Journal of Advanced Nursing

ORI GI NAL RESEARCH
Barriers faced by Vietnamese immigrant women in Taiwan who do
not regularly undergo cervical screenings: a qualitative study
Fang Hsin Lee, Hsiu Hung Wang, Yung Mei Yang & Hsiu Min Tsai
Accepted for publication 6 April 2013
Corresponding to H.H. Wang:
e-mail: [email protected]
Fang Hsin Lee MSN RN
Lecturer, Doctoral student
Department of Nursing, Chung Hwa
University of Medical Technology, Tainan,
Taiwan
and College of Nursing, Kaohsiung Medical
University, Taiwan
Hsiu Hung Wang PhD RN FAAN
Professor and Dean
College of Nursing, Kaohsiung Medical
University, Taiwan
Yung Mei Yang PhD RN
Assistant Professor
College of Nursing, Kaohsiung Medical
University Kaohsiung, Taiwan
Hsiu Min Tsai PhD RN
Associate Professor
Department of Nursing, Chang Gung
University of Science and Technology,
Taoyuan, Taiwan
LEE F. H. , WANG H. H. , YANG Y. M. & TS AI H. M. ( 2014) Barriers faced by
Vietnamese immigrant women in Taiwan who do not regularly undergo cervical
screenings: a qualitative study. Journal of Advanced Nursing 70(1), 87–96. doi:
10.1111/jan.12168
Abstract
Aim. To assess and understand the barriers faced by Vietnamese marital
immigrant women who do not regularly undergo cervical screenings in Southeast
Taiwan.
Background. Studies have shown a low uptake rate of preventive medical services
among immigrants. As immigrant women may not be aware of the healthcare
delivery system in their host country, their uptake of and access to healthcare
services might be limited.
Design. A qualitative, descriptive inquiry design was adopted.
Methods. This qualitative study employed semi-structured, individual, in-depth
interviews of 17 Vietnamese immigrant women. Data were collected from
February–July 2011 and analysed using content analysis.
Findings. The barriers to receiving cervical screening were lack of health literacy,
lack of female healthcare providers, negative perceptions of cervical screening and
personal reasons.
Conclusion. The results might serve as a reference for government entities and
healthcare providers in Taiwan to improve cervical screening rates; this should
help enhance the effectiveness of healthcare services for Vietnamese immigrant
women. The findings can also provide a reference for making appropriate
healthcare policies for immigrant women in other countries.
Keywords: barriers, cancer nurse, cervical cancer, cervical screening, immigrant
women, qualitative method, Vietnamese
Introduction
International migration and marriage immigration are
trending upward in many countries. Immigrants usually
have poorer health and experience more barriers to the
uptake of healthcare services than native populations (Shin
et al. 2007, Noymer & Lee 2013). Immigrant women living
in developed countries usually represent vulnerable popula-
tions because of their patriarchal and subservient societal
structures (Yang & Wang 2011). Therefore, immigrant
health care is an important issue in developed countries
throughout the world (Steele et al. 2002, Guerin et al.
© 2013 Blackwell Publishing Ltd 87
J AN
JOURNAL OF ADVANCED NURSING
2005). Due to trends in international migration and
Taiwan’s economic development, exchange between Taiwan
and foreign countries has expanded in recent years. Under
these circumstances, marriage immigration has become a
common phenomenon in Taiwanese society. According to
the Taiwan National Immigration Agency (2011), 131,992
Taiwanese people had foreign-born spouses from Southeast
Asian countries with confirmed certificates of alien resi-
dency. Among these foreign spouses, the largest group
consisted of Vietnamese people (64Á8%), followed by Indo-
nesian (20Á6%), Thai (6Á0%) and Filipino (5Á4%) (National
Immigration Agency 2011). Research has suggested that
immigrants tend to display low uptake rates of healthcare
services, especially for preventive health care (Bruce &
Amish 2006, Johnson et al. 2008, Lin et al. 2008). Viet-
namese women are more likely than women of other eth-
nicities to develop cervical cancer (Taylor et al. 2009). One
study has suggested that immigrant women from Southeast
Asian countries were more vulnerable to cervical cancer;
however, lower cervical screening rates and lower treatment
success rates were observed in this female sample (Love
et al. 2009). It is important to understand whether immi-
grant women are aware of and using health services (Gupta
et al. 2002), because such trends can have dire conse-
quences with regard to the increased risk of mortality due
to cervical cancer. The perception of healthcare service
uptake affects the rates of cancer screening and mainte-
nance of good health practices. For these reasons, providers
should pay attention to immigrant women’s individual per-
ceptions of healthcare service use (Gurequ et al. 2010).
