A Pap Test Intervention to Enhance Decision Making among PI Women ABSTRACT Despite the fact that cervical cancer is one of the most preventable of cancers, it remains one of the top five causes of cancer deaths in the U.S. and in California. The Pap test has been shown to be effective in not only detecting cancer but also precancerous cells. Even with the introduction of HPV testing and vaccines, Pap tests represent an important cervical cancer prevention and early detection method for women in this country. Unfortunately, the Pap test is severely underutilized among many ethnic and racial populations, including Pacific Islanders (PIs) who have high rates of cervical cancer incidence and mortality. Cervical cancer incidence and mortality data among specific PI ethnic groups is sparse, with available information underscoring significant cancer health disparities. In California as in the Pacific, cervical cancer is one of the top five causes of cancer deaths. Given the dearth of PI researchers and studies at the NIH level, community-based participatory research (CBPR) holds the potential for engaging community cultural experts alongside cancer health disparities researchers to address their pressing cervical cancer detection needs. This five year cluster unit randomized trial will develop and evaluate a social support intervention targeting both men and women to increase Pap testing decision making and behavior among Chamorro, Samoan and Tongan women age 18-65 years old in Southern California.
We aim to: 1. Apply CBPR principles and processes for community/university partners throughout the grant period;2. Develop and pretest two gender-specific and culturally tailored educational interventions for PI women and men. The interventions will be conducted separately by gender, and will employ a video, flipchart, and brochure, along with small-group discussions facilitated by gender-matched community health educators;3. Develop and validate instruments measuring men's social support (provided), women's social support (perceived) and women's decision making utility;4. Recruit and randomly assign community-based organizational samples and recruit and follow the cohorts of PI females and males in the intervention and control groups 5. Examine the associations that test the conceptual model regarding social support, decision making utility, and Pap testing intentions and behaviors;6. Follow the cohort of PI women and men in the intervention vs. control groups to assess the impact of the intervention. Using a longitudinal cohort design, we will identify, recruit, and randomly assign PI members of churches and other community-based organizations to one of two intervention options: a) a culturally tailored social support intervention group for women and men consisting of community health educator-facilitated video, flipchart and brochure;or b) a usual care control group, consisting of pre-existing cancer education materials (brochures) for PI women and men delivered by community health educators. We posit that the planned social support intervention will increase men's provision, and women's perceptions, of Pap testing social support, leading to increases in women's prioritization of Pap testing decision making utility and Pap testing behaviors. The proposed study team involves long-standing university and community collaborators, and uses a multiple PI model to institutionalize shared participation and leadership structures. The community side of this CBPR study includes three CBOs with years of experience in health promotion, disease prevention, and collaborative research for their respective PI populations. The university side includes experienced behavioral scientists in CBPR, cancer control and decision making with multiethnic populations. This study will add to the existing science of cancer health disparities by adapting and applying well-established behavioral theories to understand the ways in which collectivist-oriented interventions influence individual women's cancer screening behavioral changes. Furthermore, this study will illuminate the CBPR engagement aspects necessary to conduct rigorous intervention research in small-size populations. The product of this study will be a culturally-tailored intervention that holds the potential to become a model for other collectivistic populations. Strengths of this study include: i) a focus on a major cancer health disparity;ii) development and testing of methods that are applicable to other health disparities;iii) a theoretical focus on decision making (a priority area for NCI regarding translational research);iv) an intervention approach that investigates and develops new strategies to improve cultural tailoring and evaluation;v) a focus on men;and vi) an ethnically diverse team of community and university investigators with an established track record in CBPR research.
Pacific Islanders (PIs) experience some of the highest cervical cancer incidence and mortality rates in the U.S., yet little research exists on the ways to address and ameliorate their cancer health disparities. This five year randomized community-based participatory research study will develop and test a social support intervention targeting both PI men and women to increase women's Pap testing among three populations in Southern California: Chamorros, Tongans and Samoans. This study will add to the existing science of cancer health disparities by adapting and applying well-established behavioral theories to understand the ways in which collectivistic-oriented interventions influence individual women's cancer screening decision making and behaviors. Furthermore, this study will illuminate the CBPR engagement aspects necessary to conduct rigorous intervention research in small-size populations.
