Life Got In The Way

Life Got in the Way
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Oh, it is? But does it hurt? I felt a little bit on…there were three spatulas they scraped with so now I feel that now yes…now I shall go. P1: It was exactly the same for me. Do they check up on you? How…do you have a doctor? So I just felt that I had to call and ask them to send one of these [invitations] to me, I suppose I have to go for this [laughter].

In contrast, younger Danish and Norwegian women conveyed how their male partners supported their attendance at gynaecological examination and cervical screening. He knew she had only had one Pap smear during her 7 years in Sweden, whereas she had had one Pap smear per year when she lived in Denmark. In particular, that the presence of a social network could support women who are trying to navigate within the Swedish health care system, while the lack of a social network could make it more challenging to attend to cervical screening, as one younger Danish woman said:.

The association between age and risk of cervical cancer was multifaceted. On one hand, older age was said to be an increased risk for cervical cancer. On the other hand, some women associated older age with a low risk for cervical cancer if the woman had had normal Pap smear results in the past.

The association between older age and increased risk of cervical cancer was also said to be related to an increased risk of developing other diseases in general as one ages. Indeed, women who knew others who had been affected by disease had two quite opposite reactions: either they wanted to attend cervical screening more often, or they postponed it, not wanting to know if they had cervical cancer. My family dies from cardio-vascular diseases. It was apparent that most women considered themselves at low risk for developing cervical cancer, particularly younger Norwegian and Danish women.

Therefore when they were invited to cervical screening they decided they could postpone their attendance. Younger Danish women discussed how they felt when they received the invitation letter:.

P1: Exactly. P4: Yes, I dragged it out a bit, I think. Six months, maybe a year went by before I got round to it. But I knew, I saved the slip of paper and knew that I had to go. Women in all groups described that the risk was connected to sexual activity and number of sexual partners.

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One older Norwegian woman explained how she postponed attendance at cervical screening because she had had one normal Pap smear, and since she had had the same partner for many years after that, thought she had low risk of developing cervical cancer:. Risk perception also seemed to be associated with limited knowledge about cervical cancer, screening, and prevention. So even if these women had knowledge about cervical cancer, it did not motivate them to attend cervical screening.

One older Norwegian woman, working as a midwife, was generally positive, and advocated the idea of attending cervical screening. However, during the FGD she explained that as long as her menstruation cycle was normal and she did not have any symptoms, such as abnormal discharge, she postponed her own attendance:. This view was apparent even when the delay had been up to a decade. The main theme was generated from the categories that seemed to influence the delay in attendance at cervical screening: competing needs related to immigration, organisational and structural factors and differences in mentality, which were viewed by the women to be related to immigration, previous experiences, psychological and individual factors, childbearing-related factors, social support and social network and risk perception.

However, for some women these factors were considered to enable cervical screening attendance. Although these categories are presented separately, the women described these factors as being intertwined when discussing their reasoning for postponing cervical screening, thereby revealing the underlying complexity of this issue. The women referred to the delay in attendance at cervical screening in different ways when reasoning about why they did not attend more promptly after receiving the invitation letter from the organised screening programme.

Postponing cervical screening attendance was the category that linked all the reasons why women did not attend at cervical screening. The postponement was an interpretation of the data as the women did not seem to disregard cervical screening but only delayed their attendance. Despite the many similarities between Denmark, Norway and Sweden with regard to the way of life, history, language and social structure, including the existence of an organised cervical screening programme [ 13 , 14 ], immigration to Sweden per se seemed to influence the Danish and Norwegian immigrant women who participated in the FGDs not to attend to cervical screening according to the recommendations of the Swedish National Board of Health and Welfare.

Consistent with previous research, competing needs have been shown to be major obstacles to cervical screening attendance among immigrant women [ 33 ]. However, the competing needs evoked by immigrant women in the United States were essential needs, such as food, shelter and clothing [ 33 ]. The Danish and Norwegian immigrant women in our study discussed specifically how their energy and focus were consumed by the change of environment, attempts to learn how different societal systems worked in the new country, and to their resettlement efforts, all of which are related to competing needs due to the immigration.

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Life Got In The Way Lyrics: We knew it all from a little thing / It was everything in our first minute / And it took us to another place / Yeah another place and we fell. It usually means that someone had a plan to do something with their life, and then something unexpected happened, which prevented them.

We found that organisational and structural factors negatively influenced attendance at cervical screening. The aspects brought up by the FGD-participants were differences between the health care system in the country of origin and that in Sweden, the perception of the cervical screening invitation system as impersonal, logistical challenges and the importance of having a relationship with caregivers. However, these factors have also been mentioned by Swedish-born women who have actively chosen not to attend organised cervical screening [ 34 ].