Background
As the initial stage of cervical cancer is asymptomatic and
symptoms are not revealed until the disease advances into
invasive cervical cancer (Jane et al. 2009), cervical screen-
ing plays a significant role in decreasing the incidence and
mortality rate of cervical cancer (Brink et al. 2005). It
assists in identifying pre-cancerous lesions, thereby enabling
treatment before the full development of cancer (Wong
et al. 2009). Moreover, treatment success rates are higher if
diagnosis and treatment are performed on carcinomas in
situ (Lee-Lin et al. 2007, Wong et al. 2009).
According to statistical surveys in Taiwan (Department
of Health 2010), the cervical screening rate was 56Á3% in
2008–2010. Cervical screening rates among Vietnamese
women are lacking, because the database of the National
Health Insurance (NHI) in Taiwan does not include the
difference of nationality. Other studies, however, have
indicated that only two-thirds–three-quarters of Vietnamese
American women have undergone cervical screening in the
last 3 years (McPhee et al. 1997, Taylor et al. 2004a,b).
However, there are many barriers to the administration of
cervical screening, including lack of knowledge about cervi-
cal screening, the time-consuming process involved, embar-
rassment, the lack of female healthcare providers, busy
schedules and beliefs that such tests are unnecessary (Weng
2006, Lin et al. 2007, Chen et al. 2008, Wong et al. 2009,
Al-Naggar & Isa 2010, Hsu et al. 2011). Some of these
barriers are particularly salient among immigrant women,
especially the lack of knowledge of cervical screening,
embarrassment, the lack of female doctors (which causes
the inability to find a female doctor), cultural beliefs, dis-
comfort during the test and being accustomed to traditional
medical approaches (Carrasquillo & Pati 2004, Taylor
et al. 2004a, Chilton et al. 2005, Lee-Lin et al. 2007,
Samuel et al. 2009). Thus, cultural and medical barriers to
uptake need to be surmounted so that immigrant women
can receive proper cervical health care.
In Taiwan, women aged 30 years who are covered by
the NHI program can receive a free cervical screening each
year. Foreign residents are required to participate in
Taiwan’s insurance system after receiving an alien resi-
dency certificate and residing in Taiwan for more than
4 months; with enrolment in the system, they can also
receive a free cervical screening each year. The women
aged <30 years undergo cervical screening at their own
expenses in Taiwan. The policy of cervical screening is the
same for both Taiwanese women and Vietnamese women.
However, previous qualitative studies regarding cervical
screening among immigrant women in Taiwan have been
limited. To fill this gap, we examine the barriers faced by
Vietnamese immigrant women in receiving (or regularly
receiving) cervical screenings through the use of a qualita-
tive design. The study results might serve as guidelines for
the development of culturally appropriate healthcare inter-
ventions and policies for immigrant women in other coun-
tries that have similar marriage immigration. In addition,
our results could be useful in enhancing the effectiveness
of healthcare services, improving the cervical screening rate
and further decreasing the mortality rate due to cervical
cancer among this population.
The study
Aim
The aim of the study was to assess the barriers faced by
Vietnamese marital immigrant women who do not regularly
undergo cervical screenings in Southeast Taiwan.
88 © 2013 Blackwell Publishing Ltd
F.H. Lee et al.
Design
This qualitative, descriptive study involved semi-structured,
individual, in-depth interviews. Descriptive information was
collected regarding the barriers faced by Vietnamese
immigrant women in Taiwan who do not regularly undergo
cervical screenings.
