Cervical cancer mortality rates in Alabama are more than twice the Year 2000 objective, with rates among minorities in Alabama over six times greater than this objective. Estimates suggest that mortality could be reduced by 7.5% with early detection and effective management. Adherence to early detection practices overall is poor, and tends to be worse among older women, low income women and minorities. Poor adherence to preventive recommendations among low income minority groups has been associated with deficits in knowledge concerning cancer symptoms, risk- income minorities, such as belief that early screening and treatment do not reduce cancer morbidity and mortality, may also compromise adherence to preventive recommendations. This argues compelling for research to develop and evaluate cancer prevention and control programs designed to; 1) promote accurate knowledge and perceptions about cancer risk and cancer control, and 2) enhance adherence to screening recommendations. This proposed, three-year project is designed to address this problem by developing and evaluating a cognitive-behavioral intervention, based on Social Learning Theory and Motivational Interviewing methods, that is designed to promote accurate knowledge and perceptions about cervical cancer and increase adherence to standard preventive care recommendations. We proposed to identify 450 women who have not received a Pap test in the proceeding 12 months among the rural, low-income, and predominantly African American population of patients receiving health care from West Alabama Health Services Inc. (WAHS). Participants will be randomized to one of three groups: 1) minimal care intervention (MCI); 2) cognitive behavioral intervention (CBI); or 3) delayed treatment control (DTC). The primary outcome measure will be the number of women who schedule and attend a Pap test within six months of intervention. Relationships among patient knowledge, perceptions, and early detection behavior will be examined to identify patient characteristics that may influence adherence to cancer control recommendations among rural minorities. Intervention cost data will also be collected. Collectively, these measures will enable us to characterize both our interventions and their effect on outcomes, as well as model likely causative paths of influence. Women initially randomized to either MCI or DTC will be actively recruited into the CBI after the six-month treatment outcome window closes in order to provide optimal treatment for all participants. Outcome measures for these participants will be monitored during a subsequent six month treatment outcome window, enabling us to examine the external validity of our initial findings.
| Greene, P G; Smith, D E; Hullett, S et al. (1999) Cancer prevention in rural primary care. An academic-practice partnership. Am J Prev Med 16:58-62 |
