Date of Award

January 2023

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Kaveh Khoshnood

Abstract

Introduction: Over the past few decades, Morocco – a transit country for entry into Europe – has gradually evolved as a place of resettlement for migrants of sub-Saharan and West African origins. To combat inequities in healthcare utilization, the Moroccan government introduced a series of reforms designed to promote breast and cervical cancer screening and regularization of migrants. To date, few studies have explored the extent to which migrant residents in the country uptake these services or their awareness of cancer signs, symptoms, and risk factors relative to their native counterparts. The purpose of this study is to therefore delineate the comparative knowledge, attitudes, and practices among migrant and Moroccan women towards breast and cervical cancer screening and to identify behavioral as well as systemic barriers to screening access among migrant women. Methods: A comparative cross-sectional study was conducted between June and August 2022 in Al-Moustakbal Health Center in Casablanca, Morocco. A total of 94 Moroccan and migrant female patients above the age of 18 were sampled by convenience and interviewed to complete a structured cancer awareness questionnaire in either French or Arabic. Descriptive statistics and bivariate analysis were used to assess baseline characteristics. Adjusted multivariable analysis was used to compare mean instrument scores and the odds of selected care-seeking determinants. Results: Participant characteristics did not significantly differ by level of education, marital status, or medical history (i.e., previous screening and HPV vaccination status). Linear regression analysis revealed significantly lower mean knowledge scores among migrant participants, including knowledge of cancer symptoms and risks (p<0.05). Our adjusted logistic regression model also indicated associations between nativity status and confidence in self-identifying signs of breast (OR = 0.10, 95% CI = 0.03 - 0.41) or cervical cancer (OR = 0.11, 95% CI = 0.03 - 0.41). Prevalent reasons reported by participants who have not previously sought breast or cervical cancer screening included lack of interest/ sign (50%), insurance (24.4%), or money (22.1%). Conclusion: Our exploratory study suggests that some negative differences related breast and cervical cancer awareness and practices exist between migrant patients and their Moroccan counterparts. Given the homogeneity of the sampled participants, these discrepancies are likely wider among migrants of transitory or forcibly displaced pathways. Future studies can expand on predictive factors influencing care-seeking behavior in Morocco and explore potential interventions to mitigate any deficiencies therein.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/22/2026

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