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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 11/2010

01-11-2010 | Original Research

Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women

Authors: Matthew J. O’Brien, MD, MSc, Chanita Hughes Halbert, PhD, Rebecca Bixby, RN, Susana Pimentel, Judy A. Shea, PhD

Published in: Journal of General Internal Medicine | Issue 11/2010

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Abstract

INTRODUCTION

U.S. Hispanic women suffer a disproportionate burden of cervical cancer, with incidence and mortality rates almost twice that of whites. Community health workers, or promotoras, are considered a potential strategy for eliminating such racial and ethnic health disparities. The current study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community.

METHODS

Four promotoras led a series of two workshops with community members covering content related to cervical cancer. Sociodemographic characteristics, cervical cancer risk, previous screening history, cervical cancer knowledge, and self-efficacy were measured by a pre-intervention questionnaire. The post-intervention questionnaire measured the following outcomes: cervical cancer knowledge (on a 0–6 scale), self-efficacy (on a 0–5 scale), and receipt of Pap smear screening during the previous 6 months (dichotomous). Univariate analyses were performed using chi square, t-test, and the Mann–Whitney test. Multivariate logistic regression was used to model the association between explanatory variables and receipt of Pap smear screening.

RESULTS

There were no statistically significant differences between the two experimental groups at baseline. Follow-up data revealed significant improvements in all outcome measures: Pap smear screening (65% vs. 36%, p-value 0.02), cervical cancer knowledge (5.4 vs. 3.5, p-value < 0.001), and self-efficacy (4.7 vs. 4.0, p-value 0.002). In multivariate analysis, cervical cancer knowledge (OR 1.68, 95% CI 1.10-2.81) and intervention group assignment (OR 6.74, 95% CI 1.77-25.66) were associated with receiving a Pap smear during the follow-up period.

