Barriers to Cancer Screening Among Immigrant Women in Miami

Abstract

There is the low utilization of cancer screening among immigrant women in Miami, and it is because of many barriers which include cost and lack of health insurance, language barrier, cultural beliefs and lack of education or enough knowledge concerning cancer and cancer screening (Madhivanan et al., 2016).  These barriers have created a big obstacle for immigrant women in Miami when it comes to accessing and utilizing cancer screening. The low rate of utilization of cancer screening among the immigrant women in Miami has led to many issues which include a higher mortality rate that is as a result of late cancer screening when cancer has already progressed and spread to other parts of the body (Madhivanan et al., 2016).  It has also led to the immigrant women in Miami incurring higher costs for treatment of cancer that has already progressed to other organs of the body (Madhivanan et al., 2016).

There are healthcare legislatures that have affected cancer screening of immigrant women in Miami including the Affordable Care Act of 2010 which has expanded health insurance together with access to immigrants (Castañeda et al., 2015). The government has also come up with federally qualified Health Centers which all immigrants to access screenings, disease treatment and preventive care (Hall & Cuellar, 2016). Despite these obstacles, it is still vital for immigrant women in Miami to be able to access and utilize cancer screening. Some of the most useful tools needed to ensure that immigrant women in Miami use cancer screening is a change in legislatures to incorporate the immigrant women and invest in education for the immigrant women concerning cancer and its detection. Language barrier should also be looked at to ensure that there is always effective communication especially during training sessions.

Keywords: Cancer, Legislature, Community Health, Health Promotion, Immigrant Women

Introduction

Cancer is among the leading causes of death in immigrant women in Miami, and the utilization of regular screening is instrumental in ensuring that the cancer is detected early enough to allow for treatment and thus reduce the mortality rate caused by cancer (Seay et al., 2015). The main reason behind the high cancer mortality rate in immigrant women in Miami is the lack of cancer screening (Kobetz et al., 2017). It is a big challenge to the immigrant women and the healthcare sector. This means that the healthcare sector including the healthcare providers, the government and the target population are failing somewhere. Each of these parties has a part to play to ensure that that the rate of utilization of cancer screening among the immigrant women is high and the mortality rate low.

This paper will discuss the different angles of utilization of cancer screening among the immigrant women in Miami including the role played by the legislature, healthcare providers like nurses and the immigrant women in Miami.

Recent Health Care Legislature

One of the current healthcare legislatures is the Affordable Care Act of 2010 which has broadened health insurance and its access to many immigrants (Castañeda et al., 2015). For example, lawful immigrants who are not yet citizens of the country can access private insurance in a plan that is subsidized even though there are permanent residents who are lawful but excluded from getting Medicaid since it requires one to have resided for at least five years (Castañeda et al., 2015).

This legislature also prevents the undocumented immigrants from accessing any health insurance altogether (Castañeda et al., 2015). The government has also come up with federally qualified health centers which allow access to preventive care, screening, and treatment (Hall & Cuellar, 2016). According to Hall & Cuellar (2016), as of 2014, over twenty-seven percent of the immigrants in the United States lacked health insurance which reduced access to preventive care by the immigrants and at the same time leading to higher rates of mortality among the immigrants.

According to the Emergency Medical Treatment and Active Labor Act of 1986, every hospital is obliged to treat all the patients in any emergency regardless of whether they are capable of paying for the services or not (Hall & Cuellar, 2016). It at least provides minimal access to the healthcare services for the undocumented immigrants even though it will be costly and risk their stay in the country. However, they cannot access any preventive care or screening of any kind since the care above only works in the cases of emergencies.

There are also national screening guidelines that guide the population in the United States of America including Miami on cancer screening. For example, women aged forty to forty-five years of age should be screened of breast cancer through mammography annually while those above fifty-five years should be screened every two years or continue with annual screening (Smith et al., 2018).

The guidelines for cervical cancer screening are different from those of breast cancer. According to national screening guidelines, cervical cancer screening should begin at age twenty-one whereby Pap test should be carried out every three years for women aged twenty-one and twenty-nine years (Smith et al., 2018). Women aged thirty years to sixty-five years should be screened every five years with Pap test and HPV DNA test or pap test alone every three years (Smith et al., 2018). Women who are above sixty-five years with two or more consecutive negative tests in the last ten years should stop going for screening (Smith et al., 2018).

