Purpose Hispanic women living on the US-México border experience health disparities, are less likely to access cervical cancer screening services, and have a higher rate of cervical cancer incidence compared to women living in non-border areas. Here we investigate the effects of an intervention delivered by community health workers (CHWs, known as lay health educators or Promotores de Salud in Spanish) on rates of cervical cancer screening in Hispanic women who were out of compliance with recommended screening guidelines. Methods Hispanic women out of compliance with screening guidelines, attending clinics in southern New México (NM), were identified using medical record review. All eligible women were offered the intervention. The study was conducted between 2009 and 2011, and data were analyzed in 2012. Setting/participants - 162 Hispanic women, resident in NM border counties, aged 29-80 years, who had not had a Pap test within the past 3 years. Intervention - A CHW-led, culturally appropriate, computerized education intervention. Main outcome measures - The percentage of women who underwent cervical cancer screening within 12 months of receiving the intervention. Change in knowledge of, and attitudes towards cervical cancer and screening as assessed by a baseline and follow-up questionnaire. Results 76.5% of women had a Pap test after the intervention. Women displayed increased knowledge about cervical cancer screening and about HPV. Conclusions A culturally appropriate promotora-led intervention is successful in increasing cervical cancer screening in at-risk Hispanic women on the US-México border.
Public health studies thus far have not identified methods toward developing a shared vision to reduce health disparities in a unique area such as the U.S./Mexico border region. Purpose: To identify strategies to foster a shared vision among those in the media, the public, and policy arenas to help reduce health disparities in the U.S.- Mexico border. Methods: The Healthy Border 2010 research project included qualitative structured face-to-face interviews with ten individuals, each from Las Cruces, NM, El Paso, TX, and Cd. Juarez, Chih, Mexico, for a total of 30 interviewees from the media, the public and policy affiliations. Participants were identified and selected from the population of agenda-setters in the Paso Del Norte region. A snowball sample was used for studying the sometimes “hidden” population of border region agenda-setters. Data-analysis included extraction, coding, and quantifying of common themes from a transcription of interviews. Findings: Most participants (93%) suggested a systems level approach is required. The second most suggested strategy with 63% of participant support was sensitizing border leaders of the reality of issues in the area. Participants (46%) also suggested networking and media advocacy (40%) strategies as more important than the inclusion of priority audience (23%) or the proper allocation of resources (23%). Conclusion: In review of many current border health issues, there are significant gaps where a clear, shared vision is yet to emerge. When a common vision is well developed in a group or population, that is when genuine cooperative actions foster health policy development.
Latinas are at nearly double the risk for cervical cancer than non-Hispanic whites (NHW). The problem is especially severe in the border communities between Mexico and the United States. The border region includes some of the poorest areas in the United States and health services in the region remain scarce. Cervical cancer rates among the border population are high. In this project, we worked with three local health care systems that provide services to the poor and underserved along the New Mexican/Mexican border. One system was the intervention health care system, while the other two were controls. We obtained names from the intervention clinic system of women who were out of compliance with pap testing; that is, they had not had a pap for three or more years. Promotoras (lay health workers) in the clinic system were trained to contact the non-compliant women. We prepared a PowerPoint presentation that described cervical cancer, explained how cervical cancer spread, and showed a brief video of a cartoon woman receiving a pap test. The PowerPoint was developed as a result of focus group discussions and was approved by the promotoras. The promotoras (lay health workers) went to the homes of the non-compliant women and used the PowerPoint presentation to educate the women about the importance of pap testing; they also helped arrange clinic appointments for women to receive pap testing. A total of 198 non-compliant women in the intervention clinic system were contacted. Of these, 78% received pap testing within six months of being contacted. A baseline survey asked the women about knowledge of and attitudes toward cervical cancer screening. Data suggest that knowledge was not linked to compliance with pap testing. A final survey suggested that women who did not receive pap testing intended to be tested in the next six months. Comparisons with the control clinic is currently being made. The project supports the idea that border women can be motivated to receive cervical cancer screening. Given that Latinas are at high risk for cervical cancer and given that a promotora approach is common in the border communities of New Mexico, this study shows that screening for cervical cancer can be increased among women at high risk. This approach may be useful in other border communities. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B101.
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