promote Pap testing to help decrease the burden of cervical cancer and cancer disparities among underserved African immigrant women.
Limited health literacy is a major barrier to cancer prevention behaviors?particularly among underserved racial/ethnic minority populations such as African immigrant women. Among African immigrant women, cancer is diagnosed at a significantly later stage, and they are also among the least likely ethnic/racial groups to receive cervical cancer screening compared to African Americans, Asian and Hispanic immigrants. This proposed study seeks to understand how sources and types of health information exchange impacts health literacy, and how health literacy influences Pap testing behaviors among AIW living in the US.