DISCUSSION

Our randomized trial of a promotora-led educational intervention demonstrated improved Pap screening rates, in addition to increased knowledge about cervical cancer and self-efficacy. The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them. Future research should evaluate such programs on a larger scale, and identify novel targets for intervention.
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Literature
1.
Guzman B. Census 2000 brief: The Hispanic population. Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census; 2001.
2.
3.
National healthcare disparities report. Washington, DC: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; 2008.
4.
Smedley B, Stith A, Nelson A, eds. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The Institute of Medicine: The National Academies Press; 2003.
5.
Schlotthauer A, Badler A, Cook S, Perez D, Chin M. Evaluating interventions to reduce health care disparities: An RWJF program. Health Aff. 2008;27(2):568–73.CrossRef
6.
Howe H, Wu X, Ries L, Cokkinides V, Ahmed F, Jemal A, et al. Annual report to the nation on the status of cancer, 1975-2003, featuring cancer among U.S. Hispanic/Latino populations. Cancer. 2006;107(8):1711–42.CrossRefPubMed
7.
Cancer facts and figures for Hispanics/Latinos 2009-2011. Atlanta, GA: American Cancer Society; 2009.
8.
Barnholtz-Sloan J, Petel N, Rollison D, Kortepeter K, MacKinnon J, Giuliano A. Incidence trends of invasive cervical cancer in the United States by combined race and ethnicity. Canc Causes Contr. 2009;20:1129–38.CrossRef
9.
Cancer prevention and early detection facts and figures 2009. Atlanta, GA: American Cancer Society; 2009.
10.
Bazargan M, Bazargan S, Farooq M, Baker R. Correlates of cervical cancer screening among underserved Hispanic and African-American women. Prev Med. 2004;39:465–73.CrossRefPubMed
11.
Holschneider C, Felix J, Satmary W, Johnson M, Sandweiss L, Montz F. A single-visit cervical carcinoma prevention program offered at an inner city church. Cancer. 1999;86(12):2659–67.CrossRefPubMed
12.
Sirovich B, Welch H. The frequency of Pap smear screening in the United States. J Gen Intern Med. 2004;19(3):243–50.CrossRefPubMed
13.
Arredondo E, Pollak K, Costanzo P. Evaluating a stage model in predicting monolingual Spanish-speaking Latinas' cervical cancer screening practices: The role of psychosocial and cultural predictors. Health Educ Behav. 2008;35(6):791–805.CrossRefPubMed
14.
Johnson C, Mues K, Mayne S, Kiblawi A. Cervical cancer screening among immigrants and ethnic minorities: A systematic review using the health belief model. J Low Genit Tract Dis. 2008;12(3):232–41.CrossRefPubMed
15.
Austin L, Ahmad F, McNally M, Stewart D. Breast and cervical cancer screening in Hispanic women: A literature review using the health belief model. Womens Health Issues. 2002;12(3):122–8.CrossRefPubMed
16.
Ackerson K, Gretebeck K. Factors influencing cancer screening practices of underserved women. J Am Acad Nurse Pract. 2007;19:591–601.CrossRefPubMed
17.
Garbers S, Chiasson M. Inadequate functional health literacy in Spanish as a barrier to cervical cancer screening among immigrant Latinas in New York City. Prev Chron Dis. 2004;1(4):1–10.
18.
Rodriguez M, Ward L, Perez-Stable E. Breast and cervical cancer screening: Impact of health insurance status, ethnicity, and nativity of Latinas. Ann Fam Med. 2005;3:235–41.CrossRefPubMed
19.
Byrd T, Chavez R, Wilson K. Barriers and facilitators of cervical cancer screening among Hispanic women. Ethn Dis. 2007;17(1):129–34.PubMed
20.
Cadarelli R, Kurian A, Pandya V. Having a personal healthcare provider and recepit of adequate breast and cervical cancer screening. J Am Board Fam Med. 2010;23(1):75–81.CrossRef
21.
Mead H, Cartwright-Smith L, Jones K, Ramos C, Siegel B, Woods K. Racial and ethnic disparities in U.S. health care: a chartbook. New York: The Commonwealth Fund; 2008.
22.
Flores K, Bencomo C. Preventing cervical cancer in the Latina population. J Womens Health. 2009;18(12):1935–43.CrossRef
23.
Goel M, Wee C, McCarthy E, Davis R, Ngo-Metzger Q, Phillips R. Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. J Gen Intern Med. 2003;18(12):1028–35.CrossRefPubMed
