The highest incidence rates of cervical cancer (CC) are in sub-Saharan Africa, South Central Asia and South America. In the United States (U.S.), CC ranks 14th in frequency. However, in certain populations and geographic areas of the U.S., CC incidence and death rates are significantly higher, due in part to racial and ethnic disparities in access, utilization, and quality of care, all of which contribute to worse health outcomes. Black women experience a disparate burden of CC incidence and mortality, having a higher risk of being diagnosed with and dying from CC than non-Hispanic White women. Appropriate and timely CC screening is a key factor in prevention. Leveraging the positive benefits of CC screening may reduce the CC disparate burden among Blacks. Research studies typically treat Blacks as a homogeneous group, despite differences within this population. To begin to address a gap in the literature within the scope of a career development award, this study focuses specifically on two subgroups of Black women - African Americans (AA) and Sub-Saharan African immigrants (SAI) given that there is paucity of research with SAI despite known cancer related disparities among SAI women. To promote screening for these underserved minority women, we will conduct research to better understand factors that influence engagement in cancer screening practices and willingness to conduct HPV self-sampling in which women self-collect samples for HPV testing using a swab, brush or lavage. Guided by the findings, we will develop and pilot test an innovative tailored intervention incorporating HPV self-sampling with peer-delivered education.
The specific aims are to (1) examine general awareness and cultural factors related to cancer control and prevention among AA and SAIs; (2) examine the socioecological barriers and facilitators to CC screening with HPV self-sampling to tailor an evidenced based cervical health promotion program in these underserved subgroups; and (3) assess feasibility, acceptability, and preliminary efficacy of the intervention. The intervention, entitled Health is Wealth: A Cervical Health Program, will be pilot tested with 30 AA and 30 SAI women aged 30 to 65 years using a quasi-experimental design.
These aims will also support the candidate?s career goal of developing an independent and extramurally funded program of research to promote cancer control and prevention for minority women. To further support this goal, a mentored career development plan consisting of training in mixed methods, adaptation and development of behavioral interventions, randomized clinical trial design, and research team management, is proposed. The rich research environment at the University of Kentucky and the expertise of the mentoring team will provide the supplemental resources and support needed for the candidate to successfully complete the proposed research and training plans. As such, this K01 award will provide the training, mentoring, and research experiences needed for the candidate to successfully compete for a R01-level CC screening intervention study and expedite her career development.
Despite the availability of screening tools that can prevent cervical cancer, Black women are burdened by high cervical cancer incidence and mortality. This project seeks to enhance cervical cancer screening among Black women, African Americans and sub-Saharan African immigrants, by tailoring and pilot testing an evidence-based intervention incorporating HPV self-sampling and peer-delivered education to promote cervical cancer screening.
