Minority immigrant women are more likely to be diagnosed with and suffer from cervical cancer compared to other minority women in the United States. The purpose of this qualitative ethnographic study was to explore cultural health perceptions, behaviors, and barriers to cervical cancer prevention among Korean immigrant women (KIW) in Hawaii. The health belief model and the social-ecological model were used to guide the study. Data were collected using individual structured interviews with 20 KIW ages 21 to 65 who are first-generation KIW immigrant to Hawaii. Data were coded and analyzed to identify themes. Findings revealed that participants (a) prefer a female gynecologist and Korean-speaking physicians; (b) are highly motivated to maintain physical health, including prevention; (c) prefer culturally appropriate community-based cancer prevention programs, and (d) expect innovative health maintenance approaches. Findings may be used by healthcare providers to identify culturally specific health needs of KIW related to cervical cancer screening and to implement appropriate preventive measures for KIW to reduce cancer death.

Pap smear screening detects cervical cancer in its earliest stages, yet thousands of women in the United States die annually from this disease. Social networking websites commonly provide information about recommended health screenings. In this quantitative study, the Health Belief Model provided the theoretical framework to determine if the use of social networking websites affected nurses' decisions to receive Pap smear screening. A convenience sample of nurses was used, with the rationale that they were knowledgeable of and receptive to participating in a relevant health study. A total of 2,336 registered nurses practicing in Durham, North Carolina were invited to participate in the study. Over a period of 4 weeks, 107 participants responded to questions from the Health Belief Questionnaire and Pew Internet and American Life survey through an electronic questionnaire. Chi-square analysis determined the association between the receipt of Pap smear screening and the use of a social networking website use. Logistic regression further analyzed this association with age as a covariate. Nearly all participants reported having a Pap smear screening within the last 12 months. However, the lack of significant results showed that social networking website use was not a factor for higher screening rates. Despite the non-significant findings, the participants nevertheless reported a high use of social networking websites. These findings indicate that such platforms can be used to educate women on the importance of Pap smear screening. The study's implications for positive social change are to use such sites to more effectively, to promote and educate on the importance of Pap smear screening.

Idag erbjuds alla kvinnor mellan åldern 23 – 70 gratis gynekologisk cellprovtagning i Sverige. Trots detta är det bara 63,7% i åldersgruppen 23 – 29 som deltar i screeningen. Kallelse till besök kommer via posten. I denna studie har det undersökts om man med hjälp av visualiseringar kan få fler kvinnor att delta i gynekologisk cellprovtagning samt att minska obehaget inför ett besök. Under studiens gång har gestaltningsförslag tagits fram med målet att öka deltagandet. Tidigare studier kring varför kvinnor i Sverige avböjer att delta i gynekologisk cellprovtagning och hälsokommunikation tillsammans med bilder samt teorier inom kognition, perception, bild och text i samspel har legat till grund för hela arbetet. Metoder som intervju, dokumentanalys och skiss har använts för att motivera gestaltningsförslagets utformning. Allt detta resulterade i ett gestaltningsförslag i form av ett informationsblad som skickas med det brev den nuvarande kallelse kommer i, till de kvinnor som inte tidigare har valt att delta i provtagningen i Sverige. Informationsbladet innehåller illustrationer som komplement till information om vad HPV är, hur det sprids, varför det är viktigt att delta och hur själva provtagnings processen går till. Resultatet pekar mot att större andel av målgruppen hade övervägt att delta i screeningen samt att de upplever att obehaget skulle minskas vid användande av illustrationer. / Nowadays all women between the ages of 23 - 70 get offered free pap smear in Sweden. Despite this, only 63,7% attend the screening between the ages of 23 – 29. The women receive a mail that include a call notice for the visit. This study is going to explore how visualization could help increase the amount that attend the pap smear and reduce the discomfort before a visitation.  During the study, an artefact was created. Previous studies about why women in Sweden do not participate in pap smear testing, images in health communication and theories about cognition, perception and image and text in interaction laid the foundation for the work. Methods like interviews, documentation analysis and sketches were used to motivate the artefact design. All of this concluded in an artefact representing an information sheet, which is supposed to be sent out alongside the mail of the current call notice to all women in Sweden who have decided to not attend the pap smear. The information sheet includes information about what HPV is, how it spreads, why it is important to attend, and how the actual process of the testing is done, with illustrations as a supplement. The results point toward an indication that more women in Sweden would consider attending the pap smear, and that the discomfort about the process is reduced.

