Betsy Barton

Assessing the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action

ObjectiveTo determine whether pairing self-sampling for HPV with community health workers (CHWs) is a culturally acceptable method for cervical cancer screening among Haitian immigrant women residing in Little Haiti, the predominately Haitian neighborhood in Miami, FL.MethodsAs part of a larger, ongoing community-based participatory research (CBPR) initiative in Little Haiti, Haitian CHWs recruited 246 eligible women to this study. Participants provided self-collected cervical specimens for HPV testing and answered a series of questions about their experience with self-sampling for HPV.ResultsThe vast majority of women (97.6%) was comfortable using the self-sampler at home, would recommend this screening method to their friends and/or family members (98.4%), and described the sampler as easy to use (95.1%). Additionally, 97% of all self-collected specimens were deemed adequate for HPV testing.ConclusionsWhen paired with CHWs, who are of Haitian descent and well respected in Little Haiti, self-sampling is a highly acceptable method of cervical screening for Haitian women in this ethnic enclave. This approach addresses critical access barriers, including poverty, language difficulties, and sociocultural concerns about modesty, that may similarly affect Pap smear utilization among other immigrant or medically underserved population sub-groups. Coupled with generally positive reviews of the device, the low rate of insufficient specimens for testing suggests that this device is promising for use in non-clinical settings.

Patnè en Aksyon: Addressing Cancer Disparities in Little Haiti Through Research and Social Action

Haitian women living in Miami, Florida, experience an increased risk of developing and dying from cervical cancer compared with women in other racial/ethnic minority and immigrant groups in the area. In response to this disparity, academic investigators from a local university-based cancer center and community leaders from Little Haiti, the predominately Haitian neighborhood in Miami, created Patnè en Aksyon (Partners in Action), a campus-community partnership. We describe the partnerships effort to document the prevalence of lifetime and routine Papanicolau test use using community-based participatory research methods. Community health workers indigenous to the area recruited participants from various community venues throughout Little Haiti and administered informal, brief interviews to assess their screening practices. The results indicate that Haitian women are underscreened and underscore the importance of community involvement in study implementation.

One Size Does Not Fit All: Differences in HPV Knowledge between Haitian and African American Women

Background: Historically, all black persons, regardless of ancestry or country of origin, have been categorized as one group for cancer research and control efforts. This practice likely masks variability in exposure to determinants of disease, as well as in risk of cancer incidence and mortality. The current study examines potential differences in knowledge of human papilloma virus (HPV) between Haitian women living in Little Haiti, Miami, Florida, and a national sample of predominately African American women. Methods: Data for Haitian women were collected in 2007 as part of an ongoing community-based participatory research initiative in Little Haiti. For purposes of comparison, we used data from a largely African American subsample of the 2007 Health Information National Trends Survey (HINTS). These data sources used identical items to assess HPV knowledge, providing a unique opportunity to examine how this outcome may vary between two very distinct populations who are often grouped together for research and disease surveillance. Results: Relative to the HINTS sample, Haitian women were far less likely to have heard about HPV. Conclusions: Study data highlight important differences in Haitian and African American womens knowledge of HPV, a known determinant of cervical cancer risk. Such findings suggest that continuing to classify persons of similar phenotype but different cultural backgrounds and lifetime exposures as one group may preclude opportunity to understand, as well as attenuate, health disparity. Cancer Epidemiol Biomarkers Prev; 19(2); 366–70

Barriers to breast cancer screening among Haitian immigrant women in Little Haiti, Miami

Previous research has not examined barriers to mammography screening among Haitian immigrant women through their own discourse. Community Health Workers conducted in-depth interviews with Haitian women in Little Haiti, Miami. We used a grounded theory approach to analyze data from the in-depth interviews. Emergent themes coalesced into three core categories of screening barriers: Structural, Psychosocial, and Socio-Cultural. We developed a model of screening barriers to depict the themes within each core category. Screening barriers must be examined and understood from the social contexts in which they are produced in order to create meaningful interventions.

Community-based participatory research in Little Haiti: challenges and lessons learned.

Background: Community-based participatory research (CBPR) is an effective methodology for developing relevant interventions with socially marginalized communities. However, implementing CBPR methods is challenging for several reasons. This paper presents challenges encountered in the context of an ongoing CBPR initiative in Little Haiti in Miami, Florida, and describes the solutions used to address them.Objectives: We sought to describe the challenges faced and lessons learned while conducting CBPR in Little Haiti.Methods: Community–academic partnerships were created to guide the creation of culturally relevant cancer interventions and research.Lessons Learned: Historical distrust of research, cultural constructions of health and illness, and literacy issues are key considerations when developing partnerships with Haitian and other marginalized, immigrant communities.Conclusions: Partnerships are fostered over time through demonstrated mutual commitment to improving health and building community capacity. Communities must play an active role throughout the research process to ensure that studies are culturally relevant, and ensuing intervention, sustainable.