The Danish and Norwegian immigrant women also discussed the reasons they delayed attendance at cervical screening related to previous experiences, psychological and individual factors and risk perception, which are also known obstacles among Swedish-born women [ 34 , 35 ]. A study among immigrant women in the United States also showed an under-utilisation of cervical screening due to previous negative experiences in the health care system [ 36 ].

In our study, this category was found to be an important motivator to attend cervical screening, as has been shown in previous research [ 37 , 38 ]. It has previously been reported that older Norwegian women in Norway perceive themselves to be at low risk of sexually transmitted cervical infections, and thus delay their attendance at screening [ 39 ], which is consistent with the reasoning of our Norwegian participants.

However, in our study the reproductive years were not unanimously described as a period when they were more motivated to attend cervical screening. Indeed, some women referred to their reproductive years as an extra sensitive period in their lives, accompanied by feelings of increased vulnerability, which, on the contrary, seemed to delay attendance at cervical screening.

The reproductive years were also viewed by the women as periods with more intense contact with the health care system, which conferred feelings of safety because of the regular checks-ups, thus causing some women to postpone their attendance at cervical screening.

On the other hand, studies have shown that women who have passed their childbearing years attend cervical screening to a lesser extent [ 40 , 41 ], as mentioned by older Norwegian and Danish women in our study. Consistent with previous research [ 39 , 40 ], our results showed that the existence of social support and social networks are important aspects that can aid women in navigating within the Swedish health care system, whereas the lack of social support and network might make attendance more challenging.

The Danish and Norwegian women also discussed how differences in mentality influenced their attendance at cervical screening. In this category, the reasons why women delayed their attendance at cervical screening were related to their perception of large differences between the country of origin and Sweden, which led to overwhelming experiences that were energy-consuming. Other reasons discussed were the reluctance of women to accept regular health controls and governmental involvement in private life, and a more anxious approach towards things you should or should not do in Sweden in comparison with a more easy-going approach in the country of origin.

To the best of our knowledge, no previous research has discussed how differences in mentality between the country of origin and the new host country influence attendance at cervical screening. The concept of acculturative stress, defined as the losses that occur when adjusting to, or integrating into a new system of beliefs, routines and social roles [ 42 , 43 ], has been found to affect the lives of immigrants [ 42 ]. There are some limitations to this study. Firstly, the FGDs were held with a limited number of women in one urban area. The results can thus not be generalised to the larger Danish and Norwegian immigrant population in Sweden.

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However, obtaining a more profound understanding of how immigrant women reason about their attendance at cervical screening requires a qualitative approach. Secondly, we experienced difficulties in recruiting women, especially Norwegian women, and some women who expressed interest in participating in the FGDs were hindered by a variety of practical and logistical obstacles inherent to their life situations, which has also been reported in previous research [ 43 ].

Therefore we cannot be certain that we reached saturation i. Difficulties in recruiting hard-to-reach populations, such as minorities, pose challenges related to accessing and gaining the trust of potential participants [ 40 ]. In addition, although the participants in our study varied by socioeconomic status and also included women outside the labour force, the majority of them were of higher socioeconomic status no one had the lowest level of education.

It is therefore possible that the results would have been more nuanced if participants with even more diverse backgrounds had participated. The low response rate in this study could also reflect that women who did not participate in the study may be those who do not attend at cervical screening.

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The self-selection among participants in the study could therefore have influenced our results. However, the analysis of the study participants postponement of their attendance at cervical screening according to the NQRCP was confirmed both among Danish and Norwegian women. Therefore, especially among the study participants in the age-group 41—70 years we do have representatives of women who do not adhere to the screening recommendations, since they postpone their participation to screening. To facilitate an open atmosphere, we tried to attain homogeneity in group composition by forming groups according to country of origin and age.

Moreover, we used native-speaking moderators to facilitate the participation of women who might have been hesitant due to language problems, but also to offer the participants the possibility to use their own language at times for clarity of thought. However, this possibility was seldom used. The discussions were open and lively and allowed different views to be expressed. This was also confirmed by reviewing the field notes taken after each FGD in the debriefing session.

