Afghan refugee women who have been resettling in the US since the 1980’s are now aging and may face multiple layers of disadvantage, experience increased burden of disease, and face challenges to equitable access to preventive health screening. While research with refugee women’s health prioritizes the assessment and treatment of communicable diseases, there is a paucity of research which seeks to understand social and cultural factors influencing preventive health behaviors beyond their initial resettlement. This study used focused ethnography methodology to explore women’s perceptions of influences on health, mammography, and colonoscopy screening among a sample of Afghan women over the age of 50. Fourteen women participated in open-ended, semi-structured interviews. Interviews with their family members (n = 5) and key informants (n = 8) from the Afghan community provided richer descriptions of women’s context and social influences.

The findings of this research are presented in three manuscripts. The first manuscript is an integrative review of published literature of Afghan and other Muslim refugee women’s preventive cancer screening behaviors in high-income countries of resettlement. This study found multi-level influences on women’s screening behaviors and lower rates of mammography, colonoscopy and Pap smear use among refugee women compared to rates among the general host country's population. Findings also establish that resettled refugees from Muslim majority countries are understudied and underrepresented in health promotion interventions. The second manuscript is a qualitative study of Afghan women’s perceptions about health and sociocultural influences on health-related behaviors. Afghan women reported holistic health beliefs as well as family-centered and religion-informed motivation for healthy behaviors. This study offers new insights on Afghan women’s health concerns and health experiences as they continue to age in the US. The third manuscript is a qualitative study exploring sociocultural factors on women’s perceptions of breast and colorectal cancer and screening. Screening behaviors were influenced by culturally-informed beliefs about cancer, poor and inadequate communication with providers and the need for support from family and community in navigating the US health system. This study offers new insights into patient empowerment factors for Afghan women to obtain screening repeatedly, including religious coping and family support. Future screening and health promotion interventions should incorporate women’s cultural explanatory models of illness and religious and family-centered approaches.