24.
Witmer A, Seifer S, Finocchio L, Leslie J, O'Neil E. Community health workers: integral members of the health care workforce. Am J Public Health. 1995;85:1055–8.CrossRefPubMed
25.
Perez L, Martinez J. Community health workers: Social justice and policy advocates for community health and well-being. Am J Public Health. 2008;98:11–4.CrossRefPubMed
26.
Love M, Gardner K, Legion V. Community health workers: What they are and what they do. Health Educ Behav. 1997;24(4):510–22.CrossRefPubMed
27.
Humphrey J, Jameson L, Beckham S. Overcoming social and cultural barriers to care for patients with diabetes. West J Med. 1997;167:138–44.
28.
Ingram M, Torres E, Redondo F, Bradford G, Wang C, O'Toole M. The impact of promotoras on social support and glycemic control among members of a farmworker community on the U.S.-Mexico border. Diab Educ. 2007;33(Suppl 6):172S–8.CrossRef
29.
Lujan J, Ostwald S, Ortiz M. Promotora diabetes intervention for Mexican Americans. Diab Educ. 2007;33(4):660–70.CrossRef
30.
Thompson J, Horton C, Flores C. Advancing diabetes self-management in the Mexican-American population: A community health worker model in a primary care setting. Diab Educ. 2007;33:159S–65.CrossRef
31.
Campbell M, James A, Farrell M, Tessaro I. Improving multiple behaviors for colorectal cancer prevention among African American church members. Health Psychol. 2004;23(5):492–502.CrossRefPubMed
32.
Erwin D, Spatz T, Stotts R, Hollenberg J. Increasing mammography practice by African American women. Cancer Pract. 1999;7(2):78–85.CrossRefPubMed
33.
Koval A, Riganti A, Foley K. CAPRELA (Cancer Prevention for Latinas): Findings of a pilot study in Winston-Salem, Forsyth County. NC Med J. 2006;67(1):9–15.
34.
Paskett E, Tatum C, Rushing J, Michielutte R, Bell R, Foley K, et al. Randomized trial of an intervention to improve mammography utilization among a triracial rural population of women. J Natl Cancer Inst. 2006;98:1226–37.CrossRefPubMed
35.
Welsh A, Sauaia A, Jocobellis J, Min S, Byers T. The effect of two church-based interventions on breast cancer screening rates among Medicaid-insured Latinas. Prev Chron Dis. 2005;2(4):1–11.
36.
Balcazar H, Alvarado M, Cantu F, Pedregon V, Fulwood R. A promotora de salud model for addressing cardiovascular disease risk factors in the U.S.-Mexico border region. Prev Chron Dis. 2009;6(1):1–8.
37.
Hill M, Han H, Dennison C, Kim M, Roary M, Blumenthal R, et al. Hypertension care and control in underserved African American men: Behavioral and physiologic outcomes at 36 months. Am J Hypertens. 2003;16:906–13.CrossRefPubMed
38.
Krieger J, Collier C, Song L, Martin D. Linking community-based blood pressure measurement to clinical care: A randomized controlled trial of outreach and tracking by community health workers. Am J Public Health. 1999;89:856–61.CrossRefPubMed
39.
Staten L, Gregory-Mercado K, Ranger-Moore J, Will J, Giuliano A, Ford E, et al. Provider counseling, health education, and community health workers: The Arizona WISEWOMEN project. J Womens Health. 2004;13(5):547–56.CrossRef
40.
Fox P, Porter P, Lob S, Boer J, Rocha D, Adelson J. Improving asthma-related health outcomes among low-income, multiethnic, school-aged children: Results of a demonstration project that combined continuous quality improvement and community health worker strategies. Pediatrics. 2007;120:e902–11.CrossRefPubMed
41.
Krieger J, Takaro T, Song L, Weaver M. The Seattle-King County healthy homes project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. Am J Public Health. 2005;95:652–9.CrossRefPubMed
42.
Martin M, Hernandez O, Naureckas E, Lantos J. Reducing home triggers for asthma: The Latino community health worker approach. J Asthma. 2006;43(5):369–74.CrossRefPubMed
43.
Parker E, Israel B, Robbins T, Mentz G, Lewis T. Evaluation of Community Action Against Asthma: A community health worker intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. Health Educ Behav. 2008;35(3):376–95.CrossRefPubMed
44.
Thyne S, Marmor A, Madden N, Herrick G. Comprehensive asthma management for underserved children. Paediatr Perinat Epidemiol. 2007;21(Suppl 3):29–34.CrossRefPubMed
45.
