"I'm not ashamed to talk on it!": African-American women's decisions about cervical cancer prevention and control in South Carolina.
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.


RESULTS
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.
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina. Electronic address: Jessica.D.Bellinger@hud.gov.
Jessica D
JD
Bellinger
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Whitney
W
Millegan
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Azza E
AE
Abdalla
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D055812:Community-Based Participatory Research; D055088:Early Detection of Cancer; D005239:Fear; D005260:Female; D017144:Focus Groups; D015438:Health Behavior / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D036301:Qualitative Research; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D013022:South Carolina; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears; D055815:Young Adult