Participants
We used a snowball sampling method to recruit Vietnam-
ese immigrant women living in southern Taiwan (specifi-
cally, women who were not receiving regular cervical
screenings). A total of 17 women participated in this
study; data were collected until data saturation was
achieved. Data saturation was assured by the researchers
during the analysis phase; it was achieved when no new
significant themes were identified (Higginbottom 2004).
We included women who: (a) did not regularly (less than
once per year) undergo cervical screening; (b) had national
health insurance; (c) were at least 30 years old; (d) had
not had a hysterectomy; and (e) were able to communi-
cate verbally in Mandarin or Taiwanese. In Taiwan,
women with cervical cancer diagnosis would have routine
cervical screenings 1–2 times per year while receiving
treatments. Compared with others, these women might be
more concerned about their health and might not face the
same barriers of undergoing cervical screenings. We
excluded women who had already been diagnosed with
cervical cancer.
Data collection
The researchers designed a semi-structured interview guide
especially for the study. The questions were developed in
consultation with obstetricians and experts in community
nursing, women’s health and sociology. Two Vietnamese
immigrant women participated in a pre-test of the interview
guide and it was revised on the bases of their opinions.
Examples of the questions in the interview guide are:
(a) When was the last time you underwent a cervical screening?
(b) Describe how you underwent a cervical screening? and
(c) For what reasons do you not regularly undergo cervical
screenings? The first author (a PhD candidate who was
trained in qualitative research methods) performed the
interviews. The formal interviews lasted an average of
40 minutes (range: 30–65 minutes). Interviews were digi-
tally recorded for subsequent coding. Non-verbal data were
also collected during the interviews to provide researchers
with reference data against which to analyse the data. All
data were collected between February–July 2011 and analy-
sed using content analysis.
Ethical considerations
The institutional review board of a medical university hos-
pital approved the study. During the study period, partici-
pants maintained the right to terminate participation at any
time. Confidentiality was assured and no identifying data
were released.
Data analysis
All interview data were transcribed verbatim and analysed
using the content analysis approach described by Krippen-
dorff (1980), which involves summarizing the data by iden-
tifying themes. The researchers read the responses and
made summary-like notes and comments. The unit of analy-
sis was the response phrases related to a specific dimension.
Thematic units of analysis were analysed by grouping simi-
lar qualities or attributes, resulting in the reduction of data
into clusters. The data were analysed by all four of the
authors through panel discussions.
Rigour
The researchers adopted the following five standards of rig-
our for qualitative research: credibility, transferability,
dependability, conformability and authenticity (Lincoln &
Guba 1985, Guba & Lincoln 2005). Credibility was demon-
strated through prolonged immersion in the data. The
researchers conducted peer debriefing to discuss the analysis
and thematic formation of the study; it was concluded that
saturation had been achieved in the identified themes. Reflec-
tions triggered by the text readings were documented in jour-
nal entries, which allowed the themes to emerge from the
text. This helped avoid subjective bias. Increased credibility
was also achieved by having the semi-structured interview
guide pre-tested. However, the credibility of the results may
have decreased as a result of using only one interviewer.
To ensure transferability, the researchers continually
re-thought and re-examined the relationships among the
transcriptions to ensure the comprehensiveness, completeness
and broadness of the situational information. To establish
dependability and conformability, the interviews were digi-
tally voice-recorded and transcribed verbatim. The study
findings were established by maintaining an audit trail of
all procedural steps and methodological decisions. The
researchers used peer debriefing and an external auditor with
expertise in Krippendorff’s thematic clustering technique. To
© 2013 Blackwell Publishing Ltd 89
JAN: ORIGINAL RESEARCH Pap test of Vietnamese immigrant women
archive authenticity and fairness, quotes from all partici-
pants have been included in the results section.
Results
The characteristics of the participants are shown in
Table 1. In total, 17 women participated in this study.