Hunter J, De Zapien J, Papenfuss M, Fernandez M, Meister J, Giuliano A. The impact of a promotora on increasing routine chronic disease prevention among women aged 40 and over at the U.S.-Mexico border. Health Educ Behav. 2004;31(4):18S–28.CrossRefPubMed
46.
Navaie-Waliser M, Martin S, Tessaro I, Campbell M, Cross A. Social support and psychological functioning among high-risk mothers: The impact of the Baby Love Maternal Outreach Program. Public Health Nurs. 2000;17(4):280–91.CrossRefPubMed
47.
Rogers M, Peoples-Sheps M, Suchindran C. Impact of a social support program on teenage prenatal care use and pregnancy outcomes. J Adolesc Health. 1996;19:132–40.CrossRefPubMed
48.
Watkins E, Larson K, Harlan C, Young S. A model program for providing health services for migrant farmworker mothers and children. Public Health Rep. 1990;105(6):567–75.PubMed
49.
O'Brien M, Squires A, Bixby R, Larson S. Role Development of Community Health Workers: An examination of selection and training processes in the intervention literature. Am J Prev Med. 2009;37(6S1):S262–9.CrossRefPubMed
50.
Martinez-Donate A. Using lay health advisors to promote breast and cervical cancer screening among Latinas: A brief qualitative review. Wis Med J. 2009;108(5):49–51.
51.
Rhodes S, Foley K, Zometa C, Bloom F. Lay health advisor interventions among Hispanics/Latinos: A qualitative systematic review. Am J Prev Med. 2007;33(5):418–27.CrossRefPubMed
52.
Swider S. Outcome effectiveness of community health workers: An integrative literature review. Public Health Nurs. 2002;19(1):11–20.CrossRefPubMed
53.
Lewin S, Dick J, Pond P, Zwarenstein M, Aja G, van Wyk B, et al. Lay health workers in primary and community health care. Cochrane Database of Systematic Reviews 2005(1):1-104.
54.
Community health worker national workforce study. Washington, DC: U.S. Department of Health and Human Services, Health Services and Resource Administration; 2007.
55.
NIH. Cervical cancer consensus statement. 1996;14(1):1-38.
56.
Margolis K, Lurie N, McGovern P, Tyrrell M, Slater J. Increasing breast and cervical cancer screening in low-income women. J Gen Intern Med. 1998;13:515–21.CrossRefPubMed
57.
Bird J, McPhee S, Ha N, Le B, Davis T, Jenkins C. Opening pathways to cancer screening for Vietnamese-American women: Lay health workers hold a key. Prev Med. 1998;27:821–9.CrossRefPubMed
58.
Fernandez M, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W, et al. Effectiveness of Cultivando la Salud: A breast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health. 2009;99:936–43.CrossRefPubMed
59.
Jandorf L, Bursac Z, Pulley L, Trevino M, Castillo A, Erwin D. Breast and cervical cancer screening among Latinas attending culturally specific educational programs. Progress in Community Health Partnerships. 2008;2(3):195–204.CrossRefPubMed
60.
Lam T, McPhee S, Mock J, Wong C, Doan H, Nguyen T, et al. Encouraging Vietnamese-American women to obtain Pap tests through lay health worker outreach and media education. J Gen Intern Med. 2003;18:516–24.CrossRefPubMed
61.
Navarro A, Senn K, McNicholas L, Kaplan R, Roppe B, Campo M. Por la Vida model intervention enhances use of cancer screening tests among Latinas. Am J Prev Med. 1998;15(1):32–41.CrossRefPubMed
62.
Navarro A, McNicholas L, Cruz M, McKennett M, Sanchez O, Senn K, et al. Development and implementation of a curriculum on cancer screening for small groups of Latino women. J Cancer Educ. 2007;22:186–90.CrossRefPubMed
63.
Navarro A, Senn K, Kaplan R, McNicholas L, Campo M, Roppe B. Por la Vida intervention model for cancer prevention in Latinas. J Natl Cancer Inst Monogr. 1995;18:137–45.PubMed
64.
Theory at a glance: A guide for health promotion practice (2nd edition). Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health; 2005.
65.
Israel B, Eng E, Schultz A, Parker E, eds. Methods in community-based participatory research for health. San Francisco: John Wiley & Sons; 2005.
66.
Squires A, O'Brien M. Becoming a promotora: a transformative process for female community health workers. under review Jan 2010
67.
Hogenmiller J, Atwood J, Lindsey A, Johnson D, Hertzog M, Scott J. Self-efficacy scale for Pap smear screening participation in sheltered women. Nurs Res. 2007;56(6):369–77.CrossRefPubMed
