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Wong LP. HPV information needs, educational messages and channel of delivery preferences: Views from developing country with multiethnic populations. Vaccine. 2009;27(9):1410–5.

Kadra Ahmed Omar is an Ethiopian mannequin of Somali descent. This Somali sexy girl was working with modeling agencies and designers from all over the world. Kadra represented Heffner Management and Elite Model Management, Toronto agencies. She appeared in the 2000 Sports Illustrated Swimsuits. Cici Ali Rahma Mohamed (born in 1990) is a Somali model. Rahma was working for such famous model agencies as Next Model Management (Paris), Models 1, MD Management, Just WM. Mistakes When Dating Sexy Somali Girls Online Teachers can provide and discuss culturally appropriate information targeting the double sexual standard in schools. It is also recommended to take the cultural stigma on sexual matters into account and extend the HPV vaccination to an older age, as suggested earlier [ 33].Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. The Somali women in the study had not been aware of possible susceptibility to HPV through partners, even though they had been aware of a cultural double sexual standard, as also found in a study among Turkish and Moroccan mothers [ 33]. Also, cancer is perceived as a sensitive topic by the women [ 14]. The Somali mothers particularly attribute cervical cancer to metaphysical beliefs such as fate and God’s will [ 37]. However, the Islamic faith also plays the role of a cue to action: some participants state that their religion supports preventive care and/or medicine to improve health. The executing researcher (JS), who is a young female of Somali origin and studied Health Sciences in Amsterdam, approached Somali organizations and Community Health Services (CHSs) through gatekeepers who had access to the Somali community. Participants were recruited from a wide range of settings, including community gatherings, CHSs, the university, and Facebook. The recruitment was mostly done by JS and via members of the Somali organizations and CHS professionals. This idea of eternal shame instills fear in young Somali women and mothers. The mothers use social control and education on Islamic norms as ways to promote chastity among daughters and to prevent stigma. With the cultural double sexual standard on the virginity of girls, the HPV vaccination is not considered necessary. Yet, some girls criticize it by expressing their discontent with the Somali cultural norm that stigmatizes girls who are sexually active before marriage. ICO Information Centre on HPV and Cancer. Human Papillomavirus and related cancers, fact sheet 2013 [ http://www.hpvcentre.net/statistics/reports/SOM_FS.pdf]

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In the United Kingdom, embarrassment due to Female Genital Mutilation (FGM) is a barrier for getting Pap smears among Somali women [ 13]. In the United States (US), FGM is associated with a concern that Pap smears would increase pain among Somali girls and women [ 14]. Another study in the US has found that Somali girls accept HPV vaccination, but are less likely to complete the HPV vaccination series in comparison with white non-Hispanic girls [ 15]. Moreover, Somali women in the US are less likely to adhere to cervical cancer screening procedures than non-Somali women in the US [ 16]. Hence, there is a need to deepen our understanding of the perceptions of Somali women in the diaspora regarding the prevention of cervical cancer. Non-Somali [Preferably Ethiopians but anything will do] + Literally anything relating to Somalis) x SSpot = Guaranteed Platinum ThreadAll individual participants signed the consent letter and filled out the questionnaire. Several mothers from group discussions refused to sign and fill out the questionnaire because they were not used to giving this type of written information during their usual group gatherings. It is common that minority communities decline to provide this kind of information during research at the community level [ 14]. Also, participants did not feel compelled to stay for the whole session. Nevertheless, these mothers gave oral consent for participating and were actively engaged in giving information. Ethical approval is not required for this type of study in the Netherlands [ 23], as only particular types of behavioral research fall under the Medical Research Involving Human Subjects Act [ 24]. Measures and procedures

Natural groups” refers to groups consisting of people who know each other already from other situations, such as sports teams, work, or women’s support groups. Researching with these groups maximizes the interaction between participants, and between participants and the facilitator. It provides access to a shared group culture [ 14]. In this case, the women gathered regularly to discuss issues that were important to them. With the support of the chair of a Somali women’s organization and a Community Health Service (CHS) educator, natural group discussions were facilitated. Since 2009, prevention of cervical cancer in the Netherlands consists of two measures: first, the Papanicolaou Screening (Pap smear), for which all women aged 30 to 60 years receive an invitation every 5 years, is free of charge [ 1]. The second measure - the Human Papillomavirus (HPV) vaccination - was introduced in 2009, after the bivalent vaccine (Cervarix) targeting HPV 16 and 18 became available [ 2]. Since there is a risk of contracting HPV from the first time of intercourse [ 3], the HPV vaccination program, which is managed by the Centre for Infectious Disease Control (CIb) and is only free of charge for 12-year old girls [ 2], ensures that most girls can be vaccinated before they become sexually active [ 4]. Pretty Somali womenhave beautiful long but feminine faces, long and thin noses, full lips, and very smooth skin. BioMedCentral. Qualitative research review guidelines – RATS [ http://www.biomedcentral.com/authors/rats] Dream Singles – a popular dating portal that provides with the possibility to find women from all parts of the globe, Slavic brides, in particular

In the second theme, about how decisions in regards to the HPV vaccination are negotiated between mothers and daughters, we see that Somali mothers’ poor Dutch language skills - particularly from the second migration wave - give their children the role of translating information about HPV vaccination. This, in turn, is perceived as a barrier to participation by Somali girls. Furthermore, these Somali women live by certain traditions of information exchange. The formal leaflet is read with suspicion, or not read at all. In the Somali, female community, cultural peers are a major source of information, and decision-making on the medical prevention of cervical cancer takes places within social relations. Mothers and daughters exchange information on the HPV vaccination with each other, even though the mothers’ opinion often forms a cue to (reject) action. Some mothers perceive a limit of freedom for determining their daughters’ health actions because of the experienced information gap and the ‘dominant’ Dutch culture, in which decision-making is individualized. It becomes apparent in this interview that the girl fears that the HPV vaccination campaign normalizes sex at a young age. This is related to young Somali women’s doubts about the vaccination age. However, while they consider the age of 12 too early for girls to be confronted with sex talk, they also see the potential benefits of being prevented from acquiring HPV. The HPV vaccination is also considered as positive, as it protects women from cervical cancer and is considered as similar to other childhood vaccinations. The HPV vaccination is not seen as a measure to prevent Sexually Transmitted Infections (STIs). Aside from this, the HPV vaccine is often assumed to be mandated. Glanz K, Rimer B, Viswanath K. The Health Belief Model. In: Glanz K, Rimer B, Viswanath K, editors. Health behavior and health education: Theory, research, and practice. 4th ed. San Francisco: John Wiley & Sons; 2008. p. 45–65. Combining an intersectional approach with the Health Belief Model provides contextualized knowledge on how the women’s different positions in aspects such as age, migration status and language skills, religion, or culture are interdependent and influence individual perceptions of preventive measures and health. According to Hankivsky et al. [ 19], intersectionality directs attention to health issues that are less well understood for certain groups, in our case, Somali women and the prevention of cervical cancer. Gendered, cultural, and social structures produce and reproduce inequalities that intersect, overlap, and reinforce each other in shaping a person’s health status. To prevent disease, it is important to gain an understanding of how women’s perceptions are contextualized, and we must also target our interventions towards institutions, such as healthcare and health promotion programs, rather than target individuals. Strengths and limitations to the study Another major barrier is related to language. The Somali mothers from the second migration wave are often not fluent in Dutch, while Somali girls have access to Dutch language and culture through school. Hence, some young Somali women have to translate information about the HPV vaccination to their mothers, which daughters then sometimes perceive as a barrier. As a consequence, they have not always informed their mothers.