Community-based study seeks to break barriers to cancer screening among Afghan immigrant women

Afghan immigrant women have low breast cancer awareness and low utilization of early-detection screening, putting them at increased risk of advanced-stage breast cancer diagnosis, finds recent research from the UC Berkeley School of Public Health.

Cultural, religious, and language barriers make it difficult for Afghan immigrant women to obtain breast health care, researchers found, pointing to a significant need for community-based breast health education and outreach among these communities.

The study, which drew on interviews with 53 non-English-speaking first-generation Afghan immigrant women over 40 in Alameda County, California, is the first of its kind to look at breast health views and knowledge in this population. The study was published online in December in Psycho-Oncology.

Past research shows that immigrant Muslim women in the United States are at increased risk for health problems due to social isolation, gender roles, discrimination, and cultural and language barriers. These women are also less likely to access health care, especially breast and cervical health care.

“It takes about ten years in a country, and a couple years in a new city, before immigrants get involved with preventative health behaviors like breast cancer screening,” says Joan Bloom, senior author and professor of Health Policy and Management at the UC Berkeley School of Public Health.

“Many immigrants coming from developing nations don’t have a concept of disease prevention, and it takes a long time before they access preventive care,” she says.

Access to preventive breast health care is critical for ethnic minority women—particularly new immigrants— as studies show that they are at increased risk of late detection and breast cancer mortality.

Using community-based participatory research, Bloom and co-authors Mehra Shirazi, Aida Shirazi, and Rona Popal collaborated with the Afghan Coalition in Southern Alameda County to enroll 53 immigrant Muslim Afghan women (99.9 percent of Afghans are Muslim) with no history of breast cancer, who were diverse in age, length of residency, socioeconomic background, and tribal and regional affiliation.  A community navigator was used to assist women in making appointments, getting transportation, or childcare.

Researchers found that a number of barriers contributed to the low utilization of breast cancer screening in this population, including low health literacy, limited English proficiency, transportation, and misinformation on the diagnosis and treatment of breast cancer.

In total, 75 percent of participants reported language difficulties, lack of interpreter services, and problems scheduling appointments. Gender roles in Afghan culture were also a significant barrier, as men often serve as the “gatekeepers” to women’s health care in Afghan immigrant communities and women were often not able drive themselves to appointments.

“Many of these women are illiterate, have limited English proficiency, and many are not allowed to leave home at all because their husbands feel that their role is in the home,” Bloom says.

Culturally-attuned community outreach among these populations is critical, Bloom says. “These women want to have a place to discuss breast health, they want to be proactive.”

Bloom and colleagues are currently testing a breast health care intervention in Alameda County that incorporates the lessons learned from this study, including visual educational aids, small group “tea parties” to impart education, and the inclusion of husbands in the health education process. Pretest results from the intervention will be forthcoming this spring.

By Courtney Hutchison