Except for one Brazilian woman who was married to a Mexican partner, all participants were born in Mexico. Female participants were between the ages of 18–45. Male participants were between the ages of 25 and 62. Responses for the male-only, female-only, and couples-only group were similar for each area of inquiry, unless otherwise indicated. The main focus group questions and responses are summarized in .
Themes and participant comments on breast and cervical cancer screening
Healthcare Utilization Patterns
Focus group participants reported mixed experiences with health services, highlighting primarily language barriers and the lack of health insurance. Some participants reported that family members, even children, accompanied them to medical visits to act as the interpreter and explain medical procedures. Poor linguistic access was perceived to lead to poor quality of care. Participants commented that health care facility staff often get impatient if the participants cannot explain their health problems in English or if they have heavy accents.
We try to say the words in English, …, but we can’t pronounce them well and the physicians and nurses become impatient.
Lack of proficiency in English led to longer waiting periods, partially because of the time required for personnel to locate interpreters. Some participants complained of not understanding the medication instructions or doctors’ not always explaining the medical procedures they were performing. Language discordance also discouraged participants from using preventive services. Participants who did not experience language barriers usually encountered bilingual hospital staff or English-speaking health care providers that were more patient.
The issue of discrimination within health care settings was brought up in two of the male-only groups. Participants believed that the poor service and quality of health care, including longer waiting times, were caused by discrimination because they were Latino.
I think that we … are put at the end [of the waiting line], and when an American arrives, Hispanics are forced to wait until the end.
However, other participants in these groups commented that discrimination exists everywhere, including in Mexico.
The issue of trust in United States health care facilities was introduced in one of the couples-only groups, where a participant stated his preference to obtain his health care in Mexico because he did not trust the health care system in the States.
Health insurance was an important variable in obtaining preventive health care. The majority of participants said that without health insurance, they only sought medical attention when they were sick. Overall, several participants said that it did not make sense to pay a lot of money for screening activities just to find out that nothing was wrong, although they would take their children for preventive care. Some participants said that they had regular checkups when they were insured, but discontinued the practice when their health insurance was discontinued. Other participants reported that they would utilize preventive and early detection services once they became insured.
Cost considerations also influenced participants’ decision-making around where to go for health care. While the majority of the participants reported going to public hospitals, several participants reported seeking the care of private doctors, primarily because they would not have a long wait and losing a full day’s pay as a result. Participants reported that some doctors in private practices offered discounts for uninsured patients and sometimes provided them with free medication. One participant indicated that some doctors in private practices charged Mexican patients more. Participants also said that they took their children, who may be insured by public health insurance, to doctors in private practices.
Overall, the men reported that they were less likely to seek preventive care than their female partners and children. Some men said that they would get regular exams when they were treated for other illnesses, such as chronic back pain. The majority of the male participants did not believe there was a need to go to the doctor if they felt healthy and symptom-free. Male participants in the maleonly groups voiced such beliefs more strongly than those participating in the couples-only group.
(Male) I never go. We are irresponsible. When we are sick, we want to go. But the next day we wake up feeling better and don’t go.
General Cancer Beliefs
Cancer was strongly associated with death, being terminal, and dangers among all focus groups. The majority of participants in three of the focus groups believed that some cancers, such as cervical cancer, were untreatable. However, in the remaining four groups, participants emphasized that cancer could be treated, if it was detected early. There were no significant demographic differences among these groups. Participants also noted that cancer cannot be prevented because the causes are often unknown or hereditary.
I think that they have done research [to determine what causes cancer], but they don’t know yet…. You can never know. Who knows if it’s the environment, or what you eat? It can be hereditary many times.
In addition to environmental, dietary, and hereditary factors, participants named lifestyle factors, such as smoking and drinking, as causes of cancer. In the maleonly groups, participants mentioned work-related exposure to carcinogens from dust in the construction industry as a cause of cancer. Nevertheless, the men believed that women were at a higher risk than men of developing cancer.
Beliefs Regarding Breast Cancer
When asked specifically about causes of breast cancer, the participants named lifestyle and genetic factors. Furthermore, they thought that breast cancer could be caused by physical trauma to the breast, hitting or punching the breast. Participants in several groups also indicated that breast cancer is caused by the lack of, or insufficient, breastfeeding, which would result in “spoiled” milk remaining in the woman’s ducts, and turning into cysts, which would become malignant tumors over time.
Focus group participants reported that one’s breast cancer risk could be reduced through participation in breast cancer screening activities and breast self-exams (“observing the breast”). Women who had received a mammogram indicated that it was very painful. The majority of focus group participants indicated that women should start to have regular mammograms at age 40 and that mammograms should be performed on an annual or bi-annual basis. One male participant voiced his opinion that women should start having mammograms when they become sexually active. Two participants said that it was the doctor’s responsibility to determine when a woman was at an increased risk for breast cancer and hence when she should receive a mammogram.
Participants in the male-only focus groups stated that, in general, Latinos wait until they have severe symptoms before getting screened for cancer. It is often then too late to cure the disease. On the other hand, participants in three other focus groups seemed to believe that women did not wait too long before getting a mammogram. They also indicated that some women received mammograms and/or Pap smears in Mexico before arriving in the U.S.
