The Impact of Cultural Beliefs About Cervical Cancer Screening on Clinical Practice: A Qualitative Study of Asian Indian Women in Texas

Main Article Content

Regina Jillapalli Kavita Radhakrishnan Lorraine Walker Jane D Champion Matthew McGlone


Background: Asian Indians, primarily through immigration, are among the three fastest growing Asian minority populations in the United States. Sadly, Asian Indian Women did not meet the Health People 2020’s the 93% cervical cancer screening goal of 93%. Cervical cancer screening rates among Asian Indian Women were 70.5% compared to 82.7% among non-Hispanic Whites. A systematic review revealed the need for qualitative studies to explore influences of cultural beliefs on cervical cancer screening (pap smears) behaviors among Asian Indian Women applying symbolic interactionism theoretical framework.

Purpose: To explore the influence of cultural beliefs on cervical cancer screening behaviors among Asian Indian Women.

Method: A qualitative descriptive ethnographic design used descriptive ethosemantic semi-structured questions to investigate cultural impact on cervical cancer prevention behaviors among a purposive sample of 15 Asian Indian Women between the ages 21 to 49 years of age. Data analysis used inductive analytical methods.

Findings: Five themes influenced cervical cancer screening: locus of control, concept of health, ‘no sex before marriage,’ awareness, and body image. A healthy internal locus of control, sense of being healthy, awareness, and positive body image supported cervical cancer screening behaviors. An external locus of control, belief that health is not a priority, “no sex before marriage,” and low body image were barriers to cervical cancer screening behaviors. Additionally, the concept of “no sex before marriage” influenced timing of the first pap smear. Notwithstanding their cultural beliefs, employment, health insurance, and recommendations from their providers had a positive impact on cervical cancer screening.

Conclusion: Findings from this study have implications for both health policy and clinical practice. Health policy influences funding for basic screening and preventive services. Clinical practice implications encompass fostering partnerships within the community to promote prevention programs and cultural sensitivity training for providers. Future community-based participatory research should address interventional studies to increase compliance for cervical cancer screening and prevention behaviors among Asian Indian Women.

Article Details

How to Cite
JILLAPALLI, Regina et al. The Impact of Cultural Beliefs About Cervical Cancer Screening on Clinical Practice: A Qualitative Study of Asian Indian Women in Texas. Medical Research Archives, [S.l.], v. 10, n. 12, dec. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 19 june 2024. doi:
Research Articles


