Abstract
The cervical cancer burden in Haiti is among the highest in the world, despite being a largely preventable disease through primary (i.e., vaccination against Human papillomavirus (HPV), the principal cause of cervical cancer), and secondary (i.e., routine cervical cancer screening) prevention strategies. Haitian women likely face multiple barriers to disease prevention though knowledge of these barriers remains limited, particularly from a multilevel, transnational orientation. This dissertation aims to fill this gap. Guided by the PEN-3 model and the tenets of Community Engaged Research, the three associated papers rely on mixed methodologies to articulate the complex interplay between socio-cultural, environmental, political, and historical factors that impede screening uptake and attract attention to women’s health, more broadly, among Haitian women living in South Florida, the largest enclave of Haitians living in the U.S., and the Central Plateau of Haiti (Artibonite), one of the largest departmental regions in Haiti. Using data previously collected as part of two studies funded by the National Institutes of Health, the first paper employed multiple statistical approaches, including machine learning, to assess the relationship between cervical cancer screening behaviors, immigration history, patterns of healthcare utilization, and key sociodemographic characteristics of Haitian immigrant women in the Miami metropolitan area. Study findings indicate that more recent immigration (within five years), lack of formal citizenship, and poor access to routine care impede routine cervical cancer screening for this vulnerable population sub-group. The second paper employed the same secondary data and geospatial statistics to visualize clustering of women at risk marked by self-reported health history with absence of cervical cancer screening. Similarly, these analyses revealed regional risk for cervical cancer throughout various neighborhoods in Miami-Dade County. The third study involved primary data collection in Haiti’s Central Plateau using photovoice, a Community-Based Participatory Research methodology, which engaged community members in all aspects of the research process through storytelling and digital media. Results highlighted multiple barriers, including gendered family responsibilities, concerns about the quality of care, financial and time constraints, worries about discomfort and efficacy of the exam, and emotional deterrents such as desperation and frustration. Collectively, results from this dissertation call for more extensive examination of the heterogeneity within the racial category of Black to unearth transnational, multifaceted determinants of health including socio-cultural health behaviors and socio-environmental health access. Future interventions in Haitian women’s healthcare must include the development of proactive policies, which facilitate healthy transition into U.S. systems (e.g., medical care, education, employment), as well as programs in Haiti, which deliberately pressure the government and global community to prioritize health infrastructure while simultaneously educating women about and dispelling fear of cervical cancer, thus empowering Haitian women to live their healthiest lives.