Barriers and facilitators to the HPV vaccine among mothers of adolescent girls: a qualitative study conducted in Trinidad and Tobago.

Cervical cancer is a major public health problem in Latin America and the Caribbean and the human papillomavirus (HPV) vaccine may prevent thousands of cases of cervical cancer. The current study explored barriers and facilitators that affected the acceptance of the HPV vaccine by mothers of adolescents. This paper explores the qualitative findings from a larger mixed-methods study. Six focus groups were conducted (N = 33) throughout Trinidad and Tobago with mothers of adolescent girls. Three major themes emerged: a) cervical cancer and vaccine knowledge, b) barriers to uptake, and c) rephrasing the vaccine strategy. Data indicated that no widespread strategies to educate the population about the vaccine had occurred. Barriers to uptake of the vaccine were related to a lack of information on the efficacy and safety of HPV vaccines. Parents were unaware that the HPV caused cervical cancer. It is recommended that physicians and other health professionals be used to deliver targeted messages to parents and adolescents to improve uptake of the vaccine.

The Role of Cultural Beliefs in Accessing Antenatal care in Malawi: A Qualitative Study.

BACKGROUND: The World Health Organization in 2002 recommended a focused antenatal care model of four visits for women in low-income countries. Despite the high percentage of mothers (95%) who see a skilled attendant and the adaptation of the recommended antenatal model, only 46% of Malawian mothers meet the recommendation. The purpose of this study was to identify the cultural beliefs that influence women's antenatal care or pregnancy-related health care decisions. METHODS: Twenty pregnant mothers and eight health workers from two urban tertiary care hospitals in Malawi were recruited to participate in a qualitative study assessing barriers to antenatal care. Data were collected between September and December 2014 through face-face, audio-recorded interviews, and a demographic survey. RESULTS: Identified maternal cultural beliefs included: seeking advice from village elders, spousal fidelity, and disclosing pregnancy. Health workers mentioned that providers often held the same cultural beliefs and, therefore, turned women away if they tried to go against cultural norms. CONCLUSIONS: Cultural beliefs play an integral role in the decision-making process of antenatal care. Specifically, the belief and practice of when to disclose pregnancy prohibits women from seeking antenatal care in the first trimester.

Cultural shifts: an examination of cervical cancer stigma across age groups in the Caribbean.

BACKGROUND: Cervical cancer-related stigma is common but understudied in the Caribbean. This study aims to describe the age difference of cervical cancer stigma and to evaluate the influence on the prevention practices among the Caribbean nonpatient population in Jamaica, Grenada, and Trinidad and Tobago. METHODS: A cross-sectional study involving 1209 participants was conducted using a culturally trans-created Cancer Stigma Scale for the Caribbean context and supplemented with questions on cervical cancer and human papillomavirus (HPV) and HPV vaccine knowledge and beliefs. Descriptive analyses and χ2 tests were conducted. RESULTS: The χ2 tests showed age is statistically significantly related to participants' response to stigma items such as "community members believe cervical cancer is viewed as shameful" (P = .0001); "women with cervical cancer are treated with less respect than usual by others" (P < .0001); "women with cervical cancer are rejected by family members" (P = .0007); "women with cervical cancer are rejected by intimate partners" (P < .0001); and "intimate partners blame women for having cervical cancer" (P = .0032). Additionally, age has statistically significant associations with endorsements of negative views of cervical cancer from the community (P < .0001) and family (P < .0001) as key barriers to cervical cancer care (item: "discourage women from seeking and obtaining screening and treatment"). Notably, younger respondents (18-25 years) are more sensitized to the unfair stigma and hold more stigma. CONCLUSIONS: Among Caribbeans, age influences cervical cancer stigma. Younger persons acknowledged greater stigma within families and communities. This study can guide age-informed interventions and programs to reduce stigma and improve cervical cancer screening and care seeking to reduce cervical cancer burden and disparities.

Cervical Cancer Stigma Among Caribbean Population: A Descriptive Paper.

Objectives: Cervical cancer prevention practices are desperately low in the Caribbean. This study aims to describe the cervical cancer stigma and to evaluate the influence of the prevention practices among the Caribbean non-patient population in Jamaica, Grenada, Trinidad and Tobago. Methods: A cross-sectional study involving 1,207 participants was conducted using a culturally trans-created Cancer Stigma Scale for the Caribbean context and supplemented with questions on cervical cancer and HPV/HPV vaccine knowledge and beliefs. Data collection took place online from October 2022 to March 2023. Results: Participants are young, single, well-educated, and have stable financial resources. Over a quarter (26.4%) agreed women with cervical cancer are more isolated in their country. Almost half (47%) of respondents agreed cultural background plays a big part in how they feel about illness and getting well. One in six participants believe women with cervical cancer are treated with less respect than usual by others in their country. Conclusion: Cancer stigma of cervical cancer exists in Jamaica, Trinidad and Tobago, and Grenada. Particularly, cultural background and social norms are closely linked to stigma.

COVID-19 pandemic impact on food insecurity among college students: A mixed methods study.

Objectives: This study explores whether the COVID-19 pandemic exacerbated the prevalence of food insecurity (FI) among US college students. Participants: College students (n = 489) enrolled at a Mid-Atlantic university. Methods: A mixed methods design was utilized for data collection and analysis through an electronic survey and semi-structured interviews. Multiple regression was used to assess predictors of FI before and during COVID-19. The McNemar test determined if significant differences in FI existed. The interviews were used to explore students' personal experience with FI during the pandemic. Results: Black students (p = 0.045) and students moving in with their parents due to campus closures (p = 0.032) exhibited a higher degree of FI during the pandemic than before. Three main themes emerged from the interviews: decreased food autonomy, limited access to food, and limited access to healthful food. Conclusions: The pandemic increased the prevalence of FI among college students. Race and living arrangements were strong predictors of FI.

