Women's Health Issues

Volume 25, Issue 2, March–April 2015, Pages 120–127

Original article

“I'm Not Ashamed to Talk on It!”: African-American Women's Decisions About Cervical Cancer Prevention and Control in South Carolina

• Jessica D. Bellinger, PhD^, ,
• Whitney Millegan, MPH,
• Azza E. Abdalla, BS

doi:10.1016/j.whi.2014.10.006

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Abstract

Background

Cervical cancer disparities persist despite cervical cancer prevention advances and declining mortality rates, particularly among African-American women in the South. The purpose of this qualitative study was to explore behavior, knowledge, and attitudes as influences on health decisions and preferences for cervical cancer prevention and control among African-American women in South Carolina.

Methods

Data were collected from three focus groups conducted with 28 adult women aged 18 to 70 years in South Carolina. Purposive snowball sampling was employed. Data were coded using a content analysis approach in NVivo 10. Fleiss' kappa coefficient, a measure of interrater reliability, was 0.83.

Findings

Twenty-seven participants self-identified as African American. The mean age of focus group participants was 45.3 years. Knowledge of human papillomavirus (HPV) and cervical cancer risk was relatively low. Participants positively viewed cervical cancer screening and HPV vaccination. Lack of health insurance and costs were screening barriers. Providers were viewed as trusted health information sources, yet stigma and fear negatively influenced screening. Cultural identity served as a facilitator and barrier for screening. Motivated by strength, identified as a central to African-American womanhood, participants viewed cervical cancer prevention as an important responsibility. However, the “Strong Black Woman” script, which has been associated with self-care and coping strategies, was also a screening barrier owing to competing priorities.

Conclusions

Study findings provide insight into cervical cancer prevention decision making and support tailored interventions. Culturally relevant interventions may better convey evidence-based messages about advances in cervical cancer prevention and control.

There are no financial conflicts of interest to disclose.

Correspondence to: Jessica D. Bellinger, PhD. Phone: (202) 402-2136.

Published by Elsevier Inc.

Jessica D. Bellinger, PhD, was a Research Assistant Professor at the Arnold School of Public Health at the time of the study. Her work explores rural health disparities, cancer prevention and control, and feasible health policy solutions for increasing access to care for underserved and minority populations.

Whitney Millegan, MPH, was a graduate research assistant with experience in biology, women's health, and health disparities at the time of the study. She has training in community-based participatory research.

Azza E. Abdalla, BS, is a medical student at the Medical University of South Carolina. At the time of the study, she was a research assistant with experience in biology, women's health, and health disparities. She has training in community-based participatory research.