Understanding the Pap Testing Behaviors of African Immigrant Women in Developed Countries: A Systematic Review

J Immigr Minor Health. 2021 Aug;23(4):840-856. doi: 10.1007/s10903-020-01119-x. Epub 2020 Nov 9.


Background: African immigrant (AI) women remain burdened by cervical cancer, but the prevalence and correlates of Pap testing remains unclear in this population.

Objective: To review studies on the prevalence and determinants of Pap testing among AI women living in developed countries.

Methods: PubMed, CINAHL, Embase, and Scopus were searched for relevant articles that included African-born immigrant participants; were published in English; addressed the prevalence of Pap testing; conducted in a developed country; and identified correlates of Pap testing behavior. The Andersen Behavioral Model guided synthesis of the key findings.

Results: Sixteen studies met the inclusion criteria. The prevalence of Pap testing ranged from 4.6% to 73.0%. Having a female provider and access to primary care facilitated Pap testing. Barriers to Pap testing included low income, male healthcare providers, and no history of gynecological exam.

Conclusions: Healthcare providers and social determinants-particularly income and healthcare access, play an important role in improving Pap testing among AI women. Larger qualitative and mixed methods studies are needed to explore other important determinants of Pap testing such as disease knowledge, self-efficacy, health literacy to reduce the burden of cervical cancer among AI women.

Keywords: African immigrants; Cervical cancer; Pap smear; Systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Developed Countries
  • Early Detection of Cancer
  • Emigrants and Immigrants*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Papanicolaou Test
  • Uterine Cervical Neoplasms* / diagnosis
  • Vaginal Smears