Dominique Guillaume

Contextualizing HPV vaccination intention among Haitian immigrant and migrant women through exploring cultural worldviews and affective risk perception: a qualitative study

Haitian women experience high rates of cervical cancer and are more likely to be diagnosed at advanced stages. Although the HPV vaccine is effective in preventing cervical cancer, limited data exists regarding factors influencing HPV vaccine uptake among Haitian women. Our study explored HPV vaccination knowledge, awareness, and intentions through the domains of cultural worldviews and risk perception among Haitian immigrant and migrant women who recently arrived to the United States. These qualitative data are from a larger exploratory sequential mixed-methods study evaluating HPV vaccination intention among Haitian immigrant and migrant women. Semi-structured in-depth interviews were conducted with N = 25 participants. Interviews contained questions exploring health beliefs and knowledge, women's cervical cancer experiences, cultural worldviews, affective evaluations of cervical cancer risk perception, and HPV vaccination intention. Qualitative descriptive methodology using thematic analysis was employed for data analysis on Atlas.ti software. HPV vaccination knowledge and awareness were exceptionally low in our sample. Women endorsed maintaining cultural practices and beliefs upon migrating to the U.S. which shaped their decision to engage in health promotion behaviors. In response to affective risk perception, women believed that the unpredictability of cervical cancer increased their susceptibility to the disease. Participants endorsed cervical cancer as a fatal illness, with this perception being partly driven by superstitious beliefs toward cervical cancer, along with women's prior experience with the health system in Haiti. These factors demonstrated potential relevance toward women's decision making to engage in HPV vaccination behaviors. Culture, affective risk perception, and past experiences may be relevant toward Haitian women's decision making to engage in HPV vaccination practices. Our results underscore the importance of using alternative methods in understanding HPV vaccination intention and scaling up HPV vaccination efforts for Haitian women both in the U.S. and in Haiti.

Exploring engagement in cervical cancer prevention services among Haitian women in Haiti and in the United States: a scoping review

Haitian women in Haiti and in the United States experience a disproportionate burden of cervical cancer, however their uptake of cervical cancer prevention services remains concerningly low. A comprehensive search on bibliographic databases coupled with a grey literature search was conducted. A total of 401 studies were identified, with 28 studies retained after following Arksey and O'Malley's Scoping Review Guidelines. Knowledge levels of HPV and cervical cancer, along with preventative measures was alarmingly low. Traditional health practices, cultural worldviews, and social networks had an influence on the uptake of cervical cancer prevention. Health systems barriers were found to be a prevalent barrier among Haitian women in the U.S. Future health promotion interventions developed for Haitian women must address personal, cultural, social, and structural factors with an emphasis on modifying knowledge and beliefs to improve engagement in cervical cancer prevention behaviors.

Global perspectives of determinants influencing HPV vaccine introduction and scale-up in low- and middle-income countries

Achieving WHO cervical cancer elimination goals will necessitate efforts to increase HPV vaccine access and coverage in low-and-middle-income countries (LMICs). Although LMICs account for the majority of cervical cancer cases globally, scale-up of HPV vaccine programs and progress toward coverage targets in LMICs has been largely insufficient. Understanding the barriers and facilitators that stakeholders face in the introduction and scale-up of HPV vaccination programs will be pivotal in ensuring that LMICs are equipped to optimize the implementation of HPV vaccination programs. This qualitative study interviewed 13 global stakeholders categorized as either academic partners or global immunization partners to ascertain perspectives regarding factors affecting the introduction and scale-up of HPV vaccination programs in LMICs. Global stakeholders were selected as their perspectives have not been as readily highlighted within the literature despite their key role in HPV vaccination programming. The results of this investigation identified upstream (e.g., financial considerations, vaccine prioritization, global supply, capacity and delivery, and vaccine accessibility, equity, and ethics) and downstream (e.g., vaccine acceptability and hesitancy, communications, advocacy, and social mobilization) determinants that impact program introduction and scale-up and confirmed that strong political commitment and governance are significant in garnering support for HPV vaccines. As LMICs introduce HPV vaccines into their national immunization programs and develop plans for scaling up vaccination efforts, strategic approaches to communications and advocacy will also be needed to successfully meet coverage targets.

Development and Psychometric Testing of a Scale Evaluating Traditional Health Practices for Cervical Cancer Prevention Among Haitian Migrant Women

ABSTRACT Objective Haitian migrant women experience disproportionate rates of cervical cancer. Cultural worldviews have been implicated as a factor influencing cervical cancer behaviors. However, no validated or reliable scale has been developed to measure the influence of cultural worldviews on cervical cancer risk and behaviors in this community. Methods We detail the original development and psychometric testing of the Traditional Health Practices for Cervical Cancer Prevention Scale (THP‐CCP). A total of N  = 151 Haitian women who recently migrated to the U.S. participated in the study. Scale items were newly developed based on qualitative interviews conducted by our team. Items were administered to participants, and the scale's construct validity, reliability, and concurrent validity were evaluated. We hypothesized that the scale would be associated with women's education levels and superstitious beliefs toward cancer, which we tested with an ANOVA and Pearson's correlation. Results A total of 30 items were developed in Haitian Creole and were evaluated by an expert panel of reviewers. Factor analysis yielded a one‐factor solution consisting of 11‐items interpreted as traditional health practices and cultural beliefs influencing cervical cancer risk and behaviors. The total scale Cronbach's alpha reliability coefficient was 0.79. The THP‐CCP scores demonstrated concurrent validity with women's education level ( F  = 3.56, p  = 0.031) and superstitious beliefs toward cancer ( r  = 0.26, p value = 0.001). Conclusion The THP‐CCP scale demonstrated strong psychometric properties and can assist researchers in better understanding cultural influences toward engagement in cervical cancer prevention behaviors among Haitian women.