Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women

Abstract

BackgroundIn the US, Hispanic women have a higher incidence of, and mortality from, cervical cancer than non-Hispanic white women. The reason for this disparity may be attributable to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The 'Cervical Cancer Screening and Adherence to Follow-up Among Hispanic Women' study is a collaboration between a research institution and community partners made up of members from community based organizations, the Yakima Valley Farm Workers Clinic and the Breast, Cervical, and Colon Health Program of the Yakima District . The study will assess the efficacy of two culturally-appropriate, tailored educational programs designed to increase cervical cancer screening among Hispanic women, based in the Yakima Valley, Washington, US.Methods/designA parallel randomized-controlled trial of 600 Hispanic women aged 21–64, who are non-compliant with Papanicolau (Pap) test screening guidelines. Participants will be randomized using block randomization to (1) a control arm (usual care); (2) a low-intensity information program, consisting of a Spanish-language video that educates women on the importance of cervical cancer screening; or (3) a high-intensity program consisting of the video plus a ‘promotora’ or lay-community health educator-led, home based intervention to encourage cervical cancer screening. Participants who attend cervical cancer screening, and receive a diagnosis of an abnormal Pap test will be assigned to a patient navigator who will provide support and information to promote adherence to follow-up tests, and any necessary surgery or treatment. Primary endpoint: Participants will be tracked via medical record review at community-based clinics, to identify women who have had a Pap test within 7 months of baseline assessment. Medical record reviewers will be blinded to randomization arm. Secondary endpoint: An evaluation of the patient navigator program as a method to improve adherence and reduce time to follow-up among participants who receive an abnormal Pap test result. An additional secondary endpoint is the cost-effectiveness of the two different intensity intervention programs.DiscussionThis culturally sensitive intervention aims to increase compliance and adherence to cervical screening in a Hispanic population. If effective, such interventions may reduce incidence of cervical cancer.Trial registrationNCT01525433

Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening

“…25 Specifically, Latinas have cited barriers such as fear, lack of knowledge, scheduling difficulties, and inadequate communication as salient barriers to care. [5][6][7]26 Our findings add to previous research which found that comprehensive patient navigation approaches, such as those that are culturally specific and language concordant, can significantly improve cancer screening rates among multiethnic populations. [5][6][7] Notably, very few women included in our study did not maintain contact with clinical staff.…”

“…[5][6][7]26 Our findings add to previous research which found that comprehensive patient navigation approaches, such as those that are culturally specific and language concordant, can significantly improve cancer screening rates among multiethnic populations. [5][6][7] Notably, very few women included in our study did not maintain contact with clinical staff. In addition to language barriers, cultural barriers and Hispanic beliefs surrounding the diagnosis of cancer may contribute to observed lack of care as well.…”

“…[1][2][3] Women from groups of racial/ethnic minorities and low education and income have limited access to healthcare and are less likely to seek care after an abnormal result. [4][5][6][7][8] In 1990, Freeman introduced the model of patient navigation as a way to support screening for, timely diagnosis of, and then treatment of cancer among vulnerable women. 9 The primary function of patient navigators is to reduce barriers to care by assisting participants in navigating the healthcare system.…”

Intervenções que favorecem a adesão ao exame de colpocitologia oncótica: revisão integrativa

“…Increase in adherence to the uptake of Pap smear exam Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women (22) 2012/ USA Parallel controlled randomized intervention/600…”

“…An interventionist study carried out with 135 Chinese women living in New York City in the United States found that education in health intervention associated with the Internet was efficacious to increase women's adherence to the uptake of Pap smear exams (18) . In this sense, randomized interventionist studies considered educational activities as an efficacious intervention to increase adherence to the uptake of Pap smear exams (19)(20)(21)(22)(23) , as well as women's knowledge about prevention (24)(25)(26) . A meta-analysis of the efficacy of interventions to increase adherence to the uptake of Pap smear exams among women from ethnical minorities in the United States pointed out community-based education as one of the most efficacious methods when allied to improved health services (27) .…”