1. Peace, Dignity, and Equality, On A Healthy Planet. Accessed November 2, 2022.
2. American Community Survey Data. Revised September 27, 2022. Accessed October 5, 2022.
3. Cancer Facts & Figures 2018. Accessed January 20, 2019.
4. Cancer. Healthy People 2020. Accessed October 5, 2019.
5. Jain RV, Mills PK, Parikh-Patel A. Cancer incidence in the south Asian population of California, 1988-2000. Journal of carcinogenesis. 2005;4:21. doi:10.1186/1477-3163-4-21
6. White A, Thompson TD, White MC, et al. Cancer Screening Test Use - United States, 2015. MMWR Morbidity and mortality weekly report. 2017;66(8):201-206. doi:10.15585/mmwr.mm6608a1
7. Shoemaker ML, White MC. Breast and cervical cancer screening among Asian subgroups in the USA: estimates from the National Health Interview Survey, 2008, 2010, and 2013. Cancer causes & control: CCC. 2016;27(6):825-829. doi:10.1007/s10552-016-0750-5
8. Thompson CA, Gomez SL, Chan A, et al. Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2014;23(11):2208-2217. doi:10.1158/1055-9965.EPI-14-0487
9. Mehrotra N, Gaur S, Petrova A. Health care practices of the foreign born Asian Indians in the United States. A community based survey. Journal of community health. 2012;37(2):328-334. doi:10.1007/s10900-011-9449-4.
10. Misra R, Menon U, Vadaparampil ST, BeLue R. Age- and sex-specific cancer prevention and screening practices among Asian Indian immigrants in the United States. Journal of investigative medicine: the official publication of the American Federation for Clinical Research. 2011;59(5):787-792. doi:10.2310/JIM.0b013e3182160d5d
11. Ross JS, Nuñez-Smith M, Forsyth BA, Rosenbaum JR. Racial and ethnic differences in personal cervical cancer screening amongst post-graduate physicians: results from a cross-sectional survey. BMC public health. 2008;8:378. doi:10.1186/1471-2458-8-378
12. Misra R, Vadaparampil ST. Personal cancer prevention and screening practices among Asian Indian physicians in the United States. Cancer detection and prevention. 2004;28(4):269-276. doi:10.1016/j.cdp.2004.02.004
13. Williams JJ, Santoso JT, Ling FW, Przepiorka D. Pap smear noncompliance among female obstetrics-gynecology residents. Gynecologic oncology. 2003;90(3):597-600. doi:10.1016/s0090-8258(03)00406-2
14. Author. 2022.
15. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999-2019): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute;, Released in November 2022.
16. U.S. Preventive Services Task Force. Recommendation: Cervical Cancer Screening. March 10, 2022. Accessed November 25, 2022.
17. Spradley, JP. The ethnographic interview. 1979. New York, NY: Harcourt Brace Jovanovich College Publishers, pp. 86–91.
18. Ammirati R, Nowicki S. Locus of Control. Oxford University Press; 2015. Accessed November 16, 2019.
19. Trinh Q-D, Li H, Meyer CP, et al. Determinants of cancer screening in Asian-Americans. Cancer causes & control: CCC. 2016;27(8):989-998. doi:10.1007/s10552-016-0776-8
20. Chang CM, Lin HF. A qualitative study of women who do not take cervical screenings. Journal of Nursing and Healthcare Research. 2009;5(3):211-219-219.
21. Kim M, Lee H, Shi L, Tan K, Phala C. Cervical cancer knowledge and cultural health beliefs regarding cervical cancer and attitudes and behaviors towards cervical cancer screening among Cambodian American women. Nursing Research. 2016;65(2), E46.
22. Kwok C, Fethney J, White K. Chinese Breast Cancer Screening Beliefs Questionnaire: development and psychometric testing with Chinese-Australian women [corrected] [published erratum appears in J ADV NURS 2010 Aug;66(8):1899]. Journal of Advanced Nursing (John Wiley & Sons, Inc). 2010;66(1):191-200. doi:10.1111/j.1365-2648.2009.05177.x
23. Xingjie Wang, Fang C, Yin Tan, Liu A, Ma GX. Evidence-Based Intervention to Reduce Access Barriers to Cervical Cancer Screening Among Underserved Chinese American Women. Journal of Women’s Health (15409996). 2010;19(3):463-469. doi:10.1089/jwh.2009.1422
24. McCaffery K, Waller J, Nazroo J, Wardle J. Social and psychological impact of HPV testing in cervical screening: A qualitative study. Sexually Transmitted Infection Journal. 2006;82:169–174. doi:10.1136/sti.2005.016436
25. Nardi C, Sandhu P, Selix N. Cervical cancer screening among minorities in the United States. Journal for Nurse Practitioners. 2016;12(10), 675–682. doi:10.1016/j.nurpra.2016.98.036
