Abstract
BackgroundStudies from European and non-European countries have shown that migrants utilize cervical cancer screening less often than non-migrants. Findings from Germany are inconsistent. This can be explained by several limitations of existing investigations, comprising residual confounding and data which is restricted to only some regions of the country. Using data from a large-scale and nationwide population survey and applying the Andersen Model of Health Services Use as the theoretical framework, the aim of the present study was to examine the role that different predisposing, enabling and need factors have for the participation of migrant and non-migrant women in cervical cancer screening in Germany.MethodsWe used data from the ‘German Health Update 2014/2015’ survey on n = 12,064 women ≥20 years of age. The outcome of interest was the participation in cancer screening (at least once in lifetime vs. no participation). The outcome was compared between the three population groups of non-migrants, migrants from EU countries and migrants from non-EU countries. We employed multivariable logistic regression to examine the role of predisposing, enabling and need factors.ResultsNon-EU and EU migrant women reported a lower utilization of cervical cancer screening (50.1 and 52.7%, respectively) than non-migrant women (57.2%). The differences also remained evident after adjustment for predisposing, enabling and need factors. The respective adjusted odds ratios (OR) for non-EU and EU migrants were OR = 0.67 (95%-CI = 0.55–0.81) and OR = 0.80 (95%-CI = 0.66–0.97), respectively. Differences between migrants and non-migrants were particularly pronounced for younger age groups. Self-rated health was associated with participation in screening only in non-migrants, with a poorer health being indicative of a low participation in cancer screening.ConclusionsThe disparities identified are in line with findings from studies conducted in other countries and are indicative of different obstacles this population group encounters in the health system. Implementing patient-oriented health care through diversity-sensitive health services is necessary to support informed decision-making.
Highlights
Studies from European and non-European countries have shown that migrants utilize cervical cancer screening less often than non-migrants
By means of data from a large-scale and nationwide population survey and applying the Andersen Model of Health Services Use as the theoretical framework, the aim of the present study was to examine the role these factors have for the participation in cervical cancer screening among migrant and non-migrant women in Germany
Non-European Union (EU) migrants were younger, had a lower socioeconomic status and perceived less often strong social support than non-migrants. Among both groups of migrants, the percentage living with no partner, residing in rural areas as well as in the Eastern part of Germany was considerably lower than among non-migrants
Summary
Studies from European and non-European countries have shown that migrants utilize cervical cancer screening less often than non-migrants. Using data from a large-scale and nationwide population survey and applying the Andersen Model of Health Services Use as the theoretical framework, the aim of the present study was to examine the role that different predisposing, enabling and need factors have for the participation of migrant and non-migrant women in cervical cancer screening in Germany. Similar to breast cancer screening [10,11,12], many studies conducted in Europe have shown that migrant women participate in cervical cancer screening less frequently than the respective majority populations [13,14,15,16,17]. By means of multivariable analyses, all of these studies showed that differences between migrant and non-migrant females with respect to the utilization of cervical cancer screening are only partially attributable to the influence of demographic and socioeconomic factors. Qualitative studies have revealed that migrants encounter different types of barriers in the health care system, such as poor language proficiency and needs and expectations not sufficiently accounted for by health care providers, contribute to this differential [6, 21]
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