Effectiveness of a Breast and Cervical Cancer Screening Promotion Program for Low-Income Puerto Rican Women

Abstract

The purpose of the study was to assess the effectiveness of a Lay Health Worker (LHW) delivered intervention to increase mammography and Papanicolaou (Pap) screening among non-adherent Hispanic women. We conducted a randomized controlled trial in Puerto Rico using a pre-post comparison group design. Eligible women (40 and older and non-adherent to mammography or Pap test screening recommendations) completed a baseline survey and were randomly assigned to the intervention or to a comparison condition. The intervention consisted of an LHW delivered session in which participants received mammography and/or Pat test screening education, and referral to local breast and cervical cancer screening providers. Among the 444 women recruited, 302 and 267 were non-adherent to mammography and Pap test respectively. Lay Health Workers delivered the intervention in women’s homes and administered follow-up surveys. Women who received the intervention were 2.4 (95% CI: 1.2, 5.1) times more likely to report having had a Pap than those in the comparison group. Secondary analyses on intermediate impact variables showed that the intervention group had significantly higher self-efficacy scores for Pap test screening. There were no statistically significant differences in mammography screening between groups (OR= 0.94; CI 0.52-1.75). The intervention was effective for increasing Pap screening, but not for mammography. Possible reasons for failure to detect screening differences between the intervention and comparison group for mammography include a potential measurement effect, the possibility that the intervention was insufficiently culturally-adapted, and other factors.

Note:
Clinical Trial Registration Details: ClinicalTrials.gov Identifier: NCT04617236.

Funding Information: This work was supported by the NCI/National Institutes of Health under Grant [U54CA096297]; NCI through a Community Networks Program Center under Grant [U54 CA153505]; and the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number [2U54MD007587].

Declaration of Interests: The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval Statement: The institutional review boards of the University of Puerto Rico Medical Sciences Campus and the University of Texas Health Science Center approved the study protocol. Participants completed informed consent.

Keywords: Breast and cervical cancer, BCCS screening, Hispanic/Latina, Lay Health worker intervention, Puerto Rico