The other category of women who should stop screening is those who have had a complete hysterectomy (Smith et al., 2018). Breast cancer and cervical cancer are the primary forms of cancer that affect women not only in the whole world but also specifically to immigrant women in Miami.

Health promotion and health education are essential in public health. However, there are disparities in health and various issues of concern that need to be addressed especially I regard to Health policies and immigration policies. The harmonization of this among many other policies can have positive effects not only on the health of immigrants in the nation but also to the general public health. It is essential to appreciate the fact that screening in women is crucial. However, infrastructure that supports screening especially in immigrant women are not available, and statistics show that screening in immigrant women is very low as shall be demonstrated in the ensuing part of the paper.

Barriers do exist to screening, and they include structural, socio-cultural and psychosocial barriers. These are the barriers that need to be looked into with a view of improving on cancer screening among immigrant women in Miami. Issues such as legislation and the provision of culturally competent care will play significant roles in the transformation of statistics of screening for cancer among these women.

For instance, bill can effectively reform the structural barriers that act as impediments to regular screening for cancer in this group. On the other hand, improvements in offering culturally competent care can transform the socio-cultural and psychosocial environment in the area, allowing immigrant women to not only understand the importance of cancer screening but also understand the ways of maneuvering the complex healthcare system in the United States. If these things are not done, the statistics cannot change, and community health will significantly deteriorate.

Literature Review

Being one of the leading causes of death among the population in Miami, cancer prevention and early screening is very important (Seay et al., 2015). Utilization of cancer screening aids in ensuring that there is early detection of cancer and thus could be treated before getting to a stage that is more difficult to manage. It is easier to treat cancer when recognized at an early stage compared to diagnosing it at a more progressed stage that limits the healthcare practitioners. The leading forms of cancer not only the whole of the world but also among immigrant women in Miami include breast cancer and cervical cancer (Smith et al., 2018). Other forms of cancer include skin cancer, colorectal cancer, and lung cancer to mention a few (Smith et al., 2018).

Being a serious health concern in not only the United States but also Miami in particular, it is essential for the screening of cancer to be conducted early enough. Based on the growth of population globally and trends in cases of major cancer it has been predicted that by the year 2030, there will be 23.6 million new cases every year in the world (Cancer center the UK, 2014). This is how serious cancer has affected the population on earth. It does not select whether one is an immigrant or not. It changes every group in Miami. However, what makes the difference is the issue of utilization of screening by the population in Miami.

Immigrants in Miami have higher rates of mortality caused by cancer and incidences of cancer (Pang et al., 2017). To add to that, cancer screening rates by the immigrant women in Miami is also low when compared to the rest of the native population of women (Pang et al., 2017). This means that the number of immigrant women who die as a result of cancer is higher when compared to the death of the native women in Miami due to cancer. It also means that cancer in other women in Miami is detected or detected in the early stages compared to that of immigrant women living in Miami. This disease is detected in late stages when it has already metastasized. The reason for that is that immigrant women in Miami do not visit the healthcare facilities for cancer screening as often as they should while the native women visit the healthcare facilities regularly for screening, thus, early detection of cancer cells in their bodies.

Cancer is a very expensive disease to treat since it requires a lot of resources like medicines for chemotherapy, machines needed for screening just to mention a few (Cancer center UK, 2014). This means that the cost of treatment and screening of the disease goes back to the population. The few who can afford the healthcare services will be able to have regular screening and therefore be able to detect cancer early enough for treatment before it gets to a stage where it can only be managed and not treated.

Cancer is a costly disease to treat since it requires a lot of resources like medicines for chemotherapy, machines needed for screening to mention a few (Cancer center UK, 2014). This means that the cost of treatment and screening of the disease goes back to the population. The few who can afford the health care services will be able to have regular screening and therefore be able to detect cancer early enough for treatment before it gets to a stage where it can only be managed and not treated.

According to Pang et al., (2017), many barriers and obstacles have led to the low rate of screening for the immigrant women in Miami, and they include cost, fear, health beliefs, and lack of insurance, immigration policies and lack of education or information. Immigrants in the United States of America migrate to the country for different reasons like seeking a greener pasture and education purposes. This means that this population is not well off and therefore it becomes tough for them to access even the preventive services from the healthcare centers. This especially becomes worse for the undocumented immigrants who cannot even get a decent job or even access healthcare (Rushefsky & Patel, 2014). Being poor means that they cannot afford health insurance and since the cost of screening is also not cheap, they cannot afford it without the insurance.