68.
Marin G, Sobogal F, Marin B, Otero-Sabogal R, Perez-Stable E. Development of a short acculturation scale for Hispanics. Hisp J Behav Sci. 1987;9(2):183–205.CrossRef
69.
Martin M. Community health advisors effectively promote cancer screening. Ethn Dis. 2005;15(suppl 2):S214–6.
70.
Berman PG. DR, Burger S. Community-based health workers: head start or false start towards health for all? Soc Sci Med. 1987;25(5):443–59.CrossRefPubMed
71.
Bullock K, McGraw S. A community capacity-enhancement approach to breast and cervical cancer screening among older women of color. Health Soc Work. 2006;31(1):16–25.PubMed
72.
Hansen L, Feigl P, Modiano M, Lopez J, Sluder S, Moinpour C, et al. An educational program to increase cervical and breast cancer screening in Hispanic women. Cancer Nurs. 2005;28(1):47–53.CrossRefPubMed
73.
Larkey L. Las Mujeres Saludables: Reaching Latinas for breast, cervical, and colorectal cancer prevention and screening. J Community Health. 2006;31(1):69–77.CrossRefPubMed
74.
Park K, Park J, Park J, Kim H, Park B. Does health status influence intention regarding screening mammography? Japanese Journal of Clinical Oncology;Jan 2010 [ePub ahead of print]
75.
Glanz K, Rimer B, Viswanath K, eds. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: John Wiley & Sons; 2008.
76.
Ackerson K, Pohl J, Low L. Personal influencing factors associated with Pap smear testing and cervical cancer. Policy Polit Nurs Pract. 2008;9(1):50–60.CrossRefPubMed
77.
Anya S, Oshi D, Nwosu S. Knowledge, attitudes, and practice of female health professionals regarding cervical cancer and Pap smear. Niger J Med. 2005;14(3):283–6.PubMed
78.
Kim K, Yu E, Chen E, Kim J, Kaufman M, Purkiss J. Cervical cancer screening knowledge and practices among Korean-American women. Cancer Nurs. 1999;22(4):297–302.CrossRefPubMed
79.
Mutyaba T, Mmiro F, Weiderpass E. Knowledge, attitudes, and practices on cervical cancer screening among the medical workers of Mulango Hospital, Uganda. BMC Med Educ. 2006;6:13–9.CrossRefPubMed
80.
Nelson W, Moser R, Gaffey A, Waldron W. Adherence to cervical cancer screening guidelines for U.S. women aged 25-64: Data from the 2005 Health Information National Trends Survey. J Womens Health. 2009;18(11):1759–68.CrossRef
81.
Sait K. Attitudes, knowledge, and practices in relation to cervical cancer and its screening among women in Saudi Arabia. Saudi Med J. 2009;30(9):1208–12.PubMed
82.
Uysal A, Birsel A. Knowledge about cervical cancer risk factors and Pap testing behavior among Turkish women. Asian Pac J Cancer Prev. 2009;10(3):345–50.PubMed
83.
Abraido-Lanza A, Chao M, Gates C. Acculturation and cancer screening among Latinas: Results from the National Health Interview Survey. Ann Behav Med. 2005;29(1):22–8.CrossRefPubMed
84.
Fernandez-Esquer M, Espinoza P, Ramirez A, McAlister A. Repeated Pap smear screening among Mexican-American women. Health Educ Res. 2003;18(4):477–87.CrossRefPubMed
85.
McDonald J, Kennedy S. Cervical cancer screening by immigrant and minority women in Canada. J Immigr Minor Health. 2007;9:323–34.CrossRefPubMed
86.
Watts L, Joseph N, Velasquez A, Gonzalez M, Munro E, Muzikansky A, et al. Understanding barriers to cervical cancer screening among Hispanic women. Am J Obstet Gynecol. 2009;201:199.e1–8.CrossRef
87.
Echeverria S, Carrasquillo O. The roles of citizenship status, acculturation, and health insurance in breast and cervical cancer screening among immigrant women. Med Care. 2006;44:788–92.CrossRefPubMed
88.
Gorin SH. JE. Cancer screening among Latino subgroups in the United States. Prev Med. 2005;40:515–26.CrossRefPubMed
89.
Shah M, Zhu K, Wu H, Potter J. Hispanic acculturation and utilization of cervical cancer screening in the US. Prev Med. 2006;42:146–9.CrossRefPubMed
Metadata
Title
Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women
Authors
Matthew J. O’Brien, MD, MSc
Chanita Hughes Halbert, PhD
Rebecca Bixby, RN
Susana Pimentel
Judy A. Shea, PhD
Publication date
01-11-2010
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 11/2010
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-010-1434-6

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