UNIVERSITY OF CALGARY

UNIVERSITY OF CALGARY
Identifying Barriers to Cervical Cancer Screening in South Asian Muslim Immigrant Women
by
Syeda Kinza Rizvi
A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF SCIENCE
GRADUATE PROGRAM IN COMMUNITY HEALTH SCIENCES
CALGARY, ALBERTA
JULY, 2016
© Syeda Kinza Rizvi 2016

ii
Abstract
We sought to identify the barriers to cervical cancer screening among South Asian Muslim
immigrant women in Calgary. Qualitative, semi-structured in-depth interviews, by snowball
sampling, were conducted with South Asian Muslim immigrant women of Calgary who were
unscreened or infrequently screened for cervical cancer. Eighteen women were interviewed and
the majority (66%) never had a Pap test. Major findings include: misunderstanding about Pap
test reminders, strong preference for a female physician who also speaks their language, negative
experiences with healthcare providers including painful Pap test experience. Major barriers
involved: lack of knowledge about cervical cancer, fatalist beliefs, transportation, language and
unavailability of female physicians. Separate centers for Pap testing, awareness and
encouragement by healthcare providers to get tested were strategies participants suggested.
Different healthcare strategies are needed at the system and provider level to improve healthcare
experience of these women and to promote cervical cancer screening.

iii
Acknowledgements
I would like to thank my supervisor, Dr. James Dickinson for his continuous guidance,
and support. Dr. Dickinson confidence in me has made my master’s thesis achievable. I would
like to thank my thesis committee, Dr. Bejoy Thomas and Dr. Marilynne Hebert, for their
cooperation and constructive comments.
I would like to specially thank Dr. Rebecca Malhi for her time and patience throughout
this journey. Dr. Malhi was incredibly supportive and always had positive feedback and
encouraging words.
My deepest gratitude is for my parents and family (Mom, Dad, Unaiza, Ali) – for their
patience and support throughout my master’s studies. I would also like to say thank you to my
wonderful friends Y.M., Hayat Baba, Noreen Singh and Fouzia Usman for their constant
encouragement and support. Thanks to Carly for your feedback and guidance.
A big thank you to Dr. Elaine Douglas for always being a great company and taking a
keen interest in my studies. And last but not the least, thank you to my TARRANT team
(Virginia, Kim & Ian) for being supportive and allowing me to manage the time I needed to
dedicate towards my studies.
Finally, I would like to thank the eighteen women who shared their thoughts, stories, and
experiences, without your words there would have been no project.

iv
Dedication
This work is dedicated to my parents, Nasim and Zamir Rizvi- you have always provided me
with your unconditional love and support. Thank you for always believing in me.

v
Table of Contents
Abstract ............................................................................................................................... ii!
Acknowledgements ............................................................................................................ iii!
Dedication .......................................................................................................................... iv!
Table of Contents .................................................................................................................v!
List of Tables ................................................................................................................... viii!
List of Figures .................................................................................................................... ix!
CHAPTER ONE:!INTRODUCTION ...............................................................................1!
1.1 Introduction ................................................................................................................1!
Background .................................................................................................................1!
Rationale of the study .................................................................................................2!
1.2 Research Objective and Questions ............................................................................3!
1.3 Organization and Overview of the Thesis .................................................................4!
LITERATURE REVIEW ......................................................................5!
2.1 Cervical Cancer and Screening ..................................................................................5!
2.1.1 Guidelines for Cervical Cancer Screening ........................................................6!
2.2 Cervical Cancer Screening in Immigrants .................................................................7!
2.3 Cervical Cancer Screening in South Asian Immigrants ..........................................11!
2.3.1 South Asian Muslim Immigrants in Canada ...................................................12!
2.4 Muslim Culture, Tradition & Beliefs .......................................................................13!
2.5 Cervical Cancer & Screening in Muslim Majority Countries .................................14!
2.6 Barriers to Cervical Cancer Screening in Immigrants .............................................16!
2.7 Barriers to Cervical Cancer Screening in South Asian Immigrants ........................17!
2.8 Identified Knowledge Gaps .....................................................................................17!
METHOD ........................................................................................19!
3.1 Research Design ......................................................................................................19!
3.2 Methods ...................................................................................................................20!
3.2.1 Eligibility Criteria ............................................................................................20!
3.2.2 Recruitment & Setting .....................................................................................21!
Original Plan .....................................................................................................21!
Recruitment Method ...........................................................................................23!
3.2.3 Data Collection ................................................................................................23!
3.2.3.1 Interview Guide .....................................................................................23!
3.2.3.2 Interview Process ...................................................................................25!
3.2.3.3 Field Notes .............................................................................................26!
3.2.3.4 Data Management ..................................................................................26!
3.2.4 Ethics ...............................................................................................................26!
3.2.5 Data Analyses ..................................................................................................28!
3.2.6 Reflexivity .......................................................................................................31!
RESULTS ..........................................................................................33!