Immigration policies have also affected the immigrant women. For one to be able to move freely and access any service and resources in the United States of America, he or she has to have the necessary documents needed (Rushefsky & Patel, 2014). There are those who cannot be able to access screening and even treatment in any healthcare facility since they are not documented and therefore will have to be deported back to their country once realized. To avoid that, immigrant women and other immigrants who do not have the proper documents are forced to stay at home or look for drugs not prescribed for treatment. This means that they cannot take preventive measures like regular screening. This is a challenge that affects the immigrant women and therefore making it very difficult for them to go for cancer screening.

Knowledge is a potent tool that can be used to deal with challenges like cancer. Some immigrant women are insured but do not know about cancer (Seay et al., 2015). According to Seay et al., (2015), women without knowledge on the importance of regular screening of cancer or the having the wrong perception concerning the screening process are no different from the immigrant women who cannot afford the screening since at the end of the day, none of them has been able to access the screening services. This means that education is essential and it should be available to the immigrant women in Miami who have no access to it but remain with the wrong perceptions about screening, especially breast cancer and cervical cancer screening.

Statistical Data

Immigrant women in Miami are from different communities including Haitian and the Cuban. Cancer screening incidences among Haitian women in Miami is thirty-eight for every one hundred thousand women (Loue & Sajatovic, 2014). This is a tiny number because Haiti is the most affected community with cancer in Miami when compared to other communities like Cuban and the Native American women. There is a relationship between income, language barrier and insurance cover with cancer incidence of immigrant women not only in Miami but Florida at large (Kobetz et al., 2017). In this case, cervical cancer incidences among immigrant women in Florida shall be used. The graphs below show the relationship between cervical cancer incidence and socio-demographic factors among immigrant women.

Figure 1 cervical cancer incidences

Figure 2 Median Household Income

Figure 3 Uninsured in percentages

It is clear those areas where household income is low; there are more uninsured immigrant women and higher incidences of cervical cancer (Kobetz et al., 2017). For example, in little Haiti the annual income of immigrant women is approximately 21,646 dollars which have led to a forty percent of them being uninsured and 24.4 incidences of cancer for every 100, 000 (Kobetz et al., 2017). On the other hand, the annual household income in Florida is 46, 956 dollars which translate to only 20% of them being uninsured and only 8.8 cases of cervical cancer for every 100,000 (Kobetz et al., 2017). This clearly shows that low income, a high cost of insurance leads to higher incidences of cervical cancer and mortality rates. Low income and lack of health insurance covers are just among the many barriers to the utilization of cancer screening which leads to higher incidences of cancer and finally high mortality rates.

Population Impacted and Health Outcomes

The populations impacted in this case are the immigrant women in Miami especially the women from Haiti and the Cuban community which are the distinct immigrant communities in Miami (Seay et al., 2015). The immigrant women in the Miami community had low utilization of cancer screening when compared to the other native women in Miami since they did not comply or follow the guidelines on cancer screening by the national screening guidelines (Seay et al., 2015). This meant that the rate of mortality caused by cancer among this population was higher since they could not be diagnosed early enough to allow for treatment, the population incurred a lot of costs for the treatment of cancer.

The mortality rate due to cancer in this population increased because of some reasons. The first reason is that without the regular screening as proposed by the national screening guidelines, the disease is diagnosed among these women when it is already too late or at a stage that can only be managed since the cancer cells at this point have spread to other parts of the body. For example, according to the national screening guidelines women aged twenty-one to twenty-nine should undergo cervical screening every three years either through conventional or  Pap test, while those aged thirty to sixty-five should be tested every five years with Pap and HPV tests or every three years.

If it only includes Pap test and finally women above sixty-five years who have never had a positive result should no longer be tested unless the doctor recommends it (Seay et al., 2015). Without these regular screening for cervical cancer, for example, it will be very difficult for the woman to know that she is suffering from cancer and therefore by the time she gets to the doctor for screening and diagnosis, it is either too late for the doctors to do anything except managing it or lead to death. Some of these women are not even able to access healthcare and finally die even without any treatment.

