title: "A Somali girl is Muslim and does not have premarital sex. Is vaccination really necessary?" A qualitative study into the perceptions of Somali women in the Netherlands about the prevention of cervical cancer.
abstract: BACKGROUND
  Participation in Human Papillomavirus (HPV) vaccination and Papanicolaou Screening (Pap smears) is low among ethnic minorities in the Netherlands and hardly any information is available about the cervical cancer prevention methods of Somali women living in the diaspora. This qualitative study, based on the Health Belief Model (HBM) and an intersectionality-based framework, explores the perceptions of Somali women living in the Netherlands regarding measures to prevent cervical cancer.
  
  
  METHODS
  Semi-structured interviews have been conducted with young Somali women aged 17-21 years (n = 14) and Somali mothers aged 30-46 years (n = 6). Two natural group discussions have been conducted with 12 and 14 Somali mothers aged 23-66 years. The collected data has been analyzed thematically for content.
  
  
  RESULTS
  In this study, we have identified perceived barriers to the use of preventive measures across three major themes: (1) Somali women and preventive healthcare; (2) Language, knowledge, and negotiating decisions; and (3) Sexual standards, culture, and religion. Many issues have been identified across these themes, e.g., distrust of the Dutch health care system or being embarrassed to get Pap smears due to Female Genital Mutilation (FGM) and having a Dutch, male practitioner; or a perceived low susceptibility to HPV and cancer because of the religious norms that prohibit sex before marriage.
  
  
  CONCLUSIONS
  Current measures in the Netherlands to prevent women from developing cervical cancer hardly reach Somali women because these women perceive these kinds of preventative measures as not personally relevant. Dutch education strategies about cervical cancer deviate from ways of exchanging information within the Somali community. Teachers can provide culturally sensitive information to young Somali women in schools. For Somali mothers, oral education (e.g., poetry or theater) about the Dutch health care system and men's roles in HPV transmission may be useful. An intersectional approach, grounded in the HBM, is recommended to promote equal access to preventive health care for Somali women.
authors: Department of Medical Humanities, VU University Medical Centre, EMGO+ Institute of Health and Care Research, Amsterdam, The Netherlands. salad@unfpa.org.|United Nations Complex, United Nations Avenue, Block P, Level 2, Somali, Kenya. salad@unfpa.org.
authors: Jihan
authors: J
authors: Salad
authors: Department of Medical Humanities, VU University Medical Centre, EMGO+ Institute of Health and Care Research, Amsterdam, The Netherlands. p.verdonk@vumc.nl.|Department of Medical Humanities, VU University Medical Centre, EMGO+ Institute of Health and Care Research, School of Medical Sciences, Amsterdam, The Netherlands. p.verdonk@vumc.nl.
authors: Petra
authors: P
authors: Verdonk
authors: Department of Medical Humanities, VU University Medical Centre, EMGO+ Institute of Health and Care Research, Amsterdam, The Netherlands. fi.deboer@vumc.nl.
authors: Fijgje
authors: F
authors: de Boer
authors: Department of Medical Humanities, VU University Medical Centre, EMGO+ Institute of Health and Care Research, Amsterdam, The Netherlands. t.abma@vumc.nl.
authors: Tineke A
authors: TA
authors: Abma
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007514:Islam; D008875:Middle Aged; D009426:Netherlands; D053918:Papillomavirus Vaccines; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D012746:Sexual Abstinence / Q000208:ethnology*; D012998:Somalia / Q000208:ethnology; D014611:Vaccination; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines