Understanding cervical cancer screening disparities among Somali women in Southeast Minnesota: a community-engaged mixed methods study

Immigrant communities in southeast Minnesota, particularly Somali women, have significantly lower rates of cervical cancer screening uptake compared to the general population. We sought to learn more about this disparity by: (1) gaining a better understanding of the barriers and facilitators Somali women experience in completing cervical cancer screening; (2) identifying strategies to overcome barriers; (3) assessing the acceptability of cervical cancer screening self-collection. As members of the Rochester Healthy Community Partnership (RHCP), a 22-year community-academic collaboration with immigrant communities in southeast Minnesota, our team applies a community-based participatory research approach to advance health equity. Guided by the Health Belief Model and the National Institute for Minority Health and Health Disparities Research Framework, we employed a concurrent mixed-methods design, simultaneously collecting quantitative (survey) and qualitative (focus group) data. Our mixed methods findings revealed that Somali women face complex and interrelated barriers and facilitators to cervical cancer screening. Key deterrents include limited health literacy, fear, and mistrust, often rooted in prior negative healthcare experiences. Conversely, culturally tailored community education, active engagement, regular reminders, and supportive interactions with providers and trusted interpreters can promote screening uptake. While most participants viewed cervical cancer screening self-collection as a viable alternative to speculum-based exams, concerns remained regarding the absence of provider involvement, proper test self-administration, and mailing logistics. This study underscores the multifaceted factors shaping cervical cancer screening among Somali women in southeast Minnesota and maps a pathway forward to address existing disparities. Future efforts should center on community-identified solutions to advance cervical cancer screening access.