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An overview of the historical cultural structural and critical factors on breast cancer among south

Open in a separate window Barriers to breast and cervical cancer screening The key informants discussed a number of unique barriers faced by Muslim women to obtaining breast and cervical cancer screening. These various barriers fell into two broad categories: Most commented that a lack of translated information and access to native speaking healthcare providers were significant barriers. Another common barrier participants mentioned was insurance and cost, explaining that usually Muslim women did not have insurance which meant they were not getting the screenings.

Participants also noted that immigration status was often a barrier for many women as they may not seek screenings because of a fear of deportation. Immigration status was also related to having a limited social network to draw upon to get assistance or guidance in obtaining health screenings. In addition to structural barriers, key informants also discussed a number of socio-cultural barriers that prevented Muslim women from seeking or receiving breast and cervical cancer screening.

Nearly all of the participants indicated that many women do not get breast and cervical cancer screening because they do not think it is necessary for their health. Many come from countries where regular screenings do not take place, and thus they were not exposed to the concept of preventive health in their home country. Informants reported that women do not go to the doctor unless they are ill, so preventive health care such as screening seems unnecessary.

Several of the key informants also reported that fatalism was common among Muslim women. Most key informants also noted that socio-cultural gender norms regarding the female role were a barrier. Because of this, many Muslim women delay or do not seek preventive health care services such as breast and cervical cancer screening: They delay the test like a mammogram or Pap smear because of other obligations.

It is not something that the culture enforces but is expected. There is not as much stigma around breast cancer. There is a stigma in women putting themselves first. Because screening requires exposing sensitive areas of the body, Muslim women are embarrassed talking about or engaging in screening tests.

Because of this, many Muslim women will wait to get the screening until it gets to an advanced stage, when treatment may be more complicated [ 36 ]. For cervical cancer in particular, key informants reported stigma as a barrier to getting a Pap smear. They noted that Muslim women attribute cervical cancer to bad behaviors, so they do not believe that they need to get screened because they have not engaged in those behaviors.

Their partner is not monogamous, they get HPV, and then cervical cancer so they associate it cervical cancer with bad habits. Key informants also reported gender of healthcare providers was a barrier in breast and cervical cancer screening for Muslim women. Specifically, if Muslim women do not have a female provider, they will not go for care.

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Strategies to increase breast and cervical cancer screening in the Muslim population Informants also provided important insight into potential approaches to a tailoring health communication campaign to increase breast and cervical cancer screening among Muslim women Table 3. Given the barriers of lack of knowledge and language reported by key informants, most thought these two elements were necessary components in a tailored health campaign.

A health campaign for this population also had to be translated in different languages. In fact, participants thought it was more important to have language-specific over racial- or ethnic-specific materials. Beyond language, all participants agreed that the way a health education campaign is presented is integral to its success. In particular, participants had specific ideas on who presents the message and where the message is disseminated.

It the campaign would not be as effective with new faces because with new faces comes fear. Islam stresses the importance of personal health, and key informants stated this as a facilitator for screening.

  • Informants reported that women do not go to the doctor unless they are ill, so preventive health care such as screening seems unnecessary;
  • From a structural perspective, geographic distance to treatment clinics accounted for the high prevalence of untreated cancer;
  • Second, although a varied group of health care providers, religious leaders and community advocates that serve the Muslim community was interviewed, the study results are limited by the sample size;
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  • A few key informants stated that dissemination of a health campaign on breast and cervical cancer screening would be particularly effective during Friday prayer at mosques due to the higher rates of women attending mosques on that day.

As such, informants stressed that Islamic religious messages encourage women to get screenings as part of their efforts to stay healthy. Tailored health campaigns for Muslim women could build upon these core religious norms when explaining the importance and health promotion benefits of breast and cervical cancer screening.

Similar to religion being a facilitator to breast and cervical cancer screening, key informants also thought faith-based settings could be an important resource when disseminating information about breast and cervical cancer screening in the Muslim community.

  • There is a stigma in women putting themselves first;
  • This dissatisfaction with the way that health care is structured lead many participants to suggest a separate clinic for young people and was one of the critical suggestions put forward by Holmes et al;
  • Although the key informants were from diverse ethnic and professional backgrounds, they consistently identified the need to address both socio-cultural and structural barriers to breast and cervical cancer screening in the Muslim population.

