Summary of cervical cancer related studies that include African immigrants (AI).

Table 1: Summary of cervical cancer related studies that include African immigrants (AI).

Author/year	Study design and population	Sample	Outcome	Pap screening time frame	Key findings
Forney-Gorman & Kozhimannil, 2015 [11]	Quantitative: secondary analysis of integrated health interview data African American and African immigrants	Total N = 656 AI N = 36	Distinguish between African Americans and AI screening patterns	Pap screening within the past three years	African Americans were over 3 times more likely to have reported pap smear compared to AI (OR-3.37, 95% CI-1.89-5.96). Higher education level is associated with higher odds of current Pap test. Every 1-unit increase in income was associated with decreased of having current pap screening.
Harcourt, et al. 2013 [38]	Cross-sectional design. African immigrants in Minnesota	AI N = 421	Factors associated with screening and screening rates	Ever had a Pap screening	52% have ever had pap screening Recent immigrants ≤ 5 yrs stay were less likely to be screened Somali have higher odds of being screened compared to other AI.
Ghebre, et al. [34]	Qualitative: informant interviews/ Somali immigrants	AI N = 23	Barriers and facilitators to cervical cancer	N/A	Barriers to screening include lack of knowledge, religious beliefs, fatalism, fear, embarrassment and lack of trust in interpreters. Other barriers are language and trust in healthcare.
Ndukwe, et al. 2013 [33]	Qualitative: focus groups. Key informants/African women in Washington DC	AI N = 38	Knowledge and perception about breast/cervical cancer screening	Previously screened	Cervical cancer awareness is significantly lower among this population when compared to breast cancer. Barriers include fear, fatalism, lack of knowledge and cultural beliefs.
Piwowarczyk, et al. 2013 [44]	Quantitative: intervention Somali & Congolese in Boston	AI N = 120	Knowledge and intentions related to screening	Ever had pap screening Pap smear in the past year	Tailored DVD-based intervention increased knowledge of screening and intention receive pap smear (p < 0.01). Somali women were less likely than Congolese women to have obtained a pap smear in the past year. 21.3.1% vs. 44.1%. About 75% have ever had a pap screening.
Samuel, et al. 2009 [42]	Quantitative analysis of chart review	N = 100 AI = 39	Screening rates and factors associated with screening	Year of most recent pap screening	Somali immigrants had lowest screening rates compared to other African immigrants. There was no significant relationship between odds of being screened and years in the US.
Morrison, et al. 2012 [39]	Quantitative analysis of medical records data	N = 91,557 AI = 810	Factors associated with preventive services use	Pap screening completion within the past 3years	Somali patients had lower pap smear screening use 48.79% compared to 69.1% in Non-Somali patients. Positive association between pap smear completion and the number of primary care visits (p = 0.01) and ED visits (67 vs. 51 %, p = 0.005).
Ogunsiji, et al. 2012 [47]	Qualitative inquiry/West African women in Australia	AI N = 21	Knowledge, attitude, and usage of cancer screening	N/A	Low knowledge of screening, women who had at least a child after migration have better knowledge of cervical cancer screening, negative attitude towards screening.
Ekechi, et al. 2014 [41]	Quantitative design/African or Carribean women in London	N = 876 AI = 218 (24.7%)	Knowledge of cervical screening, screening attendance	Screened within the past 3 years Screened within 3-5 years	Being younger, single, African (compared to Caribbean) and attending religious services more frequently were associated with being overdue for screening.
Morrison, et al. 2013 [40]	Quantitative data Secondary analysis/Somali	AI N = 310	Predictors of cervical cancer completion	One pap screening within the past 3 years	51% were adherent to cervical screening; adherence was associated with more overall health care system visits. Majority of participants, saw male providers 65.8% of the time; only 20.4% of pap tests were performed by male providers. No age difference in age between adherent and non-adherent women.
Sewali, et al. 2015 [43]	Randomized control trial/Somali	AI N = 63	Screening with clinic based Pap test versus HPV self-sampling	Successful completion of Pap screening test within 3 months after enrollment	After 3 months participants in the HPV test group were more likely to complete screening test compared to those in the clinic based pap test group (65.6% vs. 19.4%) (p = 0.0002). Women who reported having friends/family members to talk about cancer screening were approximately three times more likely to complete any screening test than those who did not (P = 0.127). This was not statistically significant after multivariate adjustment. Participants who reported residing in the US longer were more likely to complete a screening test (P = 0.011).
Lofters, et al. 2011 [36]	Quantitative research: immigrant women living in Ontario's urban centers	N = 455864 AI = 26125	Screening adherence and Pap screening predictors	Screened within the past three years	49.2% of Sub Saharan African have been screened. Immigrant class was significant for Sub-Saharan African women and Western European women, with refugees being at higher risk of non-screening.
Tsui, et al. 2007 [37]	Foreign born women in the US	N = 70775 AI = 178	Receipt of pap screening and determinants of pap screening	Never receiving a pap screening	Significant determinants of screening rates were foreign born and time spent in the United States. Foreign born women were more than three times as likely as US born women to have never received a Pap screening.
Redwood-Campbell, et al. 2011 [32]	Immigrant and Canadian women	N = 77 AI = 15	Barriers and enablers associated with cervical cancer screening	N/A	Knowledge gaps, misconception about cervical cancer causes, positive attitudes about taking care of health and preference for female clinician.
Abdullahi, et al. 2009 [35]	Africa born Somali Women immigrant in Camden, London	AI = 50	Breast and cervical screening	Ever had Pap screening	Barriers to breast cancer screening included limited knowledge, lack of insurance, spiritual beliefs, and secrecy.
Brown, et al. 2011 [48]	Qualitative focus group/ethnic diverse women (Haitian, African, Caribbean, African American)	N = 54 AI = 5	Facilitators and barriers of cervical cancer	N/A	Patient-doctor relationship was the single most important facilitator for cervical cancer screening. Barriers to screening included cost, busy work schedule, fear of the unknown, lack of insurance or being unemployed, and fear of disclosing immigration status.