Outcomes of a Multicomponent Culturally Tailored Cervical Cancer Screening Intervention Among Underserved Hispanic Women ( De Casa en Casa )

Abstract

Hispanic women have almost double the cervical cancer incidence and are twice as likely to die from cervical cancer compared with non-Hispanic White women. Cervical cancer is preventable with screening, and based on available data, multiple component screening interventions have been proposed as a strategy to maximize screening, but such studies are lacking. We sought to test the effectiveness of a multicomponent screening intervention for primary prevention and early detection of cervical cancer among underserved Hispanic women. We conducted a prospective community-based cervical cancer screening intervention utilizing a quasi-experimental design. The intervention was theory based, delivered by bilingual community health workers, combined education and reduction of noneconomic barriers, and addressed economic barriers. Components included outreach, education, provision of no-cost Papanicolaou and human papillomavirus screening, on-site diagnostic and treatment colposcopy, and patient navigation with tracking to facilitate screening, diagnosis, and treatment. The main outcome was self-reported screening. We recruited 300 intervention group and 299 control group participants. Mean age of the sample was 44.7 years. The majority were Hispanic (98%), born in Mexico (79%), and had a Spanish-language preference (86%). In intention-to-treat analyses, the intervention group had a relative risk of screening of 14.58 (95% confidence interval = 8.57-24.80, p < .001) compared with the control group. A multilevel, multiple component culturally tailored bilingual cervical cancer screening intervention combining education, navigation, and no-cost screening can significantly increase cervical cancer screening uptake in a high-risk, underscreened population and has the potential to affect cervical cancer health disparities.