Jennifer Molokwu

Program implementation and evaluation of De Casa en Casa: a tailored community-based cervical cancer screening program for underserved Hispanic women

Abstract Women on the US-Mexico border have a higher cervical cancer incidence rate, are diagnosed at later stages, and have higher mortality compared to non-Border women in the US. We identified key barriers to screening through various qualitative methods and have designed a program that addresses the needs of our community and creates a coordinated program of education, outreach, service delivery, navigation, and capacity building for the future. A multicomponent, culturally tailored, bilingual, evidence-based cervical cancer screening program was developed at Texas Tech University Health Sciences Center El Paso (TTUHSC El Paso). The program was implemented in El Paso and Hudspeth counties. Key program components were (i) theory-based and culturally tailored education delivered by bilingual community health workers; (ii) no-cost Pap and HPV screening; (iii) diagnostic and treatment colposcopy; and (iv) patient navigation and tracking. A total of 2318 women were recruited into the program and offered services. 2206 women were eligible for screening: mean age of the population was 44.8 years, 4.7% (N = 108) had never had a Pap smear, and 40.9% (N = 945) last received a Pap over 5 years previously. Screening uptake was 71.6% (N = 1 569); 7.8% (N = 114) of those tested were positive for high-risk HPV. 101 colposcopies were indicated and 98.0% (N = 99) were completed. Two cancers were diagnosed. A comprehensive cervical cancer screening program can achieve significant screening uptake rates in a high-risk population with historically low screening uptake and has the potential to significantly impact cervical cancer incidence and mortality in this border region.

Effect of Text Message Reminders on Attendance at Cervical Cancer Screening Appointments in a Predominantly Hispanic Population

Hispanic women have the highest rates of incident cervical cancer in the United States (U.S.) and are 1.9 times more likely to die from cervical cancer than non-Hispanic Whites. Objective: Assess the impact of text message reminders on cervical cancer screening attendance and completion. Design: Pragmatic non-randomized study design using propensity matched analysis. Setting: Community-dwelling low-income females in the U.S./Mexico border community. A total of 2,255 mainly Hispanic females aged 21–65. Methods: Text message reminders in addition to usual care (telephone call reminders). Results: After adjusting for significant factors and propensity score matching, individuals in the text reminder group had 11% lower screening incidence than individuals without text reminders (risk difference [RD] = −0.11, 95% CI: −0.16, −0.05; p < .001). Conclusion: Participants with text reminders were less likely to complete cervical screening than usual practice in a predominantly Hispanic population. Our study demonstrates that reminders’ content rather than method may be vital to improving our population's cancer screening rates.