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In the three chapters of my dissertation, I analyze the individual behaviors including health (vaccination and preventive care) and consumer (financial literacy) behaviors and the corresponding interventions by nonlinear econometric modeling. In the first chapter, I suggest an appropriate econometric model that investigates the effect of paid sick leave on workers' decision to receive the seasonal flu vaccination. For this investigation, I apply a Bayesian non-linear structural regression model with one-outcome and two-endogenous equations. The results of my estimation indicate that having paid sick leave affects workers' vaccination decisions differently based on their income levels. Low-income workers are willing to be vaccinated because they perceive the high cost of claiming paid sick leave. However, high-income workers are willing to be vaccinated because paid sick leave reduces the cost of vaccination for seasonal flu. In the second chapter, I suggest new econometric regression models that investigate the effect of "Don't Know" or "Refuse" (DK/RF) responses on parameter identification. I estimate the effect of group characteristics and financial education on the level of young respondents' objective financial knowledge and find the actual effects and biases by my suggested models. This study examines six questions about personal finance and selects covariates in the 2015 National Financial Capability Study (NFCS). Because these questions include DK/RF responses, a simple regression model that does not consider DK/RF responses could lead to misleading conclusions, such as gender/income difference and educational effectiveness in schools. In the last chapter, I investigate the effect of three health-related interventions including a doctor's recommendation, information about human papillomavirus (HPV), and HPV vaccination, on the misuse of cervical cancer screening including too-early screening, unnecessary HPV test, annual Pap test, and no Pap smear that are not recommended for women younger than 30 years. I examine the National Health Interview Survey conducted in 2015 and applies binary and multinomial logistic regression models. From the estimation result, I observe that doctor's recommendation plays a significant role in increasing the probability of receiving cervical cancer screening while it induces the too-early screening, unnecessary HPV testing, and overuse of Pap smears. / Ph. D.

Perception of cervical cancer screening among Immigrant African women residing in Houston, Texas Esther I. Orji M.Ed., University of Lagos, 2002 B. Ed, Abia State University, 1998 A.C. E. University of Benin, 1990 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Disparities in cervical cancer screening participation still exist especially among immigrant and minority women compared to non immigrant populations. Research investigators through multiple studies have explored reasons for non participation in cervical cancer screening among immigrant and minority women. However, there was limited research specifically on how immigrant women of African descent could be empowered to overcome barriers associated with cervical cancer screening in Houston Texas. The purpose of this study was to explore and understand the perceptions of factors which are barriers to perform cervical cancer screening tests among immigrant women of African descent, as well as their beliefs on preventive medicine, and how immigrant women could be empowered in order to overcome barriers associated with cervical cancer screening. The theoretical framework was based on the health belief model. The participants for the study were 20 immigrant women of African descent aged 21-65. A semi-structured interview schedule which comprised of open ended questions was used to collect data on the perspectives of immigrant women towards cervical cancer screening. Data was transcribed verbatim and analyzed thematically. The social change implications of the study can be that immigrant women could be more encouraged to seek access to the appropriate state of the art in cervical cancer screening which could contribute in reducing mortality, morbidity rate, and costs associated with cervical cancer.