The participants ranged in age from 32–56 years
(mean = 34Á8 years). Their length of residence in Taiwan
was between 1Á5–17 years (mean = 9Á4 years). All partici-
pants had children and their average number of children
was 1Á7. All participants were married. On the basis of the
analysis, the barriers for participants who do not regularly
undergo cervical screenings were categorized into four
themes: lack of health literacy, lack of female healthcare
providers, negative perceptions of cervical screening and
personal reasons (Table 2).
Lack of health literacy
Health literacy refers to the capacity for reading, writing
and calculating health-related materials and activities
(Speros 2005). Lack of health literacy indicates that the
women had no knowledge of cervical cancer or cervical
screening. Ten participants were not aware that the NHI
program in Taiwan offers a free annual cervical screening
to women aged 30 years and twelve did not understand
the purpose of cervical screening, as exemplified by the fol-
lowing statements: ‘Can I get the test?’ (K); ‘How much
does it cost?’ (O); and ‘I don’t know what cervical screen-
ing is for’ (A). Some of the participants reported not know-
ing where they could obtain a cervical screening: ‘One time,
I brought my child to the health center for vaccination. The
staff asked if I would like a cervical screening and only then
did I become aware that they provide this service’ (F). Most
of the participants assumed that healthcare services in Viet-
nam were expensive and that regular people could not
afford private insurance, as exemplified by the following
statements: ‘It is expensive to see a doctor and buy insur-
ance in Vietnam’ (D); ‘If the condition is not serious, we
choose not to go to a doctor’ (K); and ‘When feeling uncom-
fortable, we go to drug stores to buy medicine. We only go
to the doctor if we cannot bear the symptoms of the illness’
(C). Most of the participants had never heard of the provi-
sion of cervical screening in Vietnam: ‘I used to live in the
countryside and I never heard about cervical screening’ (G).
Lack of female healthcare providers
The participants reported being unable to find female
healthcare workers to provide cervical screening, as exem-
plified by the following statements: ‘Once, I went to do a
postpartum checkup. I had a cervical screening immediately
Table 1 Sample characteristics (N = 17).
Participant
Age,
years
Stay in
Taiwan,
years
Educational
level
Number
of
children
Marital
status
A 43 14 Primary school 2 Married
B 56 17 Junior high
school
2 Married
C 32 1Á5 University 1 Married
D 32 11 Senior high
school
2 Married
E 33 5 Primary school 2 Married
F 33 11 Junior high
school
2 Married
G 33 6 Primary school 2 Married
H 34 2 Junior high
school
1 Married
I 34 10 Primary school 2 Married
J 35 4 Junior high
school
1 Married
K 35 12Á5 Primary school 2 Married
L 36 14 Senior high
school
2 Married
M 36 11 Senior high
school
1 Married
N 36 10 Senior high
school
2 Married
O 42 6 Primary school 1 Married
P 38 13 Junior high
school
2 Married
Q 39 11 Primary school 2 Married
Table 2 Barriers to undergoing cervical screening.
Themes Sub-themes
Lack of health
literacy
1. Unaware of policy and the purposes of cervical
screening
2. Unaware of where the service is provided
3. Lack of the concept of preventive care
4. Belief that a cervical screening is not required
when there are no symptoms
Lack of female
healthcare
providers
1. Having a female physician/female nurse
perform the cervical screening
2. Being unable to find a female physician
Negative
perceptions of
cervical
screening
1. Lack of a reminder system in health centres
and clinics
2. Insufficient explanation about the test
3. Uncomfortable feelings (pain, cold speculum)
Personal
reasons
1. Lack of a role model
2. Being busy; forgetting to have the test
3. Being embarrassed
4. Being worried about the test results
90 © 2013 Blackwell Publishing Ltd
F.H. Lee et al.
on the physician’s recommendation. There was no opportu-
nity to choose a female physician’ (P). Most participants
stated that if they had the choice, they would prefer that a
female physician or nurse deliver the cervical screening.
Their reasons were as follows: ‘Having a female physician
makes me feel less embarrassed’ (H); and ‘A female physi-
cian brings a sense of security. Female physicians under-
stand me better than male physicians do’ (B).
