Background Latinas have the highest rates of cervical cancer in the United States and the second-highest rate of cervical cancer mortality. One factor for the disparity is the relatively low rates of screening for cervical cancer in this population. Methods Eligible women who were out of adherence with cervical cancer screening (> 3 years since last Pap test), were identified using medical record review by a local federally qualified health center. The effects of a low-intensity intervention arm (video delivered to participants homes; N=150); and a high-intensity intervention arm (video + home-based educational session; N=146), compared to a control arm (usual care; N=147) on cervical cancer screening uptake were investigated. A cost-effectiveness analysis of the intervention was conducted by calculating all intervention costs, and computing the incremental cost-effectiveness ratio (ICER). Finally, women with positive Pap tests were navigated by a community health educator to ensure that they received follow-up care. Results A total of 443 Latinas participated. At seven months post-randomization, significantly more women in the high intensity arm received a pap test (53.4%) compared to the low intensity arm (38.7%), and the usual care arm (34.0%); p<0.001 and p<0.01, respectively. The ICER for high intensity women over the control group amounted to $4.24. Twelve women had positive Pap tests encompassing diagnoses of Atypical Squamous Cells of Unknown Significance to invasive cancer; these women were navigated for follow-up care. Conclusions A culturally appropriate in-home promotora-led educational intervention was successful in increasing cervical cancer screening in Latinas.

Participation in home-based group educational interventions delivered by promotoras may be associated with improved breast cancer screening practices among Hispanic women.

IntroductionHispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation.MethodsWe recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm.ResultsThe immediate intervention group (−0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (–37.5%, P = .04) compared with the delayed intervention group (–0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group.ConclusionThis home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.

This study shows that involving family members and increasing social support are effective strategies for improving health behaviors and chronic health outcomes among vulnerable Hispanics living with diabetes. Our findings demonstrate several important considerations regarding the design of diabetes management interventions for rural Hispanic populations including the following: (1) promotores are critical as they provide social support and encourage behavior change by building relationships based on trust and cultural understanding; (2) well-designed tools that provide step-by-step examples of healthy behaviors, such as cookbooks, and tools that aid participants to monitor behavior change, such as pedometers and glucose monitors, serve to build skills and improve confidence to achieve goals; and (3) targeting households is a promising strategy for individual and family lifestyle changes that benefit the entire family unit.

Purpose Latino cancer survivors experience lower psychosocial well-being compared to Non-Latino Whites. This study describes the development of a culturally-appropriate support group and reports on feasibility of implementation and preliminary outcomes. Methods Promotores (lay health workers) conducted all aspects of data collection and program implementation. Participants were 29 Spanish-speaking Latino cancer survivors (n=12 men, 17 women) who took part in one of three study phases. Phase 1 included one-on-one interviews and focus groups (n=14) to investigate psychosocial needs of survivors. During Phase 2, a 10-week program was developed that integrated data from Phase 1 and culturally-relevant concepts. Session topics included stress, nutrition, physical activity, body image, sexuality, medical advocacy and social support. In Phase 3, the program was implemented within gender-specific groups (n=15). Within-group pre-post comparisons of distress (distress thermometer, salivary cortisol) and quality of life (FACIT) were conducted. Follow-up focus groups assessed participant experience Results Phase 1 activities identified survivor needs and interests (e.g., isolation, family and spirituality, supporting other Latinos with cancer). Evidence of program feasibility was demonstrated (e.g., 90%–100% attendance, 100% data completion). While interpretation of significance is limited due to sample size, improvements in quality of life [functional (p=0.05), social (p=0.02), and meaning/purpose (p=0.05)] were observed among women but not men. Qualitative follow-up revealed high satisfaction with group participation, but discomfort with the topic of sexuality in women. Conclusions This project demonstrates development and feasibility outcomes for providing culturally-appropriate psychosocial support to Latino cancer survivors. Limitations, including lack of control group, and future directions are discussed.