Jessica Calderón-Mora

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.

Evaluation of a Narrative Video to Promote Prevention and Early Detection of Cervical Cancer Among Latinas

Objective To evaluate the impact of an online-delivered, theory-based narrative video on cervical cancer screening knowledge, attitudes, and beliefs in a predominantly Latino community. Methods The study design was a nonrandomized pretest–posttest evaluation. The eligibility criteria included men and women 18 years or older not previously enrolled in our community cervical cancer screening program who had internet access. Participants were recruited via in-person county-wide flyer distribution and social media dissemination. The intervention involved a narrative video designed for Latinas delivered via the internet. The 17-minute video is novella style, with a culturally tailored storyline and setting that covers cervical cancer risk factors and statistics, importance of screening, and addresses testing barriers. The measures were knowledge about cervical cancer and screening, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, subjective norms, and self-efficacy. Analysis was performed using change scores for knowledge and psychosocial variables and descriptive statistics for satisfaction and acceptability of the video. Results Data from 227 surveys were analyzed; respondent mean age: 37.6 years; 98.8% female, 88.8% Hispanic; 42.0% had an annual income of $20,000 or less; and 85.2% had at least a high school education. Knowledge and all psychosocial variables improved significantly. More than 90% of the participants rated all of the satisfaction items as good or excellent. Conclusions and Implications for Practice A culturally appropriate narrative video about cervical cancer and screening disseminated online effectively improved knowledge and psychosocial variables among Latinas. Our findings indicate that health promotion interventions online could be effective for improving desired health behavior through a new means of educational dissemination by way of websites and social media outlets.

The Prevalence of Genital Human Papillomavirus Subtypes in a Cohort of Hispanic Women Presenting for Cervical Cancer Screening Along the US-Mexico Border

Introduction : Hispanic women residing along the US-Mexico border have the highest cervical cancer incidence rates in the US. Genital human papillomavirus (HPV) is the major causative agent, but more information is needed about the prevalence and distribution of genital HPV subtypes in this high-risk population. Methods : A population-based cross-sectional study of uninsured Hispanic women along the US-Mexico border was conducted and participants had their cervical specimens undergo DNA extraction followed by HPV genotype testing using the Linear Assay from Roche® Diagnostics, to identify 37 genital HPV subtypes. Results : Among the 585 women aged 21-65 years, 584 self-identfied as Hispanic. Any HPV subtype prevalence was 53.2% (95% CI: 49.0%-57.3%) and of these 52% (i.e. 27.5% of the total) had single infections and 48% (i.e. 25.6% of the total) had multiple infections. High-risk HPV prevalence was 15.6% (95% CI: 24-31.3%). The mean number of subtypes among those testing positive was 2.1 (SD 1.6). The prevalence of any HPV and high-risk HPV showed a U shaped pattern with age; and prevalence of 16/18 and non-16/18 high-risk subtypes (e.g. 31, 33, 35, 39, 45, 51, 52, 58); also varied with age. Forty-one percent of high-risk HPV occurrences were of a subtype not covered by the current nonavalent HPV vaccine. Discussion : Our findings suggest a different high-risk HPV subtype pattern and age distribution among Hispanic women in the USA, which could have implications for future cervical cancer prevention strategies.

Group Versus Individual Culturally Tailored and Theory-Based Education to Promote Cervical Cancer Screening Among the Underserved Hispanics: A Cluster Randomized Trial

Purpose: To determine whether group education is as effective as individual education in improving cervical cancer screening uptake along the US–Mexico border. Design: Cluster randomized controlled study. Setting: El Paso and Hudspeth Counties, Texas. Participants: Three hundred women aged 21 to 65 years, uninsured, due for a Pap test, no prior history of cervical cancer or hysterectomy. Intervention: Theory-based, culturally appropriate program comprised of outreach, educational session, navigation services, and no-cost cervical cancer testing. Measures: Baseline, immediate postintervention, and 4-month follow-up surveys measured knowledge and theoretical constructs from the Health Belief Model, Theory of Reasoned Action, and the Social Cognitive Theory. Analysis: Relative risk regression analyses to assess the effects of educational delivery mode on the uptake of screening. Mixed effect models to analyze changes in psychosocial variables. Results: One hundred and fifty women assigned to each educational group; 99% Hispanic. Of all, 85.7% completed the follow-up survey. Differences in screening rate at follow-up were analyzed by education type. Overall screening rate at follow-up was 73.2%, no significant difference by education type (individual: 77.6%, group: 68.9% P = .124). Significant increases among group education at follow-up for knowledge, perceived susceptibility, perceived seriousness, and subjective norms and significant decrease for perceived benefits. Conclusion: This study provides evidence to support the effectiveness of group education to promote cervical cancer screening among vulnerable Hispanic women and offers an additional method to address cervical cancer disparities.

Comparison of Narrative Video and Flipchart Presentation to Promote Cervical Cancer Screening Among Latinas Along the Border

Introduction Cervical cancer incidence and mortality is higher among Latinas compared with non-Hispanic White women and barriers to screening include lack of knowledge, lack of access to health care, and cultural factors. Both video and printed material have been found effective as health education tools in underserved populations. The purpose of this study was to show no difference between a flipchart presentation facilitated by a community health worker and a narrative video with limited in-person interaction in increasing cervical cancer screening rates among Latinas along the U.S.–Mexico border. Methods Study design: Randomized controlled study. Participants: women in a community-based cervical cancer screening program. Outcomes Primary outcome was screening completion and secondary outcomes were changes in psychosocial variables. Results Total sample size was 500. Most participants were born in Mexico, had a low annual income, preferred Spanish, and did not have a regular doctor. Overall, 371 (74.2%) participants completed screening. There was no significant difference in screening completion between educational delivery modes. The only variable significantly associated with screening completion was age, with 51- to 65-year-olds being 44% more likely than 21- to 40-year-olds to have a Pap test. The only psychosocial variable that was significantly different by delivery mode was perceived susceptibility. The majority of all participants found both the video and flipchart presentation to be acceptable. Conclusion A health promotion program delivered via self-administered video or PowerPoint slides showed no difference in increasing cervical cancer screening rates.