Negative perceptions of cervical screening
This section identifies the participants’ negative perceptions
during cervical screening service. Eleven participants stated
that they had never received a phone call or postal remin-
der regarding cervical screening from health centres or the
obstetrics and gynaecology clinics they had visited. One
participant mentioned: ‘I have never received a phone call
from the staff of the health center that asked me to take
the cervical screening’ (L). Only three participants stated
that the physicians had clearly explained the testing proce-
dure. Most of the participants reported that they did not
receive sufficient information about the test: ‘The physi-
cian did not tell me anything but simply asked me to ‘take
it easy’ and not feel nervous during the procedure’ (Q);
‘The physician did not talk with me during the process;
only a nurse told me when I could get the results’ (A) and
‘If the physician explained (the test) more, I might not
have been so nervous’ (O). Some of the participants felt
uncomfortable during the test: ‘The speculum was cold
and the insertion was uncomfortable and a little bit
painful’ (N); and ‘The room was cold; my legs felt
uncomfortable’ (M).
Personal reasons
This section discusses the personal reasons/obstacles that
prevented women from receiving cervical screening (either
once or regularly). The barriers included being busy, forget-
ting to schedule the test, being worried about the test
results, feeling embarrassed and lacking a role model. Most
of the participants had to work during the daytime and
were busy with household chores during the evening: ‘I
work during the day and have to take care of my children.
When do I have time to take the test?’ (L). Even if the par-
ticipants were aware of the need to have cervical screening,
the burdens of their multiple roles left them no time to
schedule an appointment: ‘I did not have cervical screening
every year, because I was busy and usually forgot to do it’
(J). Some participants were worried that if the test results
confirmed cervical cancer, it would have a negative impact
on the individual and her whole family: ‘I did not want to
take the test, as I was afraid of undesirable results’ (M).
Most of the participants found cervical screening embar-
rassing: ‘Taking my clothes off in front of others is pretty
embarrassing’ (E); and ‘It is a terrible and embarrassing sit-
uation when I take the test’ (A). Female relatives and
friends also affected the participants’ behaviour regarding
the test, as shown by the following examples: ‘My mother
does not take the test’ (C); ‘My mother-in-law has never
taken the test. She has never told me about the test and I
never asked her about it’ (I); and ‘In Vietnam, only those
who are sick go to a doctor’ (F).
Discussion
Lack of health literacy
Most participants had limited knowledge of cervical cancer
and cervical screening. For example, they were not aware
that women aged 30 years could receive a free cervical
screening every year by using the NHI in Taiwan. Some did
not understand the relationship between cervical screening
and cervical cancer and did not know where a screening
could be obtained. Our findings are consistent with those of
other studies, which have revealed that 25% of Vietnamese
women have never heard of cervical screening (Nguyen
et al. 2002) and that a large proportion of Vietnamese
Americans are unfamiliar with cervical screening (Gregg
et al. 2011). Jenkins et al. (1999) discovered that Vietnam-
ese women were not aware of the importance of preventive
care; therefore, women were less likely to receive preventive
medical services.
In Vietnam, traditional beliefs about health and the lack
of preventive care policies hinder the implementation of
healthcare services (Hoang & Erickson 1982). Traditional
and cultural beliefs in Vietnam suggest that the human
body is private. Vietnamese people believe that diseases
occur because of external factors. They believe that diseases
are not preventable, regardless of how much effort goes
into prevention. Therefore, they visit a doctor only after
contracting a disease (Nguyen et al. 2007). Moreover, pre-
marital sexual behaviour is stigmatized in Vietnam; physi-
cians believe that unmarried women should not engage in
sexual behaviour and hence that young, unmarried women
have no need for cervical screening (McPhee 2002).
Women from minority ethnic groups have poorer levels
of health literacy and are less likely to receive a cervical
screening (Lindau et al. 2001). Poor literacy creates barriers
to the implementation of useful behaviours for the preven-
tion of cervical cancer (Garbers & Chiasson 2004, Lindau
© 2013 Blackwell Publishing Ltd 91
JAN: ORIGINAL RESEARCH Pap test of Vietnamese immigrant women
et al. 2006). Improving health literacy could positively
influence the adoption of health behaviours (Lindau et al.
