eHEALTH LITERACY, MEDICAL MISTRUST AND CERVICAL CANCER PREVENTION KNOWLEDGE, BELIEFS AND BEHAVIORS AMONG AFRICAN AMERICAN WOMEN

Abstract

Cervical cancer (CC) is a major global public health problem and is the third most common cancer among women worldwide. In the United States, African Americans have the second highest incidence rates of CC, due to having the highest rates of Human papillomavirus (HPV) acquisition, lower likelihood of engaging in routine pap smears, and persistently low vaccine uptake. Prevention and early intervention through HPV vaccination and pap smears, respectively, are of paramount importance to reduce racial cancer disparities. Due to cultural mistrust of the health care system, many African Americans resort to non-traditional forms of health information. Considering the combined contributions of medical mistrust, increased reliance on electronic-based health information and the disproportionate burden of HPV susceptibility among young-adult African American women, this population warrants further attention in research informed by culturally relevant frameworks. The Health Literacy Skills Framework (HLSF) considers external factors (i.e., culture, media, and family) that impact the synthesis of health information. Black Feminist Thought scholarship complements the HLSF by providing a frame through which to examine how Black women’s oppressive intersecting identities (i.e., race, gender, and class) shaped their perspectives about women’s health and added needed context for assessing Black women’s health literacy. This thesis sought to examine the relationship between eHealth literacy, medical mistrust, and CC preventive behaviors among African American college women. More specifically, this study explored relationships between the CC preventive behavior among African American college women and the following potential contributors to this behavior: 1) perceived eHealth literacy 2) CC knowledge/beliefs and 3) the Black female collective unique health experience related to provider recommendations regarding CC prevention, medical mistrust, and gendered-racial microaggressions. A total of 146 African American women completed an online survey that assessed for self-perceived eHealth literacy, medical mistrust, gendered-racial microaggressions, and CC-related prevention behaviors, knowledge, and beliefs. Most participants had received at least one-dose of the HPV vaccine and all age-eligible participants had received a pap-smear once in their lifetime. A vast majority of participants considered themselves to have high eHealth literacy but did not demonstrate adequate CC knowledge. Additionally perceived eHealth literacy did predict CC knowledge and CC prevention related beliefs. Specifically, participants who were confident in their ability to understand online health information were more likely to have greater CC knowledge and more positive beliefs toward the HPV vaccine and pap-smears. A qualitative analysis of CC prevention behaviors among study participants yielded six overarching themes including: 1) Strong Black Woman, 2) Oppression, 3) Medical Mistreatment/Mistrust, 4) Health Literacy, 5) Medical Autonomy, and 6) Cultural Health Factors. Clinical implications of these findings and relevance to future research are discussed.