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

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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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Acknowledgments

The authors thank the promotoras whose work is the subject of this article, and whose dedication to this study has been essential to its success. Their names are Susana Pimentel, Irma Zamora, Bertha Gonzalez, and Guadalupe Canchola. The authors would like to thank Giselle Dutcher and Darryl Powell for their help in the implementation of this study. We also thank Dr. Steven Larson for helping conceptualize and develop our community health worker program. We acknowledge our community partners involved in the design and ongoing implementation of the study: Puentes de Salud Health Center, the Mexican Consulate of Philadelphia, the Catholic Archdiocese of Philadelphia, and Juntos Mexicanos. The current study was supported by Grant Number UL1RR024134 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. This paper was presented at the SGIM 33rd Annual Meeting in April 2010.

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Authors and Affiliations

  1. Division of General Internal Medicine, Temple University School of Medicine, 3223 North Broad St, Suite 175, Philadelphia, PA, 19140, USA

    Matthew J. O’Brien MD, MSc

  2. Department of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Judy A. Shea PhD

  3. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA

    Chanita Hughes Halbert PhD

  4. Puentes de Salud Health Center, Philadelphia, PA, USA

    Matthew J. O’Brien MD, MSc, Rebecca Bixby RN & Susana Pimentel

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  1. Matthew J. O’Brien MD, MSc
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Correspondence to Matthew J. O’Brien MD, MSc.

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O’Brien, M.J., Halbert, C.H., Bixby, R. et al. Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women. J GEN INTERN MED 25, 1186–1192 (2010). https://doi.org/10.1007/s11606-010-1434-6

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