title: Cervical cancer screening among immigrants and ethnic minorities: a systematic review using the Health Belief Model.
abstract: OBJECTIVE
  To systematically review all studies examining sociocultural factors influencing cervical cancer screening among immigrant and ethnic minorities in the United States along the theoretical framework of the Health Belief Model.
  
  
  METHODS
  MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane database searches were conducted searching for English language, US-based studies to examine minority and immigrant populations within the theoretical framework of the Health Belief Model. Fifty-five of more than 3,381 potentially relevant articles were included in the final analysis.
  
  
  RESULTS
  Commonly held beliefs across several cultural groups emerged including the following: fatalistic attitudes, a lack of knowledge about cervical cancer, fear of Pap smears threatening one's virginity, as well as beliefs that a Pap smear is unnecessary unless one is ill. Beliefs unique to specific cultural groups included: body-focused notions among Hispanics, as childbirth, menses, sex, and stress were considered to play a role in one's susceptibility to cancer. African Americans identified administrative processes in establishing health care as barriers to screening, whereas Asian immigrants held a variety of misconceptions concerning one's susceptibility to cancer as well as stigmatization imposed by their own community and providers.
  
  
  CONCLUSIONS
  Health care providers and policy makers must be cognizant of the various sociocultural factors influencing health-related beliefs and health care utilization among immigrant and ethnic minorities in the United States. Culturally relevant screening strategies and programs that address these sociocultural factors must be developed to address the growing disparity in cervical cancer burden among underserved, resource-poor populations in the United States.
authors.affiliation: Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI 48109-5604, USA. cristaj@umich.edu
authors.forename: Crista E
authors.initials: CE
authors.lastname: Johnson
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Mues
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Mayne
authors.forename: Ava N
authors.initials: AN
authors.lastname: Kiblawi
mesh_terms: D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000208:ethnology*; D014626:Vaginal Smears / Q000706:statistics & numerical data*