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Doctoral defence of Esther Idehen, MSc, MPH, 8 Oct 2021: A "one-size-fits-all" cervical screening programme may not benefit all migrant women

The doctoral dissertation in the field of Public Health will be examined at the Faculty of Health Sciences at the Kuopio campus.

What is the topic of your doctoral research?  

Cervical cancer screening participation among women of migrant origin in Finland: Disparities, challenges, and opportunities for improvement.

Why is it important to study the topic?

Cervical cancer is a global health problem, especially among migrant living women, even in high-income countries. However, the disease can be prevented through regular screening such as Pap testing. Hence cervical cancer screening is recommended for all healthy women of targeted age groups to detect precancer and cancer early. Migrants' proportions, especially in Europe, including Finland, have increased. However, a gap exists in research knowledge about Pap testing utilisation among migrant women compared with host populations, such as Finland with a universal screening programme. Therefore, researching these populations' healthcare service use, such as Pap test participation, is crucial to enhancing screening participation and coverage.

What are the key findings or observations of your doctoral research?  

Some migrant-origin women have a lower likelihood of cervical cancer screening participation compared with the general Finnish population. This study also indicates that some migrant groups are unaware of the screening programmes in Finland. Participation in the screening differs across the populations studied. Facilitators to screening participation among all the groups studied were access to and utilising gynaecological, reproductive, or pregnancy-related healthcare services and giving birth in Finland. Among some groups studied, other facilitators were high education, employment, advanced age, and cost-free screening service provision in Finland. Among women of migrant origin, significant barriers to screening participation included low language skills, i.e., Finnish and Swedish, low socioeconomic status, residence outside of metropolitan areas of Finland, the lack of information about screening programme, and misunderstanding of the screening protocol.

To my knowledge, this doctoral dissertation research is the first to investigate Pap testing and factors influencing screening participation among migrant populations and the first to utilise survey, register, and qualitative data in Finland, for this purpose. The findings of my doctoral dissertation provide a significant opportunity to understand what determines migrant populations' participation in screening nationally and globally. The findings demand policy efforts by providing culturally tailored screening intervention programmes to women of migrant origin in enhancing screening participation. A "one-size-fits-all" programme might not benefit all migrants since these population groups are not the same. Also, disseminating appropriate information about screening protocols and through multiple channels might be helpful.

How can the results of your doctoral research be utilised in practice?

My doctoral dissertation findings suggest that women with migrant backgrounds, poor Finnish or Swedish language skills, low socioeconomic status, and those not utilising reproductive or gynaecological healthcare-related services require more attention and information from local residential healthcare authorities and municipalities about the importance of screening.

These results can be utilised in the following sectors or organisations ; municipalities in services for migrants' populations, physicians, and primary healthcare professionals in private and public health care, occupational and student health centres, maternity clinics, employment services and schools. Thus, creating awareness, informing, and encouraging these high-risk women who need their care about the screening.

What were the key research methods and materials used in your doctoral research? 

My doctoral research comprises four sub-studies and adopted quantitative (sub-studies I-III) and qualitative (sub-study IV) research methods. My research populations were migrant women of Russia or the former Soviet Union, Somali, and Kurdish of Iraq/Iran origins, the general Finnish population (Finns) as the reference population, and African migrants of Nigeria, Ghana, Cameroon, and Kenya origins in Finland. My doctoral research utilised survey data from the THL, register-based data linked with the Finnish cancer registry, national population registry-based data, and qualitative data from focus group discussions.

The doctoral dissertation of Esther Idehen, MSc, MPH, entitled Cervical cancer screening participation among women of migrant origin in Finland: Disparities, challenges, and opportunities for improvement will be examined at the Faculty of Health Sciences. The Opponent in the Public examination will be Professor Bernadette Kumar of the Norwegian Institute of Public Health, Oslo, Norway, and the Custos will be Professor Tomi-Pekka Tuomainen of the University of Eastern Finland. The public examination will be held in English, and it will be streamed online.

Photo available for download

Dissertation online

Public examination online

For further information, please contact:

Esther Idehen, estheri (at) uef.fi, 358-503678612