Barriers to Cervical Cancer Screening and Prevention in Korean American Women: Implications for Culturally Competent Intervention

Background: Cervical cancer is a major health disparity among Asian American women, although it is one of the most preventable cancers. Korean American (KA) women, in particular, have higher incidence and mortality of cervical cancer (Gor, et al., 2011). Several risk factors for low cervical cancer screening rates have been identified with KA women; a lack of cervical cancer knowledge (Kim et al.,2004), health care accessibility, including health insurance and regular sources of health care, physician’s ethnicity (Maxwell, Bastani, & Warda, 2000), and cultural factors, such as preventive health orientation and modesty. Although previous studies identified several barriers toward cervical cancer screening among KA women, there is a dearth of research on this topic focused on Korean American women in 20s. The purpose of this study was to gain an understanding of KA women’s knowledge about cervical cancer and to identify major barriers of cervical cancer screening and prevention, including both Pap test and HPV vaccine. This study also explored effective strategies to increase knowledge about cervical cancer as well as motivation for cervical cancer screening and prevention.  

Method: This study utilized a qualitative research approach using a series of focus groups. We recruited 13 KA women aged 20 to 29 residing in the Twin Cities area of Minnesota. To recruit focus group participants, we utilized our research team’s personal social network, posting flyers in libraries, Korean ethnic churches and clinics, and sending email solicitations to Korean American student associations. We used Braun and Clarke’ six phases of thematic analysis as the framework for developing the themes (Braun & Clarke, 2006).

Findings: Most participants indicated a lack of knowledge or misinformation about cervical cancer and prevention strategies. The participants stated a wide of range of beliefs and knowledge about cervical cancer, which are mainly based on their culture. A couple of obstacles for not receiving cervical cancer screening and vaccination were multi-factorial and interrelated. The obstacles included lack of awareness and knowledge about the Pap-test and HPV vaccine, distrust of health care providers and the medical care system regarding the HPV vaccine, prejudice toward women’s clinics, lack of accessibility to health services, and feeing safe from developing cancer. Participants highlighted the importance of education about cervical cancer and health service information to increase the cervical cancer screening and vaccination rate. Text-messaging using cell phones was deemed the most effective educational tool targeting younger women because of its accessibility and low cost.

Implications: The findings imply that culturally appropriate interventions considering KA women’s unique barriers to cervical cancer screening and vaccination are needed to reduce cervical cancer disparity in this population. Future intervention and research efforts should focus on increasing knowledge of HPV risk and cervical cancer prevention, improve KA women’s perception toward gynecology specialized clinics and providers, and increasing access to prevention services. This study also supports the use of mobile phone technology for public health interventions to reach this, and possibly other hard to reach populations.