2001, Schillinger et al. 2002, von Wagner et al. 2007).
Lack of female healthcare providers
The participants preferred to have female physicians or
nurses perform their cervical screenings, in accordance with
the findings of previous studies (Chen et al. 2008, Samuel
et al. 2009, Al-Naggar & Isa 2010). Physical examinations
conducted by male physicians can cause greater embarrass-
ment and anxiety among women than those performed by
female physicians (Holroyd et al. 2004, Sutton & Ruther-
ford 2005). Further, the major barrier to Vietnamese immi-
grant women in obtaining cervical screening is the lack of
female physicians available to perform the test (Donnelly
2006a,b). The cervical screening rate among Vietnamese
women increased when female physicians became able to
perform the test (Nguyen et al. 2002, Al Sairafi & Mohamed
2009).
Negative perceptions of cervical screening
Negative perceptions might provide another reason for
women to resist receiving cervical screening. In Taiwan,
cervical cancer prevention is promoted by health centres
and these centres’ primary strategy for encouraging cervical
screening uptake is to give phone calls and postal remind-
ers. However, these strategies might not be appropriate for
immigrant women: language barriers could hinder them
from receiving cervical screenings (Samuel et al. 2009).
Therefore, healthcare providers should offer detailed expla-
nations during the testing process in addition to sufficient
healthcare resources (i.e. postcards written in Vietnamese).
In traditional Asian societies, women easily feel pressured
when interacting with healthcare providers (Holroyd et al.
2001). Healthcare providers should not simply focus on
the medical process, but should pay attention to the feel-
ings and concerns of their female patients.
Personal reasons
Personal reasons for not undergoing cervical screening
included the lack of a role model, being busy, forgetting
to have the test, feeling embarrassed and being worried
about the test results. Our findings provide evidence to
support previous studies showing that fear, uncertainty
and scheduling issues affect whether women receive cervi-
cal screenings (Hislop et al. 2003, Ackerson & Perston
2009). Most participants lived with their mothers-in-law,
but seldom discussed the procedure with them, even
though women usually need a role model to engage in
positive health behaviours (Tang et al. 1999, Mattila et al.
2000).
Moreover, in Taiwanese culture, women are held
accountable for traditional responsibilities, including bear-
ing a son to carry on the family name and taking care of
the children and elder members of the family (Liao & Chan
2005). Most of our participants either had young children
and usually stayed at home taking care of their families or
worked to help provide family income. Consequently,
they were unable to (or did not) receive regular cervical
screenings.
In Vietnamese culture, women follow traditional patriar-
chal beliefs that emphasize the subordinate role of women
in the family and the larger society (Morash et al. 2007).
Therefore, family structure may affect individual healthcare
decisions (Nguyen 1985). In this study, Vietnamese women
may not undergo cervical screenings because their families
are involved in healthcare decisions; however, whether this
is the case remains to be investigated.
Limitations
The current study had some limitations. First, we recruited
only participants who could communicate in Mandarin or
Taiwanese. This might affect the generalizability of our
results to the larger population of Vietnamese immigrants
living in Taiwan. Participants who are unable to communi-
cate in either Mandarin or Taiwanese should be considered
in future studies. In Taiwan, women who are covered by
the NHI program and aged 30 years can receive a free
cervical screening each year. However, women aged
<30 years were not included in this study. Future studies
might consider including participants from all age groups
who are (or have been) sexually active.
Implications for practice
Education for cervical cancer prevention should meet the
needs of special populations and overcome their lack of
health literacy (Rogers & Cantu 2009). In Taiwan, when
educating Vietnamese immigrant women about cervical
cancer prevention, the influence of health literacy should be
taken into account. Healthcare providers should assess the
recipients’ ability to learn and acquire sufficient health
information. If necessary, bilingual written documents
should be provided and the presence of professional inter-
preters might facilitate communication between Vietnamese
immigrants and Taiwanese healthcare providers. This will
92 © 2013 Blackwell Publishing Ltd
F.H. Lee et al.
assist in the establishment of a health education model for
women with low health literacy.
