Implementing Two Randomized Pragmatic Trials of HPV Self-sampling among Underserved Women: Challenges and Lessons Learned

Abstract

WORK-IN-PROGRESS & LESSONS LEARNEDsubstantially higher than non-Hispanic White women (9.4 vs. 7.5 per 100,000). 2 Much of this disparity is attributable to poor uptake of cervical cancer screening. [2][3][4][5][6][7][8] Multiple barriers impede screening uptake including, although not limited to, lack of health insurance, limited health literacy, cultural concerns about modesty, and language difficulties. 7,9 For nearly a decade, our research team has worked with Haitian and Hispanic community leaders in South Florida to circumvent such barriers. [10][11][12][13][14][15] This work includes two recently completed randomized pragmatic trials of self-sampling for HPV, the principal cause of cervical cancer. [12][13][14][15] Each of these trials was implemented within a CBPR framework, and

Feasibility and anticipated acceptability of community health worker-facilitated HPV self-sampling for cervical cancer screening around Lake County, Indiana

“…Harnessing CHWs’ voices as insiders with knowledge of their communities’ health landscape, our analysis identified multilevel barriers to screening that spanned individual, interpersonal and community levels of the Socio-Ecological Model. While various studies explore the cervical cancer screening and/or HPV self-sampling perspectives of people with cervixes [ 17 , 30 ] and others recognize the effectiveness of engaging CHW’s in the self-sampling process [ 25 , 31 ], few studies foreground the insights of this critical stakeholder group.…”

“…Lake County is the second most populous county in Indiana with a population of over 499,000 people [4] and the highest proportion of Hispanic people of all Indiana counties (20%) [5]. Younger adults (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) and older adults (45-65) constitute 25% of the population each (for a total of 50%) [6]. Within Lake County, Hispanics have a disproportionately high cervical cancer incidence rate of 13.9/100,000, as compared to 11.1/ 100,000 for Black people and 7.8/100,000 for White people [7].…”

Barriers to Access for Cervical and Breast Cancer Screenings Among Female Latinx Migrant Farmworkers in the US: A Scoping Literature Review

“…All 4 articles that noted transportation and/or time constraints framed these barriers as logistical factors that decrease access to services. 23,24,29,30 In the 2016 article conducted by Ramos et al 24 in Nebraska, a direct quote from a focus group participant summed up the barrier and provided suggestions: “scheduling and hours are important. Use the schools, churches, and all of those centers where a lot of people go.” Similarly, women interviewed in a 2015 study in California, specific recommendations to increase cancer screening by addressing these barriers included holding a screening event in a local community setting, conducting door-to-door outreach, advertising on the radio, and providing small incentives for completing the screening.…”

“…14,17 Transportation and Time Constraints All 4 articles that noted transportation and/or time constraints framed these barriers as logistical factors that decrease access to services. 23,24,29,30 In the 2016 article conducted by Ramos et al 24 in Nebraska, a direct quote from a focus group participant summed up the barrier and provided suggestions: "scheduling and hours are important. Use the schools, churches, and all of those centers where a lot of people go."…”