1. Background Cervical cancer is a major cause of mortality in Ecuador and in developing countries worldwide It is the 2 nd leading cause of death from cancer in Ecuador Cervical cancer is theoretically easily preventable and treated if caught at an early stage ECUADORUNITED STATES INCIDENCE276 MORTALITY132 Cervical Cancer Incidence and Mortality per 100,000

2. Objective Education is a strong predictor of incidence and stage at detection Our question was how women’s beliefs about sexual health impacted cervical cancer screening Health education and cervical cancer screening brigade to urban barrios of Santo Domingo, Ecuador provided opportunity for qualitative evaluation of beliefs regarding sexual health We conducted a review of patients’ health beliefs and understanding of pre-screening education information in order to better understand barriers to screening

3. Methods Qualitative review of physician impressions Knowledge about purpose of pap smear Understanding of implications of abnormal results Barriers to cervical cancer screening Beliefs and practices concerning gynecological health Literature review Pub Med search “Health Beliefs” + “Cervical Cancer Screening” Review of articles addressing traditional medicine and women’s health Gender roles and sexual practices

4. Cervical Cancer Incidence Varies With Educational Level Cervical Cancer Incidence Varies with Educational Level Delay in Diagnosis Correlates with Educational Level

5. Common Beliefs and Practices Concerning STDs and Pap smear STD’s CAUSED BY – Dirty Water – Heat – Fungus VAGINAL CLEANSING – Herbal Douche – Toothpaste – Plant leaves – Pap smear SHAME OF – Exposure – Male providers FEAR OF – Abnormal results – Hysterectomy – Pain – Telling partner

6. Results of Literature Search Other studies corroborated perceived barriers in similar patient populations Medicinal plant use was common for gynecological symptoms in other Andean populations Vaginal cleansing is an important cultural concept in many similar populations Machismo and gender inequality is a significant barrier to women’s health

7. Conclusions Cultural beliefs contribute to barriers to cervical cancer screening Culturally defined gender roles influenced willingness to seek appropriate screening and treatment Patients cultural beliefs had a stronger influence on their behavior than new information Education about purpose of pap smear did not necessarily change prior beliefs Patients had beliefs about causes of STD’s and cervical cancer which differed significantly from ours

8. Discussion If we hope to change behavior we should: Understand and appreciate existing beliefs Work within the patient’s current framework and build upon it, not change it completely Acknowledge the effects of our own ethnocentricity and unconscious bias Empower women by opening discussions of other factors that affect the decisions regarding their health Engage and educate male partners

9. References – Bull Pan Am Health Organ. 1996 Dec;30(4):322-9. Limited education as a risk factor in cervical cancer. PubMed ID 904174 – International Agency for Research on Cancer (IARC). http://www-dep.iarc.fr/ – Prev. Med. 2004 Jul;39(1):91-8. Perceived barriers and benefits to cervical cancer screening in Latin America. – Gend Dev. 1996 Feb;4(1):39-44."Women with self-esteem are healthy women": community development in an urban settlement of Guayaquil PubMed ID 12346981 – J Ethnobiol Ethnomed. 2006 Oct 10;2:44. Traditional medicinal plant use in Loja province, Southern Ecuador – http://www.who.int/gender/regions/amro/en/index.html Acknowledgments – Nursing Students of University of Cincinnati – Medical Providers of Shoulder to Shoulder Global May 2011 Brigade to Ecuador