AMIGAS: A multicity, multicomponent cervical cancer prevention trial among Mexican American women

Abstract

BACKGROUND Considerable efforts have been undertaken in the United States to reduce cervical cancer incidence and mortality by increasing screening; however, disparities in screening rates continue to exist among certain racial and ethnic minority groups. The objective of the current study was to determine the effectiveness of a lay health worker-delivered intervention—AMIGAS (Ayudando a las Mujeres con Informacion, Guia, y Amor para su Salud [helping women with information, guidance, and love for their health])—to increase Papanicolaou (Pap) test screening among 3 populations of women of Mexican origin. METHODS Six hundred thirteen women of Mexican origin in 3 treatment sites were randomized among 4 study arms: the full AMIGAS program with a video and a flip chart (n = 151), the AMIGAS program without the video (n = 154), the AMIGAS program without the flip chart (n = 155), and a usual care control group (n = 153). Six months after enrollment, women were surveyed and reported whether or not they had been screened. RESULTS Women in any of the intervention arms were statistically significantly more likely to report being screened than those in the usual care group in both an intent-to-treat analysis and a per-protocol analysis. In the intent-to-treat analysis, 25% of women in the control group and 52% in the full AMIGAS program group reported having had Pap tests (P < .001); in the per-protocol analysis, the percentages were 29% and 62%, respectively (P < .001). CONCLUSIONS AMIGAS was effective in increasing Pap test screening among women of Mexican descent when used in a 1-to-1 setting. Future research should compare the 1-on-1 intervention with the group-based intervention.

Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

“…Of 67 articles, thirty studies involved CBHWs for cancer prevention for specific cancer types (cervical, 28,32,33,35-39,41-44,49-52 breast, 26,27,31,33,36,37,[39][40][41]46,48,50,[53][54][55] colorectal, 29,30,34,36,45 and oral 47 ). Twenty six studies focused on cardiovascular disease (CVD), [56][57][58][59]62,64,67,73,80 , and key risk factors such as diabetes, 63,69,70,[76][77][78][79]81 and hypertension.…”

“…39,52,82 Eight studies involved more than one comparison group (e.g., usual care and minimal intervention). 26,[28][29][30]61,68,75,80 34,36,42,62 Some studies relied solely on telephone contact for CBHW interventions. 27,37,53,74 …”

“…For example, only about half of the studies (n=34) discussed using a theoretical framework to develop the intervention or from which to select study outcomes. [26][27][28][29][31][32][33][34][35]39,[41][42][43][44]46,49,[53][54][55][62][63][64][65][73][74][75][76][77][78][79][80]84,85 In addition, less than one third of the selected studies discussed conducting a power analysis a priori (n=21) and less than half of studies (n=30) clearly described how they randomized study participants. Similarly, less than one in five studies discussed any type of blinding (i.e., the outcome assessor was aware of the status of the participant's group assignment) (n=13).…”

“…Of the seven cancer screening studies which verified self-reported screening behavior with chart review, discrepancies were noted in all studies (sensitivities from 59% 52 to 83% 33,42 and specificities from 81% 33 to 100% 28 ). Finally, less than one third of the studies (n=21) described how they maintained and monitored CBHW intervention fidelity.…”

“…Finally, less than one third of the studies (n=21) described how they maintained and monitored CBHW intervention fidelity. 28 …”