The other effect of low rates of cancer screening in the immigrant women is that it finally leads to a very high cost for them for their treatment. Without regular screenings, it becomes tough for cancer to be detected early enough and therefore it becomes costly later on for them to treat it since, by the time the doctors diagnose the patient with cancer, it would have already progressed. This leads to a very expensive and costly treatment for the immigrant woman, thus getting her and the family to more poverty and status than they would have been if they had gone for regular screening as advised by the national screening guidelines.

However, these women do not do this willingly. There are many reasons as to why this population of immigrant women in Miami had low cancer screening rates. Some of the reasons include the cost of screening, Immigration policies, language issue, an education issue, and lack of insurance coverage and cultural beliefs that impacted their perception negatively on screening (Pang et al., 2017). These barriers have hindered women from accessing regular screening as proposed by the national screening guidelines. To improve the utilization of cancer screening by immigrant women in Miami, each of these barriers should be eradicated or minimized.

Without dealing with these barriers, it would be impossible to improve the utilization of cancer screening by immigrant women in Miami. These barriers range from economic, social, political and even cultural barriers. Different parties play different roles in the creation or supporting these barriers, and it will, therefore, take these parties to deal with these barriers for the utilization of screening of cancer by the immigrant women in Miami to improve.

Cost and lack of health insurance are at the top of the list of barriers to accessing and utilizing cancer screening (Pang et al., 2017). Some of the main reasons as to why people migrate include getting away from poverty and searching for greener pastures, search for educational opportunities, professional opportunities and also due to political persecution in their own country to mention a few (Castañeda et al., 2015). With such reasons to migrate to another country, it is pronounced that this population is poor and cannot be able to afford costly products and services.

To add to that, some of them are even undocumented meaning that it is complicated for them to access a good job that pays well. A majority of the immigrants in the United States of America including Miami live below the federal income level (Castañeda et al., 2015). This means that immigrant women in Miami can not even afford to pay for their health insurance coverage, including Medicaid, for the poor of society. If the immigrant women cannot provide health insurance, then they can only access the hospital when their conditions have worsened. They cannot just seek healthcare services because they felt a mild pain on the abdomen. The cheapest thing for them to do is get unprescribed or over the counter drugs that will give them some relief and move on with life.

For those who can access health insurance, they are underinsured and therefore only use the insurance cover when necessary and not just for preventive measures like a regular screening of cancer. The cost of accessing the services on cancer screening is therefore not a priority for them.

The other barrier to the utilization of cancer screening by immigrant women in Miami is cultural beliefs and influences and family support (Madhivanan et al., 2016). This is primarily for cervical and breast cancer. Some of the ideas and wrong perceptions that the immigrant women have concerning cervical cancer are that the screening through pap smear will lead to the uterus removal which scares them and also the fear of male doctors seeing them mention a few (Madhivanan et al., 2016).

The Haitian women in Miami believe that cervical cancer has a supernatural origin and therefore screening and other interventions provide very little or no help at all to the person affected (Madhivanan et al., 2016). Different beliefs about screening are that Pap test introduces bacteria into the vagina and thus leading to illness or lead to a change in vaginal tone (Madhivanan et al., 2016). These cultural beliefs are very wrong and give them a very negative perspective on screening. Instead of seeing it as a positive effect or helping them, they see cancer screening as a destructive exercise. These perceptions and beliefs concerning detection should be changed, and a positive one created for the immigrant women in Miami since a negative attitude towards anything cannot lead to any success and in this case, the negative attitude towards cancer screening should be changed to a positive attitude.

Other than that, the women also fear that they will be stigmatized especially when it comes to cervical cancer since the population relates cervical cancer to being sexually promiscuous and having sexually transmitted diseases (Madhivanan et al., 2016). These beliefs are not real and have caused a significant barrier to the immigrant women accessing the cancer screening services. Immigrant women have the wrong information that ultimately affects their perception concerning screening. It is crucial for these perceptions to be changed completely. This change is not impossible since what these group of people needs is access to the correct information concerning screening of cancer.