<p>Syftet var att beskriva distriktssköterskans erfarenheter och inställningar till FYSS samt förskrivning av FaR vid hälsocentraler med hög respektive låg förskrivning. Sjutton distriktssköterskor deltog från två topplistplacerade hälsocentraler och en icke topplistplacerade hälsocentral i ett län, i Mellansverige. Datainsamlingen gjordes genom semistrukturerade intervjuer och analyserades utifrån kvalitativ innehållsanalys. Analysen gav två kategorier</p><p><strong><em>Organisation och <strong><em>Individ för de topplistade hälsocentralerna respektive den icke topplistade hälsocentralen samt sex underkategorier vardera. Kategorin Organisation inom de topplistade hälsocentralerna innehöll underkategorierna <em>ledningsstöd, utbildning samt <em>uppföljning och ekonomi. Kategorin Individ beskrev <em>förskrivarens inställning, distriktssköterska med specialiserat arbete och <em>förskrivna motionsformer. Kategorin Organisation inom den icke topplistade hälsocentralen innehöll underkategorierna <em>ledningsstöd, att öka motivationen och <em>samarbete. Kategorin Individ beskrev underkategorierna <em>förskrivarens inställning, att motivera till livsstilsförändring samt <em>uppföljning. FaR förskrevs främst av distriktssköterskor inom diabetes- och blodtrycksmottagningar och de upplevde ledningens stöd. Vid den icke topplistplacerade hälsocentralen saknades ledningsstöd, alla hade inte FaR-utbildning. Tid till kollegiediskussioner för att få in rutiner, läkarstöd p.g.a. patienters multipla sjukdomsdiagnoser och kunskap om förskrivningsbara aktiviteter efterfrågades. Lyckad förskrivning krävde motiverade patienter, individanpassade motionsformer och samarbete med t.ex. sjukgymnaster. Chefer <em>"tryckte på" för ökat antal förskrivningar, utbildning om förhållningssätt att motivera till fysisk aktivitet önskades. FaR uppgavs vara ett av distriktssköterskans ansvarsområden och förväntades öka i framtiden. </em></em></em></em></em></em></em></em></em></em></strong></em></strong></p> / <p>The purpose was to describe district nurses’ experiences and perceptions of Physical activity in Disease prevention and Treatment and Prescriptions of Physical activity (PaP), in health centers, reported high respectively low prescriptions of physical activities. Seventeen district nurses, from two top listed and one not top listed center, in a county, in the middle of Sweden participated. Semi-structured interviews analyzed by qualitative content analysis resulted in two categories</p><p><strong><em>Organization and <strong><em>Individual and six subcategories respectively, for both groups. The category Organization within the top listed centers’ included the subcategories <em>management support, education and <em>follow-ups and economy. The category Individual described <em>preceptor’s attitudes, district nurse with specialized work and <em>type of activities. The category Organization within the not top listed centre included <em>management support, to increase motivation and <em>cooperation. The category Individual described <em>preceptor’s attitudes, to motivate lifestyle changes and <em>follow-ups. PaP occurred mainly in diabetes and blood pressure care, management support was experienced. In the not top listed centre, management support and education lacked. Time for collegial discussions forming routines, physicians’ support and knowledge about type of activities were requested. Successful prescription required motivated patients, individualized activities and interaction with physiotherapists. Educations supporting patients’ motivation were demanded, managements’ stressed increased prescriptions and PaP was reported a district nurse responsibility, expected to increase. </em></em></em></em></em></em></em></em></em></strong></em></strong></p>

