The impact of health literacy, culture and psychological factors on the pap testing behaviors of African immigrant women in the United States
Joycelyn Cudjoe, PhD, RN
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- Nu Beta at-Large
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Background: African immigrant (AI) women have low Pap testing rates. Limited health literacy is a barrier to cancer screening among racial/ethnic minority populations. Sources and types of health information can shape health literacy. However, how health literacy, sources and types of health information along with cultural and psychosocial correlates impact the Pap testing behaviors of AI women remains unknown.
Objective: To examine how sources and types of health information impact health literacy and health information exchange, and in turn, how health literacy, culture and psychosocial (cancer knowledge, self-efficacy, decisional balance, cultural beliefs) factors influence the Pap testing behaviors of AI women.
Methods: Using an explanatory mixed-methods approach, a convenience sample of AI women (N=167) completed study surveys followed by semi-structured, telephone interviews with a purposive sub-sample (n=20) of survey participants. An adapted Health Literacy Skills (HLS) conceptual framework guided the selection of study variables. Qualitative and quantitative data were merged to describe differences and similarities in AI women’s experiences and display of health literacy by different sources and types of health information.
Results: Using multiple sources of health information (adjusted OR [aOR]: 0.11, p<0.01), having negative cultural beliefs (aOR: 0.17, p=0.01) and high self-efficacy (aOR: 9.38, p<0.01) were significantly associated with Pap testing. Healthcare providers (78%), female friends (46%) and internet (45%) were the most common sources of health information used by AI women followed by female relatives (32%), television (22%), social media (17%) and church (16%). Content analysis revealed: Healthcare provider was rated the most credible source; family/friends personal experiences made health information more relatable; church as the least endorsed source. Health information presented verbally (aOR: 5.51, p=0.01) was associated with higherhealth literacy. Most AI women had health information presented in verbal form (80%), with pictures (43%) being the least popular type of health information.
Conclusion: Cultural beliefs play a significant role in shaping AI women’s Pap testing behaviors. Exchanging health information in verbal form could shape health literacy and inform Pap testing among AI women. Using the internet to recruit study participants appears to be a promising strategy to consider for future studies that include African immigrants.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 27726282; ProQuest document ID: 2355986704. The author still retains copyright.
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
|Review Type||None: Degree-based Submission|
|Research Approach||Mixed/Multi Method Research|
|Keywords||African Immigrant Women;
Preventive Health Services;
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