BARRIERS AND FACILITATORS OF CERVICAL CANCER SCREENING AMONG HISPANIC WOMEN Theresa L. Byrd, DrPH; Rafaelita Chavez, MD; Katherine M. Wilson, PhD Hispanic women are less likely than non- Hispanic white women to utilize Pap test screening. Additionally, Hispanic women have higher rates of cervical cancer than non- Hispanic white women. To better understand the barriers and facilitators for Pap test screening, we conducted 13 focus groups with 84 Hispanic women aged 18–61 years. The moderator guide was developed using the Health Belief Model. These focus groups were part of a larger study aimed at developing intervention materials for women on the US- Mexico border. Most of the women knew about cervical cancer and the Pap test. Perceived benefits of screening were finding cancer early, and feeling good about taking care of one’s health. Personal barriers to having the test included embarrassment, fear, and pain. System barriers included physician gen- der and insensitivity to patient needs. Although the male partner was mentioned as a possible barrier in every group, most women expressed that this was not an issue for them personally. Facilitating factors fell into three categories: information/education, low cost or free tests, and supportive physicians and friends. Results of the focus group study were used in the subsequent development of a survey instru- ment and an intervention in a larger study. (Ethn Dis. 2007;17:129–134) Key Words: Hispanic, Cervical Cancer Screening, Barriers to Screening INTRODUCTION Hispanic women have a rate of invasive cervical cancer twice as high as that of non-Hispanic white women. 1 Nationally, the incidence of cervical cancer has been reported as 15.8 cases per 100,000 in Hispanic women, and 8.7 per 100,000 in non-Hispanic white women, with mortality rates of 3.5 per 100,000 and 2.5 per 100,000, respec- tively. 2 Mortality from cervical cancer among Hispanics may be higher in communities along the Texas–Mexico border. According to the latest report of the Texas Department of State Health Services Cancer Epidemiology and Sur- veillance Branch (1998–2002), the rate of cervical cancer in El Paso County was 15.4/100,000 and the mortality rate was 4.2/100,000. 3 Invasive cervical cancer can be pre- vented through routine screening using the Papanicolau test (Pap test) to identify and treat cervical dysplasia, a precancerous condition. 4 Hispanic women have a lower rate of participa- tion in cervical cancer screening pro- grams than other women. Nationwide in 2002, 90% of Hispanic women over age 18 reported having a Pap test within the last three years, while 96.2% of non- Hispanic white women and 96% of non-Hispanic black women reported having had the test. 5 In Texas during that same year, the rates for non- Hispanic white women, non-Hispanic black women and Hispanic women were 96.1%, 95.3% and 90.4% re- spectively. 5 In a recent study done in El Paso, Texas, only 69% of Hispanic women age 18–25 reported ever having had a Pap test. 6 Suggested reasons for the low rate of cervical cancer screening among His- panic women include embarrassment, fear and hopelessness concerning the possibility of a cancer diagnosis, lack of knowledge about cervical cancer and screening, 7,8,9 and lack of health in- surance. 10,11,12 El Paso, Texas presents a unique opportunity to better understand the beliefs of Hispanic women about cervi- cal cancer screening. Situated directly on the US-Mexico border, El Paso is ,78% Hispanic, and most are of Mexican origin. Directly across the border, Ciudad Juarez, Chihuahua, is one of the largest cities in Mexico, with approximately 2 million residents. Re- sidents often have family on both sides of the border and move fairly freely back and forth, with ,234,000 legal border crossings per day. It is not uncommon for residents of both sides of the border to cross for medical care. 13,14 Many women on both sides of the border use Mexican pharmacies to obtain both oral and injectable contraceptives without a prescription and at low cost. 15 Because women in the United States commonly receive cervical cancer screening where they obtain birth control, the use of over- the-counter contraceptives may influ- ence the rate of screening on the US- Mexico border. This paper describes results of focus groups used to explore the attitudes and beliefs of Hispanic women in El Paso about cervical cancer and screening. These focus groups were part of a larger study aimed at developing culturally appropriate, theoretically sound intervention materials. Focus group data were used to guide the development of a theoretically based survey instrument, and results of both the focus groups and the survey were used to inform intervention develop- ment. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. From the Division of Health Promotion and Behavioral Sciences, University of Texas Health Sciences Center-Houston, School of Public Health at El Paso, Texas (TLB, RC); Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (KW). Address correspondence and reprint requests to Theresa L. Byrd; University of Texas School of Public Health at El Paso; 1100 North Stanton, Suite 110; El Paso, TX 79902; 915-747-8504; 915-747-8512 (fax); Theresa.L.Byrd@uth.tmc.edu Ethnicity & Disease, Volume 17, Winter 2007 129