Promoting Health in U.S. Affiliated Pacific Islands: Examining the Cultural Impact of Mamahlao On Gynecological Screening Among Chamorro Women

Background and Purpose Peoples of Micronesia in the Pacific seem to seek western biomedical care once it is needed and not as a means of preventive care. This poses a problem since Chamorro women of the Mariana Islands are identified as third highest, behind Asian and Caucasian women in age-adjusted mortality rates for cervical cancer. This work examines the Chamorro cultural value of mamahlao (a sense of shame) and its relationship to Chamorro women seeking preventive gynecological screening, or Papanicolaou (Pap) tests. It is hypothesized that within the constructs of mamahlao there are features that generate an unwillingness to seek preventive sexual health care. Fifteen Chamorro women living on Guam participated in this research conducted on the island October through December 2007.

Methods This exploratory study was achieved by selecting a purposive sample after two years of participant observation. Semi-structured interviews were the primary mode of data collection. Open-ended questions conducive to a small-sample were used making it possible to identify a broad range of perspectives. A computerized qualitative content analysis, Atlas.ti, was used to analyze, create categories and assign codes. A tabulated system was generated to demonstrate recognized patterns and provided a categorical perspective from which to view the data.

Results A Chamorro woman stating she is mamahlao about going to the doctor encompasses a complex string of associations. Themes that emerged from the interviews included: health care, definitions for mamahlao, morality, and stigma. Health care was reported as being a priority over mamahlao and 56 % received regular Pap tests in the last ten years, however 44% did not receive a Pap test in the past year. Religion was identified as the source for the sense of morality associated with mamahlao by 80%. To varying degrees, 93% judged Pap tests as highly beneficial but were firm in exemplifying negative stigmas as attaching to unmarried women seeking the screening. The Pap test equated with STD testing for 20%.

Conclusions & Implications The data collected from this sample indicate a relationship between cultural values and health seeking behavior. If it can be suggested care is sought beyond the scope of a socially-sanctioned, prescribed context, it can and will very likely be viewed as shameful by the community and in turn, the woman, causing her to re-evaluate her decision. Chamorro women are equally concerned with their health promotion and with respecting themselves, their family, and society. Gynecological care in and of itself is not perceived an immoral act. It is the social act of indicating an interest over one's sexual health that provokes negative symbolic connotations by the community. When internalized, it creates the sense of shame, or mamahlao, in Chamorro women. The results of this research highlight the importance of recognizing culture's impact on preventive health seeking behavior. This study may have practical benefits by improving women's health care delivery in the U.S. affiliated Pacific Islands where western biomedical health promotion and local cultural norms seem to collide.