Purposes: 1) To design a community-based model for reducing disparities in cervical cancer morbidity and mortality among U.S. Hispanic women. 2) To implement and evaluate a cervical cancer prevention program led by community health workers, or promotoras, in the South Philadelphia Hispanic community.
Experimental Procedures: Focus groups conducted by an immigrant health center in South Philadelphia's Hispanic community identified cervical cancer as an important health concern and proposed the use of community health workers, or promotoras, to address this problem. Researchers at the University of Pennsylvania have partnered with this clinic, Puentes de Salud, and community members to design, implement, and evaluate a cervical cancer prevention program in South Philadelphia. We recruited and trained 6 promotoras to lead two 3-hour workshops with women in the community about the epidemiology of cervical cancer in Hispanic women, the pathogenic role of HPV, and recommended screening procedures. The study is a randomized trial of this educational intervention, with 60 participants in each arm. Using a CBPR model, the promotoras participated actively in the design of the study, planning of the intervention, and recruitment and enrollment of study subjects. Cervical cancer risk, previous screening history, baseline cervical cancer knowledge, and self-efficacy have been measured by a pre-intervention questionnaire. After the intervention and a subsequent 12-month follow-up period, the post-intervention questionnaire will measure the following outcomes: cervical cancer knowledge, self-efficacy, and receipt of Pap smear screening in the previous year. At the suggestion of community partners involved in the study design, the control group will receive the same promotora-led intervention after completion of follow-up.
Data: Analysis of baseline data was performed using t-test, chi-square, and Mann-Whitney tests where appropriate. At baseline, there were no statistically significant differences between intervention and control subjects with respect to demographic factors or outcome variables. These include: age, length of residence in U.S., acculturation, health status, smoking status, lifetime sexual partners, parity, cervical cancer screening rates, cervical cancer knowledge, and self-efficacy. Preliminary follow-up data will be available for presentation in February.
Conclusions: Many stakeholders in health care have advocated for the use of community health workers, or promotoras, to reduce health disparities in underserved communities and lower healthcare costs. There is a paucity of rigorous data to support such recommendations, providing an opportunity to strengthen the evidence base for these interventions nationwide. We expect to demonstrate that community partnership can support the design and implementation of a health promotion program using promotoras. Such community-based interventions can provide a model to improve preventive health behaviors and reduce health disparities not only in cancer, but across a wide spectrum of disease states. Lessons learned in this study can inform the implementation of similar programs nationwide.
- American Association for Cancer Research