This paper examines the low rates of cervical cancer screening among Middle Eastern women, both in their home countries and in the United States, and proposes a culturally sensitive health promotion plan to address this disparity. The paper discusses the clinical importance of regular PAP smear testing, identifies the patient population at risk, and outlines specific cultural, religious, and linguistic barriers that prevent women from seeking screening. A proposed solution involving female healthcare providers, community leaders, and structured health education is presented alongside short- and long-term goals, anticipated barriers, expected benefits, and the interdisciplinary team needed to implement the intervention effectively.
Health promotion is a behavioral social science that draws from the environmental, biological, physical, psychological, and medical sciences to promote the health of individuals and prevent diseases, premature death, and disability by educating the community. The main purpose of health promotion is to positively influence the health behavior of communities and individuals. There have been increased efforts for cervical cancer screening using PAP tests, which have led to declining mortality rates, especially in developed countries like the United States (Abboud et al., 2017). However, this has not been the case for Middle Eastern women. The screening rates for these women remain low even for those who reside in developed countries, which places them at a higher risk of advanced cervical cancer and poor health outcomes.
Considering that cervical cancer is almost entirely preventable or curable if detected early, Middle Eastern women must begin undergoing PAP smears (Vahabi & Lofters, 2016; Ziaei, Farahmand Rad, Rezaei Aval, & Roshandel, 2017). This is the only way they can detect the cancer early and undergo treatment if it is found. The reasons leading to women not undergoing the tests must be established, and solutions developed, to ensure that the health of these women is promoted so they too can achieve better health outcomes. This paper covers the issues faced by Middle Eastern women in accessing screening and the reasons why they do not undergo PAP smear tests. This information can be used to develop culturally sensitive and acceptable solutions. The paper also analyzes the goals of the intervention and creates a plan that can be implemented to address the clinical issue.
Health promotion focuses on preventive measures to ensure that a disease does not occur and the health of the community is maintained (National Council of State Boards of Nursing, 2019). Regular preventive care has been recognized as one of the most vital ways of maintaining a person's health over time. If one waits to see a doctor only when a problem is noticed, it may be too late. For the sexual health of women, cervical cancer screening is especially important. It is recommended that women begin undergoing PAP smear tests every two years once they are 21 years old, and decrease the frequency to every three years once they reach 30 and have had three consecutive normal PAP smear results (Abboud et al., 2017).
PAP smears can detect precancerous changes on the cervix, allowing for early treatment and preventing the spread of the condition. With early screening and detection, it is possible to treat the condition before it develops into cancer. Many women are at risk of cervical cancer and may not feel any symptoms even when they are infected with HPV. The only way to screen for this is through regular PAP smear testing. Therefore, to remain safe and avoid having to treat advanced cancer, women need to undergo screening as recommended. To assist in reducing deaths caused by cervical cancer, women should be educated on the importance of undergoing the test and advised on what to expect (Ziaei et al., 2017).
The patient population under focus is Middle Eastern women who reside in the United States. It has been established that many of these women are not aware of the PAP smear test, and without the necessary education, most have not — and may never — have one. It is estimated that the rates of cervical cancer among Middle Eastern women are set to double by 2035, a trend attributed to a lack of awareness and screening. According to Ali, Skirton, Clark, and Donaldson (2017), in 2018, over 20,000 women suffered from cervical cancer in the Middle East, leading to 11,870 deaths. Without screening, mortality rates will continue to rise, and more women will fall ill from a disease that is both preventable and curable.
Some difficulties are faced by these women in accessing healthcare, and this is further compounded when it comes to sexual health information (Vahabi & Lofters, 2016). Culturally, Middle Eastern women often avoid sexual health discussions and perceive their private bodies as something only their husbands may see. This results in many avoiding hospital visits for vaginal screenings, even when they are ill or pregnant. The presence of male physicians makes it even harder for them to speak openly about sexual healthcare. Language barriers are another significant challenge. Without translators, it becomes difficult to explain the importance of cervical cancer screening, resulting in many women not undergoing the test.
However, this trend is slowly changing. Many young Middle Eastern women are now aware of the importance of undergoing these tests and are willing to go for screening. The challenge lies with women who adhere to strict religious teachings and cultural norms regarding modesty. These norms make it difficult for women to seek sexual health information or engage in dialogue about sexuality.
"Culturally sensitive education plan with short and long-term goals"
"Virginity concerns, cultural norms, and language obstacles"
"Health outcomes and the roles of nurses, educators, and community leaders"
Endeshaw, M., Clarke, T., Senkomago, V., & Saraiya, M. (2018). Cervical cancer screening among women by birthplace and percent of lifetime living in the United States. Journal of Lower Genital Tract Disease, 22(4), 280–287.
National Council of State Boards of Nursing. (2019). NCLEX-RN examination blueprint. Retrieved from https://www.ncsbn.org/nclex.htm
Payton, M., Parente, M., Al-Hawarri, M., Manasseh, M., Scott, M., & Altshuler, M. (2016). Barriers and facilitators to cervical cancer screening among Iraqi refugees resettled in Philadelphia: A qualitative analysis of patient and provider perceptions.
Vahabi, M., & Lofters, A. (2016). Muslim immigrant women's views on cervical cancer screening and HPV self-sampling in Ontario, Canada. BMC Public Health, 16(1), 868.
Ziaei, T., Farahmand Rad, H., Rezaei Aval, M., & Roshandel, G. (2017). The relationship between sexual self-concept and sexual function in women of reproductive age referred to health centers in Gorgan, North East of Iran. Journal of Midwifery and Reproductive Health, 5(3), 969–977.
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