Syftet var att beskriva distriktssköterskans erfarenheter och inställningar till FYSS samt förskrivning av FaR vid hälsocentraler med hög respektive låg förskrivning. Sjutton distriktssköterskor deltog från två topplistplacerade hälsocentraler och en icke topplistplacerade hälsocentral i ett län, i Mellansverige. Datainsamlingen gjordes genom semistrukturerade intervjuer och analyserades utifrån kvalitativ innehållsanalys. Analysen gav två kategorier Organisation och Individ för de topplistade hälsocentralerna respektive den icke topplistade hälsocentralen samt sex underkategorier vardera. Kategorin Organisation inom de topplistade hälsocentralerna innehöll underkategorierna ledningsstöd, utbildning samt uppföljning och ekonomi. Kategorin Individ beskrev förskrivarens inställning, distriktssköterska med specialiserat arbete och förskrivna motionsformer. Kategorin Organisation inom den icke topplistade hälsocentralen innehöll underkategorierna ledningsstöd, att öka motivationen och samarbete. Kategorin Individ beskrev underkategorierna förskrivarens inställning, att motivera till livsstilsförändring samt uppföljning. FaR förskrevs främst av distriktssköterskor inom diabetes- och blodtrycksmottagningar och de upplevde ledningens stöd. Vid den icke topplistplacerade hälsocentralen saknades ledningsstöd, alla hade inte FaR-utbildning. Tid till kollegiediskussioner för att få in rutiner, läkarstöd p.g.a. patienters multipla sjukdomsdiagnoser och kunskap om förskrivningsbara aktiviteter efterfrågades. Lyckad förskrivning krävde motiverade patienter, individanpassade motionsformer och samarbete med t.ex. sjukgymnaster. Chefer "tryckte på" för ökat antal förskrivningar, utbildning om förhållningssätt att motivera till fysisk aktivitet önskades. FaR uppgavs vara ett av distriktssköterskans ansvarsområden och förväntades öka i framtiden. / The purpose was to describe district nurses’ experiences and perceptions of Physical activity in Disease prevention and Treatment and Prescriptions of Physical activity (PaP), in health centers, reported high respectively low prescriptions of physical activities. Seventeen district nurses, from two top listed and one not top listed center, in a county, in the middle of Sweden participated. Semi-structured interviews analyzed by qualitative content analysis resulted in two categories Organization and Individual and six subcategories respectively, for both groups. The category Organization within the top listed centers’ included the subcategories management support, education and follow-ups and economy. The category Individual described preceptor’s attitudes, district nurse with specialized work and type of activities. The category Organization within the not top listed centre included management support, to increase motivation and cooperation. The category Individual described preceptor’s attitudes, to motivate lifestyle changes and follow-ups. PaP occurred mainly in diabetes and blood pressure care, management support was experienced. In the not top listed centre, management support and education lacked. Time for collegial discussions forming routines, physicians’ support and knowledge about type of activities were requested. Successful prescription required motivated patients, individualized activities and interaction with physiotherapists. Educations supporting patients’ motivation were demanded, managements’ stressed increased prescriptions and PaP was reported a district nurse responsibility, expected to increase.

Anal cancer, like cervical cancer, is associated with Human Papillomavirus (HPV) infection. HIV+ patients have 38-60 fold increased risk of anal cancer compared to HIV- patients prompting many to suggest routine screening given the success of cervical Pap screening. Our goal is to describe our experience with routine anal Pap screening, determine which patients are most likely to have abnormal results, if anal disease on physical exam is predictive of cytology, and correlate cytology with histology findings. Charts of all patients with an anal Pap followed at the Hospital of Saint Raphael HIV Clinic were reviewed. Demographics, immune status, sexually transmitted disease history, cytology and histology data was extracted from medical charts. Patients with an anal Pap between November 1, 2002-November 30, 2004 were included. Those with an insufficient sample were excluded. Analysis was done using ÷2 for comparison of proportions and student t-test for continuous variables. Overall, 265/560 HIV+ patients had at least one anal Pap. Seventy-four of these 265 patients had an abnormal anal Pap. Mean age was 44 yrs, and 68% were men. Fifty-nine percent were African American, 34% White, and 17% Hispanic. Those with an abnormal Pap were more likely to be White (p=.03), and be gay or bisexual men (p=.02). They were also more likely to have lower CD4+ nadir (142 vs 223, p=.005) and CD4+ at time of anal Pap (353 vs 497, p<.001). Those with an abnormal anal Pap also had more anal disease (30% vs 9%, p<.001), history of warts (23% vs 12%, p=.02) and herpes (35% vs 22%, p=.02). Anal disease on physical exam had a sensitivity of 56% and specificity of 77% for abnormal cytology findings. On histology two patients had Anal Intraepithelial Neoplasia (AIN ) I, 2 AIN II, 3 AIN III, and 2 Squamous Cell Carcinoma In Situ. There was no correlation between cytology and histology. Routine anal cytology screening is a feasible tool to incorporate into an ethnically diverse HIV clinic for identifying precancerous anal lesions, a group which has been largely overlooked. Anal disease on physical exam is a poor predictor of abnormal cytology and there was no correlation between severity of disease on cytology and histology. However, further follow-up study is required to determine the impact on morbidity and mortality.