The multidisciplinary combination of the research team brought varied and practical expertise, as is recommended in migrant studies [ 44 ]. This team approach was also used in the data analysis aspect of the study in order to strengthen the trustworthiness of our categorisations and interpretations. All study participants, except two women had attended cervical screening at least once between their immigration to Sweden and the date of the FGD. This might have contributed to their view of being attenders to cervical screening even though from a biomedical perspective and according to the recommendations of the Swedish National Board of Health and Welfare they were non-attenders.

It is interesting to note that although we approached immigrant women without knowing beforehand if they had attended cervical screening, the women discussed postponing their attendance, and what motivated this decision. The effects of moving to another country and the subsequent change in life situation in general are intertwined. To distinguish between these aspects was, however, not within the scope of the study, although some of the factors discussed among Danish and Norwegian women could be relevant for attendance at cervical screening regardless of immigrant status.

There is a need for more research in these particular areas. The findings of the current study highlight various factors that could explain why Danish and Norwegian immigrant women postpone their attendance at cervical screening in Sweden. This, combined with their unawareness, from a professional biomedical perspective, of being non-attenders, reveals an opportunity to motivate these women to attend. The authors would like to thank the Danish and Norwegian women for the time they took from their busy lives and their willingness to share their experiences with us. We would also like to thank the assistants in the study, Hafida Azerkan and Semya Sofri, for their practical support, and Lina Lindqvist for the transcription of the data.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

National Center for Biotechnology Information , U. PLoS One. Published online Jul 9. Christy Elizabeth Newman, Editor. Author information Article notes Copyright and License information Disclaimer.

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Competing Interests: The authors have declared that no competing interests exist. Received Nov 29; Accepted Aug This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. This article has been cited by other articles in PMC.

Abstract Introduction Danish and Norwegian immigrant women in Sweden have an increased risk of cervical cancer compared to Swedish-born women. Conclusions The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend.

Introduction Cervical cancer is the third most common cancer among women worldwide, with a striking variation in incidence by geographic area [ 1 ]. Methods Cervical screening in Scandinavian countries According to the recommendations of the Swedish National Board of Health and Welfare, women 23 to 50 years of age are advised to undergo cervical screening by Papanicolaou Pap smear every 3 years and women aged 51 to 60 years every 5 years.

Sampling and study participants The target population for the present study was immigrant women aged 23 to 70 years from Denmark and Norway living in the Stockholm area. Table 1 Characteristics of the participants. Open in a separate window. Data collection The research team, which consisted of midwives, public health experts, epidemiologists and a medical doctor, developed the FGD guide that was pilot tested on another group of immigrant women.

Denmark Norway No. Data analysis The recorded FGDs were transcribed verbatim. Table 3 Examples of the analytical process. Now I attended once in seven years, sort of…. In Denmark had a pap smear once per year but after the move to Sweden had once in seven years. Postponing cervical screening attendance-changed behaviour related to immigration. There were so many other things you should…. There were so many other things you should. I thought they explained very well why you should have a pap smear, so I went at once.

Good information in the invitation-motivates having a Pap smear. Organisational and structural factors-motivation. Organisational and structural factors- motivation. Moderator: What was it that made you think no? Afraid that having a Pap smear should hurt. Have problem reading and taking in information that you are not interested in- it is difficult for you. Tiresome read and understand written information. I felt a little bit on. You felt a little bit so now you feel that you will have your Pap smear. Having had pap smear despite fear. Positive experience-motivated having Pap smear.

Psychological factor Previous experiences, psychological factor Previous experiences, psychological and individual factors. Ethics statement The participants were informed about the aim of the study, that participation was voluntary, and were told where to turn to if they had questions.

Results Danish women in the present study were between 27 and 66 years old. Behavioural change due to loss of routines from country of origin and many new routines in Sweden. Higher mobility pattern due to travelling or work abroad. Perception of the invitation system for cervical screening as impersonal. Logistical challenges. Importance of relationship with the caregivers. Reluctance of women to accept regular health controls and governmental involvement in private life.

More serious negative experiences in life, such as sexual abuse or rape. Negative emotions after being treated unprofessionally by health care personnel, fear of cancer or fear of disease and other negative feelings. Individual factors such as psychiatric disease, misconceptions about cervical cancer and cervical screening and reading disability.

Women viewed the reproductive years as periods with more intense contact with the health care system, which conferred feelings of safety because of the regular checks-ups. Pap smear was not given as much importance among women who had passed their childbearing years when they moved to Sweden, compared to women who immigrated when they were in their childbearing years. Knowledge about cervical cancer and screening. Postponing attendance at cervical screening It was discussed in all age groups that women who were invited to participate in cervical screening justified postponing it, according to their personal rationale.

