2026 Theses Doctoral

Using the Health Belief Model and the social-ecological model as frameworks to assess the health behavior of African-born immigrant mothers in Washington State toward the utilization of cervical cancer prevention services (cervical cancer screening and HPV vaccination)

Ayereka, Isaac Kwabena

Cervical cancer remains a significant public health concern in the United States, disproportionately affecting African immigrant women who experience higher risks and lower participation in prevention programs. Although cervical cancer is largely preventable through HPV vaccination and regular screening, many African-born immigrant mothers remain under-informed or face barriers that limit access and utilization. This study explored African immigrant mothers’ knowledge, awareness, and utilization of HPV vaccination and cervical cancer screening. It examined cultural, social, and systemic factors, as well as broader social determinants and policy contexts, that shape access to and utilization of cervical cancer prevention services in Washington State. Guided by the Health Belief Model and the Social-Ecological Model, this qualitative study involved in-depth interviews with 56 African-born immigrant mothers and key informants. Thematic analysis identified five overarching domains with 25 interrelated themes that shape cervical cancer prevention behaviors. At the individual level, limited availability of health information, cultural beliefs, misinformation, and perceived risks influenced awareness and utilization. Family, peers, and faith leaders significantly shaped decision-making, while trust in healthcare providers and access to culturally and linguistically appropriate information emerged as critical factors. Structural barriers, such as economic hardship, limited healthcare access, and a lack of follow-up reminders, further limited participation. Broader social determinants, including education, employment, and discrimination, also affected preventive behaviors. The findings emphasize the need for culturally grounded, community-driven interventions, including faith-based education, peer advocacy, mobile clinics, and HPV self-sampling, to improve awareness, access, and utilization.