Cervical cancer awareness and human papilloma virus knowledge among Syrian refugee women in Turkiye: impact of language proficiency and screening history

Year 2026, Volume: 7 Issue: 2, 349 - 354, 27.03.2026

Ahmet Beyazıt , Hasan Cem Sevindik , Leyla Bereket

https://izlik.org/JA46BT88TB

Abstract

Aims: Cervical cancer remains a major global health problem despite being preventable, with human papillomavirus (HPV) causing 99% of cases. While screening and vaccination have reduced incidence in high-income settings, refugee and migrant women face higher risks due to limited health literacy and language barriers.
Methods: Sexually active women aged 18–65 years attending a tertiary obstetrics and gynecology outpatient clinic were consecutively recruited (n=208). Data were collected face-to-face using a sociodemographic form and an Arabic-translated, culturally reviewed version of the 33-item Waller Human Papillomavirus Knowledge Scale (total Cronbach’s α=0.940). Nonparametric comparisons and multiple linear regression were performed (p<0.05).
Results: Participants’ mean age was 37.58±14.17 years; mean age at first pregnancy 22.03±4.83; mean total pregnancies 3.33±2.60; 83.65% had given birth. While 64.9% reported Turkish proficiency, only 25% had ever had a Pap smear. HPV knowledge was extremely low (total score 3.72±5.88). Turkish-speaking women had markedly higher knowledge across all subdomains and in total (5.70±6.49 vs 0.07±0.58; p<0.001), and women with prior Pap smear had higher scores than those never screened (p<0.001); parity showed no association (p>0.05). In regression, Pap smear history (β=0.848; +11.63 points) and Turkish proficiency (β=0.097; +1.21 points) independently predicted knowledge (R²=0.811), whereas age at first pregnancy did not.
Conclusion: These findings show a knowledge deficit among Syrian refugee women, worsened by language barriers, indicating that obstetric/gynecologic contacts fail to provide preventive education. Using culturally sensitive Arabic materials and leveraging screening encounters for HPV counseling may improve free screening uptake and reduce cervical cancer mortality in this population.

Keywords

Refugee women , healthcare access , cervical cancer , human papillomavirus (HPV)

Ethical Statement

Before starting the research, approval was obtained from the Clinical Researches Ethics Committee of Hatay Mustafa Kemal University Faculty of Medicine (Date:30.07.2025, Decision No: 21).

Supporting Institution

None

Thanks

None

References

• de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017;141(4):664-670. doi:10.1002/ijc.30716
• Afsah YR, Kaneko N. Barriers to cervical cancer screening faced by immigrant Muslim women: a systematic scoping review. BMC Public Health. 2023;23(1):2375. doi:10.1186/s12889-023-17309-9
• Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023;11(2):e197-e206. doi:10.1016/s2214-109x(22)00501-0
• Veeravagu T, Hamdiui N, Stein ML, Crutzen R, Timen A. Barriers, facilitators, needs, and preferences in seeking information regarding cervical cancer prevention programs among Turkish, Moroccan, and Syrian immigrant women: a scoping review. BMC Public Health. 2025; 25(1):1242. doi:10.1186/s12889-025-22359-2
• Presidency of Migration Management. Temporary protection statistics. Republic of Türkiye Ministry of Interior. Accessed Feb 5, 2026. https://en.goc.gov.tr/temporary-protection27
• El Arnaout N, Rutherford S, Zreik T, Nabulsi D, Yassin N, Saleh S. Assessment of the health needs of Syrian refugees in Lebanon and Syria's neighboring countries. Confl Health. 2019;13:31. doi:10.1186/s13031-019-0211-3
• Demir Bozkurt F, Özdemir S. Validity and reliability of a Turkish version of the human papillomavirus knowledge scale: a methodological study. J Turk Ger Gynecol Assoc. 2023;24(3):177-186. doi:10.4274/jtgga.galenos. 2023.2022-10-9
• Abohalaka R, Yeşil ST. Determination of perceived language barriers according to Syrian refugees visiting two hospitals in Ankara. Turkish J Public Health. 2021;19(2):92-105.
• Pandey M, Maina RG, Amoyaw J, et al. Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. BMC Health Serv Res. 2021;21(1):741. doi:10.1186/s12913-021-06750-4
• Whitaker KL, Krystallidou D, Williams ED, et al. Addressing language as a barrier to healthcare access and quality. Br J Gen Pract. 2022;72(714): 4-5. doi:10.3399/bjgp22X718013
• Kurtay S, Taşın C. Healthcare access and cervical cancer awareness among Syrian refugee women in Turkiye: language, cultural, and economic challenges. BMC Public Health. 2024;24(1):3610. doi:10.1186/s12889-024-21143-y
• Alsaad MA, Shamsuddin K, Fadzil F. Knowledge towards HPV infection and HPV vaccines among Syrian mothers. Asian Pac J Cancer Prev. 2012;13(3):879-83. doi:10.7314/apjcp.2012.13.3.879
• Hossain MA, Khanam SJ, Khan MN, Oldroyd J, Islam RM. Barriers to cervical cancer screening among refugee women: a systematic review. PLOS Glob Public Health. 2025;5(3):e0004225. doi:10.1371/journal.pgph.0004225
• Balcilar M, Gulcan C. Determinants of Protective healthcare services awareness among female Syrian refugees in Turkey. Healthcare (Basel). 2022;10(9):1717. doi:10.3390/healthcare10091717
• Lofters AK, Moineddin R, Hwang SW, Glazier RH. Predictors of low cervical cancer screening among immigrant women in Ontario, Canada. BMC Womens Health. 2011;11:20. doi:10.1186/1472-6874-11-20
• Azerkan F, Sparén P, Sandin S, Tillgren P, Faxelid E, Zendehdel K. Cervical screening participation and risk among Swedish-born and immigrant women in Sweden. Int J Cancer. 2012;130(4):937-947. doi:10. 1002/ijc.26084
• Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2003;16(1):1-17. doi:10.1128/cmr.16.1.1-17.2003
• Tekalegn Y, Sahiledengle B, Woldeyohannes D, et al. High parity is associated with increased risk of cervical cancer: systematic review and meta-analysis of case-control studies. Womens Health (Lond). 2022;18: 17455065221075904. doi:10.1177/17455065221075904