Lack of knowledge and education concerning cancer is another obstacle to the immigrant women utilizing screening of cancer (Madhivanan et al., 2016). As discussed above, these women have the wrong information and perception concerning the screening of cancer. Besides, some of them know nothing about cancer detection and why it is essential for them to be evaluated by the guidelines provided by national screening guidelines. Without the proper education concerning cancer and screening, it becomes complicated and almost impossible for the immigrant women to be screened. It is therefore essential for the immigrant women of all ages in Miami to be educated on screening, and its importance in order emphasize on having regular screening and remove the wrong notions they have concerning cancer screening.

The education should be carried out to women of all ages, that is both young and old women since the younger women look up to the older immigrant women for advice and directions (Madhivanan et al., 2016). This approach will help significantly in improving the chances and rate of cancer screening for the immigrant women in Miami. Education should include different stakeholders including local leaders and healthcare practitioners. Since it is challenging for immigrant women in Miami to go to the healthcare facilities unless it is an emergency to save cost and prevent any arrest and deportation, it is imperative for the education program to be organized at their community.

A plan can be arranged within their community to reach as many people as possible. Carrying out the education program at the healthcare facilities will not attract their attention, and most of them will not attend when compared to an education program that is organized within their community. The turnout will be more since they are comfortable when within their communities. There also will exist a sense of trust, and it will be easier for them to embrace knowledge.

Immigration and labor policies have also been a barrier to the utilization of cancer screening by immigrant women in Miami (Castañeda et al., 2015). The labor policies and enforcement in immigration lead to fear and a level of prejudice when it comes to health behaviors like cancer screening for the immigrants (Castañeda et al., 2015). One of the policies that show the bias to immigrants is the exclusion of the immigrants from accessing resources and services that other native residents of the United States of America like preventive care (Castañeda et al., 2015).

There should be equal access to healthcare resources including preventive care for all including the immigrants which is not the case since, in the Affordable Care Act of 2010, most of the immigrants are excluded from prevention and treatment (Castañeda et al., 2015). For example, one of the requirements to access Medicaid is being a resident of America for at least five years (Castañeda et al., 2015). It means that the immigrants who have not been residents for at least five years cannot access Medicaid.

Undocumented immigrants, on the other hand, cannot obtain at all any kind of health insurance (Castañeda et al., 2015). With such immigration policies, it has made it very difficult for immigrant women in Miami to access cancer screening which is preventive care. Undocumented immigrant women in Miami live in fear and cannot access the healthcare facilities for fear of being reported to the government which then results in their deportation back to their countries. It makes it almost impossible for them to access any health care in Miami. They would instead head to a drug store and purchase drugs that will soothe their pain or any infection.

The labor policies on the other hand also make it very difficult for the immigrant women in Miami get decent jobs. Since most of them are not educated to the college level, they would get jobs that pay very little but will provide too much work. Some of the immigrants are not documented, and the employers take advantage of that. They are paid too little for a lot of work done. Since it is complicated for an undocumented person to get a job let alone a decent job, the immigrant has to persevere and work too hard for too little. This situation is derived after your minimum income and, therefore, cannot pay any type of health insurance.

Language has also been a barrier to accessing cancer screening (Madhivanan et al., 2016). Immigrant women in Miami originate from different parts and continents of the world and therefore speak different languages. The different languages lead to a language barrier. Communication is very important to ensure that information is passed successfully between two parties and in this case, the natives and the immigrant women in Miami. The language barrier is responsible for preventing the immigrant women in Miami from accessing knowledge and information concerning cancer and in this case on cancer screening.

Cancer screening knowledge is essential for immigrant women since it will help them understand the importance of screening. The language barrier is, therefore, a significant obstacle and contributes to the low rates of cancer screening among the immigrant women in Miami. In the case where a health care practitioner needs to provide information to an immigrant woman who speaks a different language, it becomes tough for the practitioner to pass the message to the patient. The patient will either get the wrong message or miss out on some details. An interpreter has to be present for the two parties to communicate appropriately and effectively. Language is a huge barrier to the utilization of cancer screening by immigrant women. A lot of information and knowledge passes them only because of the language barrier

 For example, if a free screening has been organized and an immigrant woman cannot read, write or talk in English, the most likely outcome would be that the free screening will be carried out without even the immigrant woman knowing. They miss out on a lot due to the language barrier. Therefore, interpreters should be hired to ensure effective communication between healthcare practitioners and immigrant women. Immigrant women should also be encouraged to learn the common language that is used formally in the area. This will help the immigrant woman be able to read and therefore get instruction written down by the health practitioner.

