Understanding barriers to cervical cancer screening and acceptability of HPV self-sampling among immigrant women in Spain: a mixed-methods study

了解西班牙移民女性宫颈癌筛查的障碍和 HPV 自我采样的可接受性：一项混合方法研究

• 批准号: 2440850
• 金额: --
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2440850
• 关键词: Understanding; barriers; cervical; cancer; screening

Immigrant women from low resource countries are a vulnerable group to cervical cancer (CC). They are less likely than native women to participate in CC screening programs, which increases the risk to late diagnosis and treatment and, consequently, lower probability of survival. The reasons that make women participate or not in CC screening are multiple and complex. Individual characteristics, access to health system barriers and the social and cultural context influence CC screening behaviours. A variety of strategies have been used to encourage women to undergo CC screening. However, in many cases, these methods are not culturally sensitive and do not consider the barriers confronted by migrants (e.g. language difficulties). This study will take place in Catalonia, Spain, where the introduction of HPV self-sampling is being piloted among different female groups, including immigrant women, to increase CC screening participation. In this context, the overall aim of my PhD research will be to explore barriers and facilitators to cervical cancer screening and acceptability of HPV self-sampling among Pakistani and Moroccan immigrant women in Catalonia, Spain.My research has three specific objectives: 1) To explore knowledge, perceptions and beliefs of cervical cancer and understanding attitudes towards cervical cancer screening among Moroccan and Pakistani immigrant women in Catalonia, Spain. 2) To examine the environmental and interpersonal factors that may influence Moroccan and Pakistani immigrant women's participation in cervical cancer screening programs in Catalonia, Spain.3) To provide recommendations for an HPV self-sampling pilot intervention to increase cervical cancer screening participation among Moroccan and Pakistani immigrants women in Catalonia, Spain.To achieve the objectives of my study, primary data will be collected through mixed methods. First, key informant interviews with health providers will be conducted, followed by focus group discussions with Moroccan and Pakistani women, to explore knowledge, beliefs and attitudes toward health prevention and CC. Second, a social network analysis will be undertaken, using semi-structured interviews with visual sociograms, to elicit women's personal networks, examine information and social norms transmission, and identify influencing contacts that may facilitate or constrain their participation in CC screening. Finally, a pilot survey will be administered to assess acceptability of HPV self-sampling. Thematic content analysis will be conducted to analyse the qualitative findings, using ATLAS.TI, and descriptive statistics, network graphs and regression statistical analysis will be carried out, using STATA 17 and R.This formative research will help to inform the adaptation of the above pilot and/or to design a tailored intervention to increase CC screening participation among Moroccan and Pakistani immigrant women in Catalonia, Spain, and beyond. From an academic perspective, my study will ensure knowledge exchange and collaborative research with other academic institutions and stakeholders outside the UK, and it will provide a better understanding of the linkages between migration, social support networks and health, in particular, participation in prevention programs, such as cervical cancer screening, as well as the need to identify knowledge gaps and understand the beliefs and psychosocial barriers of communities prior to developing innovations for health and social care, which is a key ESRC's goal. On the other hand, the multidisciplinary dimension (social sciences and public health), the proposed research design (mixed methods approach) and the international scope of my study (international migrant women) fit into the ESRC's strategy which seeks to advance knowledge and provide trained social scientists who meet the needs of users and beneficiaries.Keywords: Cervical cancer screening, HPV self-sampling, migrant health, social network analysis

来自资源匮乏国家的移民妇女是宫颈癌 (CC) 的易感群体。与本土女性相比，她们参加 CC 筛查项目的可能性较小，这增加了晚期诊断和治疗的风险，从而降低了生存概率。女性参与或不参与CC筛查的原因是多重且复杂的。个人特征、获得卫生系统的障碍以及社会和文化背景都会影响 CC 筛查行为。人们采用了多种策略来鼓励女性接受 CC 筛查。然而，在许多情况下，这些方法不具有文化敏感性，也没有考虑移民面临的障碍（例如语言困难）。这项研究将在西班牙加泰罗尼亚进行，该地区正在不同女性群体（包括移民女性）中试点引入 HPV 自我采样，以提高 CC 筛查的参与度。在这种背景下，我的博士研究的总体目标将是探索西班牙加泰罗尼亚的巴基斯坦和摩洛哥移民妇女宫颈癌筛查的障碍和促进因素以及HPV自我采样的可接受性。我的研究有三个具体目标：1）探索摩洛哥和巴基斯坦移民对宫颈癌的知识、看法和信仰以及了解对宫颈癌筛查的态度 西班牙加泰罗尼亚的女性。 2) 研究可能影响西班牙加泰罗尼亚摩洛哥和巴基斯坦移民妇女参与宫颈癌筛查项目的环境和人际因素。3) 为 HPV 自我采样试点干预措施提供建议，以提高西班牙加泰罗尼亚摩洛哥和巴基斯坦移民妇女的宫颈癌筛查参与度。为了实现我的研究目标，将通过以下方式收集主要数据： 混合方法。首先，将与卫生服务提供者进行关键知情人访谈，然后与摩洛哥和巴基斯坦妇女进行焦点小组讨论，以探讨对健康预防和 CC 的知识、信仰和态度。其次，将进行社会网络分析，利用视觉社会图的半结构化访谈来引出女性的个人网络，检查信息和社会规范的传播，并确定可能促进或限制她们参与 CC 筛查的影响联系人。最后，将进行试点调查来评估 HPV 自我采样的可接受性。将使用 ATLAS.TI 进行主题内容分析以分析定性结果，并使用 STATA 17 和 R 进行描述性统计、网络图和回归统计分析。这项形成性研究将有助于为上述试点的调整提供信息和/或设计量身定制的干预措施，以提高加泰罗尼亚、西班牙及其他地区的摩洛哥和巴基斯坦移民妇女的 CC 筛查参与度。从学术角度来看，我的研究将确保与英国以外的其他学术机构和利益相关者进行知识交流和合作研究，并将更好地理解移民、社会支持网络和健康之间的联系，特别是参与宫颈癌筛查等预防计划，以及在开发健康和社会护理创新之前确定知识差距并了解社区的信仰和社会心理障碍的必要性，这是关键 ESRC 的目标。另一方面，多学科维度（社会科学和公共卫生）、拟议的研究设计（混合方法）和我的研究的国际范围（国际移民妇女）符合 ESRC 的战略，该战略旨在促进知识发展并提供训练有素的社会科学家来满足用户和受益人的需求。关键词：宫颈癌筛查、HPV 自我采样、移民健康、社交网络分析