All of the participants cited mosques as effective sites for dissemination of a health campaign. A few key informants stated that dissemination of a health campaign on breast and cervical cancer screening would be particularly effective during Friday prayer at mosques due to the higher rates of women attending mosques on that day.

Participants also thought that the effectiveness of the campaign would be strengthened if certain key stakeholders were engaged, particularly imams, female leaders within mosques and healthcare providers.

Almost all key informants thought female leaders in the mosques should be utilized in a health campaign about breast and cervical cancer. Some even thought they would be more effective than imams because women may be hesitant about talking to an imam about breast and cervical cancer.

Not the imam, but female leaders can bring up the topic of breast and cervical cancer. Other venues that key informants thought would be particularly effective for a breast and cervical cancer screening campaign for Muslim women were ethnic media and community based organizations and associations.

Although ethnic-specific campaigns were not deemed necessary for the Muslim community, most of the participants did note that ethnic media, including ethnic newspapers, radio, and TV shows, would be an effective vehicle for dissemination. TV shows would be good too.

  • Almost all key informants thought female leaders in the mosques should be utilized in a health campaign about breast and cervical cancer;
  • These agents target critical processes for cell division in rapidly in the setting of breast cancer cancer chemotherapy is a major component of;
  • Because of this, many Muslim women delay or do not seek preventive health care services such as breast and cervical cancer screening;
  • Furthermore McMichael et al;
  • By examining the interrelated historical, cultural, structural and critical factors impacting on society, we are able to better understand the inequitable distribution of health and seek to improve upon the society in which we live;
  • These agents target critical processes for cell division in rapidly in the setting of breast cancer cancer chemotherapy is a major component of.

Other community venues such as community based organizations and ethnic associations were also cited as effective locations for health campaign dissemination. Discussion Based on our literature review, this is the first study to report on barriers and facilitators of breast and cervical cancer screening among Muslim women in NYC, where the majority of Muslims in the US reside.

An overview of the historical cultural structural and critical factors on breast cancer among south

Through the use of qualitative and community-engaged approaches, the current study provides important information that will guide development of breast and cervical cancer control initiatives among the Muslim population. Although the key informants were from diverse ethnic and professional backgrounds, they consistently identified the need to address both socio-cultural and structural barriers to breast and cervical cancer screening in the Muslim population.

Key informants particularly emphasized the need to address the lack of knowledge about preventive care, language barriers, and gender roles. The importance of leveraging faith-both beliefs and support structures- was emphasized by the key informants as a means of enhancing the dissemination and promotion of breast and cervical cancer screening for Muslim women.

Importantly, our study highlights the distinct roles that gender, cultural, and religious norms play in health beliefs and practices. This is an especially important consideration in working with the Muslim population, given its cultural diversity. There are several limitations to this study. Generalizability may be limited due to the focus on key informants in NYC, which may be a unique setting compared to other areas in the US with high concentrations of Muslims.

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Second, although a varied group of health care providers, religious leaders and community advocates that serve the Muslim community was interviewed, the study results are limited by the sample size. There are only a few studies that have elicited responses from key stakeholders working with this community, particularly related to the development of health campaigns. Following the principles of CBPR, findings from the key informant interviews have been reviewed and interpreted by community partners and will be used to guide the further work with this community.

Future phases of this initiative will need to involve in-depth interviews with Muslim women concerning their beliefs and attitudes on breast and cervical cancer screening to further inform the development of a health campaign to increase knowledge and receipt of screening among this population.

Given the growth of the Muslim population in the US and evidence which suggests religious beliefs impact breast and cervical cancer screening, CBPR studies that engage diverse stakeholders in the Muslim community such as MARHABA are essential to understanding the barriers and facilitators to breast and cervical cancer screening in this population and to the development of culturally and religiously tailored interventions and messaging to increase screening for these cancers [ 37 ].

Additionally, this study would not be possible without the support, time, and expertise of our two Community Health Workers, Gulnahar Alam and Ramatu Ahmed, and other study staff including our interns Mahreen Kazmi and Rahma Mkuu.

The investigators are also especially grateful to all of the community members who participated in the study including Women Conquering Cancer, Women in Islam, Turning Point, Adhunika, and Council of African Imams.