Addressing multilevel barriers to cervical cancer screening in Korean American women: A randomized trial of a community‐based intervention

Abstract

Background Korean American women have among the lowest rates of cervical cancer screening in the United States (US). We evaluated a multi-component intervention combining community education with navigation services to reduce access barriers and increase screening rates in this underserved population. It was hypothesized that cervical cancer screening rates would be higher among women receiving the intervention program compared to women in the control program. Methods Korean American women (N=705) were recruited from 22 churches. Using a matched-pair, group-randomized design, 347 women received the intervention, which consisted of a culturally-relevant cancer education program combined with provision of navigation services. The control group (N=358) received general health education including information about cervical cancer risk and screening and where to obtain low- or no-cost screening. Screening behavior was assessed 12-months post-program. Results Screening behavior data were obtained from 588 women at 12-months post-program. In both site-level and participant-level analyses, the intervention program contributed to significantly higher screening rates than the control program (Odds Ratio [OR] = 25.9, 95% CI=10.1-66.1, p< 0.001). In sensitivity analysis, the treatment effect remained highly significant (OR = 16.7, 95% CI =8.1-34.4, p< 0.001). Conclusion A multi-component intervention combining community cancer education with navigation services yielded significant increases in cervical cancer screening rates among underscreened Korean American women. Community-accessible programs that incorporate cancer education with delivery of key navigation services can be highly effective in increasing cervical cancer screening rates in this underserved population.

Efficacy of a community‐based participatory and multilevel intervention to enhance hepatitis B virus screening and vaccination in underserved Korean Americans

“…Some of these intervention strategies were tested and found to be efficacious in our other cancer screening studies. 35,36 Despite the large and robust intervention effect observed in the current study, several limitations remain. First, the majority of the participants in the current study were foreign-born Korean individuals residing in Pennsylvania and New Jersey.…”

“…Furthermore, these results demonstrate that a combination of the CBPR method and a multilevel approach would yield the most optimal results and could be essential to considerably enhancing HBV screening and vaccination, particularly for those immigrant populations with limited English proficiency and insurance coverage. Some of these intervention strategies were tested and found to be efficacious in our other cancer screening studies …”

“…Some of these intervention strategies were tested efficacious in our other cancer screening studies. 35,36…”

Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review

“…These professionals can help migrants navigating through health system and can also inform healthcare providers of specific needs of these populations. Some examples of successful community-based interventions regarding CCS documented elsewhere include: partnerships with doulas sharing language and cultural background with migrant women [ 41 ] or faith-based community organizations [ 65 ], and interventions based on community education activities to increase awareness of CCS and help women navigate through the system [ 66 ].…”

Barriers to reproductive health care for migrant women in Geneva: a qualitative study

“…Engaging communities in health care interventions to reduce barriers or stigma can present a unique mode to deliver care with the potential advantage of improving individual’s health. Community health programs, either in ethnic communities or in faith-based organizations, have been implemented with notable success, among others, in the United States of America [ 15 – 17 ].…”