Reducing the Cervical Cancer Burden in the Hmong American Community: The Importance of Cervical Cancer Screening Literacy

Background/Purpose: Hmong Americans’ cervical screening practices has received considerable focus in recent years due to its unusually high cervical cancer incidence rate, that of three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites (Yang, Mills, & Riordan, 2004).  While studies has shown that Hmong Americans face cultural, linguistic and structural barriers to Pap test receipt, relatively little is known about the cervical cancer screening knowledge of Hmong Americans (Fang, Lee, Stewart, Ly, & Chen, 2010; Ho & Dinh, 2011; Lee & Vang, 2010; Lee, Yang, Lee, & Ghebre, 2015).  Therefore, the objectives of this study are to investigate: a) the level of cervical cancer screening knowledge, b) Pap test receipt rate, and c) factors associated with cervical screening literacy in the Hmong American community.

Methods: A self-administered paper and online health survey was conducted among Hmong Americans living in the Twin Cities metropolitan area in Minnesota, with 192 participants completing the survey. Andersen’s behavioral model of health services utilization, with its three components of predisposing, enabling and need factors, was used as the theoretical framework for this study (Andersen, 1995). 

Results: Participants had a mean score of 3.21 (SD=0.91) for the 5-item questionnaire measuring Pap test knowledge. The Pap test receipt rate for 121 female participants in their lifetime, between the ages of 18 to 53 years in old, was 44.6 percent (n=54) with 44 participants indicating they had a Pap test within the past year. Multiple regression analysis showed that having a primary doctor (β=-.138; p<.05), health insurance (β=.192; p<.05), and increased HPV literacy (β=.173; p<.05) were significantly associated with cervical cancer screening literacy.

Conclusion/Implications: Results indicate that Hmong Americans in the study’s sample had relatively low cervical cancer screening knowledge (mean score of 3.21, SD=0.91) with less than half of the female participants (44.6%) having had a Pap test in their lifetime.  This finding parallels other studies that show low cervical cancer screening literacy decreases the likelihood of having a Pap test, particularly among immigrant and refugee populations (Fang et al., 2010; Kim & Han, 2016; Lam et al., 2003; Lee, Roh, Vang, & Jin, 2011; Lee et al., 2015).  Study results also indicate that having a primary doctor, health insurance, and higher HPV literacy was associated with higher cervical screening literacy.  It is therefore important that Hmong Americans have access to health care resources as well as a trusted primary health provider, to improve cervical cancer literacy and reduce the cervical cancer burden disproportionally experienced by this at-risk population.