Latinas have 70% higher incidence and double the mortality rate of cervical cancer than non-Latinas in the U.S., primarily due to low rates of screening and COLPOscopy, the recommended follow-up for abnormal Papanicolou (Pap) tests. Factors related to low rates include access to health care, anxiety, fear of pain and cancer, low educational and low health literacy levels. While the Affordable Care Act will increase access, it may decrease health care provider (HCP) time to provide complex education needed to address other factors. Patient education challenges for Latinas with low health literacy can be further complicated by language differences and by low basic literacy - an inadequate ability to read. Low literacy is not limited to Latinos but affects many who have had little opportunity for formal schooling. Due to high rates of low basic literacy, low health literacy, and increasing pressures on HCPs, we propose a paradigmatic shift in health education. The purpose of this Phase I SBIR proposal is to establish technical/scientific merit and feasibility of using an interactive computer-based education (ICBE) approach to educate and prepare Spanish speaking Latinas, with low educational and health literacy levels, for a colposcopy. This proposal is significant in its focus on the health disparity of cervical cancer in Latinas and on the need for quality health education in a changing health care environment. ICBE programs can greatly augment health education by providing time, basic health knowledge, repetition, language and attentiveness to personal and cultural barriers that vulnerable populations need, but that clinical settings realistically cannot provide.
Specific aims for this Phase I study are to develop COLPO PRIMER-S (Spanish) and to pilot the product in a clinical setting. The long term goal is to create, evaluate and market the """"""""PRIMER series"""""""" (Patient Ready Interactive Multi-media Educational Resources) - a line of health educational products appropriate for all literacy levels. Methods: COLPO PRIMER-S will be modeled after an English language version, but informed by a different literature for its content. It will be piloted at a health department in the Midwest U.S. with 20 women, half with low to marginal health literacy. Survey data assessing knowledge and preparedness, anxiety related to abnormal Pap and colposcopy, technology- related anxiety, learner pathway through COLPO PRIMER-S, acceptability and satisfaction with the program, and actual follow-up with the procedure will be collected through the touch screen and recorded automatically , before and after viewing and after colposcopy. HCP interviews will evaluate the amount of teaching needed for participants to begin using the program, difficulties encountered, user engagement with HCP following viewing, the impact on staff time and feasibility within the organization. While educational resources explaining colposcopy procedures do exist for Latina populations, none identified are theory and evidence-based ICBE, Spanish language programs that address literacy, knowledge and psychosocial barriers. Findings will guide paradigm shifts in health education and marketing of ICBE products and service.
The Latina death rate from cervical cancer is nearly twice that of non-Latinas. Latinas, particularly those Spanish speaking with low-health literacy, have high no-show rates for colposcopy (standard follow-up for an abnormal pap result), which can lead to delayed diagnosis and treatment of cervical cancer and, ultimately, needless deaths. This Phase I application will study the feasibility of an innovative, evidence-based, interactive, multimedia patient education program to promote empowered patient decision making and colposcopy adherence while also improving provider productivity and reducing costly patient no-shows.