The main barriers to obtaining cancer screening included lack of money, lack of transportation, lack of time, and embarrassment. One participant in the male-only group stated that the husband’s jealousy might prevent his partner from getting a mammogram. In one of the male-only focus groups, participants did not feel that women experienced any barriers to cancer screening.
Beliefs Regarding Cervical Cancer
There was an overall lack of knowledge about cervical cancer. The participants were less likely to volunteer their opinions when discussing cervical cancer compared with breast cancer; the facilitator had to employ more probing questions. In two of the groups, facilitators had to clarify where the cervix was located in a woman’s body.
(Male 1): Cervical cancer, is that something in the mouth? In the throat?
(Male 2): How ignorant are we men.
Female participants appeared to be more fearful of developing cervical cancer than breast cancer. Women and men named the risk factors for cervical cancer as frequent intercourse, intercourse with a person with sexually transmitted diseases, or a general lack of hygiene. Some stated that virgins did not need to get tested for cervical cancer. Participants also speculated that vaginal ruptures or cesarean sections during pregnancy and childbirth might be risk factors.
Most of the women and men did not know the screening guidelines for cervical cancer. One participant indicated that she received a Pap smear only at the time of her pregnancy. Of the females who did get Pap tests, few of their male partners were aware of this. One participant said that his wife had commented to him that the procedure was painful. In one focus group, participants thought that a woman needed to make a special appointment to receive a Pap smear additionally to the regular medical visit, similar to what is required to schedule a mammogram. Of those who were familiar with the Pap test, all had received one at least once in their lives. Many participants cited embarrassment and discomfort as barriers to getting screened for cervical cancer.
(Facilitator): What is the main barrier for you to get a Pap smear?
(Female 1): How I am forced to open my legs. It is very uncomfortable.
(Female 2): It’s embarrassing.
The embarrassment factor was heightened with male providers. One woman said that it felt “awkward” to be seen by male providers in the U.S., because she had only seen female providers in Mexico. However, none of the male participants stated that they did not want their female partner to see a male gynecologist. Some women reported that male doctors could be “unfriendly” and “not gentle” in conducting Pap smears, which made the experience more uncomfortable and discouraged them from seeking future care. In response to these comments, some men in the couples-only focus groups argued that female doctors could also be rude and that, ultimately, the woman had to select a provider based on comfort, rather than on gender.
Social Support and Decision-Making Within the Couple
Women reported talking to friends, sisters, or partners about health issues, whereas men indicated that they sought health advice exclusively from their spouses/partners. Women often went to medical appointments alone, or on some occasions, with a female relative or friend. Men stated that inflexible work schedules impeded them to accompany their spouses/partners to doctor’s appointments. In some cases, the male partners would stay at home to care for the children while their partners were at medical appointments. Both male and female participants did not consider this to be an indicator of poor social support.
None of the male participants reported problems in communicating with their partners about health care issues, from scheduling appointments to selecting a provider or medical facility. However, some male focus group participants did state that the women felt embarrassment when talking to their partners about sexual health, cervical cancer, and Pap smears. Partners reported that they encouraged one another to seek preventive care and to adhere to prescribed medication plans. The desire to stay healthy to be able to provide for the family and the children was named as a powerful motivator.
Men said that women are more likely to get medical and preventive health care for themselves and their children and that they are, therefore, more knowledgeable about the health care system than men.
They (the women) already know more, since they go more often with the kids to the hospital. They know more or less where to go, what to do and what to say.
Women indicated that they made their health care decisions either by themselves or with their partners. However, the women were often the ones to encourage their partners to get regular check-ups. In some cases, men seemed to dominate the decision-making process because they were “more experienced” with a specific disease or more likely to remain calm. Women offered the following suggestions of how their male partners could be more helpful: being more patient and understanding; assisting them in finding a medical provider or specialist; or reminding them to make or keep future appointments. Men believed that their primary role was to provide the financial means for health care visits.
(Facilitator): What do you think you could do as men in your relationship to help women have better health?
(Male 1): Apart from good nutrition, getting health insurance.
(Facilitator): Health insurance?
(Male 1): Yes, and to get it as soon as possible. Many of us don’t have it. We have what our work offers, but usually it doesn’t cover the family.
(Male 2): Even when you have health insurance and go, they still make us wait. I think that in that case it is better, having a private doctor see her when she’s sick, even if we have to pay.
Interest in Cancer Education
Both male and female participants stated a desire to attend cancer health education workshops open to both men and women, even if workshops focused on a specific gender (i.e. women’s cancer health issues, such as cervical cancer), if they were offered at a convenient time. Men indicated that they could provide better support to their partners, if they knew more about the female cancers.
They [the women] want us to be more knowledgeable about this disease so that we can say “no, this is severe, you have to get it looked at.”
Interest was not universal, however. Some men stated that women should attend the cancer educational sessions and then tell their spouses about what happened when they returned home.
I’d go play soccer instead.