As they described it, cervical screening attendance was given low priority at the time, and they therefore waited to attend, forgot about it, had the intention to attend later on, thought that they would attend after receiving the next invitation, or it was put aside, as one younger Danish woman explained: [FGD D] P1: Well I think that I received my first invitation letter at the age of 23 and I believe that it took me one or 2 years before I had my Pap smear.

Competing needs related to immigration Participants often postponed attendance at cervical screening due to other competing needs related to immigration. The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend. Read Article at publisher's site. How does Europe PMC derive its citations network? Protein Interactions. Protein Families. Nucleotide Sequences.

Functional Genomics Experiments. Protein Structures. Gene Ontology GO Terms. Data Citations. There are some limitations to this study. Firstly, the FGDs were held with a limited number of women in one urban area. The results can thus not be generalised to the larger Danish and Norwegian immigrant population in Sweden.

However, obtaining a more profound understanding of how immigrant women reason about their attendance at cervical screening requires a qualitative approach. Secondly, we experienced difficulties in recruiting women, especially Norwegian women, and some women who expressed interest in participating in the FGDs were hindered by a variety of practical and logistical obstacles inherent to their life situations, which has also been reported in previous research [ 43 ].

Therefore we cannot be certain that we reached saturation i. Difficulties in recruiting hard-to-reach populations, such as minorities, pose challenges related to accessing and gaining the trust of potential participants [ 40 ]. In addition, although the participants in our study varied by socioeconomic status and also included women outside the labour force, the majority of them were of higher socioeconomic status no one had the lowest level of education.

It is therefore possible that the results would have been more nuanced if participants with even more diverse backgrounds had participated. The low response rate in this study could also reflect that women who did not participate in the study may be those who do not attend at cervical screening. The self-selection among participants in the study could therefore have influenced our results. However, the analysis of the study participants postponement of their attendance at cervical screening according to the NQRCP was confirmed both among Danish and Norwegian women.

Therefore, especially among the study participants in the age-group 41—70 years we do have representatives of women who do not adhere to the screening recommendations, since they postpone their participation to screening. To facilitate an open atmosphere, we tried to attain homogeneity in group composition by forming groups according to country of origin and age.

Moreover, we used native-speaking moderators to facilitate the participation of women who might have been hesitant due to language problems, but also to offer the participants the possibility to use their own language at times for clarity of thought. However, this possibility was seldom used. The discussions were open and lively and allowed different views to be expressed. This was also confirmed by reviewing the field notes taken after each FGD in the debriefing session. The multidisciplinary combination of the research team brought varied and practical expertise, as is recommended in migrant studies [ 44 ].

This team approach was also used in the data analysis aspect of the study in order to strengthen the trustworthiness of our categorisations and interpretations. All study participants, except two women had attended cervical screening at least once between their immigration to Sweden and the date of the FGD. This might have contributed to their view of being attenders to cervical screening even though from a biomedical perspective and according to the recommendations of the Swedish National Board of Health and Welfare they were non-attenders.

It is interesting to note that although we approached immigrant women without knowing beforehand if they had attended cervical screening, the women discussed postponing their attendance, and what motivated this decision. The effects of moving to another country and the subsequent change in life situation in general are intertwined. To distinguish between these aspects was, however, not within the scope of the study, although some of the factors discussed among Danish and Norwegian women could be relevant for attendance at cervical screening regardless of immigrant status.

There is a need for more research in these particular areas. The findings of the current study highlight various factors that could explain why Danish and Norwegian immigrant women postpone their attendance at cervical screening in Sweden. This, combined with their unawareness, from a professional biomedical perspective, of being non-attenders, reveals an opportunity to motivate these women to attend.

The authors would like to thank the Danish and Norwegian women for the time they took from their busy lives and their willingness to share their experiences with us. We would also like to thank the assistants in the study, Hafida Azerkan and Semya Sofri, for their practical support, and Lina Lindqvist for the transcription of the data. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.

Abstract Introduction Danish and Norwegian immigrant women in Sweden have an increased risk of cervical cancer compared to Swedish-born women. Conclusions The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend. Introduction Cervical cancer is the third most common cancer among women worldwide, with a striking variation in incidence by geographic area [ 1 ].

Methods Cervical screening in Scandinavian countries According to the recommendations of the Swedish National Board of Health and Welfare, women 23 to 50 years of age are advised to undergo cervical screening by Papanicolaou Pap smear every 3 years and women aged 51 to 60 years every 5 years. Sampling and study participants The target population for the present study was immigrant women aged 23 to 70 years from Denmark and Norway living in the Stockholm area.

