Term of Award

Fall 2019

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


College of Public Health

Committee Chair

Bettye Apenteng

Committee Member 1

Raymona Lawrence

Committee Member 2

Samuel Opoku

Committee Member 3

Evans Afriyie-Gyawu

Committee Member 3 Email



Introduction: Cervical cancer is the most common type of HPV- associated cancer, disproportionately affecting minority women worldwide. Various strains of the human papillomavirus have been linked to the incidence of this disease. The gradual development of cervical cancer makes it one of the most preventable female cancers, as malignant cell changes can take up to two decades to occur. Regular Pap smears lead to early detection of persistent HPV infection. Together with HPV vaccination, Pap smears are effective in controlling cervical cancer incidence. Although these preventative programs are readily available in the U.S., screening, and vaccination rates have been consistently suboptimal among immigrants. Previous studies have examined the enablers as well as the challenges experienced by immigrants in accessing cervical cancer prevention services. The purpose of this qualitative research was to explore the attitudes, barriers, and sociocultural factors that facilitate the uptake of cervical cancer preventative services among Ghanaians in Ghana, and Ghanaian immigrants living in Georgia. Methods: Semi-structured interviews were conducted in two parts; (a) a preliminary study in Ghana with 35 females and 15 males, and (b) the main study in Georgia, U.S.A. among Ghanaian immigrants, with 17 females and 10 males. Nvivo 12 was used to code the interview transcriptions, from which emerging themes and sub-themes were identified. The Social Ecological Model and the Theory of Reasoned Action were applied to examine the impact of personal and contextual influences on the participants’ decision to access prevention programs. Results: Barriers to screening and vaccination included the lack of knowledge, fear of cervical cancer, fear of the side effects of the HPV vaccine, embarrassment with a physical examination, and cost. Facilitators to screening and vaccination included increased knowledge of and access to cervical cancer prevention programs, health insurance, and encouragement from healthcare providers to utilize these services. Immigration, improved knowledge, and access to Pap smear and HPV vaccines were the strongest influences of change. Conclusion: The study results show that health education and social support could significantly improve the willingness of Ghanaian immigrants to access Pap smear and HPV vaccination. These findings could serve as an outline for the implementation of related programs in Georgia, and other locations with similar high-risk populations.

OCLC Number


Research Data and Supplementary Material