In clinical practice, female patients should be provided
with recommendations and information about cervical
screening when receiving medical services. If necessary,
patients could be referred to female physicians or female
nurses for the test. Nurses are allowed to perform cervical
screening in many countries (Hilton et al. 2003, de Villiers
et al. 2004, Castellsague et al. 2006), but according to Tai-
wan’s health policy, nurses are forbidden from performing
the procedure (Law & Regulations database of The Repub-
lic of China 2012). The results of this study might serve as
a reference for the government to consider the legitimacy of
allowing nurses to perform cervical screening, which not
only helps to reduce embarrassment among patients (as
nurses are often women themselves) but also encourages
autonomy among nursing professionals regarding cervical
cancer prevention. Female volunteers from Vietnam could
be recruited to help with phone reminders to Vietnamese
immigrant women to help increase the adoption rate of cer-
vical screening. Furthermore, a mobile service could be pro-
vided for women who cannot regularly schedule cervical
screenings because of work or family duties. This might
help to enhance the accessibility and availability of cervical
screening services for immigrant women.
Conclusion
The current study showed that the barriers preventing Viet-
namese immigrant women from receiving regular cervical
screenings could be categorized into four themes: lack of
health literacy, lack of female healthcare providers, negative
perceptions of cervical screening and personal reasons.
Although the NHI program in Taiwan offers free cervical
screenings, our findings suggest that the uptake of this service
among Vietnamese immigrant women was still affected by
personal and healthcare-delivery system-related factors.
These themes might serve as references for the government
and healthcare providers in Taiwan to improve the cervical
screening rate and enhance the effectiveness of healthcare ser-
vices for Vietnamese immigrant women. Future research
should employ a larger-scale survey to provide an overall pic-
ture of cervical screening among immigrant women.
Acknowledgements
We are grateful to the participants in the interview.
Funding
The authors would like to express their appreciation to the
National Science Council of Taiwan for funding this study
(NSC 100-2314-B-037-008).
Conflict of interest
No conflict of interest has been declared by the authors.
Author Contributions
FHL, HHW, YMY and HMT were responsible for the study
conception and design. FHL performed the data collection.
FHL, HHW, YMY and HMT performed the data analysis.
FHL and HHW were responsible for the drafting of the man-
uscript. FHL, HHW, YMY and HMT made critical revisions
to the paper for important intellectual content. FHL and
HHW obtained funding. HHW supervised the study.
All authors have agreed on the final version and meet at
least one of the following criteria [recommended by the
ICMJE (http://www.icmje.org/ethical_1author.html)]:
What is already known about this topic
•
Cervical screening has been reported to decrease the
mortality rate of cervical cancer.
•
Cervical screening rates are lower among immigrant
women, because immigrant women often face lan-
guage and cultural barriers and have difficulty access-
ing the unfamiliar healthcare system.
What this paper adds
•
The barriers faced by Vietnamese immigrant women in
the implementation of cervical screening were catego-
rized as lack of health literacy, lack of female health-
care providers, negative perceptions of cervical
screening and personal reasons.
•
The perceptions of cervical screenings among immi-
grant women in Taiwan have been explored and may
be the reference of policy making.
Implications for practice and/or policy
•
These findings could enable the provision of effective
healthcare services to improve the cervical screening
rate of Vietnamese immigrant women.
•
These findings can serve as guidelines for the develop-
ment of culturally appropriate healthcare interventions
and policies for immigrant women in other countries
with similar marriage immigration practices.
© 2013 Blackwell Publishing Ltd 93
JAN: ORIGINAL RESEARCH Pap test of Vietnamese immigrant women
•
substantial contributions to conception and design, acqui-
sition of data, or analysis and interpretation of data;
•
drafting the article or revising it critically for important
intellectual content.
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