Barriers to cervical cancer screening among Haitian immigrant women in Little Haiti, Miami

Previous research has not examined barriers to Pap test screening among Haitian immigrant women through their own discourse. Community Health Workers conducted in-depth interviews with Haitian women in Little Haiti, Miami. We used a grounded theory approach to analyze data from the in-depth interviews. Emergent themes coalesced into three core categories of screening barriers: structural, psychosocial, and sociocultural. We developed a model of screening barriers to depict the themes within each core category. Screening barriers must be examined and understood from the social contexts in which they are produced in order to create meaningful interventions.

Burden of Human Papillomavirus among Haitian Immigrants in Miami, Florida: Community-Based Participatory Research in Action

Background. Haitian immigrant women residing in Little Haiti, a large ethnic enclave in Miami-Dade County, experience the highest cervical cancer incidence rates in South Florida. While this disparity primarily reflects lack of access to screening with cervical cytology, the burden of human papillomavirus (HPV) which causes virtually all cases of cervical cancer worldwide, varies by population and may contribute to excess rate of disease. Our study examined the prevalence of oncogenic and nononcogenic HPV types and risk factors for HPV infection in Little Haiti. Methods. As part of an ongoing community-based participatory research initiative, community health workers recruited study participants between 2007 and 2008, instructed women on self-collecting cervicovaginal specimens, and collected sociodemographic and healthcare access data. Results. Of the 242 women who contributed adequate specimens, the overall prevalence of HPV was 20.7%, with oncogenic HPV infections (13.2% of women) outnumbering nononcogenic infections (7.4%). Age-specific prevalence of oncogenic HPV was highest in women 18–30 years (38.9%) although the prevalence of oncogenic HPV does not appear to be elevated relative to the general U.S. population. The high prevalence of oncogenic types in women over 60 years may indicate a substantial number of persistent infections at high risk of progression to precancer.

Mammography use among Haitian women in Miami, Florida: an opportunity for intervention.

When compared to other racial/ethnic minorities and immigrants in Miami, Florida, Haitian women are more likely to be diagnosed with late-stage breast cancer when the prognosis for survival is poor. This disparity likely reflects mammography underutilization. Previous research has not examined the frequency of mammography use among Haitian women in Miami. Our study addresses this gap. In 2007, Community Health Workers (CHWs) recruited nearly 1,000 Haitian women from community venues across Little Haiti, the predominately Haitian area in Miami, to participate in Rapid Assessment Surveys (RAS). RAS are a quick, cost-efficient method for assessing the prevalence of health behaviors in communities with high-rates of illiteracy and/or distrust of research. Our data indicate Haitian women are less likely than other women in Florida to report regular mammography. Such findings, though not surprising, suggest that grouping all black persons, regardless of ancestry, into one research category may mask variation in disease risk.

The sociocultural context of gynecological health among Haitian immigrant women in Florida: applying ethnographic methods to public health inquiry

Objective. Twalet deba, a culturally mediated feminine hygiene practice, is widespread in Little Haiti, the predominately Haitian neighborhood in Miami, Florida. This practice may have important implications for susceptibility to sexually transmitted infections, including human papillomavirus, the principal cause of cervical cancer. Previous research has not examined the full context of twalet deba in consideration of cultural beliefs and norms about womens hygiene and sexual health. Design. Ethnographic methods guided two phases of exploratory research. The first phase included observation, participant observation, and semi-structured in-depth interviews, which were conducted with key consultants (n=6) and a subsequent purposive sample of 35 women regarding gynecological health beliefs, hygiene practices, and associated home remedy agents. These data informed the second research phase, which involved observation and informal interviews with owners of botánicas in Little Haiti, Miami, FL, USA, to assess the availability of various ethnomedical remedies, their preparation, and preferred uses. All data were analyzed qualitatively to discern patterns in interview responses and using grounded theory to identify key themes. Results. Cultural constructions of gynecological health and illness were generally incongruent with the biomedical model and emphasized the control of self-defined non-specific vaginal infections through routine hygienic practices using ethnobotanical and commercial agents to avert illness, including cancer. Such practices also encourage vaginal tightness and dryness, characteristics desired by male sexual partners, on whom women were frequently economically dependent. Data from the second phase of research reinforced these findings and revealed a wide variety of feminine hygiene agents available for purchase in local botánicas. Conclusion. The results suggest that cultural beliefs about gynecological health and dependence on male partners influence womens routine feminine hygiene practices. Botánicas are culturally salient sites for health information. Ethnographic methods were critical for collecting personal sensitive data that are necessary to inform future intervention.