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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Vietnamese women experience the highest incidence rate of invasive cervical cancer, and those age 55 to 69 have a rate that is ten times higher than that of White women. While screening for cervical cancer in Asian women is substantially lower than that of the general population, the recent Pap test rate for Vietnamese women in the eastern region of the U.S. (PA, NJ) is even lower (29 percent versus 85 percent nationwide). Our studies revealed barriers that prevent Vietnamese women from obtaining Pap tests. Most Vietnamese women we serve (75 percent) are medically underserved, have low income and educational levels, lack knowledge about cervical cancer risks, are unaware of screening benefits and the health care system, and have limited access to culturally and linguistically appropriate regular medical care. Considering the fast growing Vietnamese immigrant population, cervical cancer prevention through screening and early detection is a critical public health priority. Center for Asian Health, ATECAR Community Network, Fox Chase Cancer Center, Asian Community Cancer Coalition, Vietnamese community partners and health providers are proposing a five-year, large-scale community-based participatory group randomized intervention trial to increase cervical cancer screening and reduce health system access barriers among high risk medically underserved Vietnamese women in the eastern region of the US (PA, NJ). The proposed study is based on a CBPR pilot project that demonstrated acceptability and feasibility of multifaceted innovative intervention components and evaluation measures. The specific aims of the study are to: (1) evaluate the effectiveness of a culturally appropriate cervical cancer intervention in increasing cervical cancer screening among Vietnamese women; (2) examine whether a culturally appropriate cervical cancer screening intervention is more effective in increasing knowledge about perceived risks of and susceptibility to cervical cancer, increasing perceived benefits of screening, and increasing levels of self-efficacy than general cancer education; and (3) examine whether the intervention is more effective than general cancer education in reducing perceived health care barriers to adherence to cervical cancer screening. Methods for achieving these aims (detailed in Section D, Research Design and Methods) include using a scientifically rigorous group randomization research design (40 Vietnamese community organizations, 20 control and 20 intervention, 40 participants per site, a total of 1,600), applying CBPR principles throughout the project and a combination of HBM and SCT models to guide intervention and evaluation measures, as well as employing an evidence-based multifaceted innovative intervention that emphasizes both individual and health care system barriers through CHE-led group education, client-physician interaction, patient navigation, linkage to health providers for screening, and follow up with abnormal cases.