Nursing Role in Passing the Legislature

The role of the nurse is to the patient, and the health of the patient is their priority. Some of the legislation put in place prevent a specific group of people in society and this case the immigrant women in Miami from accessing preventive care and screening. One of the roles of the nurse in passing the legislature is providing care for the immigrant woman who requires health care services. Differently put, the purpose, in this case, is to make sure that the prevailing laws that work to cater for equality in access to health are followed to the later. This is regardless of the nationality or residence status of the patient since it is the role of the nurse to care for the patient. According to the Medicare Modernization Act, healthcare facilities are reimbursed funds for any care that is not compensated and has been offered to illegal immigrants (American Nurses Association, 2014). The nurse only requires determining what the residency status of the patient is. Therefore, allows the nurses to exercise their responsibility of providing care to their patient even if the patient is an illegal immigrant.

Nurses also need to understand their position in society especially when it comes to advocacy. Nurses are regarded as change makers, and they are one of the most critical stakeholders in the healthcare industry. Nurses are in the filed, and they get to understand the issues that affect the community especially in regards to public health. Nurses are active in research and therefore can effectively relate issues to do with health disparity and lack of appropriate policies to reduce such disparities. Thus, as change makers, nurses need not only take part in the active implementation of laws that prevail to improve health in the community, but they should also advocate for better policies that go hand in hand with the specific community in which they work in. For instance, in this case, the low statistics regarding screening of immigrant women is caused by various legislative gaps that need to be filled. Nurses can take part in advocacy and help formulate laws that provide for better infrastructure that support screening for immigrant women in Miami.

The other role of a nurse is defending their role and advice the legislatures on what is right and wrong concerning health care for the immigrants. The American Nurses Association in the year 2010 reaffirmed that health care is a fundamental right of every human being despite their condition or nationality and therefore each person in the United States of America whether documented or not should be able to have access to healthcare (American Nurses Association, 2014). It is the responsibility of the nurse and letting the legislature and government know their position of standing with the patient is very important. They should discourage the government from passing legislatures that prejudice a particular group of people.

The nurse is also responsible for educating the immigrant women on not only health issues but also legislation issues related to health. Education is an essential tool. Equipping the patients with information is very important. For example, the nurse should educate the patient on the importance of screening and the importance of having health insurance to mention a few. Providing them with information and allowing them to make their own decision is very helpful to not only the nurse but also the patients. Some of the immigrant women have no info concerning cancer screening while others require information concerning the different kinds of health insurance available for them to use. Such information is significant for immigrant women in Miami. Knowledge is power.

Citizens of the United States are always taken through health education and are ever made to understand how they are affected by different legislative decisions especially in regards to their health. If this is necessary for citizens of the nation, it is only evidence that the same should apply for immigrants also. They need to learn how various laws affect them especially when it comes to issues regarding health.  This, coupled with health promotion should help improve the statistics regarding screening and general health of this population.

Community participation may also be a tool that can be used in the addressing of the problem at hand. Community participation programs which involve stakeholders such as public health nurses, immigrant women and lawmakers can provide valuable insight into the gaps that exist in the law. Immigrant women can express their health needs and, in this case, their needs regarding screening. On the other hand, community health nurses can substantiate their pleas through the use of available statistics from research and data in the community. Through such partnership and collaboration, community participation can be a useful tool in the improvement of general health for immigrant women.

Conclusion

In conclusion, it is crucial for immigrant women in Miami to access and be able to utilize cancer screening. Regular screening as proposed by the national screening guidelines applies to each, and every woman is not only Miami but the whole of the United States of America. This means that the immigrant women in Miami should also be screened as per the national screening guidelines. This would help a long way in getting to detect cancer when still at an early stage. There are different barriers to immigrant women utilizing the screening of cancer.

Most of these barriers can be removed, thus allowing them access to the cancer screening. For example, the legislature and immigration policies are too harsh on the immigrant women, especially the undocumented women in Miami. Such women cannot even access healthcare services even with their cash for fear of being deported back to their countries once identified. The government should also reduce the amounts needed to be paid for health insurance covers for the poor immigrant women in Miami to afford it. Affording the health insurance would mean that the immigrant women will be able to provide and thus utilize cancer screening as advised by the national screening.

