Talk and Backtalk: Negotiating Cervical Cancer Screening Among Appalachian Women in West Virginia

Abstract

Cervical cancer, once a major killer of women, still remains a quiet threat to the lives of discreet populations within the United States. Women living in Appalachia are among those most vulnerable to this disease primarily due to lack of participation in screening programs. Despite efforts of government subsidized programs to educate, enroll and provide screening facilities throughout high-risk areas, unacceptable rates of inadequately screened women persist. Little is known about the reasons Appalachian women do not seek screening. The literature identifies sociodemographic data related to screening, and suggests that healthcare providers play a significant role in women's participation in screening programs. Little attention has been directed toward culturally-constructed attitudes and beliefs that influence a woman's decision to be screened, or how the interface between woman and provider affects screening behavior.

This study utilized focused ethnography grounded in a feminist framework to uncover sociocultural themes influencing Appalachian women's attitudes, beliefs, and behaviors related to cervical cancer screening. Formal interviews with seven healthcare providers, 12 regularly screened women, and 10 rarely or never screened women were conducted in southern West Virginia over a three month period. Additional data were collected from informal interviews and conversations, community observations, and relevant artifacts. Three central cultural themes emerged: (1) perception of role; (2) talk; and (3) backtalk. Women's perception of their primary social roles influenced the priority they placed upon their healthcare. Providers' perceptions of their role shaped their likelihood to value the woman as a patient, and provide sensitive and respectful care. Communication ( talk) conveyed information and attitudes about cervical cancer and screening between women, and could motivate or deter screening participation. Dialogue between women and providers permitted the bi-directional exchange of health-related information, conveyed care and comfort, and allowed for the development of mutually constructed health goals. Without dialogue in the clinical encounter, women disengaged from care, and negatively influenced other women toward screening through backtalk.

The results of this study will be useful to providers and advocacy groups in the creation of a gender-appropriate and culturally-congruent framework needed to address the existing disparity related to cervical cancer in Appalachia.