Mental health impacts of the COVID-19 pandemic on college students.

The COVID-19 pandemic is having profound effects on college students, and those with mental health conditions are more vulnerable to the impact of this stress. Objective: To study the impact of the COVID-19 pandemic on college students' mental health. Participants: Participants (n=489) were mostly female, undergraduate, and aged 18-25. Methods: Participants completed an online survey assessing symptoms of mental health problems including hopelessness, loneliness, sadness, anxiety, sadness, and anger. Results: Approximately 81.6 % self-reported at least one negative mental health symptom. Students reported increased feelings of hopelessness (+7.8%), loneliness (+6.7%), sadness (+8.8%), depression (+2.6%), anxiety (+5.2%), and anger (+14.6%) during the pandemic than before. LGBTQ students and Black students had significantly more mental health symptoms during the pandemic than straight and White students. Conclusions: Results of this study highlight the negative impact of the pandemic and resultant changes on college students' mental health.

Fall-related Comorbidity and Health Beliefs among Cancer Survivors Participating in a Community-based Exercise Intervention.

OBJECTIVES: Health beliefs (HB) and fall and balance-related outcomes were examined following a 26-week community-based exercise intervention among cancer survivors (CS). METHODS: Fall and balance-related measures and HB were quantitatively and qualitatively examined during a 26-week intervention among CS (N = 33). Of the 33 participants, 28 consented to an interview about their physical activity (PA) behavior. RESULTS: Participants scored high on balance efficacy (median ± range = 8.68 ± 1.53) and reported high perception of having barriers to PA (mean ± SD = 4.66 ± 0.59). Fall-related measures improved after the 26-week intervention (p = .002). Most cues to action to engage in PA were delivered by a healthcare professional (N = 18). Once enrolled in the intervention, social benefits and access to a program tailored toward CS emerged as motivating factors to engage in PA (N = 12, N = 11, respectively). CONCLUSIONS: There is a need to design fall risk reduction programs tailored to CS and to offer these programs in an environment that fits the unique physical and social needs of CS.

Contextual factors influencing health-related quality of life in African American and Latina breast cancer survivors.

PURPOSE: This study explored the relationships between systemic- and individual-level contextual factors and health-related quality of life (HRQOL) in a cohort of African American and Latina breast cancer survivors (BCS). METHODS: Baseline questionnaire data of 320 BCS who participated in a HRQOL psycho-educational intervention were abstracted from the parent study. Hierarchical regression analysis tested the independent effects of contextual factors on HRQOL. RESULTS: HRQOL was higher in BCS who: were diagnosed at < stage 2 (b = -1.38, p < 0.05), expressed satisfaction with their health care (b = 0.20, p < 0.001), had fewer comorbidities (b = - 0.60, p < 0.001) and depressive symptoms (b = -0.30, p < 0.001), and practiced healthy diet and exercise habits (b = 0.02, p < 0.05). Demographic and cancer-related factors accounted for 14 % of the variance in HRQOL (F[6, 274] = 7.25, p < 0.001). The socio-cultural context (i.e., ethnicity, life stress, perceived social support) explained 20 % of the variance in HRQOL (FΔ[3, 271] = 27.32, p < 0.001). The health care system context contributed an additional 8 % to explaining HRQOL (FΔ[1, 270] = 34.88, p < 0.001). Health status and behavioral factors accounted for 18 % of the variance (FΔ[4, 266] = 29.55, p < 0.001). The full model explained 59 % of the variance in HRQOL (F[14, 266] = 27.76, p < 0.001). CONCLUSIONS: HRQOL in ethnic minority BCS is multifaceted and is significantly influenced by cancer-related, socio-cultural, health care system, health status, and behavioral contextual factors. Therefore, survivorship research and practice must address broad multi-level domains to achieve equitable and optimal breast cancer outcomes. IMPLICATIONS FOR CANCER SURVIVORS: To enhance HRQOL, survivors must be provided the know-how and support to maintain healthy lifestyle and self-management practices. Advocates must engage the care team to consider systemic factors, including life stress and community resources, to be more patient-centered.

Closing the disparity gap: cancer screening interventions among Asians--a systematic literature review.

BACKGROUND: Cancer is a leading cause of deaths among Asian Americans. However, the rates of screening among Asian Americans are low. The use of effective culturally-appropriate interventions needs to be explored. METHODS: Electronic databases were searched for articles published between January 1995 and December 2010 for a comprehensive literature review. Interventions to increase breast, cervical and colorectal cancer screening among Asians populations in the US and overseas were included. RESULTS: A total of thirty studies were reviewed. These studies differed on study design, target population, theoretical underpinning of intervention approach and outcome measures. Effective interventions employed a variety of strategies including the use of social networks, lay health workers, media education, community-based education, reminder notices, health care provider assistance and health system changes. Fifteen studies utilized behavioral theories in intervention development. CONCLUSIONS: This review finds culturally-appropriate community-based interventions and lay health worker strategies can improve cancer screening behaviors among Asian populations. Selections of intervention strategies will depend on the characteristics of the target group and feasibility of implementation. Challenges and recommendations for tailored screening interventions for Asians are discussed.