Other barriers like a lack of education or knowledge and cultural beliefs can also be avoided and prevented through education. The healthcare providers should take time to educate the immigrant women in Miami on issues to do with cancer and cancer screening. With education, immigrant women will have a change of perception concerning cancer and especially screening for cancer. With a shift in understanding and the correct knowledge, the immigrant women will be well empowered, and they will be able to see the importance of regular cancer screening. This in turn will lead to the reduction of deaths caused by a late diagnosis of cancer in these women. It will allow for the diagnosis of cancer early enough before the cells spread and progress to other parts of the body.

With early diagnosis, it becomes easier for the healthcare practitioners to treat the disease and the whole process is also cheaper when compared to if the treatment was to be carried out after cancer has already spread to another part of the body.

The nurses also have a role to play when it comes to by educating and even standing their ground and advising legislatures on what legislature is right and what interferes with the health right of an individual and thus stand their ground on the protection and care of the patient. If each party takes its responsibilities and does that which is expected of them, the utilization of cancer screening among the immigrant women in Miami will improve. This can only be achieved if the government revises its legislature to ensure that the immigrants, whether documented or undocumented can be able to access the health insurance and healthcare facilities not only for emergency purposes only but also for preventive care, screening and management if diseases or treatment.

Policies on labor should also be revised to create room for immigrants to access jobs that pay decently. The healthcare practitioners on their hand should be available to provide health care services to the immigrant women whether documented or undocumented and also ensure that they are educated adequately concerning cancer and the importance of screening to have the right information and perception that will help them be able to accept and access information.

References

American Nurses Association. (2014). Nursing beyond borders: Access to health care for documented and undocumented immigrants living in the US. ANA issue brief: Information and analysis on topics affecting nurses, the profession and health care.

Cancer Research UK. (2014). World cancer incidence statistics http://www.cancerresearchuk.org/cancer-info/cancers tats/world/incidence/#source who_2013.pd.

Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M. E. D., Beyeler, N., & Quesada, J. (2015). Immigration as a social determinant of health. Annual review of public health, 36, 375-392. DOI: 10.1146/annurev-publhealth-032013-182419.

Hall, E., & Cuellar, N. G. (2016). Immigrant health in the United States: A trajectory toward change. Journal of Transcultural Nursing, 27(6), 611-626. DOI:10.1177/1043659616672534.

Kobetz, E., Seay, J., Amofah, A., Pierre, L., Bispo, J. B., Trevil, D., … & Carrasquillo, O. (2017). Mailed HPV self-sampling for cervical cancer screening among underserved minority women: study protocol for a randomized controlled trial. Trials, 18(1), 19. DOI 10.1186/s13063-016-1721-6.

Madhivanan, P., Valderrama, D., Krupp, K., & Ibanez, G. (2016). Family and cultural influences on cervical cancer screening among immigrant Latinas in Miami-Dade County, USA. Culture, health & sexuality, 18(6), 710-722. DOI: 10.1080/13691058.2015.1116125.

Pang, H., Cataldi, M., Allseits, E., Ward-Peterson, M., de la Vega, P. R., Castro, G., & Acuña, J. M. (2017). Examining the association between possessing a regular source of healthcare and adherence with cancer screenings among Haitian households in Little Haiti, Miami-Dade County, Florida. Medicine, 96(32). DOI: 10.1097/MD.0000000000007706.

Rushefsky, M. E., & Patel, K. (2014). Healthcare Politics and Policy in America: 2014. DOI: 10.2753/PIN1099-9922170107.

Sana, L., & Sajatovic, M. (2014). Encyclopedia of Immigrant Health. Springer Science & Business Media. DOI: 10.1007/978-1-4419-5659-0_522

Seay, J. S., Carrasquillo, O., Campos, N. G., McCann, S., Amofah, A., Pierre, L., & Kobetz, E. (2015). Cancer screening utilization among immigrant women in Miami, Florida. Progress in community health partnerships: research, education, and action, 9(2), 11-20. DOI: 10.1353/cpr.2015.0029.

Smith, R. A., Andrews, K. S., Brooks, D., Fedewa, S. A., Manassaram‐Baptiste, D., Saslow, D., … & Wender, R. C. (2018). Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians, 68(4), 297-316.DOI: 10.3322/caac.21446.