Download: PPT. Data collection The research team, which consisted of midwives, public health experts, epidemiologists and a medical doctor, developed the FGD guide that was pilot tested on another group of immigrant women. Table 2. Data analysis The recorded FGDs were transcribed verbatim. Ethics statement The participants were informed about the aim of the study, that participation was voluntary, and were told where to turn to if they had questions.

Results Danish women in the present study were between 27 and 66 years old. Table 4. Postponing attendance at cervical screening It was discussed in all age groups that women who were invited to participate in cervical screening justified postponing it, according to their personal rationale. As they described it, cervical screening attendance was given low priority at the time, and they therefore waited to attend, forgot about it, had the intention to attend later on, thought that they would attend after receiving the next invitation, or it was put aside, as one younger Danish woman explained: [FGD D] P1: Well I think that I received my first invitation letter at the age of 23 and I believe that it took me one or 2 years before I had my Pap smear.

Competing needs related to immigration Participants often postponed attendance at cervical screening due to other competing needs related to immigration. There is a lot in life. Organisational and structural factors In all the FGDs, women stated that initially they considered the Swedish health care system to be similar to that in their country of origin. P3: No, no. P4: Just the test. P5: Beforehand you think that it would be just like living in Denmark, of course… P2: Yeah right laughter.

Previous experiences, psychological and individual factors It was discussed in all age groups that prior negative experiences with the health care system and cervical screening programme in Sweden led to delayed contact with health care services even if there was a need. P2: With your naked backside [in full view]. P3: So you are going…?

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P2: You keep notice of it…? P5: Well…[laughter]. Conclusions The findings of the current study highlight various factors that could explain why Danish and Norwegian immigrant women postpone their attendance at cervical screening in Sweden. Acknowledgments The authors would like to thank the Danish and Norwegian women for the time they took from their busy lives and their willingness to share their experiences with us. References 1. Int J Cancer — World Health Organization Global incidence of cervical cancer, projections for Bulletin of the World Health Organization 81— View Article Google Scholar 3.

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Copenhagen: Statistics Denmark. Suarez L Pap smear and mammogram screening in Mexican-American women: the effects of acculturation. Am J Publ Health — View Article Google Scholar Women Health 37— Lum T, Kwon H Health disparities among immigrant and non-immigrant old people: The effects of acculturation and human capital. Gerontologist — J Immigr Health 6: 5— J Immigr Health 4: — J Immigr Health 7: 65— Womens Health Issues — Health Care Women Int — Anttilaa A, Roncob G Description of the national situation of cervical cancer screening in the member states of the European Union.

J Med Screen 9: 86— Scand J Public Health — Eur J Cancer 45 15 : — Morgan DL Focus groups as qualitative research. Barbour R Doing Focus Groups. Swedish Tax Agency Population registration in Sweden. SKV B. Edition 4. Stockholm: Swedish Tax Agency. Elo S, Kyngas H The qualitative content analysis process. J Adv Nurs — Graneheim UH, Lundman B Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today — Krueger RA Focus groups.

A practical guide for applied research. Thousand Oaks: Sage Publications, Inc. Mat Child Health J 9: — Psychooncology — J Psychosom Obstet Gynaecol 23— Ann Epidemiol 10 8 Suppl : S13— Allahverdipour H, Emami A Perceptions of cervical cancer threat, benefits, and barriers of Papanicolaou smear screening programs for women in Iran. Women Health 23— Cancer Nurs E11—E Hansen BT, Hukkelberg SS, Haldorsen T, Eriksen T, Skare GB, et al Factors associated with non-attendance, opportunistic attendance and reminded attendance to cervical screening in an organized screening program: a cross-sectional study of 12, Norwegian women.

BMC Public Health Am J Prev Med 82— Mandelblatt JS, Yabroff KR Breast and cervical cancer screening for older women: recommendations and challenges for the 21st century. J Am Med Womens Assoc — Caplan S Latinos, acculturation, and acculturative stress: a dimensional concept analysis.

Policy Polit Nurs Pract 8: 93— Suggestions from face-to-face and internet focus group discussions with year-old women in Stockholm, Sweden. Acta Oncol — Can Fam Physiciane— J Psychosom Obstet Gynaecol 81— Whose responsibility is it anyway? Vietnamese Canadian women and their healthcare providers' perspectives. Nurs Inq 2— Idestrom M, Milsom I, Andersson-Ellstrom A Knowledge and attitudes about the Pap-smear screening program: a population-based study of women aged 20—59 years.