26. Robinson K, Clark L, Eng W, Wu L, Raker C, Clark M., & ... Dizon DS. Cervical cancer prevention: Asian-American women’s knowledge and participation in screening practices. Women’s Health Issues: Official Publication of The Jacobs Institute of Women's Health, 2014;24(2), e231–e236. doi:10.1016/j.whi.2013.12.005
27. Brown DR, Wilson RM, Boothe MA, Harris CE, Brown DR, Wilson R M, … Harris CES. (2011). Cervical cancer screening among ethnically diverse black women: Knowledge, attitudes, beliefs, and practices. Journal of the National Medical Association. 2011;103(8), 719–728.
28. Gor BJ, Chilton JA, Camingue PT, Hajek RA. Young Asian Americans’ Knowledge and Perceptions of Cervical Cancer and the Human Papillomavirus. Journal of Immigrant and Minority Health. 2011;13(1):81-86. doi:10.1007/s10903-010-9343-7
29. Tung WC. Cervical Cancer Screening Among Hispanic and Asian American Women. Home Health Care Management & Practice. 2011;23(6):480-483. doi:10.1177/1084822311413555
30. Ma GX, Toubbeh JI, Wang MQ, Shive SE, Cooper L, Pham A. Factors Associated with Cervical Cancer Screening Compliance and Noncompliance among Chinese, Korean, Vietnamese, and Cambodian Women. Journal of the National Medical Association. 2009;101(6):541-551. doi:10.1016/S0027-9684(15)30939-1
31. Yoo GJ, Le MN, Vong S, Lagman R, Lam AG. Cervical Cancer Screening: Attitudes and Behaviors of Young Asian American Women. Journal of Cancer Education. 2011;26(4):740-746. doi:10.1007/s13187-011-0230-2
32. Lee-Lin F, Pett M, Menon U, et al. Cervical cancer beliefs and Pap test screening practices among Chinese American immigrants. Oncology Nursing Forum. 2007;34(6):1203-1209. doi:10.1188/07.ONF.1203-1209
33. Lee-Lin FF. Mammography and Pap testing screening among first generation Chinese Americans. Mammography & Pap Testing Screening Among First Generation Chinese Americans. January 2006:159.
34. Leyva M, Byrd T, Tarwater P. Attitudes towards cervical cancer screening: a study of beliefs among women in Mexico. Californian Journal of Health Promotion. 2006;4(2):13-24.
35. Liang W, Wang JH, Chen M-Y, et al. Developing and Validating a Measure of Chinese Cultural Views of Health and Cancer. Health Education & Behavior. 2008;35(3):361-375.
36. Grandahl M, Tydén T, Gottvall M, Westerling R, Oscarsson M. Immigrant women’s experiences and views on the prevention of cervical cancer: a qualitative study. Health Expectations. 2015;18(3):344-354. doi:10.1111/hex.12034
37. Gregg J, Nguyen-Truong CKY, Wang P, Kobus A. Prioritizing Prevention: Culture, Context, and Cervical Cancer Screening among Vietnamese American Women. Journal of Immigrant and Minority Health. 2011;13(6):1084-1089. doi:10.1007/s10903-011-9493-2
38. Lee HY, Ju E, Vang PD, Lundquist M. Breast and cervical cancer screening among Asian American women and Latinas: Does race/ethnicity matter?...[corrected] [published erratum appears in Journal of Women’s Health, 2011; 20(12):1938]. Journal of Women’s Health (15409996., 2010;19(10), 1877–1884. doi:10.1089/jwh.2009.1783
39. Title X: The Nation’s Program for Affordable Birth Control and Reproductive Health Care. Accessed August 4, 2021.
40. Annual Report 2018-2019. Published June 30, 2019. Accessed July 2019.
41. Planned Parenthood Withdraws from Title X Program Over Trump Abortion Rule. Published August 19, 2019. Accessed August 24, 2019.
42. Trump Administration Enacts Sweeping Executive Order Attacking Access to Birth Control on The Same Day House Votes to “Defund” Planned Parenthood. Published May 4, 20217. Accessed August 2, 2019.
43. In Huge Victory for Sexual and Reproductive Health Care, Biden-Harris Administration Announces End to Title X Gag Rule. Published October 4, 2021. Accessed November 2, 2022.
44. H.R. 1245 — 109th Congress: Gynecologic Cancer Education and Awareness Act of 2005.” 2005. September 4, 2019.
45. Inside Knowledge About Gynecologic Cancer Campaign. Revised August 6, 2021. Accessed August 15, 2019.
46. Public Health Grand Rounds: Preventing Cervical Cancer in the 21st Century.
47. Sung H, Siegel RL, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer Journal for Clinicians. 2021;71(3):209-249-249. doi:10.3322/caac.21660
48. Lee J, Carvallo M. Socioecological Perspectives on Cervical Cancer and Cervical Cancer Screening Among Asian American Women. Journal of Community Health: The Publication for Health Promotion and Disease Prevention. 2014;39(5):863-871. doi:10.1007/s10900-014-9887-x