Cervical cancer control for Hispanic women in Texas: Strategies from research and practice

Abstract

Purpose Hispanic women in Texas have among the highest rates of cervical cancer incidence and mortality in the country. Increasing regular Papanicolaou test screening and HPV vaccination are crucial to reduce the burden of cervical cancer among Hispanics. This paper presents lessons learned from community-based cervical cancer control programs in Texas and highlights effective intervention programs, methods and strategies. Methods We reviewed and summarized cervical cancer control efforts targeting Hispanic women in Texas, focusing on interventions developed by researchers at the University of Texas, School of Public Health. We identified commonalities across programs, highlighted effective methods, and summarized lessons learned to help guide future intervention efforts. Results Community-academic partnerships were fundamental in all steps of program development and implementation. Programs reviewed addressed psychosocial, cultural, and access barriers to cervical cancer control among low-income Hispanic women. Intervention approaches included lay health worker (LHW) and navigation models and used print media, interactive tailored media, photonovellas, client reminders, one-on-one and group education sessions. Conclusions Small media materials combined with LHW and navigation approaches were effective in delivering Pap test screening and HPV vaccination messages and in linking women to services. Common theoretical methods included in these approaches were modeling, verbal persuasion, and facilitating access. Adaptation of programs to an urban environment revealed that intensive navigation was needed to link women with multiple access barriers to health services. Collectively, this review reveals 1) the importance of using a systematic approach for planning and adapting cervical cancer control programs; 2) advantages of collaborative academic-community partnerships to develop feasible interventions with broad reach; 3) the use of small media and LHW approaches and the need for tailored phone navigation in urban settings; and 4) coordination and technical assistance of community-based efforts as a way to maximize resources.

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients

“…This research study supports previous research [125] and the importance of academic-community partnerships in the successful delivery of community-based cancer control programs that reach and impact Latina women. Results demonstrated that recruitment, intervention, and assessment methods were feasible and accepted by the target community.…”

Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas

“…16 Purported reasons for the success of such programs include the recognition that promotoras are part of the community in which they work, they have an understanding of the women with whom they work, they are socially and culturally similar to the population that they aim to reach, and they communicate in a similar language and style. 16,17 Although many programs to increase adherence to Pap testing have used promotora programs, not all have been compared with other approaches; fur-thermore, few have assessed the cost-effectiveness of such programs. Building on the notion that effective, culturally appropriate interventions are critical to reducing the burden of cervical cancer in the Latina population, especially among women living in underserved areas, we tested a 3armed randomized controlled trial examining the effects and cost-effectiveness of a culturally relevant, tailored promotora-led arm, a culturally tailored video intervention arm, and a usual-care arm targeting the use of Pap screening.…”

Salud es Vida: a Cervical Cancer Screening Intervention for Rural Latina Immigrant Women

“…Efforts to increase cancer screening among Hispanic/Latina women have used various educational strategies including mass media, clinic-based strategies, church-based strategies, and community health workers ( promotoras de salud in Spanish) [21]. One Texas study successfully increased Pap test screening among Hispanic/Latina women in Texas using small media (videos and printed materials) combined with community health worker and navigation approaches [13]. In a different multi-site study, the community health worker intervention AMIGAS trial, 52% of participants not up-to-date with their Pap tests completed them within six months compared with 25% of women in the control group [5].…”