Latinos are the fastest growing population in the United States (US). The incidence of cervical cancer among Latino women is about 70% higher than that among non-Latino Whites . Latino women also experience 50% higher cervical cancer mortality than non-Latino whites . The disproportionate burden of cervical cancer among Latinas is thought to be attributed to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The overall goal of the proposed project is to test the efficacy of a culturallyappropriate clinic-based program to increase Pap test utilization and improve adherence to follow-up after an abnormal Pap test in a sample of Latino women in the Yakima Valley of Washington State. The primary specific aims for this project are to: 1) Assess the relative efficacy of two culturally-appropriate, tailored programs to increase cervical cancer screening among Latino women, the two programs are: a) a low-intensity program, consisting of a video approach to cervical cancer screening;and b) a higher intensity program that consists of the video plus a promotora-intervention to encourage cervical cancer screening;2) Assess the costeffectiveness of the two intervention programs. A secondary aim ofthis proposal is to: 1) Evaluate the efficacy of a patient navigator program to improve adherence and reduce time to follow-up among women who receive abnormal Pap tests in the participating clinics. The components of this aim are to: a) conduct qualitative one one-one interviews among 20 Latino women with a recent abnormal Pap test to identify salient factors related to adherence to recommended follow-up;b) develop and pilot-test a culturally-appropriate patient navigator program to improve adherence and reduce time to receipt of recommended follow-up. The primary aims will be evaluated by assessing changes in the use of screening services for cervical cancer (based on self-report and medical record review) in pair-wise comparisons of the intervention and control arms, six months following randomization. Cost per woman screened will be calculated for each intervention arm. The secondary aim will be evaluated by assessing pre- and post-intervention changes in the proportions of women who receive recommended follow-up within 90 days of an abnormal Pap test and changes in the time to treatment.
Project Description: The proposed project will evaluate, in a clinic-based setting, a culturally-tailored cervical cancer prevention intervention for Latino women. The intervention will be evaluated for efficacy and cost effectiveness of two approaches;a promotora-led intervention and a video approach. Patient navigation will be used to improve adherence to recommended follow-up among women with abnormal Pap tests.
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